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NURS 2156 OB 2 > Test 2: Acquired & Congenital Conditions > Flashcards

Test 2: Acquired & Congenital Conditions Flashcards

1
Q

Cause of TNT (Occurs in 1st 4 hrs of life)

Number of respirations

Conditions resolves itself in first few days

Risk factors…

TX….

A

Fluid in lungs & resp distress

60 - 120

Normal RR 30 - 60

Risk factors: CS without labor, Asphyxia, Maternal analgesia, bleeding, DM

TX: Gavage feeding maybe needed, Monitor O2, IV, Antibiotics

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2
Q

Causes of TTN

A

Retained lung fluid & resp distress devs.

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3
Q

Does TTN resolve itself

A

Yes within a few days

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4
Q

Describe respirations during TTN

A

60 - 120 per min

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5
Q

Risk factors for TTN…

SS 60 - 120 resp
Grunting
Flaring
Cyanosis
Retractions

A

CS w/o labor
Asphyxia
Maternal analgesia
Bleeding
DM

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6
Q

Tx for TTN…

A

O2, IV or gavage feeding, possibly antibiotics

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7
Q

TTN usually happens when…

A

Within 4 hours of life

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8
Q

Meconium aspiration

Interuterine Asphyxia causes increase in _____ and relaxation of _____

A

Peristalsis/ Anal Sphincter

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9
Q

Meconium aspiration

Meconium may enter the lungs at birth air cannot enter.

T or F

A

F

Air can enter but not escape.

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10
Q

_____ mechanism, over distends alveoli, causing pneumothorax

A

Ball valve

Can breath in but cannot breath out due to Meconium

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11
Q

Usually SS of resp distress happens with Meconium aspiration

Describe the breath sounds..

A

Course

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12
Q

Pathological Jaundice is Dangerous

Occurs when…

A

1st 24 hours of life

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13
Q

At what levels can you see bilirubin…

What level is it dangerous…

A

5 or above you can see Yellowing starting in the face and eyes and move downward with high levels

bilirubin levels >20 mg/dL can lead to complications like kernicterus, a form of brain damage caused by bilirubin toxicity.

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14
Q

2 froms of Bilirubin

Describe solubility/ toxicity

Unconjugated….

Conjugated….

A

Unconjugated Fat soluable / Toxic

Conjugated Water soluable / NonToxic

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15
Q

Type of detrimental effects a bilirubin levels of 18 will have on a healthy full term baby…

A

None with close observation

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16
Q

Bilirubin encephalopathy, irreversible brain damage.

Level >20 in healthy term baby

Name postural condition that may occur with this level..

A

Kernicterus

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17
Q

Leading cause of hyperbilirubinemia…

A

Rh disease

ABO Incompatibility
Insulin dept mom
Asian / Indians
Maternal drug intake (sulfonamides, salicylate, ibuprofen)
Delayed Um Cord clamping
Prenatal complications: Cephalohematoma, Cerebral hemorrhage, Occult bleeding

Infrequent feedings/ breastfeeding

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18
Q

Why increased risk of jaundice with infrequent feedings / breast feeding?

A

Bilirubin is excreted in feces.

Less food in or less frequent consumption of food will cause less poop with will increase Bilirubin

Breast Feeding = Smaller portion of food compared to formula

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19
Q

Phototherapy helps with bilirubin problems

Facilities excretion of ______ bilirubin via conversion to photobilirubin then transported into bile. Does not require conjugation.

A

Unconjugated

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20
Q

Bilirubin therapy.

Unclothed
Eye shields
With in ____ (until of measurement) of the lights
Turn baby how often….

A

20 inches

2 hrs

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21
Q

Transcutaneous Bilimeter

Place against sternum

May not be accurate in…

A

Premies or High lvl of bilirubin

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22
Q

Sepsis Neonatorum

Infection occurs during or after birth

Causes……

2 categories
Early: At birth, symptoms within 24 hrs
Late: 8 - 90 days after birth

A

Causes: GBS, E. Coli, Staphylococcus, Candida

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23
Q

DX of sepsis…

A

CBC
Urine/ lesion culture
Cerebrospinal fluid

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24
Q

Risk factors for sepsis in newborn…

A

Premature
ROM >18hrs
Preciptious birth
Maternal infection
GBS positive
Invasive procedure (SVE, UPC, ISIL)

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25
Q

SS of sepsis

Describe body temp…
Resp….
Cardio…
GI….
Neurological…

A

Temp <36.3

Tachypnea/ apnea > 60 resp / min

Tachycardia >160/min. (Norm 110 - 160), hypotension, edema, Cyanosis

Decrease intake milk, vomit, diarrhea, distention

Change in muscle tone, lethargy, jittery, high pitched cry

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26
Q

The following are SS of…

Jaundice
Hemorrhage, petechiae
Anemia
Enlargement of liver / spleen
Resp failure
Shock
Seizures

A

Advanced infection (Sepsis)

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27
Q

LGA are common in DM mothers due to glucose transfer to the infant.

