Final- Mn- Ch 39

Front 1

Physiologic or Pathologic Jaundice

-occurs in about half of all healthy term newborns and in 80% of preterm babies

Back 1

Physiologic

Front 2

Physiologic or Pathologic Jaundice

-typically arises more than 24 hrs after birth

Back 2

Physiologic

Front 3

Physiologic or Pathologic Jaundice


-in African Americans and Caucasians, it is manifested by progressive increase in the unconjugated bilirubin level in cord blood from 2-6mg/dl b/w 60-72 hrs of age

Back 3

Physiologic

Front 4

Physiologic or Pathologic Jaundice


-resolution is evidenced by a rapid decline in the unconjugated bilirubin level to 2 mg/dl by 5 days after birth

Back 4

Physiologic

Front 5

Physiologic or Pathologic Jaundice

-in Asian and native American infants, the level may increase to 10-14 mg/dl between 72 and 120 hours of age

--resolution is evidenced by a rapid decline in the unconjugated bilirubin level to 2 mg/dl by 7-10 days after birth

Back 5

Physiologic

Front 6

Physiologic or Pathologic Jaundice

-more common and severe in preterm infants in whom serum bilirubin reaches 10-12 mg/dl by the 5th day of life.

why?

Back 6

Physiologic Jaundice


-it takes longer for the max concentration to be reached in preterm than in full term infants b/c the livers of preterm infants are immature, therefore liver function is not fully developed

Front 7

Physiologic or Pathologic Jaundice

also called hyperbilirubinemia

Back 7

-pathologic jaundice,

Front 8

-pathologic jaundice, or hyperbilirubinemia, is the level of serum bilirubin that,

Back 8

if left untreated, can result in acute bilirubin encephalopathy which describes the clinical CNS findings caused by bilirubin toxicity to basal ganglia and brainstem nuclei

Front 9

-is used to describe the chronic and permanent results of bilirubin toxicity

Back 9

kernicterus

Front 10

the following support a diagnosis of pathological jaundice
-serum bilirubin great than ___ in cord blood
-clinical jaundice evident when?
-a serum bilirubin level in a term newborn that exceeds ___ at any time
-or clinical jaundice lasting more than how many days

Back 10

-serum bilirubin greater than 4mg/dl in cord blood
-clinical jaundice evident within 24 hrs of birth
-a serum bilirubin level in a term newborn that exceeds 15 mg/dl at any time
-clinical jaundice lasting more than 10 days

Front 11

the following support a diagnosis of pathological jaundice

-a serum bilirubin level in a preterm newborn that exceeds __ at any tiem

--any case of visible jaundice that persists for more than ___days of life in a term infant or __days in a preterm infant, unless the infant is receiving breast milk

Back 11

-a serum bilirubin level in a preterm newborn that exceeds 10 mg/dl at any time
-any case of visible jaundice that persists for more than 10 days of life in a term infant or 21 days in a preterm infant, unless the infant is receiving breast milk

Front 12

-the nomogram is used to determine

Back 12

the infant’s risk for development of hyperbilirubinemia requiring medical treatment or closer screening

Front 13

Jaundice

-risk factors recognized to place infants in the high risk category include -3

Back 13

gestational age less than 38 wks,

breastfeeding,

previous sibling with significant jaundice and jaundice appearing before discharge.

Front 14

-it is now recommended that healthy infants (35 wks of gestation or greater) receive follow up care and assessment of bilirubin within ___days of discharge if discharged at less than 24 hours and a risk assessment with tools such as the hour specific nomogram

Back 14

3

Front 15

Rh incompatibility =

Back 15

isoimmunization

Front 16

Rh incompatibility occurs when?

Back 16

an Rh negative mother has an Rh-positive fetus who inherits the dominant Rh positive gene from the father

Front 17

-if the mother is Rh negative and the father ir Rh positive and homozygous for the Rh factor, what would the offspring be

Back 17

Rh positive

Front 18

-an Rh negative fetus is in no danger , why?

Back 18

because it has the same Rh factor as the mother

Front 19

-an Rh negative fetus with an Rh positive mother also is in no danger

true or false

Back 19

true

Front 20

Rh incompatibility
-when is there a risk?

