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545 Cards in this Set
- Front
- Back
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neonate
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an infant from the time of birth to one month of age
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newborn
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a baby in the first few hours of life
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antepartum
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before the onset of labor
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intrapartum
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occurring during childbirth
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extrauterine
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outside the uterus
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ductus arteriosus
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channel between the main pulmonary artery and the aorta of the fetus
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persistent fetal circulation
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condition in which blood continues to bypasses the fetal respiratory system, resulting in ongoing hypoxia
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diaphragmatic hernia
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protrusion of abdominal contents into the thoracic cavity through an opening in the diaphragm
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meningomyelocele
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herniation of the spinal cord and membranes through a defect in the spinal column
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omphalocele
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congenital hernia of the umbilicus
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choanal atresia
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congenital closure of the passage between the nose and pharynx by a bony or membranous structure; suspect this condition if you are unable to pass a catheter through either nare into the oropharynx
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cleft palate
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congenital fissure in the roof of the mouth, forming a passageway between oral and nasal cavities
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cleft lip
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congenital vertical fissure in the upper lip. Infants with cleft palate and/or lip may require an ETT
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Pierre Robin Syndrome
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unusually small jaw, combined with a cleft palate, downward displacement of the tongue, and an absent gag reflex; if the obstruction cannot be bypassed with a simple airway, then intubation will be necessary, although it can be very difficult to carry out
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APGAR scoring
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numerical system of rating the condition of a newborn. It evaluates the newborn’s heart rate, respirations, muscle tone, reflex irritability and color.
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DeLee suction trap
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suction device that contains a suction trap connected to a suction catheter. The negative pressure that powers it can come either from the mouth of the operator or, preferably, from an external vacuum source
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meconium
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dark green material found in the intestine of the full-term newborn. It can be expelled from the intestine into the amniotic fluid during periods of fetal distress
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polycythemia
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an excess of RBC. In a newborn, the condition may reflect hypovolemia or prolonged intrauterine hypoxia
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hyperbilirubinemia
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an excessive amount of bilirubin in the blood. In newborns, the condition appears as jaundice. Precipitating factors include maternal Rh or ABO incompatibility, neonatal septis, anoxia, hypoglycemia, and congenital liver/GI defects.
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vagal response
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stimulation of the vagus nerve causing a parasympathetic response
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glottic function
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opening and closing of the glottic space
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PEEP
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positive end-expiratory pressure
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nasogastric tube/orogastric tube
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tube that runs through the nose/mouth and esophagus into the stomach, used for administering liquid nutrients/medications or for removing air/liquids from the stomach.
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isolette
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(aka incubator) clear, plastic enclosed bassinet used to keep prematurely born infants warm.
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herniation
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protrusion or projection of an organ or part of an organ through the wall of the cavity that normally contains it.
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subtle seizures
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consist of chewing motions, excessive salivation, blinking, sucking, swimming movements of the arms, pedaling movements of the legs, apnea, and changes in color
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tonic seizures
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characterized by rigid posturing of the extremities and trunk; sometimes associated with fixed deviation of the eyes; occur more commonly in premature infants, especially those with intraventricular hemorrhage
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focal clonic seizures
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consists of rhythmic twitching of muscle groups, particularly the extremities and face; may occur in both full-term and premature infants.
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multifocal seizures
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similar to focal clonic seizures, except that multiple muscle groups are involved; clonic activities randomly migrates; primarily occur in full-term newborns
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myoclonic seizures
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involve brief or generalized jerks of the extremities or parts of the body that tend to involve distal muscle groups; may occur singly or in series of repetitive jerks
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phototherapy
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exposure to sunlight or artificial light for therapeutic purposes. In newborns, light is used to treat hyperbilirubinemia or jaundice
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neonatal abstinence syndrome (NAS)
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generalized disorder presenting a clinical picture if CNS hyperirritability, gastrointestinal dysfunction, respiratory distress, and vague autonomic symptoms. It may be due to intrauterine exposure to heroin, methadone, or other less potent opiates;
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thyrotoxicosis
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toxic condition characterized by tachycardia, nervous symptoms, and rapid metabolism due to hyperactivity of the thyroid gland
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birth injury
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avoidable and unavoidable mechanical and anoxic trauma incurred by the newborn during labor and delivery
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caput succedaneum
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large hematoma that develops during the birth process, usually resolves over a week’s time
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____ is the newborn of an alcoholic or drug-addicted woman
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drug-dependent infant
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____ effects is the less severe fetal mainfestations of maternal alcohol ingestion, including mild to moderate cognitive problems and physical growth retardation
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fetal alcohol effects (FAE)
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____ syndrome is caused by maternal alcohol ingestion and characterized by microcephaly, intrauterine growth retardation, short palpebral fissures, and maxillary hypoplasia
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Fetal alcohol Syndrom (FAS)
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____ work - the inner process of working through or managing the bereavement
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Grief work
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____ - a hereditary deficiency of a specific enzyme needed for normal metabolism of specific chemicals
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Inborn error of metabolism
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____ - At-risk infant born to a woman previously diagnosed as diabetic, or who developes symptoms of diabetes during pregnancy
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Infant of a diabetic mother (IDM)
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____ - Fetal undergrowth due to an etiology, such as intrauterine infection, deficient nutrient supply, or congenital malformation.
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Intrauterine growth restriction (IUGR)
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____ - excessive growth of a fetus in relation to the gestational time period
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large for gestational age (LGA)
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____ - number of deaths of infants in the first 28 days of life per 1000 live births
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neonatal mortality rate
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____ - the chance of death within the newborn period (first 28 days)
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Neonatal mortality risk
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____ - a common metabolic disease caused by an inborn error in the metabolism of the amino acid phenylalanine
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Phenylketonuria
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____ newborn - any infant born after 42 weeks' gestation
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Postterm newborn
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____ infant - any infant born before 38 weeks' gestation
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preterm infant
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____ - inadequate weight or growth for gestational age; birth weight below the tenth percentile
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Small for gestational age (SGA)
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____ dysplasia - chronic pulmonary disease of multifactorial etioloty characterized initially by alveolar and bronchial necrosis, which results in bronchial metaplasia and interstitial fibrosis. appears in x-ray films as generalized small cysts
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Bronchopulmonary dysplasia (BPD)
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____ stress - excessive heat loss resulting in compensatory mechanisms (increased respirations and nonshivering thermogenesis) to maintain core body temperature
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cold stress
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____ fetalis - hemolytic disease of the newborn characterized by anemia, jaundice, enlargement of the liver and spleen, and generalized edema. Caused by isoimmunization due to Rh incompatability or ABO incompatibility
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Erythoblastosis fetalis
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____ - hyperbilirubinema secondary to Rh incompatibility
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Hemolytic disease of the newborn
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____ - yellow pigmentation of ody tissues caused by the presence of bile pigments
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jaundice
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____ - an encephalopathy caused by deposition of unconjugated bilirubin in brain cells; may result in impaired brain function or death
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kernicterus
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____ syndrome - respiratory disease caused by inhalation of meconium in amniotic fluid in the lungs, respiratory distress, hyperexpansion of chest, hyperinflated alveoli and secondary atelectasis
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Meconium aspiration syndrome
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____ - respiratory disease resulting from right to left shunting of blood away from the lungs and through the ductus arteriosus and patent foramen ovale
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Persistent pulmonary hypertension of the newborn (PPHN)
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phototherapy is treatment of ____ by exposure to light
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jaundice
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Polycythemia is an abnormal increase in the number of total ____ in the body's circulation
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RBC
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Respiratory distress syndrome (RDS) is a respiratory disease of the newborn characterized by interference with ventilation at the ____ level
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alveolar
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____ neonatorum - is infections experienced by a neonate during the first month of life