Why might a baby be SGA to a DM mom…

A

SGA happens when mother is Long Term DM and has vascular changes / perfusion issues

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28
Q

Are congenital anomalies more common with DM moms?

A

Yes 6x more likely

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29
Q

Appearance of baby from DM mom

Normal?
Abnormal?

A

Normal head and length size

Abnormal Round face and body Obesity/ poor muscle tone

Maybe Irritabe due to hypoglycemia

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30
Q

New born with DM mom

May require CS

Monitor for hypoglycemia at birth how often…

If BS is <_____ repeat lab & feed instantly

A

q2H × 4 then, q4H × 6

BS below 45 - 40

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31
Q

First 4 hours of life BS is 25 and baby is showing no signs of Irritability, jitteryness.

What do you do?

A

Continue monitor

BS as low as 25 maybe seen in the first 4 hours of life and are no concern if baby is symptom free.

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32
Q

Give definition of Polycythemia…

Cause….

A

Hgb >22 & Hct > 65% 1st week of life.

Poor Intrauterine oxygenation (Forces baby to produce more RBCs)

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33
Q

Thickness of blood with Polycythemia may cause this problem…

A

Perfusion

Hyperbilirubinemia & jaundice may occur

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34
Q

TX for Polycythemia…

A

Close monitoring
Increase hydration
Possible blood transfusion

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35
Q

Baby may appear Red
Lethargic
Jittery
Cyanosis
Resp distress
Poor feeding

This problem….

A

Polycythemia

Hgb >22 & Hct >65% first week of life

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36
Q

Hypocalcemia in preterm, why?

A

Calcium delivered via placenta

At birth Calcium stops vía placenta

Parathyroid hormone makes Calcium/ Premie has blunted PTH function

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37
Q

Prenatal drug exposure

Drugs taken _____ cause congenital defects

Withdrawal signs start _____ after birth

Alcohol withdrawal starts faster at ______

A

1st trimester

Withdrawal normal start is 48 - 72 hrs after birth

Alcohol 3 - 12 hrs after birth

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38
Q

Super Moro reflex
High pitched cry
Multiple sneezes
Uncoordinated suck
Seizures
Lacrimation
Rub marks
Apnea
Weight loss
Diarrhea
Hyperactive
Tremors
Irritability
Wakefulness

SS of…

A

Withdrawal infant

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39
Q

SS of infant withdrawal (14)

A

Super Moro reflex
High pitched cry
Multiple sneezes
Uncoordinated suck
Seizures
Lacrimation
Rub marks
Apnea
Weight loss
Diarrhea
Hyperactive
Tremors
Irritability
Wakefulness

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40
Q

Describe barriers to bonding with Withdrawal babies…

A

Mom is guilty/ Withdrawing

Baby is withdrawing tok

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41
Q

Newborn Infant Pain Scale NIPS

FACIAL EXPRESSION:
BREATHING PATTER:
LEGS:
ARMS:
CRY:
STATE OF AROUSAL:

Interpretation:
0-2: No pain
3-4: Mild to moderate pain
5-7: Severe pain

A

FACIAL EXPRESSION
0 Relaxed muscles, neutral expression
1 Tight facial muscles, furrowed brow, chin/jaw

BREATHING PATTER:
0 Relaxed
1 Change in breathing, irregular,

LEGS:
0 Relaxed no rigidity, occasional random movements
1 Flexed/Extended, Rigidity, Rapid movements

ARMS:
0 Relaxed, No Rigidity, occasional random movements
1 Flexed/Extended, Rigidity, Rapid Extension

CRY:
0 Not Crying
1 mild moaning/Interment Crying
2 Loud screaming/Shrill cry

STATE OF AROUSAL:
0 Sleeping/awake quiet, peaceful
1 Fussy, Alert, Restlessness, Thrashing

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42
Q

When to perform NIPS scale…

A

When baby is at rest and not bothered

43
Q

Neonatal Abstinence Scoring Tool

The Finnegans scale has a more streamed line version called…

A

Eat-Sleep-Console tool

44
Q

Autosomal recessive genetic trait

Body’s ability to metabolize phenylalanine is impaired rt enzyme deficiency

This disease…

Results

A

PKU / Phenylketonuria/ Hyperphenylalaninemia

Result: Accumulation of phenylalanine in blood and Untreated: mental, physical, behavioral Disability

45
Q

Normal PKU levels 2 - 5 days after birth…

Dangerous level…

A

Norm: <2

Dangerous: >8

46
Q

PKU safe diet…

A

Avoid all types of protein foods

Avoid Aspartame

47
Q

Give PKU test before baby begins breastfeeding/formula

A

False

After to test to its levels

48
Q

When does the PKU diet stop?