Back 20

-only the Rh positive fetus of an Rh negative mother is at risk

Front 21

Pathogenesis of Rh incompatibility

-the formation of blood cells in the fetus begins around the 8th week of gestation and these cells pass through the placenta into maternal circulation

-if the fetus is Rh positive and the mother is Rh negative, what happens?

Back 21

the mother forms antibodies against the fetal blood cells, first IgM antibodies that are too lg to pass through the placenta and then later, IgG antibodies that can cross the placenta.

Front 22

Pathogenesis of Rh incompatibility

-the process of antibody formation is called

Back 22

maternal sensitization

Front 23

Pathogenesis of Rh incompatibility

-usually women become sensitized when with an Rh positive fetus but do not produce enough antibodies to cause lysis of fetal blood cells during what period?

Back 23

in their first pregnancy

Front 24

Pathogenesis of Rh incompatibility

-severe Rh incompatibility results in _______--b/c the fetal erythrocytes are destroyed by maternal Rh positive antibodies.


what is also known as icterus gravis?

Back 24

marked fetal hemolytic anemia

The placenta usually clears the bilirubin resulting from the RBC breakdown, but in extreme cases, fetal bilirubin levels rise, this results in fetal jaudince

Front 25

-the fetus compensates for the anemia by doing what?

Back 25

producing lg #s of immature erythrocytes to replace those hemolyzed, the name for this condition is erythroblastosis fetalis.

Front 26

ABO incompatibility

-more common than Rh incompatibility but causes less severe problems in the affected infant

true or false

Back 26

true

Front 27

ABO incompatibility occurs with what blood types:

Back 27

-it occurs if the fetal blood type is A, B, or AB and the maternal type is O

Front 28

ABO incompatibility

-the incompatibility arises because naturally occurring anti-A and anti-B antibodies are

Back 28

transferred across the placenta to the fetus

Front 29

ABO incompatibility

-ABO incompatibility is a common cause of

Back 29

hyperbilirubinemia

WHY

-glucose-6-phosphate dehydrogenase deficiency (G6PD) which may cause an exaggerated jaundice in a newborn within 25-48 hrs of birth

-the G6PD red cells hemolyze at a greater rate than healthy red cells and overwhelm the immature neonates livers ability to conjuguate the indirect bilirubin

Front 30

Cardiovascular system anomalies

-the critical period for the cardiovascular system is from week __of embryonic development to week ___(many women don’t know they are pregnant)

Back 30

3 - 8

Front 31

Cardiovascular system anomalies

-congenital heart defects (CHDs) are ________in the heart that are present at birth

Back 31

anatomic abnormalities

Front 32

Cardiovascular system anomalies

-after prematurity, ______, are the next cause of death in the 1st yr of life

Back 32

CHDs

Front 33

-maternal factors that are known to be associated with a higher incidence of CHD include the following:

Back 33

-viral infections, such a rubella
-ingestion of folic acid antagonists, progesterone, estrogen, lithium,
warfarin, anticonvulsants
-use of acne medication (accutane)
-ETOH intake
-poor nutrition
-radiation exposure
Complications of pregnancy such as antepartal bleeding
-metabolic disorders such as diabetes mellitus and phentlyketonuria
-lupus
-maternal age greater than or equal to 40

Front 34

-genetic factors play a role in ______– familial occurrence of all forms is noted

Back 34

CHD

Front 35

___________abnormalities may be associated with CHDs (ex: 45% of children with trisomy 21 have a cardiac defect

Back 35

chromosomal

Front 36

Physiologic classification of cardiac defects

1.defects that result in increased pulmonary blood flow, often with congenital heart failure

examples (3)

Back 36

ex:
artrial and ventricular septal defects,
patent ductus arteriosus

Front 37

Physiologic classification of cardiac defects

tetralogy of Fallot is a defects that involves (increased or decreased) pulmonary blood flow and typically result in cyanosis

-2

Back 37

decreased


ex: tetralogy of Fallot, tricuspid atresia

Front 38

Physiologic classification of cardiac defects

3.defects that cause obstruction to blood flow out of the heart

Back 38

ex:

pulmonary stenosis, causes cyanosis,
coarctation of the aorta;
congestive heart failure,

Front 39

Physiologic classification of cardiac defects


4. complex cardiac anomalies that involve a flow of mixed saturated and desaturated blood in the heart or great vessels

2 examples

Back 39

ex:

transposition of the great vessels,

total anomalous venous return

Front 40

Cardiac Defects

affected newborns may be cyanotic and unrelieved by oxygen treatment, with the cyanosis increasing whenever the child is what position? or when the child does what?