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sepsis neonatorum
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why is low socioeconomic level of mother a newborn risk factor
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limited access to healthcare and education
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what are some environmental danges that make a newborn at risk
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toxic chemicals and illicit drugs including alcohol
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What are some preexisting medical conditions that puts the newborn at risk
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heart disease, diabetes, hypertension, and renal disease
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Maternal factors that affect newborn risk factor
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very young, very old and parity (number of privious births)
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name 2 devices that detect distress in fetus
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electronic fetal heart monitor and fetal heart ausculation by doppler
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Clinical risk factors for SGA newborns
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perinatal asphyxia, aspiration syndrome, hypothermia, hypoglycemia, hypocalcemia, polycythemia, congenital anomalies, intrautererine infection
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Etiology of SGA newborns
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maternal or newborn factors, maternal disease, environmental factora, placental factors
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T/F SGA newborns need more calories per oz than regular newborns
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True (more than 20cal/oz of formula and if breastfeeding, add human milk fortifier
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SGA babies ned small frequent feedings - why
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smaller stomach
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Why might SGA newborns need gavage feeding
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if they do not breathe well, helps preserve energy
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Why should a SGA newborn have cluster care
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allow baby to get longer stints of rest - also decrease stimuli - hospital background noise, lighting
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How should a nurse look for signs and complications of polycythemia
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keep on top of Hb/Hct, O2 stat, mucus membranes, pulse will decrease with polycythemia, viscous and sluggish
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Assessment findings for the SGA newborn
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soft tissue wasting, loose dry and scaling skin, perinatal asphyxia, resp distress, CNS prob, congenital anomalies and labs sowing low BS increased Hct as a result of chronic hypoxia
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What is used to help close the ductus arteriosus of a premature infant
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prostaglandin inhibitor - They have too much prostaglandin
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Why do premies have reflux
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cardiac sphincter is immature
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Hypoxia at at premie's birth causes bowels
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Necrotizing entercolitis (NEC)
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What is a big problem with premies in which the incidence needs to be decreased
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MRSA
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What causes anemia of prematurity
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rapid rate of growth, shortened RBC lifespan in premies (baby has 80ml/kg body weight and premies even lower)
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When is apnea considered too long in an infant
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more than 20 seconds
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What causes intraventricular hemorrhage in premies less than 1500g, less than 34 wks
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hypoxic events - ventricles more susceptible and brain bleeds
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long-term problems of premies
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bronchopulmonary dysplasia from use of mecanical vent, neurologic defects such as sensorineural hearing loss and speech defects
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Why is a IDM large
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exposure to high levels of maternal glucose = high level of fetus insulin = growth hormone effect
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Why is a IDM suseptible to hypoglycemia
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exposure to high levels of maternal glucose = higher insulin in fetus and when born has all this extra insulin and no maternal nutrition coming in
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What causes hyperbilirubinema 48-72hrs after birth of a IDM
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Decrease in extracellular fluid = increase in hematocrit levels,
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What kind of birth trauma is seen in IDM
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fractured skulls, clavicles, pinched facial nerves and brachial plexus
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Why is polycythemia seen in IDM
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increased RBC due to tissue hypoxia
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T/F congenital birth defects risks are higher for IDM
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True
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IDM infants must have their blood sugar tested at what level is hypoglycemia
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40mg/dl - hosp protocol will determain how often. Make sure infant gets early feedings
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5% of post term babies get postmaturity syndrome what does it include
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hypoglycemia, asphyxia, meconium aspiration, polycythemia, congenital anomalies, seizure activity and cold stress due to placenta not functioning
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postmatur newborn continued exposure to amniotic fluid causes what manifestations
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skin wrinkled leathery dry parchment-like and cracked, long nails (may be meconium stained), skinny (emanciated), eyes are wide open - looks like ET
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what may be done during labor to dilute the meconium in amniotic fluid and decrease the risk of meconium aspiration
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amnioinfusion
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A preterm newborn is one who is born before the completion of ____ weeks gestation
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37 - therfore a baby born at 37 1/2 weeks gestation is considered a premature
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At what week of gestation does the fetus start producing serfactant
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32 weeks. By 35 weeks may have enough surfactant
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What are the 2 factors in development of respiratory distress to a preterm infant
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not enough surfactant and pulmonary blood vessles have incomplete muscular coat
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bounding fermoral pulses, carbon dioxide retention, increased respiratory efort, pulmonary congestion and increased blood voume to lungs is due to what
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patent ductus arteriosus
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Preterm babies dont have enoug ____ in the liver to help with shivering thermogenesis to generate heat
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glycogen
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What physiologic and anatomic factors increase heat loss in preterm infant
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high body surfact to body weight ratio, not flexed, low subQ fat, BV close to skin, thin skin
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Preterm babies are at greatest risk for aspirations due to
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underdeveloped gag reflex, incompetent esophageal cardiac spincter, poor sucking and swallowing reflex
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T/F preterm infants have a decreased basal metablolic rate
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False it is raised as well as O2 requirements
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why do preterm babies have anuria or oliguria and limited ability to concentrate urine
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low glomerular filtration rate (GFR) - metabolic acidosis
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Why is drug calc accuracy imperative for preterm babies
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inability to excret drugs in kidneys
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preterm babies may be hypotonic and ____ for several days after birth
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unreactive - prepare parents for it
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What is the range of caloric intake for preterm baby
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95-130 ml/kg/day - early feedings maintain normal metabolism
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gavage - tube feeding is measured how
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ear to nose to xyphoid process to make sure it goes into stomach do not x-ray
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fluid therapy for preterm babies for the first three days
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80-100 mL/kg/day - day 2 100-120, day 3 120-150
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long-term needs of preterm baby includes a team for what
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retinopathy of prematurity, bronchopulmonary dysplasia, speech defects, neurological defects, and auditory defects - nurse helps inform about the infant
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T/F there is more vernix caseosa and languo with premies
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True
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what part of the skull fills with hydrocephalus
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ventricles
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manifestations of hydrocephalus
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enlarged head (measure daily) >90% growth cart, bulging fontanelle, split or widened sutures, setting sun eyes, NV
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____ atresia is when one or both nares is closed off
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Choanal Atresia - to assess, close off one at a time and try to pass an NG tube gently
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____ is a fissure connecting the oral and nasal cavity
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cleft palate - prevent aspiration and infection and plot weight gain
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an infant with tracheoesophageal fistula has a hx of mother having _____
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hydramnios (excessive amniotic fluid)
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manifestations of tracheoesophageal fistula
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excessive mucous secretions, constant drooling, abdominal distention, choking and cyanotic episodes, regurgitation
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nursing mgt for tracheoesophageal fistula
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maintain respiratory status in warmed humidified incubator with HOB elevated 20-40 degreess, access patency before putting to breast, place suction cannula on low intermittent suction to control saliva and mucus, and keep quiet
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bowel sounds heard in thoracic cavity, gasping respirations with nasal flaring, barrel chest and scaphoid adomend asymmetric chest expansion, breath sound on left side with heart sounds on right are manifestations of ____ hernia
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diaphragmatic hernia
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nursing interventions for diaphragmaic hernia
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Never ventilate b/c lungs are obstructed - but should give blow-by O2, initiate gastric decompression, place in high fowlers, turn to affected side for lung expasion of unaffected lung and alleviate acidosis
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____ is a saclike cyst in thoracic and or lumbar area and hydrocephalus is often associated
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mylomeningocele - no or varying response to sensation below level of sac
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Interventons of myelomeningocele
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prevent trauma or infection, clean after elimination, observe for oozing or pus and crede (massage) bladder in immediate NB period
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manifestations of fetal alcohol syndrome (FAS) - some of these are due to withdrawl
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sleeplessness, excessive arousal, unconsolale cry, abnormal reflexes, hyperactivity, jitteriness (blood sugar levels), and exaggerated mouthing behaviors
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nursing care of FAS newborn
