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PNCB CPNP-PC > Perinatal > Flashcards

Perinatal Flashcards

1
Q 
Newborn Assessment
Prenatal concern: -1-
maternal health issues: -2-
Retrieve history regarding: -3-
Personally assess: -4-
A
  1. Xenobiotics (nicotine, caffeine, illicit drug use)
  2. blood sugar/pressure, infectious disease (herpes, HIV)
  3. fetal growth issues
  4. mother-child affect
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2
Q

Perinatal:
Assessment - history, Apgar, etc.
Assess intellectual disability risk: -1-, -2-, -3- and rationale

size of baby:

lbw: -4-
vlbw: -5-
elbw: -6-

Apgar: 0-2 points/5 sections
-7- (chart)

A
  1. placenta previa, abruption
  2. meconium
  3. forceps, vaccuum, NICU
  4. <2500 g
  5. <1500 g
  6. <1000 g
  8. Color
  9. blue/pale, peripheral cyanosis
  10. pink
    HR: absent, <100, >100
    Res: absent, weak cry, strong cry
    MT: Limp, some flexing, active movement
    NR: absent, grimace, cough/sneeze
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3
Q

Birth statistics:
most newborns: -1-

SGA “small for gestational age”
symmetric: -2-, often -6-; pathophys: intrauterine -7-, -8-
asymmetric (after 24 weeks): -3-; why? -9-, fetal -10-, altitude

LGA (large for gestational age): -4-, often -11-. Often due to -12-, could also be -13-, -14-, or sometimes large -15- babies

appropriate for GA “AGA”: -5-

A
  1. 20”; 7.5 lb
  2. all categories < 10th %ile
  3. only weight <10th %ile
  4. Wt >90th %ile
  5. 10th %ile < Wt < 90th %ile
  6. physiologic (small family, small baby)
  7. infection, maternal hypertension
  8. drug exposure, etc
  9. chronic maternal hypertension/preecclampsia
  10. heart disease, hemoglobinopathy
  11. 42+ weeks
  12. DM2 in mom
  13. bethwick-wiedemann syndrome (congenital)
  14. hydrops fetalis (universal edema)
  15. mothers make large
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4
Q 
Neonatal vitals
0-2 months
Temp: -1-
HR: -2-
RR: -3-
A
  1. 38C/100.4F or higher = fever
  2. 140 pulse
  3. 30-60 rpm
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5
Q

Central cyanosis: warm -1-, deep -2-; signifies -3-

Peripheral: -4- skin; just -5-

A
  1. skin
  2. blue nails
  3. an underlying problem
  4. cold/clammy
  5. needs heat
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6
Q 
Perinatal history
Type of delivery: -1-
respiratory status: -2-
cardiac status: -3-
Color changes: -4-
A
  1. vag, c-section, forceps, vacuum?
  2. grunting, flaring?
  3. murmur?
  4. plethora (red)/jaundice/gray (low APGAR)
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7
Q

Milia: -1- to -2- with NO -3- OR -4-, can last -5-, but if they persist, concerning for -6-

Miliaria
> obstructed -7-: -8-; -9-

A
  1. pinpoint white papules
  2. nose and cheeks
  3. underlying red rash
  4. PUSTULES (erythema toxicum)
  5. a few weeks (to 2 months)
  6. genentic syndrome
  7. sweat glands:
  8. “prickly heat”
  9. pale, pink, flesh-colored
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8
Q

Erythema toxicum: -1- and -2-; starts -3-

Typically resolves -4-

A
  1. red blotches, white/yellow papules
  2. PUSTULES
  3. age 2-5 days
  4. 2nd week of life
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9
Q

Cafe-au-lait spots, assessment: -1-

Hallmark of -2-

A
  1. how many? How big? Macular

2. NF1

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10
Q

Junctional nevi: in -1-, concerning for -2- & -3-

Assessment considerations: -4-

A
  1. large number,
  2. tuberous sclerosis
  3. xeroderma pigmentosis
  4. location, size, description
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11
Q

Mongolian spots: -1-, often in the -2-, often -3-
Common among those of -4-
Long term prognosis: -5-

A
  1. grey-green discoloration
  2. lumbar-sacral area
  3. mistaken for BRUISING
  4. mediterranean, african heritage
  5. permanent, so DOCUMENT (but do fade some over time)
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12
Q

Port-wine stains -1-, or could indicate -2- (-3- in -4-)

Pathophys: -5-

A
  1. could be benign
  2. stirge-webber/glaucoma
  3. especially if located
  4. the eye, face
  5. compiled superficial/deep capillaries
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13
Q

Hemangiomas: appear -1-
last: -2-
fade: -3-
If found around the mouth or eye: -4-

A
  1. can appear anywhere
  2. up to 2 years
  3. from inside out, but never completely smooths
  4. send to derm (inderal to decrease size)
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14
Q

Primitive reflexes, main concern: -1-

Chart: when do they go extinct? -2-

A
  1. Symmetry
  2. Age in months - Reflex:
    2: Sucking
    2: Stepping/Placing
    3: Tonic Neck
    3-4: Moro
    4: Rooting
    5-6: Palmar grasp (Plantar is 12-24)
    12 or walking: Babinski
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15
Q

