Outcome 6 Neonatology Flashcards
5 areas of Apgar score
- appearance: color
- pulse: heart rate
- grimace: response to stimuli
- activity: muscle tone
- respiration: respiration rate
The Apgar score is measured at ___ minute after birth and again at ___ minutes, and the total possible score is ___.
1, 5, 10
The Moro Reflex is also called the _____
startle reflex
In the Moro Reflex, a change in _____ causes extension and abduction of the extremities and fanning of the ____, followed by flexion and adduction of the extremities.
equilibrium, fingers
The Dance Reflex is also called the _____.
stepping reflex
The Sucking Reflex causes a newborn to ___ anything that touches the lips.
suck
The Rooting Reflex occurs when the cheek is touched or stroked along the side of the mouth, and the newborn turns its head toward the _____ and begin to suck.
stimulated side
The Palmar Grasp Reflex is flexion of the fingers caused by stimulation of the ______.
palm of the hand.
The Plantar Grasp Reflex is flexion of the toes when the ____ is gently stroked.
sole of the foot
The Crossed Extension Reflex is the adduction and extension of one leg when the _____ is stimulated. You
foot of the other leg
The Crawling Reflex is also called the _____.
symmetric tonic neck reflex
The Tonic Neck Reflex is also called the _____.
asymmetric tonic neck reflex
This reflex prevents the infant from rolling over until adequate ____ and ____ occurs.
neurologic and motor development
The Neck Righting Reflex occurs where turning the head to one side while the infant is in a ____ position causes rotation of the shoulders and trunk in the ____ direction.
supine, same
The Landau Reflex is that when the infant is held in a ____ position, it maintains a ____ with the head raised and the legs slightly flexed.
horizontal prone, convex arc
The Parachute Reaction is a variation of the ____, and persists for ___.
Moro reflex, life
In the Parachute Reaction, if ____ is normal, when the infant is dropped a short distance onto a soft surface, it will ____ the arms, hands and fingers on both sides of the body in a protective movement.
motor nerve development, extend
Birth before ___ weeks is considered premature
37
Infant Respiratory Distress Syndrome (IRDS) is also called _____
Hyaline Membrane Disease
Acute hypoxemia caused by infiltrates within the alveoli
IRDS
Inability of lungs to expand; there is inadequate surface area for proper gas exchange
IRDS
Tests involved in IRDS
- blood gas studies
2. radiographic chest films
In IRDS, blood gas studies show reduced ____ and ineffective ____
oxygen tension; gas exchange
In IRDS, radiographic chest films show presence of ____ or ____
infiltrate or hyaline membrane
IRDS: acute ____ caused by _____ within the ____
hypoxemia, infiltrates, alveoli
IRDS: inability of ___ to expand; inadequate ____ for proper ___
lungs, surface area, gas exchange
In IRDS, lungs lack ____ needed to allow alveoli to expand
surfactant
Surfactant is normally produced in late ____
fetal life
In IRDS, treatment should begin within the first __ hours of life
48
3 options for IRDS treatment:
- carefully titrated supplemental oxygen through mechanical ventilation
- positive end-expiratory pressure (PEEP)
- drug therapy
In IRDS drug therapy, aerosol infusion of an exogenous surfactant such as ____ or ___ into the pulmonary tree by endotracheal tube
beractant or poractant
Serious chronic lung disease where lungs are stiff, obstructed and hard to ventilate
bronchopulmonary dysplasia (BPD)
What are the two tests to diagnose BPD?
- radiographs
2. arterial blood gases
In BPD, radiographs show alveolar damage with a ____ appearance
ground glass
In BPD, arterial blood gas tests show low ____ levels and high ____ levels
oxygen, carbon dioxide
In BPD, wet or crackling sounds are heard on ____ of the lungs
auscultation
BPD is caused by an insult to the neonate’s ___
lungs
BPD is often a sequela to which 4 disorders?
- IRDS
- lung infections
- pneumonia
- extreme prematurity
What is the goal of treatment for BPD?
replace damaged alveoli
In BPD, supplemental oxygen O2 saturation must be at __% or greater
90
What family of medicine is used to treat BPD
diuretics
Diuretics reduce ____ HTN, ____ heart failure, and fluid ____ in the lungs
pulmonary, right sided heart failure, fluid accumulation
Abnormal growth of the blood vessels in the retinas of infant eyes
retinopathy of prematurity (ROP)
ROP usually occurs in premature infants because retinal blood vessels don’t develop until the __th week of gestation
28th week
Retinopathy of prematurity or ROP is also called ____
retrolental fibroplasia
ROP can be caused by which four things?