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avoid heat loss, provide adquate nutrition and reduce environmental stimuli - breastfeeding is not contraindicated but alcohol will inhibit letdown reflex
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why do you not want to give narcan to a mother or baby with drug abuse mothers
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precipitates acute withdrawal
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what symptoms can go on for months of newborns from drug abuse mother
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withdrawl, bone pain, diarrhea
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nursing mgt of newborn from mother with drug abuse
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test for syphilis, HIV and HepB, urine and meconium analysis for drugs, social service referral (MD order not needed), quiet environment and swaddle
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Drugs used to control withdraw symptoms in infant of mother with drug abuse
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phenobarbital for seizures, oral morphine sulfate for pain, and diazepam to relax them - do not give narcan can make withdraw worse
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Newborn exposed to HIV/AIDS are what size
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small - premature, SGA or both and failure to thrive during neonatal (first 28days)
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Signs of exposure to HIV/AIDS during pregnancy:
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enlarged spleen and liver, swollen glands, recurrent respiratory infections, rhinorrhea, intestitial pneumonia, recurrent GI (diarrhea and wt loss), UTI, Thrush (oral candidiasis) and loss of achieved developmental milestones
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When caring for a newborn exposed to HIV/AIDS special care includes
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standard precautions, keep well nourished (will have nutritional probs), special care to protect from infections and prevent skin rashes, facilitate growth development and attachment, Hand Washing
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Breastfeeding can cause an increased infection in which case
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HIV
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Feeding Intolerance can happen with infants exposed to HIV/AIDS what are the signs
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increased regurgitation, abdominal distention, and loose stools
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What is given for infants born from mothers infected with HIV/AIDS and when does it begin and how long
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Antiretroviral drug therapy beginning at 8-12 hours of life and continuing for 6 weeks
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A newborn of a HIV/AIDS mother will get a prohylaxis tx to prevent what at 4-6 weeks
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Pneumocystis carinii pneumonia (PCP)
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If PKU is not broken down to tyrosine due to lack of tyrosine conversion enzyme and PKU builds up, what happens
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Brain damage - do a Guthrie test 24-48 hours after first feed to see if infant has PKU
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Characterized in an infant by the presence of sweet-smelling urine, with an odor similar to that of maple syrup, is an inborn error of metabolism called
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Maple Syrup Disease
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___ is a CHO metabolism inborn error, inability to convert glactose and lactose to glucose
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glactosemia
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primary goal of prenatal mgt
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prevent preterm birth
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____ enhances fetal lung development and ___ postnatal therapy
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glucocorticoids - Beta methasone
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If membranes rupture, the first sign of infection ____ is likely
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C-Section
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____ positive pressure ventilaiton is ventilation therapy for infant not breathing and ____ positive airway pressure prevents respiratory failure in spontaneously breathing NB
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intermittent positive pressure ventilation non breathing - continuous positive airway pressure breathing
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which is less invasive with fewer complications, Intermittent positive pressure ventilation or continuous positive airway pressure
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continuous positive airway pressure
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Clinical manifestations of RDS
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central cyanosis & pale mottling, jaundice, tachypenia >60, grunting, see- saw breathing, nasal flaring, retractions, apnea, systolic murmur, PMI displaced, hypothermia, flaccid, seizures, edema
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RDS infant how often check for resp rate, aterial blood gass, O2 sat
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Monitor respiratory rate ever 1-2 hours, monitor arterial blood gasses at least every 8 hours and PRN, Monitor O2 stat at least every 4 hours and PRN
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Transient Tachypnea of the Newborn clinically can resemble
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RDS
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Transient Tachypnea of the Newborn can be caused from
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Intrauterine or intrapartal asphyxia, maternal oversedation, maternal bleeding, prolapsed cord, breech birth, maternal diabetes, cailure to clear airway of lung fluids, prevalent in CS neborns
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Clinical Manifestations of Transcient Tachypnea of the Newborn
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little or no difficulty at the onset of breathing, shortly after birth difficulties emerge like expiratory grunting, flaring nares, mild cyanosis, resp rate 100-140 breaths/min, mild acidosis, overexpansion of lungs
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presence of meconium in amniotic fluid - asphyxia insult is ___
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meconium aspiration syndrome (MAS)
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When is meconium aspirated
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either in utero or during the first breath, more common in long labor babies
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clinical manifestations of meconium aspiration syndrome
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fetal hypoxia in utero, slowing of FHR or weak and irregular heartbeat, meconium staining of amniotic fluid, signs of distress at birth such as pallor cyanosis apnea slow heartbeat low apgar score
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when to do mechanical ventilation at birth for baby of meconium aspiration syndrome
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general cyanosis, tachypnea, severe retractions, overdistended barrel-shaped chest, diminished air movement with rales and rhonchi, displaced liver and yellowish staining of the skin, nails and umbilical cord
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some nursing interventions of meconium asphyxiation syndrome
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Performe glucose testing at 2 hrs of age and monitor intravenous antibiotic therapy (ampicillin or gentomyicin)
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Preterm and SGA newborns are susptible to cold stress due to
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decreased adipose and brown fat as well as glycogen
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signs and symptoms of cold stress
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increased movement and respirations, decreased skin temp and peripheral perfusion, hypoglycemia, possible metabolic acidosis
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Don't want temp lower than ____F, if below what do you do
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97..7, wrap in warm blanket, check BS, 1hr later if not 97.7 then radiant warmer if one hour still low call MD may want in incubator
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If a newborn has hypoglycemia, what else do you want to check for
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CNS disease, sepsis (GBS+), metabolic aberrations, polycythemia, congenital heart disease, drug withdrawal, temp instability, hypocalcemia
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S/S hypoglycemia
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lethargy, jitteriness, oor feeding, vomiting, pallor, apnea, irregular resp, resp distress, cyanosis, hypotonia, tremors, high pitched cry, exaggerated moro reflex,
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At risk newborns for hypoglycemia
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AGA preterm, SGA, type 1 diabetic mothers
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When to monitor for hypoglycemia
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2 hours after birth(within 30 min of IDM), before feedings and whenever there are abnormal signs
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T/F physiologic or neonatal jaundice is a normal process
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True
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Physiologic or neonatal jaundice occures during transition from intrauterine to extrauterine life and appears after ____ hours of life
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24
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When is phototherapy reuired for tx of neonatal jaundice
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anything over 12
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cause for physiologic or neonatal jaundice
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shortened RBC life span, slower uptake by liver and can't hand load, lack of intestinal bacteria breakdown, poorly established hydration
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Unconjugated bilirubin average levels at birth, 3rd to 5th day and after 10 days
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At birth 2mg, 3rd to 5th day 5-6mg, usually not visible after 10 days
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hyperbilirubinemia occures when and at what level per hour
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first 2 hours of life rising over 5mg/dl/hr
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signs of hyperbilirubinemia
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vomiting, lethargy, poor feeding, wt loss, tachypnea, apnea, temp instability, jaundice after 6 days newborn and after 14 days premature newborn
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causes of hyperbilirubinema
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Rh incompatibility, erythoblastosis fetalis, hydrops fetalis, diabetes, intrauterine infection, gram - bacilli, drug ingestion, too much oxytocin or pitocin, polycythemia, pyloric stenosis,obstruction of biliary duct, UTI, GBS, hypothyroidism, cephalohema
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____ fetalis is Rh-negative mother pregnant with Rh+ fetus, transplacental passage of maternal antibodies takes place
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erythoblastosis fetalis
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All Rh- mothers get RhoGam at ____ weeks
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28 and after birth
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ABO incompatibility is when mother is type ____ and baby is type ____
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Mother O - baby A or B, may result in jaundice, need to give direct coombs if + keep eye on them
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causes of neonatal anemia
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blood loss, hemolysis impaired RBC production
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Cerebral bleeding may occure because of ____
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hypoxia
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____ anemia is a normal gradual dropin hemoglobin for the first 6-12 wks of life
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Physiologic Anemia
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Signs of shock
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capillary filling time greater than 3 sec, decreased pulse, tachycardia, low blood pressure
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Polycystemia - Venous hematocrit value is greater than ____% and venous hemoglobin level is greater than ___g/dl
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hematocrit over70%, hemoglobin over 22g/dl
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Symptoms of polycythemia
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DECREASE in pulses, ruddy, tachycardia & congestive heart failure sx, respiratory distress, hyperbilirubinemia, discoloration of extremities seizures, jitteriness, hematuria, decreased urine output
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sepsis neonatorum is from syphillis, gonorrhea, herpes type 2, or ____ left untreated before vaginal birth that baby aspirates
|
Group B streptococcus
|
|
|
Signs and symptos of sepsis neonatorum
|
pallor duskiness cyanosis, cool clammy, temp instability, lethargic, mottling
|
|
|
sepsis neonatorum is treated with
|
ampicillin and gentamycin (do peaks and throughs, can affect hearing if long term) take VS hourly
|
|
|
____ protein - can tell if sepsis neonatorum is evident
|
C-Reactive Protein
|
|
|
With ____ tachycardia initially, followed by apnea or bradycardis
|
hyperbilirubinemia
|
|
|
hematologic signs and symptoms
|
jaundice, petechial hemorrhages, heptaosplenomegaly
|
|
|
