TEST 4 Flashcards
Sepsis Neonatorum - EARLY-ONSET SEPSIS
- acquired during birth, often from complications of labor such as prolonged rupture of membranes, prolonged labor, or chorioamnionitis.
- Infants often show signs during the first hours after birth, and 90% show signs within 24 hours
- Rapidly progressive multisystem illness with high mortality and morbidity rates.
- Pneumonia and meningitis are commonly present
Regarding SGA infants, ________ growth restrictions involve the whole body
Symmetric
Symmetric growth restrictions may be caused by what 5 things?
- congenital anomalies
- genetic disorders
- exposure to infections
- drugs early in pregnancy
- normal genetic predisposition.
Measurements of the head, chest, length, and weight are _____________ in the infant with symmetric growth restriction.
below normal.
Sepsis Neonatorum - LATE-ONSET SEPSIS
90 days after birth in healthy term infants or after 72 hours of life in very-low-birth-weight infants
- It is acquired during or after birth, before or after hospital discharge. It usually is a localized infection such as meningitis, and serious long-term effects are common.
SEPSIS NEONATORUM
- Infection that occurs during or after birth may result in sepsis neonatorum, a systemic infection from bacteria in the bloodstream.
- COMMON CAUSES - agents of neonatal sepsis include bacteria such as GBS, Escherichia coli, coagulase-negative Staphylococcus, Staphylococcus aureus, Haemophilus influenzae, and fungi such as Candida albicans
- Infection. In the newborn, early signs of infection are not as specific or obvious as those in the older infant or child. Instead, they tend to be subtle and could indicate other conditions.
Characteristics of Preterm Infants - APPEARANCE
- frail and weak, with decreased muscle tone/flexion - Their extremities are limp and offer little or no resistance when moved.
- Typically lie in an extended position
- The infant’s head is large in comparison with the rest of the body.
- Preterm infants lack subcutaneous or white fat, which makes their thin skin appear red and translucent, with blood vessels being clearly visible.
- The nipples and areola may be barely perceptible,
- vernix caseosa and lanugo may be abundant.
- Plantar creases are absent in infants of less than 32 weeks of gestation
- The pinnae of the ears are flat and soft and contain little cartilage, lack the rolled-over appearance of the pinnae of a full-term infant.
- In the female infant, the clitoris and labia minora appear large and are not covered by the small, separated labia majora.
- The male infant may have undescended testes, with a small, smooth scrotal sac
Danger signs that women need to seek emergency care POST BIRTH
Pain in chest
Obstructive Breathing
Seizures
Thoughts of hurting yourself or baby
Bleeding Incision that's not healing Red or swollen leg that is painful & warm to the touch Temp over 104 Headache that does not get better
Signs & Symptoms to watch Postpartum
Excessive bright red bleeding
- Boggy fundus deviated to the right
- Difficult to locate the fundus
- Fundus above expected level
- Large clots
- Backache
- Elevated Temp, Pulse, Resp; low B/P
- If hematoma; perineal pain
Patient teaching regarding HEMORRHAGE
- Void 1-2 hrs after delivery
- Fundal massage
- teach patient
- Encourage breastfeeding
- Patient teaching report clots/excessive bleeding
Postpartum Hemorrhage interventions
CALL FOR HELP
- Monitor Fundus
- Monitor bleeding - weigh pads etc
- Check Uterine Tone
- Measure blood loss - 1 gram = 1ml
- A drop of 1 gram in Hgb or 3% drop in Hct is = 500 ml of blood loss
Medications used for Hemorrhage
- Oxytocin 10-40 units (10 units im if not IV access)
- Cytotec (misoprostol) PO, Rectally- 800mcg, Vaginally
- Methergine - 0.2mg IM, IV, or PO
- Prostin (Hemabate) IM 250mcg - Diarrhea, elevated diastolic fever flushing, (DON’T GIVE IF PT HAS ASTHMA)
- Action-prostaglandin to control bleeding after delivery. Side effects-headache, nausea/vomiting, and diarrhea. Note-often given with Lomotil. Don’t give with history of asthma
Interventions for Hemorrhage
- D&C - dilation and curettage (stretching of the cervical os to permit suctioning or scraping of the walls of the uterus)
- Manual removal of placenta
- Bakri Balloon - A balloon may be inserted into the uterus to apply pressure against the uterine surface to stop bleeding
- Hysterectomy is a last resort to save the life of a woman with uncontrollable postpartum hemorrhage.
Asymmetric growth restriction is caused by complications such as preeclampsia that begin in the ____ Trimester and interfere with uteroplacental function
3rd
Physical characteristics of an SGA infant with Asymmetric growth restrictions
- Normal head size but seems large for the rest of the body
- Normal brain growth and heart size
- Normal Length
- Weight is below the 10th percentile
- Abdominal circumference is decreased because the liver, spleen, and adrenals are smaller than normal
An SGA infant with Asymmetric growth restriction appears ………
- The infant appears long, thin, and wasted.
- The dry, loose skin has longitudinal thigh creases from loss of subcutaneous fat.
- sunken abdomen, sparse hair, a thin cord, and the facial appearance of being elderly.
- The anterior fontanel may be large with wide or overlapping cranial sutures
How do SGA infants with Asymmetric growth continue to develop?
- They generally “catch up” in growth, particularly in the first 2 years, if they are adequately nourished after birth.
Risk factors in the immediate post-partum in women related to heart disease
- The fourth stage of labor is associated with special risks.
- To minimize the risks of overloading the heart, abrupt positional changes should be avoided.
- The uterus should not be massaged to expedite separation of the placenta.
- Careful assessment for signs of circulatory overload, such as a bounding pulse, distended neck and peripheral veins, and moist rales in the lungs, is performed throughout labor and the postpartum period.
Although no evidence of distress during pregnancy, labor, and childbirth, women may have cardiac decompensation during the postpartum period due to …….
- After delivery of the placenta, about 500 mL of blood is returned to the intravascular volume. Blood from the placenta and uterus increases the workload on the heart.
What conditions can act together to precipitate postpartum heart failure.
- infection, hemorrhage, and thromboembolism
Signs and symptoms of postpartum congestive heart failure include:
- Cough (frequent, productive, hemoptysis)
- Progressive dyspnea with exertion
- Orthopnea
- Pitting edema of legs and feet or generalized edema of face, hands, or sacral area
- Heart palpitations
- Progressive fatigue or syncope with exertion
- Moist rales in lower lobes, indicating pulmonary edema
Early-onset newborn GBS disease occurs during the first week after birth, often within 48 hours. What are the primary infections in early onset GBS disease?
-Sepsis, pneumonia, and meningitis
Late-onset GBS disease occurs after the first week of life, and _________ is the most common clinical manifestation.
meningitis
Regarding Late-onset GBS, what patients are neurologic consequences are more likely in
- infants who survive meningeal infections