Formula considerations…

NO ASPARTAME

A

Never, its 4 Life brother.

Special PKU formula

49
Q

SS

Fever
Rash
Joint pain
Conjunctivitis
SAB

4 /5 times there are no symptoms

Name disease…

A

Zika

50
Q

Zika maybe transmitted how…

A

Mosquitoes
Mother to fetus
Sexual contact
Blood transfusion

51
Q

Standard precautions for Zika

Name issues….

A

Severe brain problems
Microcephaly
Eye/hearing
Joint contracturas
Growth restriction

52
Q

2 vessel cord will promopt more investigation into this system of the baby…

A

Renal

53
Q

Cleft Lip & Palate

Maybe together or separate
Unilater/bilateral
1:1000 incident
More common in males

Risk factors…

A

Maternal Anticonvulsants
FAS Fetal Alcohol Syndrome
Chromosomal abnormalities

54
Q

When checkkng for cleft Palate ensure that…

A

Finger is inserted far enough back to feel cleft

55
Q

Esophageal Atresia

Define…

A

Esophagus divided into 2 parts

Upper portion ends in a pouch
Lower portion is attached to trachea (Tracheoesophageal fistual)

56
Q

SS

Polyhydramnios

Frothy drooling, unable to pass catheter into stomach

If upper potion is connected to trachea Aspiration wil occur

A

Esophageal Atresia

57
Q

Omphalocele vs Gastroschisis

Intestine, liver, and other organs protrude into base of umbilical cord.

Defect to Side of Abdomen, next to but not involving the cord. Intestine protrude through the Defect and float freely in amniotic fluid

A

Omphalocele
Intestine, liver, and other organs protrude into base of umbilical cord.

Gastroschisis
Defect to Side of Abdomen, next to but not involving the cord. Intestine protrude through the Defect and float freely in amniotic fluid

58
Q

Congenital defects in abdominal wall (Organs are OUTSIDE infants body)

Omphalocele & Gastroschisis

Dx….

Tx….

A

Dx: US & elevated AFP

Tx: Prevention of infection/trauma, apply sterlie plastic bag with warm water, silo

59
Q

Diaphragm fails to fuse in 1st trimester

Abdominal contents move into chest cavity.

If severe lungs do not develop (Hypoplastic Lungs)

This problem…

A

Diaphragmatic Hernia

60
Q

Mild / Severe resp distress
Diminished breath sounds
Barrel chest
Abdomen maybe scaphoid (Concave / Sunken-in)
Maybe diagnosed US prenatal

Name condition…

A

Diaphragmatic hernia

61
Q

SS of Diaphragmatic hernia

A

Mild / Severe resp distress
Diminished breath sounds
Barrel chest
Abdomen maybe scaphoid (Concave / Sunken-in)
Maybe diagnosed US prenatal

62
Q

Diaphragmatic hernia

Put baby in this position to help breathing…

A

Side with the organs down.

Lateral posistion

63
Q

Most dangerous Esophageal Atresia…

A

Fistula into trachea

64
Q

Diaphragmatic hernia

Big concern…

TX….

A

Big concern. Not able to breathe due to GI tract in lungs field

ET tube for ventilation
GT tube to decompress stomach- allow for expansion of lungs
Surgery
ECMO - Extracorporeal membrane oxygenation. Oxygenates blood and bypassing the lungs , allowing them to rest.

65
Q

Neural tube defects

Spinal Bifida most common (Failure of vertible arch to close, usually No Other Complications)

3 types:

Spinal Bifida occulta….

Meningocele….

Myelomeningocele….

A

Spinal Bifida occulta
Dimple or tuft of hair, without anomalies

Meningocele
Meninges protrude, Spinal cord not involved

Myelomeningocele
Meninges & spinal cord protrude. Degree of paralysis depends on location

66
Q

Dose of Folic Acid to prevent Neural tube defects…

A

400 micrograms

67
Q

NTD

If hydrocephalus what is the treatment…

A

Shunt CSF away from brain

68
Q

Assessments for NTD…

Nursing Management….