When does spirochetes cross the placenta with maternal syphili
|
after 16th week
|
|
|
Infant assessment of maternal syphilis
|
elevated cord serum IgM, rhinitis, fissures on mouth corners, rash mouth and anus, copper colord rash face and palms, edema joints, bone pain, cateracts, SGA
|
|
|
infant assessment of Gonorrhea
|
conjunctivitis, corneal ulcerations, sepsis, temp instability, hypotonia, jaundice
|
|
|
Infant assessment of Herpes Type 2 births
|
sm cluster vesicular skin lesions all over body, DIC, assess for fever, respiratory congestion, tachypnea and tachycardia
|
|
|
Nursing management of Herpes type 2 births
|
careful handwashing, s/b in isolation, administer acyclovir
|
|
|
motehr with HPV, (genital warts) will have automatic
|
CS
|
|
|
Infant assessment of chlamydia trachomatis birth
|
perinatal hx of preterm birth, pneumonia, conjunctivitis, chronic follicular conjunctivitis
|
|
|
four physchologic tasks for coping
|
anticipatory grief, acknowledgment of maternal failure, resumption of the process of relating to infant, understanding of special needs and growth patterns
|
|
|
Personal Social Economic Risk Factors
|
age ,16.35, primigravida or null X3, nutrion ,20% IBW or > 20%, dug use including nicotene, alcohol, addictive drugs, otc on a regular basis, longterm rx, unusual stress or anxiety, enviroment or occupation anesthetic gases, radiation or pesticides
|
|
|
Medical Risk factors
|
low intake folic acid, prepregnacy, DM, HTN, cardiac disease, thyroid disorders, anemia, maternal infection, psychiatric disorders (depression)
|
|
|
Present Pregnancy
|
exposure to tetraogens, hyperemesis, vaginal bleeding, polyhydraminos, oligohydraminos, PROM, multiple gestation, abnormal presentation, preterm labor, fetal distress, inappropriate fetal growth, cord accident, placental abruption, prolonged labor an ddel
|
|
|
Genetic Risk Factors
|
Family hx of inheritable disorder, previous infant congenital anomalies, parents are known carriers of recessive disorder, maternal age over 40
|
|
|
Stages of Grieving
|
Shock and disbelief (denial) can result in noncomliance, 2) anger and rage directed toward self or others, 3) Bargaining with God, Depression develops with awareness of loss can include a communication breakdown within family, 4) Acceptance
|
|
|
Developmental Tasks of Pregnancy
|
accepting the less than perfect pregnancy, assuring safe passage ( great effort and $$$ means high drive to assure safe passage) Acceptance of child by significant others, Attachment (mother may be afraid to attach prenatally) Giving of oneself no work et
|
|
|
Tetarogen
|
any enviromental factor chemical or physical that effects fetus adversely Timing critical. Most devastating effects 3rd to 8th wk
|
|
|
Fetal response to tetratogen
|
tissues may atrophy or hypertrophy, structures may fuse or split, genreal inhibition of normal growth or development
|
|
|
Caffeine
|
no more than 300 mg daily associated with low birth weight and PROM
|
|
|
Drug withdrawal
|
seen in neonate 6-12 hrs after delivery
|
|
|
Heroin
|
IUGR, preterm birth, SGA, hyperbilirubinemia, hypoxia, inrauterine death, breech presentation, PROM, abruptio placentai and pre term labor. HIGHER O2 needed during withdrawal can lead to fetal distress, hypoxia, meconium staining and intrauterine death
|
|
|
Marijuana
|
shortened gestation, higher incidenceof precipitate delivery, higher incidence of meconium staining. 'When used with alcohol 5X risk FAS. Infants have fine motor tremors, prolonged startle reflexes, irritablilty, disappears by age 2
|
|
|
Cocaine
|
effects are immediate, vasoconstriction tachycardia, acute HTN, uterine cx. Placental vasoconstriction causes reduced blood flow to fetus IUGR. Spontaneous abortion, congenital anomolies, abruptio placenta within one hr of use in 3rd trimester Fetal tachy
|
|
|
barbituates
|
RDS, withdrawal
|
|
|
smoking
|
IUGR, LBW, preterm birth, incidences increase with maternal age, higher incidence spontaneous abortion, placenta previa, abruptio placenta and PROM direct correlation to # smoked, dec placnetal blood flow
|
|
|
smoking also
|
shows changes in placenta that may indicate toxicity, Also seems to affect absorption of calcium, vit C B12 B6 B1 and A
|
|
|
Radiation
|
causes a number of congenital malformations specific organs affected depend on stage of fetal development at time of exposure
|
|
|
Lead
|
small weak amd neurologically damaged infants Sources: unglazed pottery, jewelery making, stained glass hobbies, acidic food left in open cans, old painted surfaces (1978) old pipes. Also associated with congenital anomalies, prematurity and fetal death
|
|
|
Drug Book Categories
|
Category A no risk to fetus or remote risk, B no risk to fetus of an animal possible in human C No study available D positive evidence of fetal risk, benefit may outweigh risk, X contraindicated risk outweighs benefit
|
|
|
TORCH
|
Toxoplasmosis, Oher (usually Hep A or B) Rubella, Cytomegalovirus and Herpes
|
|
|
Toxoplasmosis
|
protozoan cat feces and raw or undercooked meat
|
|
|
Risks of Toxoplasmosis
|
abortion, prematurity, stillbirths, severe CNS congenital anomolies. Microcephaly, coma, hydrocephaly Will recommend abortion if before 21 weeks
|
|
|
DX Tosoplasmosis
|
serological blood tests for antibodies
|
|
|
S/S Tosoplasmosis
|
unfortuantely non specific flu like
|
|
|
TX Tosoplasmosis
|
sulfa drugs or clindamycin if allergic to sulfa
|
|
|
Education is most important intervention
|
avoid poorly cooked or raw beef pork lamb, wash fruits and vegts thoroughly, wash all cooking utensils carefully, avoid contact with litter box, wear gloves when gardening
|
|
|
Hepatitis
|
pregnancy affected by both A&B sontaneous abortion, fetal anomalies, PTL, Neonatal hepatitis, intrauterine fetal demise, Infant often becomes affected during birth
|
|
|
DX Hep
|
Hep B surface antigen test
|
|
|
Prevention Hep
|
vaccination during pregnancy OK
|
|
|
Rubella
|
Viral infection with major effects on fetus. Transmission often occurs before development of rash. 50% infected pregnancies result in transmission to fetus
|
|
|
Rubella Fetal Risks
|
spontaneous abortion, congenital infection- cardiac disease (patent ductues areriolitis) IUGR, cataracts, petichial rash, hepatosplenomegaly, hyperbilirubinemia, mental retardation , cerebral palsy
|
|
|
If infant is born with congenital rubella syndrome
|
they are infectious
|
|
|
Management Prenatal Rubella
|
prevention is most important. assess rubella titer, avoid infected individuals, vaccination given postpartum do not become pregnant 3 mos
|
|
|
Cytomegalovirus
|
chronic persistant infection with virus that the individual may shed (saliva, blood) continually over many years. Becomes reactivated during pregnancy. Cam cross the placenta or baby can contract it as it passes through cervix. Results in severe effects
|
|
|
Effects Cytomegalovirus
|
fetal death, hemolytic anemia, jaundice, hydrocephaley, micrcephaly, SGA or Cytolmegalic Inclusion Disease
|
|
|
CID
|
Cytomegalic Inclusion Disease infants shed large amounts of the virus in saliva, urine, and respiratoru secrettions. Similar to cerebral palsy. Profuse secretions and very contagious Short lifespan
|
|
|
DX Cytomegalovirus
|
presence of CMV in urine or serum antibodies
|
|
|
TX Cytomegalovirus
|
none, avoid exposure
|
|
|
Herpes
|
HSV 1 oral HSV 2 genital often have both. Transmission occurs with close contact with a person shedding the virus. First infection smptoms are more pronounced and risk of transmission higher. Stressors can trigger a reoccurence often milder and shorter
|
|
|
S/S Herpes
|
painful blisters, fever, anorexia, painful inguinal nodes, dysuria, and painful intercourse
|
|
|
Herpes Transmission to Fetus
|
spontaneous abortion, PTL, IUGR. After rupture of membranes as virus ascends from active leisons can cross placenta or if baby comes into contact with leisions
|
|
|
C Section r/t Herpes
|
must be done within 6 hr window to prevent ascension of virus to fetus. Cultures may be done to r/o presenceof active leisons for vaginal delivery
|
|
|
Neonatal Infection of Herpes
|
82% mortality lethargy, poor feeding, jaundice, bleeding, pneumonia, convulsions, bulging fontanels, skin and mouth leisions
|
|
|
Tx Herpes
|
Aclovvir not a cure decreases healing time, shortens time of live virus in the leisions, but not recommended during pregnancy. Balyclovar used during pregnancy.
|
|
|
Nx care Herpes
|
educate r/t infection control measures
|
|
|
gonorrhea
|
gram negative dipplococci. Women often asymptomatic ntil complications occur (PID). Screened during initial prenatal exam. May be r/t preterm birth, PROM, chorioamnionitis
|
|
|
Effects Gonorrhea Fetus/Neonate
|
opthalmia nenatorum (blindness), pneumonia, risk for infection at other sites
|
|
|
Mgt Gonorrhea
|
Rocephin or Spectinomycin
|
|
|
Neonatal prevention gonorrhea
|
erythromycin opthalmic ointememt
|
|
|
syphilis
|
caused by a spirochete Pregnancy does not alter progression of diseaseIf left untreated can lead to abortion or congenital syphylisNo residual effects if treated before 5 mos of pregnancy.
|
|
|
congential syphilis
|
occurs when spirochetes cross the placenta after 16th or 18th week of gestation
|
|
|
Neonatal manifestations of syphilis
|
rhinitis, rhagades (cracks & fissures around mouth) hydrocephaly, opaque corneas, . Later saddle nose, saber chin, hutchinson's teeth ( notched, tapered canines) and DM
|
|
|
Jarisch Herxheimer reaction
|
a transient, short-term, immunological reaction commonly seen following antibiotic treatment of early and later stage [infectious] diseases manifested by fever,chills,headache,tachycardia and exacerbations of cutaneous lesions. Preterm labor
|
|
|
VDRL
|
testing of infant for syphilis that detemines management and follow up
|
|
|
TX neonates syphylis
|
active infection PCN
|
|
|
PROM
|
sponataneous rupture of membranes before 38 wks Unknown cause
|
|
|
Contributing factors PROM
|
incompetent cervix, infection (UTI) hydraminios, trauma, multiple pregnancies and maternal genital tract abnormalities
|
|
|
Maternal Risks r/t PROM
|
chorioamnionitis, endometriosis
|
|
|
Fetal/Neonatal Risks PROM
|
RDS, sepsis, malpresentations, prolonged L&D
|
|
|
Mgt PROM
|
Dx confirmed nitrazine test, caculate gestational age. Of signs of infection antibiotic therapy IV and fetus will be born regardless of gestational age. If no signs infection and , 37 wks, conservative tx and bedrest betamethosone
|
|
|
Testing gestational age
|
Nagele's rule (EDD)fundal height, ultrasound (fetal biparietal diameter), and amniocentesis to assess lung maturity
|
|
|
Best time for surgery
|
early 2nd trimester; post op promote oxygenation TCDP and IS, positioning to provide optimal uteroplacental perfusion. Can place wedge under tips to tip uterus
|
|
|
Mothers over 35
|
internal enviroment less than optimal, eggs may be defective with chromosomal abnormalities, increased incidence of multiple gestation, Inc incidence of HTN and DM Higher rate of C section r/t better insurance
|
|
|
Teen pregnancy
|
physical development still incomplete needs inc calories for own development as well as that of fetus, structural aspects may include cephalopelvic disproportion.
|
|
|
Tx teen pregnancy
|
non judgemental and accepting, need concrete examples when teaching, show not tell, emphasize nutrition and increased caloric demands,
|
|
|
Teens and L&D
|
you may need to play role of support, coach, and comforter
|
|
|
Teens Postpartum
|
assess support system, bonding, knowledge and attitude, contraception education, financial assistance, educational aspriations, who is going to care for baby
|
|
|
maternal mortality can be caused from ectopic pregnancy or obstertric events such as
|
hemorrhage, pulmonary embolism and pregnancy-induced hypertension (PIH)
|
|
|
What is the major cause of perinatal (5 months before and 1 month after) mortality
|
prematurity
|
|
|
risk factors for pregnancy complications
|
age (especially younger than 17), socioeconomic status (urgan poor, lack of education), primipariety (first), and multiple pregnancies
|
|
|
What is the best prevention of pregnancy complications
|
prenatal care
|
|
|
Name two pregestational disorders
|
cardiovascular disease and endocrine disorder (diabetes)
|
|
|
Name the 4 pregestational cardiovascular diseases
|
rheumatic heart disease, congenital heart disease, mitral valve prolapse and peripartum cardiomyopathy (disease of the heart muscle between the last month of pregnancy and 5 months post partum)
|
|
|
Why is rheumatic heart disease decreased in pregnant women
|
better treatment of strep infections
|
|
|
Why is congenital heart disease seen more
|
better treatment of heart anomalies bc of survival rate
|
|
|
Why are we conserned with mitral valve prolapse in pregnant women
|
Prevention of any infection that could travel to the heart and weaken valves, usually caused by stress. Give prophylactic IV antibiotic during labor
|
|
|
Why is peripartum cardiomyopathy a concern
|
can be very severe, may go unnoticed until after delivery
|
|
|
pregnancy increases ____ on the heart causing symptoms and risks to increase
|
stress
|
|
|
T/F signs of cardiac decompression can be similar to normal responses to pregnancy
|
True (fatigue, dyspnea, palpitations, tachycardia, heart murmurs, edema and cough) Decompensation is the functional deterioration of a previously working structure or system
|
|
|
What causes murmurs and palpitations
|
blood volume increase
|
|
|
main sign of cardiac decompensation is due to ____ - b/c this is the only sign that is not a common change in pregnancy
|
cough - red flag b/c increasing heart alteration, heart failure, pulmonary edema (congestion)
|
|
|
Class I and II heart disease in pregnancy is the milder form of heart disease, are these women able to have a normal pregnancy
|
yes - but need to be watched very closely - coordinate care OB with CV doctor
|
|
|
Can a woman with class III & IV heart disease become pregnant
|
yes - but it is in their best interest not to try to have a baby
|
|
|
What is the primary goal of a pregnant woman with heart disease
|
adaquate rest - other goals include prevention of respiratory infection (adds stress to lung), monitoring for signs of cardiac decompensation and attempt a trial of labor avoiding valsalva (closed glottis) puts pressure on thoracic cavity
|
|
|
Why is diabetes worse with pregnancy
|
stress alters CHO metabolism (pregnancy is a diabetogenic state)
|
|
|
Gestational diabetes (type III) stops once pregnancy ends but are at higher risk for mature onset diabetes - why
|
because they have subclinical diabetes when not pregnant, they are often overweight so need to encourage to eat well and exercise.
