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Nursing Semester 2 > Toni - Week 7 - Exam 4 > Flashcards

Toni - Week 7 - Exam 4 Flashcards

1
Q

what is the definition of small for gestational age (SGA)?

A

birth weight < 10th percentile

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2
Q

what are characteristics of a SGA baby?

A

Loose, dry skin, little fat/muscle, scaphoid (sunken) abdomen, thin cord, wide skull sutures, weak cry

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3
Q

what are SGA babies at risk for?

A

Risk for hypoglycemia and developmental delay

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4
Q

what is the definition of large for gestational age (LGA)?

A

Birth weight > 90th percentile or full term > 4000 g

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5
Q

LGA could be related to what?

A

maternal diabetes, postdates, large parents

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6
Q

what are LGA babies at risk for?

A

Risk for hypoglycemia, respiratory distress, birth trauma

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7
Q

what are the two different gestational age variations?

A

postterm and preterm

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8
Q

what is the definition for postterm??

A

born > 42 weeks

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9
Q

T/F a postterm baby can be SGA, LGA, or AGA

A

TRUE

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10
Q

what are the characteristics of a postterm baby?

A

Wasted appearance, lack vernix, lanugo, & subcutaneous fat. Dry, cracked skin

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11
Q

what is a postterm baby at risk for?

A

Risk for asphyxia, hypoglycemia, meconium aspiration, birth trauma

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12
Q

what is the definition for preterm?

A

born < 37 weeks

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13
Q

preterm baby could could be related to what?

A

infection, ATOD, trauma, preeclampsia, malnutrition, diabetes, multiple pregnancy

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14
Q

what are the characteristics of a preterm baby?

A

Lack subcutaneous fat & surfactant. Weak lungs, suck, &
gag. Fragile capillaries (cerebral bleed)

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15
Q

what are the 4 characteristics of preterm infant care setting?

A
  • Flexed in quiet, dark, warm nest
  • Avoid overstimulation
  • Facilitate self stimulation
  • Prevent skin dryness/breakdown
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16
Q

what type of feedings are given in preterm infant care?

A

TPN, gavage, nipple supplemental nursing system, breastmilk fortifier

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17
Q

what are nurses assessing for in preterm infants?

A

Assess for cerebral bleed, necrotizing enterocolitis (NEC) - breakdown in bowel → infection → prevent by breastfeeding, hypothermia, hypoglycemia, retinopathy of prematurity, respiratory distress syndrome (RDS), cerebral palsy, developmental delay

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18
Q

what are risk factors for neonatal respiratory distress?

A

prematurity and maternal diabetes

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19
Q

what is the pathophysiology associated with neonatal respiratory distress?

A

Insufficient surfactant, inadequate/collapsed alveoli,

weak skeletal muscles

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20
Q

what should we be assessing for with neonatal respiratory distress?

A

• Signs/symptoms develop first 1-2 hours life
• Decreased O2 sat; duskiness, pallor, cyanosis; tachypnea, retractions,
nasal flaring, grunting, crackles, diminished breath sounds,
tachycardia

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21
Q

what are interventions for neonatal respiratory distress?

A
  • Intra-tracheal surfactant replacement therapy
  • Oxygen via bubble CPAP, oscillator, ventilator, hood, or NC
  • Monitor O2 sats & arterial blood gases (ABGs)
  • No oral feedings if respiratory rate > 60
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22
Q

what are the benefits of kangaroo care?

A
  • Increased sleep time
    – HR regularity
    – Fewer apneic &bradycardic spells
    – Decreased need O2
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23
Q

what are the outcomes of kangaroo care?

A 
– Thermal synchrony
– Effective breastfeeding
– More rapid weight gain
– Increased attachment
– Shorter hospital stays
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24
Q

what implementations should be done during kangaroo care?

A 
– Quiet warm environment
– Infant upright on parent chest, ear
over heart, skin to skin
– Encourage to rock/stroke infant
– Decrease activity if overstimulated
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25
Q

what causes hypoglycemia in an infant with a diabetic mother?

A

Fetal hyperinsulinism causes neonatal hypoglycemia

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26
Q

what should be assess for in an infant of a diabetic mother?

A

Assess for macrosomia, RDS, congenital anomalies (cardiac & spinal), birth trauma, polycythemia

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27
Q

what are interventions that should be implemented for an infant of a diabetic mother?