A

Assess back & front of baby

Observe for movements of lower extremities

Examine for relaxed anus & dribbling urine

Management.

Surgery
Shunt if hydrocephalus
Antibiotics
Longterm Physical therapy

69
Q

Problem with absorption or obstruction of the flow of CSF in ventricles of the brain

Causes compression of brain & head enlargement.

This problem…

A

Congenital Hydrocephalus

70
Q

Congenital Hydrocephalus is problem absorbing CSF in the ventricles of the brain.

Causes compression of brain & enlargement of head

Assessment….

A

Full or bulging fontanel
Separation of suture line
Head enlargement esp in frontal area
Setting Sun Sign: Sclera is visible above the pupils

71
Q

Setting Sun Sign: Sclera is visible above the pupils

Happens with which problem…

A

Congenital Hydrocephalus

72
Q

Congenital Hydrocephalus

Corrected surgically. Shunt is inserted to drain CFS into ___ cavity

Measure head circumference how often..

A

Peritoneal

Daily

73
Q

Fetal oxygenation

Before birth oxygenated blood to carried to the baby via the….

Which structure put Deoxygenated blood away from the baby back to the placenta…

A

Umbilical vein

Umbilical artery

74
Q

3 shunts distribute blood to baby in a different manner.

Ductus Venosus…

Ductus Arteriosus…

Foramen Ovale…

A

Ductus Venosus
Shunts oxygen rich blood to by pass Liver - directly into Vena Cava

Ductus Arteriosus

Deoxygenated blood in Right Ventricle- Pulmonary Artery - Ductus Arteriosus Shunts blood away from lungs via the Descending aorta

Foramen Ovale:

Shunts blood from right atrium to the left - to left ventricle and out to the ascending aorta and to the body

75
Q

Most common type of congenital heart defect….

A

Ventricle Septal Defect

76
Q

Ventricular Septal Defect (Most Common)

Opening maybe small and close spontaneous

When (Right / Left) Ventricle contracts amd blood is shunted into the (Right / Left) Ventricle and recirculate to the lungs

A

When Left Ventricle contracts amd blood is shunted into the Right Ventricle and recirculate to the lungs

77
Q

Ventricular Septal Defect

Increased pulmonary resistance may cause pulmonary hypertension, hypertrophy of….

A

Right Ventricle

78
Q

Ductus Arteriosus

Normal structure that allows blood to by pass the lungs.

How and when does this structure close…

A

High levels of oxygen close it

With in 24 hrs

79
Q

Patent Ductus Arteriosus PDA

Blood flows from higher pressure of the aorta to pulmonary artery & lungs (Left - Right)

Which meds to give / avoid

Tx….

A

Avoid: Prostaglandin- Cause Vasodilation- promoting PDA

GIVE: Indomethacin (Prostaglandin inhibitor) may close PDA & Ibuprofen

Tx: Surgery

80
Q

Reason why mom cant take Ibuprofen during pregnancy….

A

Ibuprofen may cause premature closure of Ductus Arteriosus

81
Q

The _________ shunts oxygenated blood from the pulmonary artery (which would typically go to the lungs) directly into the aorta, ensuring efficient delivery of oxygen-rich blood to the body.

A

ductus arteriosus

82
Q

Blood flow is impeded by constriction of aorta, incrssing pressure behind the defect.

BP is raised in upper extremities & low / Absent in lower.

Increased pressure in left ventricle causes left ventricular hypertrophy

Name problem…

A

Coarctation of heart.

83
Q

Coarctation of heart.

Describe….

Which ventricular will be affected..

A

Blood flow in aorta is impeded.

Increased BP in upper extremities & Decreased BP in lower extremities

Increased pressure in Left Ventricle causing Left Ventriclar hypertrophy

84
Q

Worst case scenario for Coarctation of the Heart

A

CHF

85
Q

Ventricular Septal Defect VSD
Aorta positioned over VSD
Pulmonary Stenosis
Hypertrophy of Right Ventricle

(Vacations Are Pretty Helpful)

Describes…

A

Tetralogy of Fallot

86
Q

Tetralogy of Fallot
(Right to Left Shunt)

Cyanosis occurs if ….

Blood flow to lungs is decreased due
to…

A

Cyanosis occurs if Venosus Blood Flows through VSD - Ventricle Septal Defect, into overriding aorta

Blood flow to lungs is decreased due to Narrowed Pulmonary Valve

87
Q

Transposición of the Great Arteries.