Back 40

in the supine positions or cries

Front 41

-the respiratory and _____systems function together

Back 41

cardiac

Front 42

-interventions planned if a nursing diagnosis of decreased cardiac output is made include administering ________-as ordered, as well as cardiotonic and other medications such as ________ that rid the body of accumulated fluid, decreasing the workload of the heart by maintaining a thermoneutral envt, feeding with the gavage method if necessary

Back 42

oxygen


diuetics

Front 43

Hypospadias
-constitutes a range of penile anomalies associated with an abnormally located urinary meatus.

-The meatus can open below the glans penis or anywhere along the ventral surface of the penis, the scrotum, or the perineum.

Back 43

Hypospadias

Front 44

-it is the most common anomaly of the penis

Back 44

Hypospadias

Front 45

-Hypospadias is classified according to -2

Back 45

the location of the meatus and the presence or absence of chordee, which is a ventral curvature of the penis

Front 46

Hypospadias
-etiology?

Back 46

-cause is unknown but is more prevalent in infants who had uniformly poor intrauterine growth in wt, length, and head circumference

Front 47

Hypospadias
-circumcision?

Back 47

-these infants are not circumcised b/c the foreskin may be needed during surgical repair.

-repair is done early soon after the 1st yr of life, so that body image is not impaired

Front 48

Physiologic vs Pathologic jaundice

Immature liver, can’t concentrate bilirubin

Back 48

Physiologic jaundice

Front 49

Physiologic vs Pathologic jaundice

happens later, day 2 or day 3

Back 49

Physiologic jaundice

Front 50

Physiologic vs Pathologic jaundice


Manifested by progressive increase in unconjugated bilirubin level in cord blood

Back 50

Physiologic jaundice

Front 51

Physiologic vs Pathologic jaundice
In the cord blood, the baby is combs positive, on the 1st day of life may be under lights, they want eating and pooping – so blood in poop doesn’t reabsorb

Back 51

Pathologic

Front 52

Physiologic vs Pathologic jaundice


Breastfeed babies may have less quantify so we need to add a forced supplementation b/c they don’t eat and poop a lot

Back 52

Pathologic

Front 53

Physiologic vs Pathologic jaundice


happens earlier

Back 53

Pathologic

Front 54

ABO incompatibility leads to pathologic jaundice
Fetal blood type is what?

the maternal type is what?

Back 54

Fetal blood type is A, B, or AB, and the maternal type is O

Front 55

This happens when we don’t do anything about hyperbilirubinemia or don’t treat bilirubin

Back 55

Acute Bilirubin Encephalopathy

Caused by deposition of bilirubin in brain

Front 56

Congenital heart defects (CHDs) are anatomic abnormalities in the heart that are present at birth, although they may not be diagnosed immediately.
-first sign may be what?

Back 56

(first sign may be a respiratory problem for a CHD)

Front 57

what is the most common type of heart defect and cyanotic lesion

Back 57

Ventricular septal defect

what is it???

-abnormal opening between the right and left ventricle


what happens with the shunting of blood???????




because the high pressure in the left ventricle, a shunting of blood from the left to right ventricle occurs during systole.
if pulmonary vascular resistance produces hypertension, the shunt of blood is reversed from the right to left ventricle, resulting in cyanosis

Front 58

Tetralogy of Fallot is most common type resulting in cyanosis
4 problems with these hearts:

Back 58

pulmonary stenosis,
ventricular septal defect,
overriding aorta,
hypertrophy of the right ventricle
These babies can have surgery and can live