Test 2: Acquired & Congenital Conditions Flashcards
Cause of TNT (Occurs in 1st 4 hrs of life)
Number of respirations
Conditions resolves itself in first few days
Risk factors…
TX….
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
Causes of TTN
Retained lung fluid & resp distress devs.
Does TTN resolve itself
Yes within a few days
Describe respirations during TTN
60 - 120 per min
Risk factors for TTN…
SS 60 - 120 resp
Grunting
Flaring
Cyanosis
Retractions
CS w/o labor
Asphyxia
Maternal analgesia
Bleeding
DM
Tx for TTN…
O2, IV or gavage feeding, possibly antibiotics
TTN usually happens when…
Within 4 hours of life
Meconium aspiration
Interuterine Asphyxia causes increase in _____ and relaxation of _____
Peristalsis/ Anal Sphincter
Meconium aspiration
Meconium may enter the lungs at birth air cannot enter.
T or F
F
Air can enter but not escape.
_____ mechanism, over distends alveoli, causing pneumothorax
Ball valve
Can breath in but cannot breath out due to Meconium
Usually SS of resp distress happens with Meconium aspiration
Describe the breath sounds..
Course
Pathological Jaundice is Dangerous
Occurs when…
1st 24 hours of life
At what levels can you see bilirubin…
What level is it dangerous…
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.
2 froms of Bilirubin
Describe solubility/ toxicity
Unconjugated….
Conjugated….
Unconjugated Fat soluable / Toxic
Conjugated Water soluable / NonToxic
Type of detrimental effects a bilirubin levels of 18 will have on a healthy full term baby…
None with close observation
Bilirubin encephalopathy, irreversible brain damage.
Level >20 in healthy term baby
Name postural condition that may occur with this level..
Kernicterus
Leading cause of hyperbilirubinemia…
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
Why increased risk of jaundice with infrequent feedings / breast feeding?
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
Phototherapy helps with bilirubin problems
Facilities excretion of ______ bilirubin via conversion to photobilirubin then transported into bile. Does not require conjugation.
Unconjugated
Bilirubin therapy.
Unclothed
Eye shields
With in ____ (until of measurement) of the lights
Turn baby how often….
20 inches
2 hrs
Transcutaneous Bilimeter
Place against sternum
May not be accurate in…
Premies or High lvl of bilirubin
Sepsis Neonatorum
Infection occurs during or after birth
Causes……
2 categories
Early: At birth, symptoms within 24 hrs
Late: 8 - 90 days after birth
Causes: GBS, E. Coli, Staphylococcus, Candida
DX of sepsis…
CBC
Urine/ lesion culture
Cerebrospinal fluid
Risk factors for sepsis in newborn…
Premature
ROM >18hrs
Preciptious birth
Maternal infection
GBS positive
Invasive procedure (SVE, UPC, ISIL)
SS of sepsis
Describe body temp…
Resp….
Cardio…
GI….
Neurological…
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
The following are SS of…
Jaundice
Hemorrhage, petechiae
Anemia
Enlargement of liver / spleen
Resp failure
Shock
Seizures
Advanced infection (Sepsis)
LGA are common in DM mothers due to glucose transfer to the infant.
Why might a baby be SGA to a DM mom…
SGA happens when mother is Long Term DM and has vascular changes / perfusion issues
Are congenital anomalies more common with DM moms?
Yes 6x more likely
Appearance of baby from DM mom
Normal?
Abnormal?
Normal head and length size
Abnormal Round face and body Obesity/ poor muscle tone
Maybe Irritabe due to hypoglycemia
New born with DM mom
May require CS
Monitor for hypoglycemia at birth how often…
If BS is <_____ repeat lab & feed instantly
q2H × 4 then, q4H × 6
BS below 45 - 40
First 4 hours of life BS is 25 and baby is showing no signs of Irritability, jitteryness.
What do you do?
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.
Give definition of Polycythemia…
Cause….
Hgb >22 & Hct > 65% 1st week of life.
Poor Intrauterine oxygenation (Forces baby to produce more RBCs)
Thickness of blood with Polycythemia may cause this problem…
Perfusion
Hyperbilirubinemia & jaundice may occur
TX for Polycythemia…
Close monitoring
Increase hydration
Possible blood transfusion
Baby may appear Red
Lethargic
Jittery
Cyanosis
Resp distress
Poor feeding
This problem….
Polycythemia
Hgb >22 & Hct >65% first week of life
Hypocalcemia in preterm, why?