- incomplete vascularization in premature infants
- high supplemental oxygen concentrations
- drugs: surfactant and indomethacin
- intense artificial lighting-
T or F. Mild forms of ROP resolve without treatment
T
In serious cases, ROP is treated with laser treatment anterior to the vascular shunt, eliminating abnormal vessels before they cause _____
retinal detachment
Acute inflammatory process of the fragile intestinal tract in premature or sick newborns
necrotizing enterocolitis (NEC)
NEC is caused by _____ of the mucosal lining of the small and/or large intestine
ischemic necrosis
NEC is caused by breakdown in normal defense systems of the GI tract; ____ invades ____
normal flora, intestinal mucosa
Risk factors for NEC include:
- prematurity
- hypovolemia
- sepsis
- umbilical catheters
- exchange transfusions
When a neonate is diagnosed with NEC, he or she must be ordered ___ where fluids and antibiotics are administered intravenously
NPO
NEC is treated by surgical intervention with removal of ____
necrotic tissue
Two surgical procedures for NEC
- ileostomy
2. colostomy
In NEC, a small tube is inserted into the stomach through the nose or mouth for ____
decompression
Condition of small stature and related incidence of interorbital distance, bulging forehead, depressed nasal bridge, malaligned teeth and short limbs
Robinow Syndrome
Bulging forehead
bossing
2 types of Robinow Syndrome
- dominant
2. recessive
Robinow syndrome is an ____ syndrome
inherited generic
In dominant Robinow Syndrome, the gene is ____
not yet established
In recessive Robinow Syndrome, there is a mutation of a specific gene located in chromosome ___, which deals with ___ and ___ formation
9q22, bone and cartilage
There is no cure for Robinow Syndrome; treatment involves treating treatable conditions like ____, ____ and ____
dental abnormalities, cleft palate, and orthopedic conditions
Genetic syndrome where the individual has __ chromosomes instead of the usual __
47, 46
Mild to severe congenital mental retardation accompanied by characteristic facial features and distinctive physical abnormalities
Down Syndrome
What are the two types of tests to diagnose Down Syndrome in pregnancy?
- amniocentesis
2. karyotype
There is an extra chromosome number __ in Down Syndrome
21
Down Syndrome occurs more often in infants born to women older than ___
35
The treatment plan for Down Syndrome is a _____ approach to maximize the development of motor and mental skills
multi-dimensional
Life expectancy for babies with Down Syndrome is improved through surgical correction of _____ and antibiotic therapy for _____
cardiac defects, pulmonary disease
Down Syndrome is associated with ____ defects
heart
Condition consisting of a group of disorders involving the brain and nervous system functions
Cerebral Palsy (CP)
3 types of cerebral palsy
- spastic
- athetoid
- ataxi
- Type of cerebral palsy: hyperactive reflexes, rapid muscle contractions; 70% of cases
spastic
- Type of cerebral palsy: involuntary muscle movements during stress, reduced muscle tone, difficulty with speech
athetoid
- Type of cerebral palsy: involuntary movements, poor balance, and wide gait
ataxic
CP may be congenital or acquired, bilateral or unilateral in the form of a _____ that results from damage to the CNS
non-progressive paralysis
Most common crippler of children
cerebral palsy
Cerebral palsy is caused by inadequate blood or oxygen supply to brain during which 3 possible time frames?
- fetal development
- the birth process
- early childhood until 9 years of age
Cerebral palsy may also be caused by ___ or ___ during the first month of life
infection or head trauma
Cerebral palsy is more common in premature infants and male or female babies?
male babies
There is no cure for cerebral palsy, but what is the goal of treatment?
Minimize the handicap by providing therapeutic measures to help the child reach his or her potential
What are 5 other treatment options for cerebral palsy?
- physical therapy
- speech therapy
- special education
- orthopedic intervention
- anticonvulsants for children with seizures
Progressive degeneration and weakening of the skeletal muscles where muscle fibres are abnormally vulnerable to injury
muscular dystrophy (MD)
MD first affects the muscles of which 4 areas?
- shoulders
- hips
- thighs
- calves
Later forms of MD involve all the muscles causing ____
immobility
MD is associated with what 4 conditions?
- mental impairment
- spinal deformities
- contractures
- serious pulmonary infections
How many types of muscular dystrophy are there?
several, but most are rare
The most common type of muscular dystrophy is ____
Duchenne Muscular Dystrophy
What are the 2 tests used to diagnose muscular dystrophy?
- muscle biopsy
2. electromyography (EMG)
MD can certainly be a genetic defect, but is caused by the absence of ____, a protein involved in maintaining the integrity of muscle
dystrophin
Muscular dystrophy affects only ____ and is inherited through female carriers
males
1/3 to 1/2 of muscular dystrophy cases are caused by a ____ and is not associated with family history
newly acquired mutation
T or F. There is no cure for MD
T
Corticosteroids slow ____ in MD
muscle degeneration
- 3 types of spina bifida
- spina bidifa occulta
- meningocele
- myelomeningocele
Spina bifida: posterior arches of the vertebrae (usually in the lumbosacral area) fail to fuse but there is no herniation of meninges or spinal cord
spina bifida occulta
Spina bifida: no spinal cord or spinal nerve involvement; usually asymptomatic
spina bifida occulta
Spina bifida occulta is associated with exposure to ____ during ____ life
ionizing radiation, early uterine
Spina bifida occulta may also be caused by metabolic imbalances where there are reduced levels of ___ and ___ consumed during pregnancy
Vitamin A and folic acid
What intervention is needed for spina bifida occulta?
There is no intervention needed
Treatment for spina bifida occulta depends on the degree of _____
neurologic involvement
Spina bifida: posterior portion of the neural tube fails to close in the early stages of fetal development
meningocele
Spina bifida: meninges protrude through an opening in the spinal form, forming a sac that becomes filled with cerebrospinal fluid
CSF
T or F. Nerves are involved in meningocele.
False
In meningocele, the sac formed over the defect may ___ because the skin over the area is usually fragile
rupture
