S3 M4 Newborns Flashcards
Initial breathing is a reflex triggered by
pressure change
Rooting reflex
Latching-on and sucking pattern
Babinski Reflex
The sole of the foot has been firmly stroked
The big toe then moves upward
Moro reflex
Happens when the baby is startled
Extending arms, legs and neck following by rapidly bring arms together
Galant reflex
hold newborn in ventral suspension (face down) and stroke along one side of the spine.
Normal reaction is for newborn to laterally flex toward the stimulated side.
Largest part of newborns body
Head
Keep wrapped to conserve heat
Why is vit k given to new borns
Vit K is a part of the synthesis process for various clotting proteins like prothrombin.
Babies don’t have a lot of K at the beginning, so they are susceptible to bleeding.
Birth weight
Normal
low
very low
extremely low
2.5-4 kg
less than 2.5 kg
less than 1.5 kg
less than 1 kg
New born vitals
Temp
HR
Resp
BP
97.7-99.5 F
110-160 bpm
30-60 breaths
50-70 systolic/30-45 diastolic
APGAR
Appearance COLOR
Pulse HEART RATE
Grimace REFLEX
Activity MUSCLE TONE
Respiratory RESPIRATORY EFFORT
Blink/pupillary reflex
Bring object close to eye, will blink
PEARL for pupils
Ortolani Maneuver
Move hips outward and up
Listen for clicking
Indicates hip dysplasia
Stepping reflex
Hold baby upright and incline forward
Baby should try to walk
Tonic neck reflex
AKA fencing reflex
Babys hands will assume position of a fencer depending on the side that the baby is looking
Palmar grasp
Plantar grasp
Place finger in open palm, baby will hold it
Place finger just below tows, toes will curl
Skin assessment
Smooth
Flexible
Good turgor
Well hydrated
Warm
Variations and common skin problems for babys
Jaundice
Acrocyanosis
Milia
Mongolian spots
Stork bites
Anocutaneous reflex
Stimulate perianal skin close to anus
Anus should wink
For anal patency
Average head circumference
32-38cm
What can cause a small head
Microcephaly due to
Rubella
Toxoplasmosis
SGA (small gestational age) status
What can a large head indicate
Hydrocephalus
Increased intracranial pressure
Vernix caseosa
Thick white substance to protect skin during first 2-3 days
don’t remove
Stork bites
superficial vascular areas on nape, eyelids, upper lip
immature blood vessels
normal variant
Milia and Epstein pearls
white/yellow unopened sebaceous glands
Milia if on chin, forehead and nose
Epstein if in mouth
normal, will disappear in 2-4 weeks
Mongolian spots
Benign blue or purple splotches
Lower back and buttocks as well as legs and shoulders
Concentration of pigmented cells
Disappear spontaneously within first 4 years
Erythema toxicum
Newborn rash
face chest back
looks like flea bites
disappears in days
Harlequin sign
Blood vessel dilation on only one side
affected side will be red
happens in underweight babies
no intervention needed
Nevus vasculosus
Strawberry marks
raised rough dark red skin found on head
seen in immature infants
appear after first few weeks of life
resolve by age 3
Molding WILL BE ON TEST
Elongating of the fetal head to accommodate passage through birth canal
resolves in 24 to 48 hours
CAN happen with c section
resolves in a week
Caput succedaneum
Localized edema of scalp due to birth pressure
pitting edema and petechia (red spots) and ecchymosis (redness)
appears on suture lines
resolves in 3 days
Cephalohematoma
Swelling under one cranial bone with no skin redness
due to prolonged labor or use of tools for extraction
does NOT cross suture lines and is firm
appears on 2 day and resolves in months
Microcephaly
Head circumference more than 2 standard deviations below average
Reduced production of neurons
Microcephaly leads to
Seizures
Developmental delays
Vision, hearing, balance, feeding problems
What leads to microcephaly
Cytomegalovirus
Rubella
Toxoplasmosis
Trisomy
use of alcohol and drugs
Macrocephaly
Circumference more than 90% of normal
Typically related to hydrocephalus
Hydrocephaly
increased volume of cerebrospinal fluid (CSF) in or around the brain
Large fontanels
more than 6cm in anterior diameter
more than 1cm in posterior fontanel
Large fontanels are associated with
Malnutrition
Hydrocephaly
Congenital hypothyroidism
Trisomy
Small or closed fontanels (craniosynostosis)
lead to abnormal brain development
Associated with microcephaly
requires complex reconstructive approach
With baby face look for
full cheeks