Calcium delivered via placenta
At birth Calcium stops vía placenta
Parathyroid hormone makes Calcium/ Premie has blunted PTH function
Prenatal drug exposure
Drugs taken _____ cause congenital defects
Withdrawal signs start _____ after birth
Alcohol withdrawal starts faster at ______
1st trimester
Withdrawal normal start is 48 - 72 hrs after birth
Alcohol 3 - 12 hrs after birth
Super Moro reflex
High pitched cry
Multiple sneezes
Uncoordinated suck
Seizures
Lacrimation
Rub marks
Apnea
Weight loss
Diarrhea
Hyperactive
Tremors
Irritability
Wakefulness
SS of…
Withdrawal infant
SS of infant withdrawal (14)
Super Moro reflex
High pitched cry
Multiple sneezes
Uncoordinated suck
Seizures
Lacrimation
Rub marks
Apnea
Weight loss
Diarrhea
Hyperactive
Tremors
Irritability
Wakefulness
Describe barriers to bonding with Withdrawal babies…
Mom is guilty/ Withdrawing
Baby is withdrawing tok
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
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
When to perform NIPS scale…
When baby is at rest and not bothered
Neonatal Abstinence Scoring Tool
The Finnegans scale has a more streamed line version called…
Eat-Sleep-Console tool
Autosomal recessive genetic trait
Body’s ability to metabolize phenylalanine is impaired rt enzyme deficiency
This disease…
Results
PKU / Phenylketonuria/ Hyperphenylalaninemia
Result: Accumulation of phenylalanine in blood and Untreated: mental, physical, behavioral Disability
Normal PKU levels 2 - 5 days after birth…
Dangerous level…
Norm: <2
Dangerous: >8
PKU safe diet…
Avoid all types of protein foods
Avoid Aspartame
Give PKU test before baby begins breastfeeding/formula
False
After to test to its levels
When does the PKU diet stop?
Formula considerations…
NO ASPARTAME
Never, its 4 Life brother.
Special PKU formula
SS
Fever
Rash
Joint pain
Conjunctivitis
SAB
4 /5 times there are no symptoms
Name disease…
Zika
Zika maybe transmitted how…
Mosquitoes
Mother to fetus
Sexual contact
Blood transfusion
Standard precautions for Zika
Name issues….
Severe brain problems
Microcephaly
Eye/hearing
Joint contracturas
Growth restriction
2 vessel cord will promopt more investigation into this system of the baby…
Renal
Cleft Lip & Palate
Maybe together or separate
Unilater/bilateral
1:1000 incident
More common in males
Risk factors…
Maternal Anticonvulsants
FAS Fetal Alcohol Syndrome
Chromosomal abnormalities
When checkkng for cleft Palate ensure that…
Finger is inserted far enough back to feel cleft
Esophageal Atresia
Define…
Esophagus divided into 2 parts
Upper portion ends in a pouch
Lower portion is attached to trachea (Tracheoesophageal fistual)
SS
Polyhydramnios
Frothy drooling, unable to pass catheter into stomach
If upper potion is connected to trachea Aspiration wil occur
Esophageal Atresia
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
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
Congenital defects in abdominal wall (Organs are OUTSIDE infants body)
Omphalocele & Gastroschisis
Dx….
Tx….
Dx: US & elevated AFP
Tx: Prevention of infection/trauma, apply sterlie plastic bag with warm water, silo
Diaphragm fails to fuse in 1st trimester
Abdominal contents move into chest cavity.
If severe lungs do not develop (Hypoplastic Lungs)
This problem…
Diaphragmatic Hernia
Mild / Severe resp distress
Diminished breath sounds
Barrel chest
Abdomen maybe scaphoid (Concave / Sunken-in)
Maybe diagnosed US prenatal
Name condition…
Diaphragmatic hernia
SS of Diaphragmatic hernia
Mild / Severe resp distress
Diminished breath sounds
Barrel chest
Abdomen maybe scaphoid (Concave / Sunken-in)
Maybe diagnosed US prenatal
Diaphragmatic hernia
Put baby in this position to help breathing…
Side with the organs down.
Lateral posistion
Most dangerous Esophageal Atresia…
Fistula into trachea
Diaphragmatic hernia
Big concern…
TX….
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.
Neural tube defects
Spinal Bifida most common (Failure of vertible arch to close, usually No Other Complications)
3 types:
Spinal Bifida occulta….
Meningocele….
Myelomeningocele….
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
Dose of Folic Acid to prevent Neural tube defects…
400 micrograms
NTD
If hydrocephalus what is the treatment…
Shunt CSF away from brain
Assessments for NTD…
Nursing Management….
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
Problem with absorption or obstruction of the flow of CSF in ventricles of the brain
Causes compression of brain & head enlargement.
This problem…
Congenital Hydrocephalus
Congenital Hydrocephalus is problem absorbing CSF in the ventricles of the brain.
Causes compression of brain & enlargement of head
Assessment….