|
|
|
what are the influences of pregnancy on diabetes (woaman already having diabetes)
|
changes in CHO metabolism and control of blood glucose as well as vascular disease may increase because blood gets sticky, picks up debris and at capillaries oxygenation decreases leading to ulcers, poor healing, infection and amputation
|
|
|
What are some maternal complications of diabetes on pregnancy
|
kidney problems, retinopathy, early pregnancy increased insulin production = hypoglycemia, later in pregnancy is lack of insulin production = hyperglycemia
|
|
|
How much does insulin demand increase in later pregnancy
|
3-5X over non pregnant level
|
|
|
When is gestational diabetes picked up during pregnancy
|
after 26th week due to increased hyperglycemic effect, high rate of C-section
|
|
|
What are some fetal complications of maternal diabetes
|
by 36 weeks - aged placenta, later in pregnancy placenta releases an insulin-destroying enzyme to make more glucose avail to fetus so mother uses protein
|
|
|
Type I, II, or III diabetes have the most difficulty controlling blood glucose levels during pregnancy
|
Type 1
|
|
|
Type I, II, and or III pregnant women are more likely able to control their diabetes with diet
|
Type II & III (these woman may go on insulin if needed), type II may use oral hypoglycemic agents, the newer ones dont have same tetratogenic effects
|
|
|
what other specialists may a pregnant woman with diabetes see
|
endocrinologist, ophthalmologist
|
|
|
Poor control of insulin can lead to oversized or undersized babies
|
undersized r/t placenta getting old too quickly and baby not getting adequate nutrition. Generally fetal obesity due to growth acceration (macrosomia) if insulin is under control.
|
|
|
Why is it important to assess newborn of a diabetic mother for hypoglycemia shortly after birth
|
blood sugar can plummet after birth because glucose source is cut off and they are used to producing lots of insulin which is still in their system
|
|
|
Why does a fetus of a diabetic mother have hydramnios (excess amniotic fluid)
|
fetus urinating higher glucose, hyperosmotic, pulls in more water
|
|
|
Nurses role of taking care of a diabetic mother
|
assessment of disease process, education (anticipatory guidance), physhological support, and assessment of fetal well being, placental function, fetal maturity
|
|
|
gestational disorders are health alterations associated with pregnancy and usually disappear when
|
after delivery
|
|
|
T/F Premature rupture of membranes is an onset of preterm labor
|
Can be true -but- premature ROM occures before onset of labor even if baby is full term
|
|
|
What is the primary concern for premature ROM
|
infection (chorioamnionitis inflammatory condition of pregnancy affecting the uterus)
|
|
|
what diagnostic measures are used to determine if there has been ROM
|
sample fluid - nitrazine paper (measures pH amniotic fluid will be alkaline and urine acidic - and ferning test
|
|
|
what is amniotic fluid
|
fetal urine - so if premature ROM, can be replinished and hope it seals itself off, if no infection, pregnancy can continue
|
|
|
between which weeks is preterm labor
|
20-37
|
|
|
risk factors for preterm labor
|
previous preterm labor, durg use (especially stimulants), genital tract infections such as bacterial vaginosis and group B streptococcus (GBS)
|
|
|
____ is the term for excessive N/V
|
hyperemesis gravidarum - the worst morning sickness, proglonged
|
|
|
Results of hyperemesis gravidarum
|
F&E imbalance (can affect fetus), weakness & fatigue (due to dehydration), and scant, dark urine (identification of severe problem)
|
|
|
Management of hyperemesis gravidarum
|
dry CHO (then wait 1 hr for fluids b/c fluids trigger vomiting), antiemetics (start with smallest therapeutic dose), IV therapy (correct F&E and acid-base imbalance), potential TPN (last resort), psychological (difficulty adjusting to pregnancy)
|
|
|
What is the difference between threatened abortion and imminent abortion
|
In an imminent abortion, the cervix had dilated, can't do anything about it, placenta starts to seperate from uterine wall.
|
|
|
what is the percentage of spontaneous abortions (miscarriage)
|
10-30%, some women don't know they are pregnant before they miscarry
|
|
|
What is the main concern of imcomplete abortion
|
risk of hemorrhage increased because uterus can't contract, may be a risk of infection - if cervix is open a D&C is done to expell everything and if closed then there will be an attempt to save the pregnancy
|
|
|
what are some causes of incompetent cervix
|
multiple abortions, D&C (dilation of the cervix and curettage or scraping the uterus), possible previous large baby delivery
|
|
|
What is the procedure done for an incompetent cervix
|
cerclage procuedure - go around cervix and drawstring it closed, remove after 37 weeks unless signs of labor b4
|
|
|
What is the main cause of implantation in a site other than the endometrium (ectopic pregancy)
|
pelvic inflammatory disease (PID) narrowing of tube (sperm gets through but not the fertilized egg - may be caused from gonorrhea, chlamydia
|
|
|
Manifestations of ectopic pregnancy
|
shock from internal bleeding, pain in lower left or right quandrant, pregnancy test is not a sign, may be negative
|
|
|
Diagnosis of ectopic pregnancy
|
sonogram - if high WBC count it is probably appendicitis
|
|
|
Management of ectopic pregnancy
|
laparascopic - removal of that poriton of the tube
|
|
|
What is the early sign of hemorrhagic shock
|
thirst - later signs are pale, sweaty, clammy, BP drop and elevated pulse also soaking more than one pad an hour
|
|
|
____ benign proliferation of trophoblastic tissue. Developing embryo implants somewhere, and the tissue surrounding it (trophoblastic tissue) starts growing uncontrollably, cutting off nutrition and necrosis occures so body calcifies to prevent infection
|
gestational trophoblastic disease (molar pregnancy) generally not a viable pregnancy
|
|
|
Manifestations of gestational trophoblastic disease (molar pregnancy)
|
Bleeding. scant dark to copious full blown bright red. Fundal height bigger, N/V extreme
|
|
|
treatment of gestational trophoblastic disease (molar pregnancy)
|
D&C or methotexate an antineoplastic which attacks fast growing tissue
|
|
|
Why should women be cancelled for one year after gestational trophoblastic disease to not become pregnant
|
Need to monitor for tissue that may not have been removed and continue to grow for a year, this tissue can be diagnosed via hCG levels. If a woman becomes pregnant hCG levels increase and can not differenciate between tissue and fetus
|
|
|
____ is a potential after gestational trophoblastic disease (molar pregnancy) and can be fatal
|
Choriocarcinoma - a malignant and aggressive cancer, usually of the placenta. It is characterized by early hematogenous spread to the lungs
|
|
|
____ is pregnancy-induced hypertension (PIH) used to be called toxemia 5% of all pregnancies and diagnosed after 20-24 weeks gestation
|
preeclampsia/eclampsia
|
|
|
There are three signs to pregnancy induced hypertension. Pre-eclmpsia has two and eclampsia will have all three
|
hypertension (>140/90), edema (>2lbs/week), and proteinuria (albumin in the urine)
|
|
|
although >140/90 is diagnostic of gestational hypertension an increase of ____ systole or ____ diastole over baseline is considered
|
increase 30 systole or 15 diastole - especially diastole b/c indicated heart rest is stressed too (so if normal is 120/80, a pregnant 145/96 indicates hypertension due to diastole more than 15 over - not systole)
|
|
|
why should blood pressure be checked if more than 2lb per week is gained
|
risk for pre-eclampsia, should gain 1lb per week in later pregnancy, edema follows and it is a sign if seen when awakenging in the morning
|
|
|
other signs of pregnancy induced hypertension (PIH)
|
clonus (muscular contractions due to sudden stretching of the muscle), HA (prolonged/severe), blurred vision, and scotoma (spots in front of the eyes)
|
|
|
What is the difference between mild and severe PIH (pregnancy induced hypertension)
|
mild - BP 140/90 - 160/110, proteinuria and edma are both 1+ or 2+, occasional HA. Severe - BP >160/110, proteinuria and edema both 3+ to 4+ and may have oliguria (kidney's shutting down), pulmonary edema and RUQ pain r/t liver congestion
|
|
|
increased incidence of pregnancy induced hypertension (PIH) r/t
|
primigravidas, teens and over 35, hx of pre-eclampsia, multiple gestation,GTD (genetic trophoblastic disease), Rh incompatibility, and diabetes
|
|
|
maternal risks of pregnancy induced hypertension (PIH)
|
convulsions...coma, renal failure, abruptio placentae, DIC, ruptured liver, and pulmonary embolism
|
|
|
fetal-neonatal risks from pregnancy induced hypertension (PIH)
|
SGA related to IUGR, 10% mortality with pre and 20% with eclampsia
|
|
|
What happens to blood volume in pregnancy induced hypertension (PIH)
|
volume doesn't change with mild but will decrease with severe, normal pregnancy will increase blood volume 30-50%
|
|
|
What happens to peripheral resistance, blood pressure and hematocrit in pregnancy induced hypertension (PIH)
|
peripheral resistance increases where normal pregnancy it decreases, BP rises, and hematocrit rises where normal pregnancy it falls due to more fluid
|
|
|
Why does BP remain unchanged in a normal pregnancy when there is a 30-50% increase in blood volume
|
vessles diolate in normal pregnancy - with pre-eclampsia you have vasospasm so extra fluid is pushed out and get edema - don't treat with diuretics unless have pulmonary or cerebral edema, also do not use Ace-Inhibitors
|
|
|
Tx of pregnancy induced hypertension
|
bed rest left side (off of vena cava) decreased blood pressure and promotes diuresis due to fluid back to organs, consume extra protein and push fluids due to loss of both
|
|
|
What do you assess with pregnancy induced hypertension (PIH)
|
BP, daily weight, proteinuria, reflexes, urine output
|
|
|
After the baby is born, the mother with pregnancy induced hypertension is given what