symmetry
With baby nose look for
Smallness
midline placement
Ability to smell
With baby mouth look for
Midline
Symmetry
Intact soft and hard palate
With baby neck look for
Short
Creased
Moves freely
Baby holds head in midline
In baby eyes look for
Clearness
symmetry
online with ear
love
in baby ears look for
soft
pliable
quick recoil
in baby chest look for
round
symmetry
smaller than head
in baby abdomen look for
Protuberant (bulging) contour
soft
three vessels in umbilically cord
In baby genitals look for
male
female
Smooth glands
meatus centered at tip of dick
swollen genitals due to maternal estrogen
In baby spine and extremities look for
symmetry
free movement
If thrombocytopenia drops below 100,000
Dr will start C section
+1
+2
+3
+4
EDEMAS
2mm
4mm
6mm
8mm
Greater than 8mEq of magnesium is considered
Toxic
Trisomy 21
Down syndrome
presence of an extra 21 chromosome
Children with down syndrome are at a higher risk of what complications
Hearing/vision
Sleep apnea
Hypo/hyper Thyroidism
Heart disease
Gastrointestinal disorders
Hematological problems
Children with down syndrome develop on their own _
The earlier you start therapy the _
timetable
better
Physical examination for down syndrome appearance
Lack of muscle tone
Loose joints
Small head
Flat face
Large tongue
Maternal age over _ indicates a GREAT risk for down syndrome
35
Because down syndrome children grown slower use _ to document
Special ones are available to account for the condition
Growth chart
Lab/diagnostics for downs
11-14 weeks
Nuchal translucency
PAPP-A
hCG
16-18 weeks
3/4 blood test
AFP
estriol
Downs is truly diagnosed at
Birth
with a chromosome analysis
Common assessments for complications of Downs
Echocardiogram
Vision/hearing check
Thyroid levels
Cervical radiography
Ultrasound
Nursing management for downs
^ growth/development
v complications
^ nutrition
^ support/education
Promoting growth and development with downs
Speech/language therapy
Occupation/physical therapy
Promoting nutrition
During feeding use
Bulb syringe
Humidification
Position changing
to accommodate the larger tongue
Because of muscle underdevelopment at birth, downs babies have a hard time
Sucking/feeding
Because of a slower metabolic rate, downs kids have problems with
obesity
Huntington disease
Nervous system disease
involves choreiform (coordination problem) movement AND dementia
Huntington is autosomal dominant meaning
Each child of a Huntington patient has a 50% chance of inheriting the disorder
The gene for Huntington is mapped and
Can be tested for
Patho of Huntington
Death of cells in cerebellum/basal ganglia (small ram horns in the middle of brain)
These cells are in control of movement
and
Death in cells of the cortex
What is the cortex associated with
Thinking, memory, perception, judgment, behavior.
Death in these cells results in huntington associated dementia
Symptom triad of Huntingtons
Motor dysfunction (chorea- jerky movement)
Cognitive impairment (attention/emotion recognition)
Behavior features
(apathy/blunt affect)
As huntington progresses and body starts to constantly jerk and move involuntarily, speech will become incomprehensible and patient will be at risk for
Choking/aspiration
Chorea
Involuntary jerking
Huntington
With increased loss of muscle control, the huntington patient will lose
Bladder/bowel control
Huntington onset occurs at
35-45y
Personality changes in huntington are
severe
depression, apathy, anxiety, psychosis, delusions etc.
Assessment for Huntington
Fam history and characteristic symptoms
Genetic marker CAG repeats in HTT
CT/MRI of brain
Cure of huntingtons
None
focus on treating symptoms
Med for huntingtons
Tetrabenazine specifically for Huntington chorea
Benzodiazepines and neuro drugs also help
Med for controlling psych huntington symptoms
SSRI
Tricycline antidepressants
Therapies for huntingtons
Physical/occupational
Speech/social
Genotype
Phenotype
25000 genes
Observable characteristics of those genes
Adenine=
Guanin=
Thymine
Cytosine
How many chromosomes do humans have
which one is responsible for sex
46 total
23 paired
23rd
Mitosis vs meiosis
Duplication of almost all body cells 46chromosomes
Duplication of reproductive cells
23chromosomes
Nondisjunction during meiosis can lead to
Trisomy, downs
Monosomy, turners
Gene mutations leads to
Huntington
Fragile X
Mytonic dystrophy
etc.