Full or bulging fontanel
Separation of suture line
Head enlargement esp in frontal area
Setting Sun Sign: Sclera is visible above the pupils
Setting Sun Sign: Sclera is visible above the pupils
Happens with which problem…
Congenital Hydrocephalus
Congenital Hydrocephalus
Corrected surgically. Shunt is inserted to drain CFS into ___ cavity
Measure head circumference how often..
Peritoneal
Daily
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…
Umbilical vein
Umbilical artery
3 shunts distribute blood to baby in a different manner.
Ductus Venosus…
Ductus Arteriosus…
Foramen Ovale…
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
Most common type of congenital heart defect….
Ventricle Septal Defect
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
When Left Ventricle contracts amd blood is shunted into the Right Ventricle and recirculate to the lungs
Ventricular Septal Defect
Increased pulmonary resistance may cause pulmonary hypertension, hypertrophy of….
Right Ventricle
Ductus Arteriosus
Normal structure that allows blood to by pass the lungs.
How and when does this structure close…
High levels of oxygen close it
With in 24 hrs
Patent Ductus Arteriosus PDA
Blood flows from higher pressure of the aorta to pulmonary artery & lungs (Left - Right)
Which meds to give / avoid
Tx….
Avoid: Prostaglandin- Cause Vasodilation- promoting PDA
GIVE: Indomethacin (Prostaglandin inhibitor) may close PDA & Ibuprofen
Tx: Surgery
Reason why mom cant take Ibuprofen during pregnancy….
Ibuprofen may cause premature closure of Ductus Arteriosus
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.
ductus arteriosus
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…
Coarctation of heart.
Coarctation of heart.
Describe….
Which ventricular will be affected..
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
Worst case scenario for Coarctation of the Heart
CHF
Ventricular Septal Defect VSD
Aorta positioned over VSD
Pulmonary Stenosis
Hypertrophy of Right Ventricle
(Vacations Are Pretty Helpful)
Describes…
Tetralogy of Fallot
Tetralogy of Fallot
(Right to Left Shunt)
Cyanosis occurs if ….
Blood flow to lungs is decreased due
to…
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
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…
Right
Left
Give Prostaglandins to keep Ductus Arteriosus open until surgery
Congenital Patent ductus Arteriosus
Side of the babies heart that is oxygenated
Left side. Same as adults
Tetralogy of Fallot
Describe problem…
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
Tetralogy of Fallot
Describe the cause of the following problems:
- Mixing of Unoxygenated blood with oxygenated blood
- Unable to push adequate blood into the vessel that leads to the lungs.
- Due to excessive force caused by attempting to push blood through the pulmonary artery.
- Pumping mixed oxygenated and Deoxygenated blood through the body.
- 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)
- Unable to push adequate blood into the vessel that leads to the lungs. (Pulmonary Stenosis) Narrowing of Pulmonary Artery
- Due to excessive force caused by attempting to push blood through the pulmonary artery. (Right ventricular hypertrophy)
- 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
Tet spell is…
What is nursing interventions…
Activity creates: Cyanosis, SOB, Increase RR, Fainting
Intervention: Knee to chest posistion, Ox, IV fluids ( Decreases Left to Right Shunt)
Describe shunt movement in tetralogy of Fallot…
Right to Left
Dangerous
Do you want ductus Arteriosus to close quickly after birth in tetralogy of Fallot?
Treatment…
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
Patent Ductus Arteriosus causes what….
Increased Pulmonary Blood Flow
Fetus (before birth)
Umbilical vein carries oxygenated blood to Right Atrium- Right Ventricle- Pulmonary Artery….. (Where next)
Aorta to be distributed throughout the body.
Via. Pulmonary Artery - Ductus Arteriosus- Aorta
Tyoe of baby most likely to have PDA Patent Ductus Arteriosus
Premature
Patent Ductus Arteriosus
High pressure blood travels from Aorta to Pulmonary Artery.
What negative effects will happen to the Pulmonary Artery…
Stenosis- Vessel will narrow
Result: Pulmonary Hypertension
Patent Ductus Arteriosus can cause heart failure how…
Stenosis of the Pulmonary Artery (Caused by PDA)
Heart has to work too hard
Descrube Shunt from PDA
Left- Right
Continous machine like murmur is heard in…
PDA
Treatment for Patent Ductus Arteriosus (2)
Meds: Indomethacin/ Ibuprofen (Prostaglandin inhibitor)
NOT: PROSTAGLANDIN - THIS KEEPS DUCT OPEN
Surgery
Vessel connecting the aorta and pulmonary artery has failed to close at birth, which is leading to a Left-Right shunting of blood.
PDA
Patent Ductus Arteriosus
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
Crackles - This suggest patient is heading toward Left sided HF.
All other findings are expected to be found in PDA.
Newborn Infant Pain Scale NIPS
Categories (6)
Give numerical ratings for NIPS scale…
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