Caput Succidenum: -1-

Cephalohematoma: -2- which -3-, result of -4-; high -5-

A
    • Crosses Suture line (fluid under the skin)
  2. fluid under the skin
  3. doesn’t cross midline
  4. vacuum delivery
  5. BILI re:collecting blood
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16
Q

frontal bossing: -1-; common in -2-

  • Microcephaly: -3-*
  • Macrocephaly: -4-*; often -5-
A
  1. frontal cranium enlargement
  2. premies and rickets (food deserts)
  3. 2 SD < average HC (genetic diseases, T21)
  4. 2 SD > average HC (hydrocephalus)
  5. overriding sutures
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17
Q

Hair assessment in the newborn: -1-, -2-

A
  1. twirls/whirls/unruly (brain development issues)

2. coloring, tufting, white/depigmented forelock (congential conditions: deafness, delay, whartonburg syndrome)

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18
Q

Fontanel closure:
Anterior: by -1-
Posterior: by -2-

Wide fontanel/split sutures: seen in -3-

A
  1. 18 months
  2. 2 months of age (hypothyroidism if still open)
  3. premies, IUGR, hydrocephalus, down syndrome, hypothyroidism (posterior)
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19
Q

Red reflex

Assess for…

A

…black/white color/spots? (Retinal blastoma, cataracts)

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20
Q

Sclera: abnormal findings:

  • 1-
  • 2-
  • 3-
A
  1. bluish (premie)
  2. deep blue (windex) - osteogenesis imperfecta hallmark
  3. brushfield spots (salt and pepper around irises, T21)
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21
Q

Coloboma: pupil is -1-, indicative of a -2-

A
  1. slit-like/reptilian;

2. congenital CNS/midline anomaly

22
Q

Cloudy cornea: Most common causes of congenital cloudy cornea are -1-, -2-, -3-, infection, inflammation, congenital glaucoma, -4-, corneal dystrophy [congenital hereditary endothelial dystrophy (CHED), congenital hereditary stromal dystrophy (CHSD) and posterior polymorphous dystrophy] and -5-.

A
  1. birth trauma
  2. sclerocornea
  3. Peter’s anomaly
  4. mucopolysaccharidosis
  5. dermoids
23
Q

Ears: Preauricular skin tags indicative of -1-

Nose: -2-

Mouth
Microstomia: -3- are causes
Macrostomia: caused by -4-
Tongue size - macroglossia, indicative of -5-

A
  1. renal disease
  2. choanal atresia (NG for patency), & genetic conditions
  3. T13 & T18
  4. mucopolysaccharoidosis (MPS) & FAS
  5. MPS, hypothyroidism
24
Q