A

– Blood glucose check @ 30 min
& 1, 2, 4, 6, 9 12, & 24 hrs of
age
– Treat hypoglycemia

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28
Q

what is the definition of newborn hypoglycemia?

A

blood glucose < 40 mg/dL

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29
Q

what should we be assessing for hypoglycemia?

A

Assess for tremors, jitteriness, lethargy, poor feeding,

decreased muscle tone, apnea, cyanosis

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30
Q

T/F there is a poor prognosis for hypoglycemia if not treated

31
Q

Interventions for hypoglycemia in newborns.

A

– Assess blood glucose before feeds
– Treat low blood sugars:
• <40: breastmilk, formula, or D5W PO
• <20: D10W IV

32
Q

what is the definition of meconium aspiration?

A
  • Asphyxiated fetus passes meconium into amniotic fluid

* Aspirated meconium blocks airway

33
Q

what should be assessed in neonates with meconium aspiration syndrome?

A

Apgar < 6, respiratory distress, barrel-shaped chest,

diminished breath sounds,meconium staining

34
Q

what is management for meconium aspiration syndrome?

A

– Suction mouth/nose after head
born
– If airway obstructed, baby will be intubated & trachea suctioned

35
Q

what are the two different maternal/fetal blood incompatibilities?

A

ABO incompatibility and Rh factor incompatibility

36
Q

what are the characteristics of ABO incompatibility?

A

If type O mom has type A or type B fetus
• Maternal anti-A or anti-B antibodies cross placenta
• Causes mild neonatal hemolysis & jaundice
• Prenatal sensitivity testing (indirect Coombs) not
recommended

37
Q

what are characteristics of Rh factor incompatibility?

A

• Rh- mom with Rh+ fetus
• Fetal Rh+ RBCs leak into maternal blood & trigger
maternal Rh antibody formation
• Maternal antibodies cross back into fetal blood & attack fetal RBCs, usually in subsequent pregnancy

38
Q

what are the two types of hyperbilirubinemia?

A

physiologic and pathologic

39
Q

what are the 3 characteristics of physiologic hyperbilirubinemia?

A

– Appears after 24 hrs
– Result of increased RBCs & immature liver (born w/ ↑ H + H)
– Bilirubin level ≤ 15

40
Q

what are the 2 characteristics of pathologic hyperbilirubinemia?

A

– Appears before 24 hrs

– Etiology: Rh or ABO incompatibility or infection

41
Q

T/F hyperbilirubinemia moves in a cephocaudal progression

42
Q

what are characteristics of unconjugated bilirubin?

A

insoluable; permeates skin, sclera, mucus membranes

43
Q

what are characteristics of conjugated bilirubin?

A

bound in liver; excreted in urine and stool

44
Q

what are 3 complications of hyperbilirubinemia?

A
  • kernicterus (bilirubin encephalopathy)
  • erythroblastosis fetalis (hemolytic anemia)
  • hydrops fetalis (severe form of erythroblastosis fetalis)
45
Q

what is kernicterus? what does it cause?

A

– Bilirubin deposits in brain tissues cause brain damage

– Hearing/vision loss, cerebral palsy, intellectual disability

46
Q

what is erythrobalstosis fetalis? what does it cause?

A

– Maternal antibodies attack fetal RBCs

– Anemia, jaundice, & compensatory erythropoiesis (marked increase in immature RBCs)

47
Q

what is hydrops fetalis? what does it cause?

A

– severe form of erythroblastosis fetalis (demand to make ↑ RBC → RBC immature; not functional)
– Severe anemia leads tomulti-organ system failure, blood flow
problems, & hydrops (excessive accumulation of fluid)
– Edema, pleural effusions, ascites, tachycardia, hypoxia

48
Q

how do we assess hyperbilirubinemia?

A

• Blanch skin to see color
• Inspect mucosa, conjunctiva, sclera
• Check bilirubin level with transcutaneous bilimeter
(TCB) or serum bilirubin

49
Q

when is treatment indicated for hyperbilirubinemia?

A

Treatment indicated if:
– Term: bilirubin >15
– Preterm: bilirubin >10

50
Q

how can we facilitate bilirubin clearence?

A
  • encourage feeding
  • phototherapy
  • exchange transfusion
51
Q

what are the characteristics of phototherapy?

A

– Maximal skin exposure
– Eye protection
– Hydration

52
Q

what are the characteristics of exchange transfusion?