Aorta carries Deoxygenated Blood from the _____ ventricle back to general circulation.

Pulmonary artery returns oxygenated blood from the ____ ventricle to the lungs

For infant to survive do this…

A

Right

Left

Give Prostaglandins to keep Ductus Arteriosus open until surgery

Congenital Patent ductus Arteriosus

88
Q

Side of the babies heart that is oxygenated

A

Left side. Same as adults

89
Q

Tetralogy of Fallot

Describe problem…

A

Reduced blood flow going to the pulmonary artery/ Lungs. (Baby will have less blood being oxygenated)

Ventricular Septal Defect
Aorta over VSD
Pulmonary stenosis
Hypertrophy of Right Ventricle

90
Q

Tetralogy of Fallot

Describe the cause of the following problems:

  1. Mixing of Unoxygenated blood with oxygenated blood
  2. Unable to push adequate blood into the vessel that leads to the lungs.
  3. Due to excessive force caused by attempting to push blood through the pulmonary artery.
  4. Pumping mixed oxygenated and Deoxygenated blood through the body.
A
  1. Mixing of Unoxygenated blood with oxygenated blood (Ventriclar Septal Defect) - Hole between the ventricles aloows Unoxygenated (Right side) blood to mix with Oxygenated (Left side)
  2. Unable to push adequate blood into the vessel that leads to the lungs. (Pulmonary Stenosis) Narrowing of Pulmonary Artery
  3. Due to excessive force caused by attempting to push blood through the pulmonary artery. (Right ventricular hypertrophy)
  4. Pumping mixed oxygenated and Deoxygenated blood through the body. (Overriding Aorta) Aorta normally only recieves from the left ventricle. BUT in Overriding Aorta it recieves blood from both ventricles
91
Q

Tet spell is…

What is nursing interventions…

A

Activity creates: Cyanosis, SOB, Increase RR, Fainting

Intervention: Knee to chest posistion, Ox, IV fluids ( Decreases Left to Right Shunt)

92
Q

Describe shunt movement in tetralogy of Fallot…

A

Right to Left

Dangerous

93
Q

Do you want ductus Arteriosus to close quickly after birth in tetralogy of Fallot?

Treatment…

A

No, an open ductus Arteriosus allows blood to flow from the Aorta to the Pulmonary Artery (Allowing it to be oxygenated)

Give Prostaglandins Keeps ductus Arteriosus Open

94
Q

Patent Ductus Arteriosus causes what….

A

Increased Pulmonary Blood Flow

95
Q

Fetus (before birth)

Umbilical vein carries oxygenated blood to Right Atrium- Right Ventricle- Pulmonary Artery….. (Where next)

A

Aorta to be distributed throughout the body.

Via. Pulmonary Artery - Ductus Arteriosus- Aorta

96
Q

Tyoe of baby most likely to have PDA Patent Ductus Arteriosus

A

Premature

97
Q

Patent Ductus Arteriosus

High pressure blood travels from Aorta to Pulmonary Artery.

What negative effects will happen to the Pulmonary Artery…

A

Stenosis- Vessel will narrow

Result: Pulmonary Hypertension

98
Q

Patent Ductus Arteriosus can cause heart failure how…

A

Stenosis of the Pulmonary Artery (Caused by PDA)

Heart has to work too hard

99
Q

Descrube Shunt from PDA

A

Left- Right

100
Q

Continous machine like murmur is heard in…

A

PDA

101
Q

Treatment for Patent Ductus Arteriosus (2)

A

Meds: Indomethacin/ Ibuprofen (Prostaglandin inhibitor)

NOT: PROSTAGLANDIN - THIS KEEPS DUCT OPEN

Surgery

102
Q

Vessel connecting the aorta and pulmonary artery has failed to close at birth, which is leading to a Left-Right shunting of blood.

A

PDA

Patent Ductus Arteriosus

103
Q

Which would you alert HCP immediately in an assessment of a NICU baby with PDA

Loud,harsh continuous murmur
Abnormal pulse pressure
Crackles
Diaphoresis when eating

A

Crackles - This suggest patient is heading toward Left sided HF.

All other findings are expected to be found in PDA.

104
Q

Newborn Infant Pain Scale NIPS

Categories (6)

Give numerical ratings for NIPS scale…

A

FACIAL EXPRESSION:
BREATHING PATTER:
LEGS:
ARMS:
CRY:
STATE OF AROUSAL:

Interpretation:
0-2: No pain
3-4: Mild to moderate pain
5-7: Severe pain

NURS 2156 OB 2 (12 decks)

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