|
apresoline - during pregnancy can take MgSO4
|
|
|
Why is MgSO4 the drug of choice for a pregnant woman with eclampsia (Eclampsia is pregnancy-related seizure activity that is usually caused by high blood pressure)
|
lowers blood pressure, makes woman seizure proof
|
|
|
side effects of MgSO4 - used to treat pre-eclampsia
|
Flushing, Muscle weakness, lack of energy, HA, N/V, fluid in lungs, chest pain slurred speech and blurry vision. Hypotension hypocalcemia, arrhythmia and asystole
|
|
|
What is the antidote for MgSO4
|
Calcium
|
|
|
What does HELLP syndrome stand for and when is it seen
|
people with pre-eclampsia are at risk. H=hemolysis. EL= Elevated Liver enzymes. LP = Low Platelets
|
|
|
Elevated Liver enzymes in HELLP sndrome cause
|
intra-arterial lesions, platelet aggregation, fibrin accumulation, microemboli in hepatic vasculature and eschemia
|
|
|
____ period is the first few hours of life when the newborn stabilizes respiratory and circulatory function
|
transition period
|
|
|
What is the nursing goal during the transition period
|
To identify actual or potential problems that may require immediate or emergency attention
|
|
|
____ stimuli - The head and chest moves through the vaginal canal to expel fluid by squeezing
|
Mechanical Stimuli
|
|
|
____ stimuli is rubbing with a towel, tapping the bottom of the foot, and noisy birthing room
|
Sensory Stimuli
|
|
|
____ stimuli is the difference in temperature the newborn feels after being inside a warm mother
|
Thermal Stimuli
|
|
|
____ is made up of lipoprotein in the lungs to keep alveoli from collapsing creating an alveolar surface tension
|
Surfactant
|
|
|
Surfactant is made up of Lecithin/Sphingomyelin, what L/S ratio is needed to create alveolar surface tension
|
L/S 2:1 (premies born without this ratio can be given an artificial surfactant
|
|
|
Antipoxia causes muscles to relax including the anal spincter and expel ____ into the amnionic fluid which changes the viscosity of lung fluid within respiratory tract which causes ____
|
mechonium - Hypoxia
|
|
|
degree of lung ____ is how well the lungs expand and contract
|
degree of lung compliance
|
|
|
Greater blood volume to the ____ contributes to conversion of fetal circulation to newborn circulation
|
Lungs
|
|
|
Benign physiological ____ come and go and is caused by shunting of blood common in early newborn period
|
murmers
|
|
|
Onset of respiration triggers increased blood flow to the ____ after birth
|
lungs
|
|
|
With increased ____ pressure comes decreased ____ pressure as newborn starts to breath
|
Increased aortic pressure and Decreased pulmonary pressure
|
|
|
Increased ____ pressure cooresponds with decreased venous pressure
|
increased systemic pressure
|
|
|
Within the cardiovascular system, what closes when a newborn is born
|
closure of foramen ovale (L&R atriums), ductus arteriosus (aortic arch and pulmonary artery) and ductus venosus (to liver)
|
|
|
T/F oxygen saturation of newborn's blood is greater than adult's
|
True
|
|
|
The fetus has special iron oxygen hemoglobin that has a greater affinity for ____
|
oxygen.
|
|
|
____ resistance is increased in newborn as compared to adult
|
Airway resistance
|
|
|
In a quiet and alert state, the newborn heart rate is ____ beats/min
|
120-160
|
|
|
Newborn heart rate during deep sleep state is ____ and crying is ____
|
90 deep sleep 180 crying
|
|
|
____ values during the first 12 hours of life vary with birth weight and are not routinely done unless in PICU or NICU
|
Blood pressure
|
|
|
Average mean blood pressure is ____ - ____ mmHg in full-term over 3kg during first 12 hours of life
|
50-55 mm/Hg
|
|
|
____% of all murmers in newborns are transient
|
90%
|
|
|
Newborn respiratory rate ____ - ____
|
30 - 60
|
|
|
periodic breathing with short periods of apnea lasting ____ - ____ seconds is normal
|
5-15 seconds
|
|
|
____ is when the palms of hands and feet are blue because the cardiovascular system has not caught up yet.
|
acrocyanosis - being cold makes it more noticable
|
|
|
The newborn is an obligatory ____ breather
|
nose
|
|
|
initial respirations are diaphagmatic, shallow, and irregulare in depth but normal in ____
|
rhythm - if rhythm was not normal there would be a sea saw breathing where the abdomen and thorasic are in opposition
|
|
|
what happens to hematocrit levels in a newborn
|
rise 1-2g/dL as a result of placental transfusion, low oral fluid intake and diminished extracellular fluid volume, fall as a natural progression over the first 2 months of life
|
|
|
---- is a normal finding because stress of birth stimulates increased production of neutrophils during the first few days of life
|
leukocytosis
|
|
|
Blood volume of term infant is estimated to be ____ mL/kg of body weight
|
80mL/kg
|
|
|
blood volume varies based on:
|
delay in cord claming (normal shift of plasma to extravascular spaces), gestational age, and prenatal and or perinatal hemorrhage
|
|
|
____ in newborn is closely related to rate of metabolism and oxygen consumption
|
thermoregulation
|
|
|
Newborns don't ____ for thermoregulation, they break down brown fat
|
shiver
|
|
|
Newborns have decreased ____ and ____ fat
|
subcutaneous and brown fat
|
|
|
Newborn's poor thermal stability primarily due to excesive ____ rathen than impaired heat production
|
heat loss. blood vessles closer to skin, thin epidermis, decreased subcutaneous and brown fat.
|
|
|
example of heat loss by convection
|
losing heat to air currents with AC and fans
|
|
|
example of heat loss by radiation
|
cold environment, infant placed next to (not on) cold surface areas and window..
|
|
|
example of heat loss by evaporation
|
Bath - turn off fans
|
|
|
example of heat loss by conduction
|
body placed on cold surface like a scale
|
|
|
Three ways a newborn can produce heat by thermogenesis-physiologic mechanisms
|
increased metabolic rate, muscular activity, and nonshivering thermogenesis (convert brown fat to heat energy)
|
|
|
Encouraging early breastfeeding and using heated and humidified oxygen are some interventions of minimize ____ stress
|
cold
|
|
|
___ bilirubin is the conversion of yellow lipid soluble pigment into water-soluble pigment done in the liver. Since the fetus doesn't use thier liver it goes across the placenta and mother does it for them
|
Conjugated bilirubin (direct) Think lipid to water
|
|
|
____ bilirubin is breakdown product derived from heoglobin, not water soluable, released primarily from destroyed RBC's and crosses the placents
|
Unconjugated bilirubin (indirect) Think RBC
|
|
|
Total serum bilirubin (conjugated and unconjugated) is less than ___ mg/dl shortly after birth
|
3mg/dl
|
|
|
jaundice is caused by
|
hyperbilirubinemia
|
|
|
Concentration of bilirubin in the blood must exceed ___ mg/dL for the coloration of jaundice to be visible
|
2-3mg/dL
|
|
|
physiologic jaundice is a ____ bilogic response of newborn after the first 24 hours
|
normal
|
|
|
physiologic jaundice of newborn is caused by:
|
accelerated destruction of RBC, impaired conjugation of bilirubin, increased bilirubin reasorption from GI, when get cold
|
|
|
Theraputic interaction to get rid of jaundice:
|
encourage early and frequent feeding, sunlight helps,
|
|
|
Jaundice in the first 24 hours is never normal, can be caused from:
|
obstruction of liver, ABO incompatibility
|
|
|
____ jaundice occures in first days of life associated with poor feeding practices
|
Breastfeeding jaundice, avoid supplementation, access lactation counseling and encourage frequent breastfeeding
|
|
|
Coagulation factors (senthesized in liver) activated under influence of ____
|
vitamin K
|
|
|
Vitamin K is synthesized in ___
|
normal flora of the gut, which is missing in the newborn
|
|
|
Vitamin K is given prophylactically on day of birth to combat potential ____
|
bleeding - prevents hemorrhagic disease of the newborn
|
|
|
____ - ____ weeks gestation, the gastrointestinal system is mature
|
36-38
|
|
|
intestinal and pancreatic ____ are needed to digest most simple carbohydrates, proteins and fats and are deficient during the first few months of life
|
enzymes (pancreatic amylace breaks down carbs from saliva)
|
|
|
Newborn has trouble digesting ____ and digests and absorbs ____ less efficiently
|
trouble digesting starches and digests and absorbs fats less efficiently
|
|
|
____ are well digested and absorbed from newborn intestine
|
proteins
|
|
|
Air enters stomach immediately after birth and with bottle feeding more often than breast feeding. so burp baby every ____ oz or ____ with breastfeeding
|
every 1/2 oz or after each breast
|
|
|
newborn's stomach capacity
|
50-60 mL
|
|
|
regurgitation is due to
|
immature cardiac sphincter
|
|
|
Due to the sucking reflex, a newborn can ____ easily
|
overfeed
|
|
|
term newborn requires approx. ____ cal/kg/day
|
120
|
|
|
term newborns usually pass mechonium within ____ hours
|
8-24
|
|
|
____ is formed in utro from amniotic fluid and its constituents, intestinal secretions and shed mucosal cells
|
mechonium - thick, tarry black or dark green
|
|
|
newborn's kidney's have full complement of functioning nephrons by ____ weeks gestation
|
34-36 weeks gestation
|
|
|
Newborn's kidney is unable to dispose of water rapidly when necessary due to ____ filtration rate
|
low compared to adult rate
|
|
|
Why are full term newborns less able than adults to concentrate urine
|
tubules are short and narrow
|
|
|
newborn has reduced ability to concentrate urine caused by limited ____ reabsorption of water and limited excretion of solutes
|
tubular
|
|
|
First 2 days postnatally, newborn voids ____ times daily with urine output of ____ mL/day
|
6 times with 15mL/day (about 5mL/kg/day)
|
|
|
Newborn subsequently voids up to ____ times a day with urine output of ____mL/kg per day
|
up to 25 times a day with 25mL/kg/day
|
|
|
limitations in newborn's ____ response result in failure to recognize, localize, and destroy invasive bacteria
|
Inflammatory response
|
|
|
Because the hypothalmic response to pyrogens is poor, ____ is not a reliable indicator of infection.