Newborn assessment - chin

Micronathia: -1-; cause(s): -2-; consideration(s): -3-

A
  1. underdeveloped chin
  2. pierre-robain, treacher-collins, hollarman-strife
  3. airway assessment!
25
Neck assessment Webbed neck, indicative of: -1- Supraclavicular fractures, possible cause(s): -2-, -3- > Other concerning finding(s): -4-
1. Turner Syndrome 2. rough delivery 3. LGA 4. clavicular lymph nodes
26
Newborn Chest: naked baby! | Assessing for: -1-, -2- (-3-, -4-, and/or -5-)
1. breathing quality/retractions 2. breasts 3. enlargement 4. redness 5. infection
27
Assess: -1-, -2- -3-: all four extremities before leaving for home; assesses for -4- Also assess for -5-
1. cap refill 2. cyanosis: central vs peripheral 3. Pulse ox & pulse characterization (bounding v. thready) 4. coarctation 5. murmur (closing PDA/innocent murmur?)
28
Protuberant belly in the newborn is -1-, flat is -2- Umbilicus assessment: assess the -3-, and assess for -4- Anal assessment: assess for -5-
1. physiologic 2. pathologic 3. cord (arterites/veins - renal disease) 4. herniation/leakage 5. patency (cath)
29
Penis: -1- Testacles: *2*. Assess for -3- in females Assess for -4- in either
1. location of meatus (hypospadias), retractible foreskin? 2. *two, retractile/, not engorged/inflammed* 3. Pseudoperiods 4. ambiguous geniatalia (genotype/karyotype)
30
Newborn MS Assessment > -1- survey > clavicular -2- > digit count & -3- > developmental dysplasia of the hip: -4-; frequent -5- >> Untreated hip dysplasia in an ambulatory child presents with -5- and -6-, as well as either -7- or -8-.
1. Spine 2. fractures 3. creases (palmar) 4. Ortolani & Barlow 6. hip exams (up to fifteen months) 5. leg-length discrepancy 6. toe-walking 7. waddling gait 8. painless limping
31
Newborn assessment/screening Sens or Spec (+/-) Screening for: -1- and -2- Rescreen if -3- before tests were done (need -4- for accurate results) takes up to 2 weeks to result
1. CF, PKU 2. Galactosemia, Hemoglobinopathies, Hypothyroidism 3. <24 hours of age 4. to have fed
32
Newborn screen considerations Vision screenings: -1- Sensory conditions: hearing screen before -2-, loud noises - repeat -3- if failed, [then -4- no later than -5-
1. risk factors, structural malformations (Cyanotic heart disease/hyperoxygenation) 2. discharge 3. at 1 month 4. Brainstem Auditory Evoked Response (BAER) test 5. 3 months]; further failure - Audiologist referral before 6 months
33
Inborn Errors of Metabolism - Newborn Assessment PKU - untreated: -1-, -2- Galactosemia in the liver: leads to -3-; presents as -4-
1. neuro conditions 2. developmental sequelae 3. coagulopathies in the liver 4. septic until treatment
34
Hemoglobinopathies examples: -1- | Hypothyroidism considerations: -2- --> -3-; otherwise, -4-
1. Thalassemias, SCD, SCT 2. early synthroid 3. good outcome 4. developmental issues
35
Consequences of poor neonatal screening:
Neuro/intellectual, metabolic, & developmental sequelae
36
FAS > Sequelae: -1- disregulation/delay; -5- disorders > Presentation: -2- facies, small eyes, -6-, nose upturned, microcephaly, -7- > Dx through -3- > Symptom care: Treatment aims at positive outcomes through -4- & long-term support (-8- for family), brain -9-
1. brain damage; developmental 2. Abnormal facial muscular 3. history and physical 4. early treatment/specialist care 5. seizure disorders, psych 6. smooth filtrum/upper lip 7. FTT 8. OT/PT/ST, social support 9. damage is irreversible;
37
Other newborn considerations: Poor -1- Infections: -2-
1. prenatal care/vaccination status | 2. Rubella, CMV, herpes
38
Also picked up in newborn screen: > Congenital -1- > CF - assess risk from -2- >> -3- common; consists of -4-; -5- involvement.
1. syphillis 2. family history also 3. meconium plug 4. "sticky disease" all systems 5. growth and respiratory
39
``` Neonatal assessment BP: 0-12 hours: ELBW: -4- AGA: -5- 12 hours to 4 days: -6- ```
4. 49/26 (50/30) 5. 68/38 (70/40) 6. 75.5/44 (80/40)
40
Newborn exam - General Neuro: -1- MS: -2-, should -3- a little
1. LOC, affect 2. Tone, posture 3. hold head up
41
Newborn exam - Mouth (cont'd) - other complications - 1- - 2-
1. Cleft lip/palate | 2. Eppstein pearls
42
The -1- is tested in -2- but only in the -3-, not the -4-. The amount and -1- are tested whether the -5-, to determine gestational age.
1. elasticity of cartilage 2. the Dubowitz/Ballard exam 3. ears 4. nose 5. eyes are fused or open
43
Newborn Assessment - Prematurity | -1-, which is a -2-, can be assessed to determine the -3-.
1. Hypertonic flexion 2. neuromuscular activity 3. gestational age
44
-1- over the -2- could be used to assess an -3- who may have less -4- at term.
1. Plantar creases 2. anterior 2/3 sole 3. African American newborn 4. developed sole creases
45
A -1- with -2- is indicative of a -3-, not a -4-, newborn.
1. flat areola 2. no bud 3. premature 4. post-term
46
PKU is a genetic disorder characterized by a mutation in the phenylalanine hydroxylase gene. This gene mutation can lead to an buildup of phenylalanine, which interferes with -1-. A -2- is the primary treatment for PKU, and involves avoidance of -3-.
1. the developing brain 2. phenylalanine-restricted diet 3. protein-rich foods (like meat, eggs, milk, and peanut butter)
47
PKU Nonadherence to the -1- can cause neurological changes that can result in cognitive deficits, -2-, seizures, EEG changes, and -3- to include -4-, irritability, and -5-.
1. phenylalanine-restricted diet 2. developmental delays 3. behavioral changes 4. *hyperactivity*/distractibility 5. anxiety/depression
48
PKU While treatment can -1- behaviors such as hyperactivity, it will not -1- resultant -2-. Individuals with PKU also require -3- of phenylalanine-free elemental medical foods for -4-. Most state laws require that insurance companies -5- of these foods.
1. reverse 2. intellectual disabilities 3. daily supplementation 4. nutritional support 5. cover the cost
49
When -1- early with appropriate dietary interventions, children with PKU can -2- like their peers.
1. diagnosed and treated | 2. progress in school
50
Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is commonly diagnosed in -1- when an infant has recurrent -2- with feeds. The diagnostic test for EA is -3- followed by -4- to confirm -5-.
1. the newborn period 2. spitting and choking 3. orogastric tube passage 4. radiologic imaging 5. thoracic tube coiling
51
Esophageal atresia w/ or w/o tracheoesophageal fistula -1- are often used to diagnose obstruction, intestinal malrotation, and -2-. CT scan would deliver potentially unnecessary radiation and is not -3-, nor is a -4-. Newborns are -5-, so it is best not to put the feeding tube in the nose.
1. Upper GI studies 2. intestinal duplication 3. diagnostic 4. NGT with fluoroscopy 5. obligatory nose breathers

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