A

– If phototherapy ineffective, positive direct Coombs, or
baby Hgb <12
– 5-20 ml blood removed & replaced with donor blood

53
Q

what is the etiology (cause) of neonatal sepsis?

A

– Group B strep most common cause.

– Also PROM, long labor, many vaginal exams

54
Q

what are we assessing for in neonatal sepsis?

A

Lethargy, pallor, temp instability, feeding intolerance,

tachypnea, apnea, seizure activity, hyperbilirubinemia, tachycardia, bradycardia

55
Q

how is neonatal sepsis managed?

A
  • Culture blood, urine, & spinal fluid
  • Administer antibiotics IV
  • Manage signs/symptoms
56
Q

cleft lip/cleft palate has increased incidence infants of ______ and in ______ infants

A

smokers; male

57
Q

what is the difference between cleft lip and cleft palate?

A
  • Cleft lip can range from notch to complete separation lip to nose
  • Cleft palate can range from uvular cleft to complete palate separation
58
Q

T/F cleft lip and cleft palate may occur together or separately

59
Q

what are the 6 complications of cleft lip/palate?

A 
– Parents need lots of support 
– Feeding issues r/t difficulty forming seal 
– Poor weight gain 
– Ear infections 
– Increased aspiration risk 
– Breastfeeding may be possible
60
Q

what is the treatment for cleft lip/palate?

A

– May need special nipples
– Surgical repair
– Follow-up with orthodontia, speech therapy

61
Q

when is neonatal abstinence syndrome seen?

A

Seen in newborns exposed to opiates in utero - baby has to withdraw
Symptoms appear 1-10 days of age

62
Q

what main four systems are affected by NAS?

A

neuro, GI, metabolism, and respiratory

63
Q

what are the symptoms of neuro in NAS?

A

abnormal cry (piercing), sleep problems, tremors, hypertonia, hyperactive reflexes

64
Q

what are the symptoms of GI in NAS?

A

excessive sucking, poor feeding, diarrhea, slow weight gain, regurgitation

65
Q

what are the symptoms of metabolism in NAS?

A

fever, sweating, yawning

66
Q

what are the symptoms of respiratory in NAS?

A

sneezing, nasal stuffiness/flaring, tachypnea

67
Q

how do we assess and manage babies with NAS?

A 
• Toxicology screen 
• Swaddle, reduce stimuli &amp; noise
• Feed on demand 
• NAS (Finnegan) score ≥ 8 is severe, requires
pharmacologic therapy:
– Morphine 
– Phenobarbital 
– Breastfeeding
68
Q

what are 3 characteristics of prenatal alcohol use?

A
  • No safe amount or type in pregnancy
  • Developing baby cannot process alcohol
  • More harmful than heroin or cocaine
69
Q

characteristics of maternal alcohol?

A

– Crosses placental barrier
– Remains in fetal circulation longer than maternal circulation
– Is teratogenic

70
Q

what are the 5 different fetal alcohol spectrum disorders?

A 
– Fetal Alcohol Syndrome 
– Partial Fetal Alcohol Syndrome
– Alcohol-Related Neurodevelopmental Disorder
– Alcohol-Related Birth Defects
– Fetal Alcohol Effects
71
Q

fetal alcohol syndrome can cause brain damage that results in what?

A

– Microcephaly
– Impaired executive function
– Intellectual disability
– Behavioral problems

72
Q

fetal alcohol syndrome can cause what type of facial abnormalities?

A

Small eyes, epicanthal folds
– Thin upper lip, smooth philtrum
– Flat midface, narrow forehead

73
Q

what are 5 characteristics of perinatal loss and grief?

A 
Associated with infertility, SAB, abortion, stillbirth,
neonatal death, SIDS, fetal anomaly
• Usually sudden, unexpected 
• Often first death experience
• Added grief if difficulty conceiving
• Woman may grieve more openly
74
Q

therapeutic response to perinatal loss

A
  • What to say/not to say
  • Inform of prognosis ASAP
  • Provide privacy & consistent nursing staff
  • Prepare for appearance; allow unlimited time with child • Dress infant
  • Offer remembrances
  • Take pictures & offer to parents
  • Inquire if autopsy desired
  • Encourage positive coping
  • Support cultural practices
  • Send card at anniversaries

Nursing Semester 2 (21 decks)

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