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Pathopharm > Peds Flashcards genetics and Prematurity (3) > Flashcards

Peds Flashcards genetics and Prematurity (3)

1
Q

How many births are preterm?

A

1 in 8

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2
Q

What are 8 major influences that influence preterm birth?

A

genes, fetal growth, gestational clock, uterine activity, labor cascade, membrane strength, susceptibility to infection and twinning

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3
Q

In 3rd week, what is developed?

A

neural tube

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4
Q

In 4th week, what is developed?

A

heart beat

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5
Q

In 7th week what is developed?

A

a rudimentary skeleton

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6
Q

In 7th - 8th week, what is developed?

A

sexual development

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7
Q

______ is any agent that can harm an embryo or fetus

A

teratogen

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8
Q

True or False, one teratogen can cause different defects

A

TRUE

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9
Q

What are some rule-of-thumbs related to teratogens

A

longer exposure/higher dose = more harm, father’s exposure may affect embryo, long-term effects depend on postnatal environment, some effect not apparent until later in life

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10
Q

What 2 things make each pregnancy unique?

A

genetic makeup and prenatal environment

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11
Q

3 things that affect perinatal environment

A

medications, delivery practices, and social environment

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12
Q

7 problems you might expect to see in premature infants

A

poor thermal regulation, immature CNS, immature immunity, IVH, immature cardiopulmonary system, immature GI system, an glucose instability

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13
Q

Nursing interventions for poor thermal regulation premies

A

prewarming the delivery room and placing infant in a plastic bag up to the neck during delivery room stabilization to prevent heat loss

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14
Q

What is apnea?

A

pause in breathing of longer than 10 to 15 seconds assoc. with bradycardia, cyanosis or both

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15
Q

Your are caring for a preemie baby in the NICU. The alarm for desats goes off. What are your actions?

A

Assess baby for signs of breathing and skin color. If apneic, cyanotic or bradycardic, tactile stimulation needs to be given. If that doesn?t work, bag and mask w/ suctioning and airway positioning

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16
Q

What does IVH stand for?

A

Intraventricular Hemorrhage

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17
Q

What are risk factors for IVH?

A

extreme prematurity, presence of labor, birth asphyxia and need for vigorous resuscitation, mechanical ventilation, sudden change in BPs r/t hypertonic volume expansion

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18
Q

Describe common s/s for IVH

A

symptoms of increased intracranial pressure- seizures, decreased or absent reflexes, hypotonia, bulging fontanels, enlarged head circumference, setting-sun eyes, shrill cry, hypothermia, apnea and bradycardia

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19
Q

________ is a hypoxic-ischemia injury to the mucosa of the intestinal tract which results in abdominal distention, sepsis, and nutritional impairment

A

Necrotizing enterocolitis

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20
Q

_____ ______ causes vessel damage in the tiny periventricular capillaries, resulting in symptoms on increase ICP

A

Intraventricular Hemorrhage

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21
Q

NEC, is the disease of prematurity. What are the parameters for prematurity?

A

< 1000 grams, <28 weeks gestation

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22
Q

Besides prematurity, NEC is associated with what other causes?

A

ischemia, immunity, infection, immaturity, nutrition

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23
Q

What is the grading system for IVH?

A

grade 1 = small bleed, grade 4= severe bleed

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24
Q

You are caring for a baby with NEC, how are you going to proceed with feeding?

A

constant 1-2 ml per hour flow, and mom’s milk b/c fortified with antibodies

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25
Q

Soft signs ( hard to identify) in NEC, include-

A

increased residual, lethargy, blood glucose instability, and temp instability

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26
Q

S/s of NEC include:

A

abdominal distention, visible bowel loops, bloody stool, feeding intolerance, bilious vomiting, apnea, bradycardia, desat

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27
Q

A baby was just admitted for NEC, what are your FIRST actions?

A

stop all feedings and place IV for fluids. 100-120cc/kg/day

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28
Q

What are care management goals for NEC?

A

ventilation by trach, NG compression and TPN, broad spectrum antibiotics, pain control and minimal handling of child, serial exams and abdominal X-rays, frequent labs, surgery

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29
Q

clef lip > in _____, palate > in _____

A

boys, girls

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30
Q

What ages are lip and palate correction surgeries performed?

A

lip - 2 week - 3 mon, palate 6-18 mon (minimize speech impairment)

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31
Q

What should be included in the nursing assessment of cleft lip and palate?

A

failure of fusion of lip, palate or both difficulty sucking and swallowing and parent reaction

32
Q

As a nurse caring for a baby with cleft lip and palate, what feeding education can you provide?

A

longer, softer nipple, squeezable bottle, feed upright position, feed slowly w/ bubbling

33
Q

Common types of nipples for cleft lip and palate

A

lambs nipple, prosthetic palate, rubber tipped aspeto syringe

34
Q

Baby Ellie just came from the OR for corrective lip and palate surgery. What is number 1 priority?

A

Patent airway and proper positioning

35
Q

Positioning for cleft lip post op

A

side or upright in infant seat. NOT prone

36
Q

positioning for cleft palate

A

on side or abdomen

37
Q

How can the nurse protect the surgical site for lip and palate surgery?

A

elbow restraints, minimize crying to prevent strain, and maintain Logan bow to lip if applied

38
Q

How do you care for a restrained child?

A

remove one restraint at a time, perform ROM exercises and age-appropriate stimulation

39
Q

Why do you clean suture site with sterile water after feeding?