|
Fever - anything over 100 F call pediatricians office
|
|
|
newborn immunity period of resistance varies: Immunity against common viral infections may last ____ months and immunity to certain bacteria may last ____ weeks
|
Viral 4-8 months, certain bacteria 4-8 weeks.
|
|
|
Normal newborn produces antibodies in response to ____
|
antigen (except IgM antibodies which respond to bacteria and some viruses)
|
|
|
Immnizations at 2 months of age is to develope active ____ immunity
|
active acquired immunity. Active because it is given in a shot
|
|
|
Newborn Immunity IgA is from
|
breastmilk
|
|
|
____ antibodies are produced in resonse to blood group antigens such as gram negative enteric organisms and some viruses in expectant mother
|
IgM
|
|
|
IgM antibodies does not normally cross ____
|
placenta
|
|
|
IgM antibodies are produced by fetus beginning at ____ weeks gestation
|
10-15 weeks gestation
|
|
|
elevated levels of IgM at birth may indicate
|
placental leaks or antigenic stimulation in utero
|
|
|
Which antibody is a passive acquired immunity which crosses the placenta and is transferred to fetus in utreo during third trimester
|
IgG
|
|
|
Passive acquired immunity includes ____ that mother passed on in utero that the fetus does not make
|
antibodies (HIV antibodies)
|
|
|
The first period of reactivity is followed by a sleep phase before the second period of reactivity, how long do these periods last?
|
First period of reactivity lasts 30 minutes, followed by sleep 30-120 minutes then the second period of reactivity lasts 2-8 hours
|
|
|
During the first period of reactivity it is good to initiate breastfeeding, why
|
strong sucking reflex and awake and active
|
|
|
During the period of ____ (between the two periods of reactivity), the newborn is difficult to awaken, shows no interest in sucking and bowel sounds become audible, and cardiac and respiratory rates return to baseline values
|
inactivity to sleep phase
|
|
|
The first mechonium stool is frequently passed during the ____ stage because GI tract becomes more active
|
second period of reactivity
|
|
|
during the second period of reactivity, gagging, choking and regurgitating with turning blue are due to
|
increase production of respiratory and gastric mucus
|
|
|
During the second period of reactivity the nurse must be alert for ____ periods
|
apneic periods, may cause a drop in heart rate
|
|
|
During sleep, the newborn has two stages: deep or quiet sleep and ____
|
REM Rapid eye movement
|
|
|
What are the characteristics of deep or quiet sleep
|
No eye movement, regular respirations, jerky motions (startles but rapidly suppressed), heart rate 100-120,
|
|
|
Characteristics of REM
|
Irregular respirations, eye movement, sucking motions, minimal activity, smooth nonjerky movements
|
|
|
REM (active sleep) and quiet sleep occure in intervals of
|
50-60 minutes
|
|
|
How much total sleep of the newborn is active REM and how much is quiet sleep
|
45-50% active REM, 35-45% quiet, 10% transitional between two
|
|
|
Which stage of sleep stimulates highest peaks of growth hormone and growth of neural system
|
REM. but disturbance of sleep wake cycle result in irregular spikes of GH
|
|
|
The alert state has three states, they are:
|
drowsey or semi dozing, wide awake, active awake
|
|
|
What are the manifestations during the drowsy state
|
eyes can be open or closed, eyelids fluttering, slow regular movements, & mildly startles
|
|
|
What is the difference between wide awake and active awake
|
wide awake - quietly takes in the environment and stimuli. Active awake - Lots of moving, increased stimuli response and crying
|
|
|
Which alert state elicits an appropriate response of help from parents
|
Active awake, child will cry
|
|
|
Normal behavioral-sensory capacities of newborn
|
Self-quieting ability & Habituation (ability to process and respond to stimuli) for example; ability to fixate and follow complex visual stimuli, and newborn perfers human face and bright objects
|
|
|
Auditory behavior capacity of normal newborn include:
|
minimal starter reflex, cardiac rate rises, and respond with definate organized behavior
|
|
|
olfactory capacity of norman newborn include
|
select people by smell, distinguish mother's taste and sugar increases sucking
|
|
|
tactile capacity of normal newborn include
|
sensitive to being touched, cuddled and held & settled newborn is able to interact with environment
|
|
|
What is the Heidi Als theory for developmental care in the NICU?
|
Synactive theory, naturalistic observation of newborn behavior, each premature baby is different, givve them individualized treatment/care, family focused, comprehensive, developmentally supportive
|
|
|
What type of external environmental things are appropriate for the NICU?
|
"-cycled lighting
|
|
|
What is kangaroo care?
|
Baby in diaper against Mom/Dad's bare chest, skin to skin.
|
|
|
What is kangaroo care and co-bedding associated with?
|
"-Increased weight gain
|
|
|
What percentage of babies born are premature?
|
7-10%
|
|
|
What is considered premature?
|
Less than 37 weeks
|
|
|
What is within the normal time frames for gestation?
|
38-42 weeks
|
|
|
What is the cut of time for viable babies?
|
24 weeks is generally considered viable.
|
|
|
4. Micropremie"
|
"1. 1501-2500g/36 weeks g.a.
|
|
|
What are the standards for small for gestational age (SGA) or large for gestational age (LGA)?
|
"SGA - birth wt. is below the 10th % of norms. Can be full term, fully developed.
|
|
|
What is IUGR?
|
Intrauterine growth retardation, stunted growth
|
|
|
What types of disorders are associated with VLBW?
|
Neurologic sequelae, developmental delay, decreased intellectual and language skills. The smaller the baby, the greater the risk for delays and developmental problems.
|
|
|
What do Apgar scores look at? How is it scored?
|
HR, RR, ms tone, response to stimuli, color. Refers to how baby is doing after birth. 0 = no response, 2 = best response. Max score is 10. Taken at 1 min., 5 min., 10 min. and every 10 min thereafter. The lower the Apgar score, the worse off the babies diagnosis will be.
|
|
|
Name and describe three causes of premature birth.
|
"Social - teenage preg., little family support, drugs, alcholol.
|
|
|
Name four respiratory complications with premature babies.
|
"1. Apnea
|
|
|
What is the most common respiratory problem in neonates?
|
Hyaline Membrane Disease
|
|
|
What is HMD?
|
Pulmonary immaturity, decreased surfactant production which leads to an increase in surface tension of alveoli. This leads to alveolar collapse, diffuse atelectasis and decreased lung compliance.
|
|
|
At what week do the alveoli develop?
|
24 weeks
|
|
|
What week does the brain control respirations?
|
30 weeks
|
|
|
At what weeek does the baby start to make surfactant?
|
22 weeks
|
|
|
What are some treatments for HMD/RDS?
|
surfactant, oxygen assisted ventilation via High Frequency Oscillatory Ventilation. (Little puffs, most premature babies). ECMO - extracorporeal membrane oxygenation.
|
|
|
-Risks"
|
Prognosis varies w/ severity, mortality rate is 10%, Increased risk for neurodevelopmental delay and URTI
|
|
|
What is Broncho-Pulmonary Dysplasia? (BPD)
|
A chronic lung disease characterized by interstitial fibrosis, alveolar collapse, scarring w/ increased airway resistance, increased work of breathing caused by prematurity, increase ventilator pressure, O2 toxicity. Lungs have lots of scarring
|
|
|
How do premies get BPD?
|
Greatest risk if O2 dependent for more than 28 days, or after mechanical ventilation for more than a week.
|
|
|
What percentage of premies get BPD?
|
5% of premies, 12-69% of those less than 1500g (VLBW)
|
|
|
How can BPD be detected?
|
Increased density areas on x-ray
|
|
|
What risks are associated with BPD?
|
Neurodevelopmental delay, poor weight gain, decreased fat deposits. Risks - CHF, cor pulmonale, increased right ventricle hypertrophy, pulmonary edema, trouble with bone healing.
|
|
|
What is Meconium aspiration?
|
Aspiration of meconium prior to or during birth, airway obstruction, tissue damage. 1st attempt at metabolizing amniotic fluid, meconium gets into lungs
|
|
|
What is the frequency of Meconium aspiration? What babies get this?
|
5-10% of all live births, infants born at term or post term.
|
|
|
What is hyperbilirubinemia?
|
Excessive accumulation of bilirubin in the blood.
|
|
|
What are the causes of hyperbilirubinemia?
|
"-Immature liver function
|
|
|
Hyperbilirubin can result in what condition of the brain?
|
Kernicterus
|
|
|
What is Kernicterus?
|
Yellow staining of the brain caused by unconjugated bilirubin deposits. Bilirubin acccumulates around the brain.
|
|
|
What two structures of the brain are affected with Kernicterus?
|
Basal ganglia and hippocampus
|
|
|
What are some long term neurological problems that develop as a result of Kernicterus?