X-linked recessive inherited conditions mostly affect
transmitted
Males
Vertically
Autosomal dominant inherited conditions vs autosomal recessive inherited conditions
Vertical transmission
Horizontal transmission
Variable expression
Variation of degree to which a condition is expression
Usually occurs with Autosomal DOMINANT conditions
Do Autosomal recessive carriers have symptoms of conditions
NO
only autosomal DOMINANT carriers do
Dominant vs recessive % of inheritance chance
Dominant = 50% Recessive = 25%
X linked recessive pass down
50% chance of carrier MOTHER to pass to SON
General term for having extra or missing chromosomes
Aneuploidy
Breast cancer
Diseases of unregulated cell growth
Most common cancer in women
Pathophysiology of breast cancer
Clonal, daughter cells are also mutated
growth depends on estrogen and progesterone levels
2 categories of breast cancer
invasive (infiltrating) extends into surrounding tissue, can metastasize
noninvasive (in situ) have not extended beyond the duct
Where does breast cancer metastasize
Bone
Lungs
Lymph nodes
Liver
Brain
Most common breast cancer
Invasive ductal carcinoma
80% of all cases
Invasive lobular carcinoma
originates in terminal lobular units of breast duct
ill-defined thickening
upper outer quadrant of breast
cancer stages
0
1
2
3
4
in situ
less than 1in diameter
1-2in diameter spread to axillary lymph nodes
2in diameter spread to other lymph nodes and tissues
Cancer has metastasized to other organs
Breast cancer risk factors
Age over 50
BRCA1 and BRCA2 genes
Increased breast density
White race
Diagnosing breast cancer
Mammography
Magnetic resonance mammography
biopsy
hormone status
HER2/neu genetic marker
Local treatment for breast cancer
Surgery and radiation
Systemic treatment for breast cancer
Chemo
Hormonal therapy
Immunotherapy
Preventative breast cancer surgery
Mastectomy
Lumpectomy with radiation
Breast conserving surgery
Used in early stage localized tumors
Radiation begins 2-4 weeks after, goes on for several weeks
Simple mastectomy
Removal of all breast tissue, nipple and areola
Modified radical mastectomy
Also removes lymph nodes in the arm pit in case of spread
After mastectomy, the woman can choose to have _ surgery
It is recommended to be done _ after mastectomy
Reconstructive
SOON
Radiation therapy
Uses high energy rays to destroy microscopic cancer cells to reduce recurrence
Done 5 days a week for 6 to 8 weeks
Side effects of radiation therapy
Inflammation
Edema
Swelling
Sunburn skin
Fatigue
Chemotherapy
Use of drugs
Toxic to call cells and interfere with cell reproduction
Done in cycles of 3 to 6 months depending on severity
Breast cancer side effects
N/V
Diarrhea
Constipation
Hair loss
Weight loss
Fatigue
Most serious effect of chemo
Bone marrow suppression
Hormone therapy for breast cancer
Endocrine therapy to counter effects of estrogen which contributes to cell growth
Tamoxifen
Well know SERM aka Hormone therapy for breast cancer
Given for 5 years
Immunotherapy
Increases immune response to cancer cells
Trastuzumab/pertuzumab
Immunotherapy side effects
Cardiac toxicity
Thrombosis
Fever
N/V
Hepatic failure
Postop breast cancer care
Pain management
Care of arm
Wound/Mobility care
Resp care
Emotional care
phytochemical rich foods
Good for boost against cancer
Herbals tea
Garlic
Onion
Soy
Veg
Self breast exams should be done
monthly
Local vs systemic treatment for b cancer
surgery/radiation
chemo/hormone/immunotherapy
Brachial plexus injury
Injury to arm of baby
will curve back
no nerve connection
MIlia looks like
Erythema toxicum looks like
Small whitehead acne
Red acne
Both present at birth, if appears after birth REPORT, probably a reaction to skin product
Nevus flammeus
Red skin areas like spilled wine
NO intervention
When to do APGAR
1 min and 5 min after birth
Down syndrome kids have dental care Q_months
6 may be on test
Nutrition for down syndrome for preventing constipation
high fiber high water
may be on test
Huntington disease is an autosomal _ gene
DOMINANT
WILL be on test
BRCA 1 and BRCA 2 are autosomal _
so chance of passing down breast cancer is _
DOMINANT
50/50
WILL be on test
BRCA is associated with cancer in what age category of women
20-30 y/o
Anemia is autosomal
Recessive
With anemia the first organ to get damaged is the
Spleen (helps fight infection)
Meaning, PT more susceptible to infections
Hydroxyurea for Anemia
Raises fetal hemoglobin to counteract sickling of cells.
Priority Sickle Cell Anemia management
Pain - Narcotics
Tenderness and abdominal pain with Sickle Cell Anemia may indicate
Spleen damage
May be on test