A

formula remaining on suture line may impede healing and lead to infection

40
Q

____ _____ is a nonprogressive disorder of the developing brain causing neuromuscular disorders of spasticity or dyskinesia (involuntary movement)

A

cerebral palsy

41
Q

True or False, CP may be present only at childbirth

A

False, can be present at birth or evident in infancy/early childhood

42
Q

What are common problems associated with CP?

A

mental retardation, epilepsy, and visual and hearing disturbances

43
Q

Risk factors for CP include:

A

birth asphyxia, intrauterine infection, preterm infant, very low birth weight (MAJOR)

44
Q

How might CP be diagnosed?

A

neuro exam, history, posture/tone, persistence of primitive reflexes

45
Q

Which reflexes might remain after 6 mon, which indicate CP?

A

moro, tonic neck

46
Q

What disease the following assessment indicate?

A

CP

47
Q

What are common CP management ideals the nurse should use?

A

Team approach ( PT, OT, ST, nutritionist, ortho, neuro, maximize motor fxn/ADLs, AFOs, enhance communication, bracing/casting/surgery, meds which decrease spasticity, nutrition assistance, fam support

48
Q

What are 2 common meds used for CP?

A

Dilantin (anticonvulsant) and Valium (muscle spasms)

49
Q

One goal for CP patients is preventing aspiration during feeding. As a nurse how would you educate you patient on this?

A

position child upright and support lower jaw

50
Q

____ _____ is defined as a deformity, a defect of the spine that includes several injuries with different severity and prognosis

A

Spina Bifida

51
Q

What is the most common location of SB?

A

lumbosacral (85%)

52
Q

What may Spina Bifida lead to?

A

paralysis, neurogenic bowel/bladder, hydrocephalus, ortho abnormalities

53
Q

Spina bifida occulta

A

vertebrae only. No sac present, usually benign. Bowel and bladder problem may occur

54
Q

Meningocele spina bifida

A

only meninges and spinal fluid, has less neurologic involvement than a myelomeningocele. Has a sac somewhere along the spine

55
Q

Myelomeningocele

A

more severe than meningocele because the sac contains spinal fluid, meninges and nerves

56
Q

Dimple with or without hair tuft at base of spine can indicate

A

spina bifida occulta

57
Q

Presence of sac at lumbar or lumbosacral area may indicate?

A

myelomeningocele

58
Q

Flaccid paralysis, limited or no feeling below the defect, head circumference at variance with noms on growth grids are s/s of what?

A

spina bifida

59
Q

What are immediate nursing interventions for spina bifida?

A

cover sac with moist clean dressing (prevent rupture of defect/infection), no pressure on affected area, antibiotics, IV fluid, latex precaution, pre-op care

60
Q

What is preop care for spina bifida?

A

keep sace clean, cover with moist sterile dressing, elevate foot of bed w/ child on abd legs abducted, measure head cir. Q 8 hr w/ fontanel check, assess neuro, monitor for s/s of infection, empty bladder w/ crede method or foley

61
Q

What is post op care for spina bifida?

A

prone for first 7 d. and then sides (NOT SUPINE), foley then intermittent cath, keep incision clean, observe for leaks, antibiotics, head circ. , urecholine to decrease retention, colace to soften stool

62
Q

Long term care for spina bifida

A

teach straight cath & bowel program, splints, ROM, PT, assess skin, Chari malformation

63
Q

What is a common bowel program for spina bifida?

A

high-fiber diet, increased fluids, reg. fluids, and suppositores prn

64
Q

_______ is a mismatch between the production and absorption of CSF.

A

Hydrocephalus

65
Q

True or False, Cause of hydrocephalus can be flow obstruction or absorption impairment

A

TRUE

66
Q

True or False, hydrocephalus is most often associated with IVH and a possible complication of meningitis

A

FALSE, spina bifida and meningitis

67
Q

HESI hint for ICP vs shock

A

Shock= increase in HR and decrease in BP. ICP= decrease pulse and increase in HR

68
Q

Irritability, increase head circ., bulging fontanels, widening suture lines, sunset eyes and high pitched cry are all s/s of what?

A

ICP in infants

69
Q

What would explain to a parent about the placement of a shunt for hydrocephalus?

A

shunt is being inserted into ventricle, tubing is tunneled through skin to peritoneum where it drains excess CSF

70
Q

What can cause hydrocephalus?

A

infection, IVH, tumor, structural abnormality, prematurity

71
Q

What is post op care for hydrocephalus VP shunt insertion?

A

HOB flat to decrease rapid and excess drainage of CSF, don?t pump shunt unless prescribed because it can change pressure in ventricle

72
Q

What is primary apnea and how would you intervene?

A

premie forget to breathe, O2 drop, RN can intervent by tactile stimulation

73
Q

What is Secondary apnea and how do you intervene?

A

baby continues to desat and deteriorate. This apnea will lead to a bradycardic state. The nurse will need to give O2, possibly bag and mask.

74
Q

What is the feeding order when bottle feeding a child with cleft palate?

A

child suck, then squeeze, child suck, then squeeze

75
Q

If bottle doesn?t work when feeding a cleft lip/palate baby, what do you expect to intervene with?

A

NG/G Tube.

76
Q

Why wouldn?t you want to send a baby home with a NG tube?

A

because It can get displaced

77
Q

What are your 2 biggest concerns when caring for a child post-op cleft lip/palate surgery?

A

Feeding and aspiration

Pathopharm (24 decks)

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