|
Athetosis, rigidity, hypotonia, hi-fequency hearing loss, MR
|
|
|
What is the treatment used for Hyperbilirubin?
|
Phototherapy via UV lights, exchange transfusions
|
|
|
What is the most common brain lesion in infants less than 32 weeks g.a.? How common is it?
|
Intraventricular Hemorrhage, 40% of pre-terms
|
|
|
When do IVH occur?
|
Within the first 2 days and generally within the first week of birth.
|
|
|
What exactly is a IVH?
|
Bleeding into the subependymal germinal matrix.
|
|
|
When is the subependymal germinal matrix prominent? What is it?
|
"Prominent from 26-34 weeks gestation and then gone by term.
|
|
|
What are three causes of intraventricular hemorrhage?
|
"1. Fluctuating cerebral blood flow
|
|
|
What is the onset of IVH like?
|
Can occur suddenly or evolve over 2-3 days. Baby will hemorrhage one time, but not repeatedly.
|
|
|
What is a grade I IVH?
|
Grade I: isolated within the germinal matrix, low risk. Minimal risk for long-term neurological deficit.
|
|
|
What is a grade II IVH?
|
Grade II: IVH into the lateral ventricles with normal sized ventricles. No damage to surrounding tissues. Minimal risk for long-term neurological deficit.
|
|
|
What is a grade III IVH?
|
Grade III: IVH with ventricular dilation. Increased risk for hydrocephalus, CP, MR.
|
|
|
What is a grade IV IVH?
|
Grade IV: IVH into the periventricular white matter, can be unilateral or asymmetric. Ventricle dilates w/ irritation around the tissues. Increased risk for hydrocephalus, CP, MR.
|
|
|
Why is it important to measure a babies head?
|
To ensure brain growth, watch for hydrocephalus.
|
|
|
What is PVL?
|
Periventricular Leukomalacia. Leuko (white), malacia (softening). Softening of the white matter around the ventricles.
|
|
|
How is PVL caused?
|
Caused by decreased blood flow in the periventricular region (systemic hypotension) where the end zones of the middle, posterior and anterior cerebral arteries meet. "Water shed effect" - decrease in blood flow from middle cerebral artery causing tissue necrosis. Also caused by apnea, bradycardia.
|
|
|
With PVL, what areas are affected?
|
Descending motor tracts due to the close proximity of the ventricles.
|
|
|
How is PVL diagnosed?
|
Serial cranial U/S
|
|
|
What is the difference between cystic PVL and PVL?
|
Cystic PVL has cysts or holes in the area. Causes destruction of tissue. More likely to see loss of vision and spasticity in LE and possibly UE.
|
|
|
What is PVL associated w/?
|
CP, MR, visual impairment
|
|
|
What type of management do you do for PVL?
|
Maintain adequate ventilation and blood pressure.
|
|
|
What is HIE?
|
Hypoxic-Ischemic Encephalopathy aka perinatal asphyxia. Hypoxia is decreased O2 in blood and ischemia is O2 deprivation. Extended amount of time of O2 deprivation.
|
|
|
What are some major signs of HIE?
|
Seizures, abnormalities in consciousness, ms tone, posture, reflexes,repiratory patterns, autonomic function, quality of movement, feeding difficulties.
|
|
|
What are some causes of HIE?
|
"-Mom could be anemic
|
|
|
How can HIE be confirmed?
|
#NAME?
|
|
|
How can HIE be prevented?
|
Identify high risk pregnancies, fetal monitoring, C-section, mantain BP on infants, monitor blood glucose levels, control seizures/brain swelling.
|
|
|
What is the most frequent overt sign of neurologic disorders?
|
Neonatal seizures
|
|
|
When do most neonatal seizures occur?
|
Usually within the first 2-5 days of life with 85% in the first 15 days of life.
|
|
|
What causes neonatal seizures?
|
Hypoxic-Ischemic Encephalopathy, Intraventricular Hemorrhage, hypoglycemia, Mom with infection or a diabetic, developmental defects, drug withdrawal.
|
|
|
What are some clinical signs of seizures?
|
Facial, tongue, oral, eye movements, apnea, changes in BP, HR, pupil size, tonal changes. Rhythmic movements in teh extremities and face.
|
|
|
How do you treats neonatal seizures?
|
Anti-convulsants and glucos if hypoglycemic to regulate blood sugar.
|
|
|
What are some secondary results of seizures?
|
15-20% have mental retardation, motor impairment, or both if seizures are in the first days of life.
|
|
|
What is Necrotizing Entercolitis? (NEC)
|
Acute inflammatory disease of the bowel. Necrosis of the intestines. Associated with sepsis.
|
|
|
When does NEC usually happen?
|
Within the 1st 6 weeks of life in infants less than 2000g, tiny babies.
|
|
|
What are some signs of Necrotizing Entercolitis?
|
Abdominal distension, bloody stools, change in respiratory status.
|
|
|
What is a secondary risk with NEC?
|
25-35% form stricutres leading to failure to thrive (FTT), feeding difficulties, diarrhea, bowel obstruction. Difficulty growing, because they burn all the calories that they are ingesting.
|
|
|
What is Retinopathy of Prematurity (ROP)?
|
A vascular disturbance in the retina of the premature infant. Abnormal growth of blood vessels in the developing eye.
|
|
|
What causes ROP?
|
It's multifactorial, but supplemental O2 is indicated, along with shock, hypothermia, Vit E deficiency, light exposure.
|
|
|
How is ROP caused?
|
By severe vasoconstriction of the retinal vessels leading to hypoxia of the vasculature of the retina with subsequent vascular proliferation of the retinal capillaries ino the hypoxic area. The retina become edematous and begins to detach. There is too much blood, vessels become filled and start to pull away and retina becomes detached.
|
|
|
ROP incidence is proportional to what?
|
a decreased birth weight
|
|
|
ROP outcomes are...
|
range from normal vision to total loss of vision
|
|
|
What are the prevention strategies with ROP?
|
Close monitoring of O2 delivery, surgery to prevent detaching of the retina.
|
|
|
What is stage I of ROP?
|
Stage I: normal eye w/ incomplete vascularization of the peripheral retina
|
|
|
What is stage II of ROP?
|
Active stage, early vascularization with engorged arterioles and venules.
|
|
|
What is stage III of ROP?
|
Advanced active stage, all of stage 3 with retinal traction.
|
|
|
What is stage IV of ROP?
|
Retinal traction with partial detachment
|
|
|
What is stage V of ROP?
|
Retinal detachment
|
|
|
What is screened prior to discharge on all infants in NE?
|
Hearing
|
|
|
What is Ototoxicity?
|
Toxicity due to drugs, antibiotics that can damage nerves.
|
|
|
Describe Brachial Plexus Injuries. Trauma to?
|
"-Usually unilateral
|
|
|
Where is the damage for Erb's Palsy?
|
C5-C6, "waiters tip"
|
|
|
Where is the damage for Klumpke's palsy?
|
C8-T1
|
|
|
Where is the damaage for Erb-Klumpke?
|
Entire UE
|
|
|
How does a baby get a Brachail Plexus injury?
|
"1. Prolonged difficult labor
|
|
|
Other injuries that you could see as a result of a brachial plexus injury?
|
"-Facial N. involvement
|
|
|
What are some treatment options for brachial plexus injury?
|
"-Rest for 7-10 days w/ partial immobilization of UE across abdomen.
|
|
|
BPI treatment from infancy thru childhood includes...
|
"-ROM/developmental activities
|
|
|
What are some other birth injuries that could occur?
|
"-Fracture to skull, humerus, clavicle
|
|
|
How does alcohol affect the baby?
|
Alcohol readily crosses the placental and blood brain barrier. The babies liver and kidney's are immature and cannot process the alcohol.
|
|
|
What determines if the baby will be affected by alcohol intake by the mother?
|
It's dose dependent btwn maternal intake in the first few weeks of pregnancy and hte occurrance of FAS features.
|
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What is the leading cause of mental retardation that is preventable?
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Alcohol related birth defects, FAS
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What is the triad of symptoms that a baby with FAS would have?
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"1. Growth deficiency (LBW, poor suck)
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What types of behaviors would you expect to see in the NICU from a baby with FAS?
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"Irritability
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What is the current treatment for babies w/ FAS?
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Drugs, morphine to calm them.
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What types of drugs will severely affect the baby in gestation?
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Cocain, meth, heroine, opiates
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What would you expect to see from a baby that was exposed to drugs?
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"Irritability
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What percentage of babies born to HIV+ mothers develop HIV?
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10-40%
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80% of children w/ HIV....
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Contract the virus inutero via tansplacental transfer.
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What is the major risk factor for contracting HIV?
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IV drug use
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Issues with maternal antibodies and HIV?
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Maternal antibodies to HIV cross the placenta; infants of infected mothers will have antibodies whether infected or not.
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What do infants with AIDS present with?
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"-Opportunistic infections (HSV, CMV, viral, fungal, protozoal)
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How can Herpes Simplex Virus hurt the baby?
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Because the developing brain of the baby is susceptible to injury as a result of viral infection acquired intrauterine or early in neonatal life. Infection during organization or myelination can cause malformations or impeded brain growth.
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What is the primary concern with Herpes?
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Active lesions and a vaginal birth. 1 = No contract, 2 = Contract and skin lesions, 3 = contract and encephalitis
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What does TORCH infections stand for?
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"Toxoplasmosis via cat feces
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What types of problems does TORCH cause?
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Various neurologic problems, psychomotor, retardation, microcephaly, LD, seizures. Can also cause blindness, senorineural hearing loss and hydrocephalus. The earlier in the pregnancy the worst for the baby.
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Other medical complications for babies include...
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Congenital Heart Disease (in 1st 8 weeks) and Myelodysplasia (Spina Bifida). These both can be corrected via surgery.
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What ages are appropriate for the TIMP?
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32 weeks to 4 months
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