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56 Cards in this Set
- Front
- Back
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What does APGAR stand for? |
Ø Activity (Muscletone) Ø Pulse Ø Grimace (Reflexirritability) Ø Appearance (Skincolor) Ø Respirations |
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What is the range of scores for each APGAR category? |
Ø 0-2 |
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When is APGAR scoring done? |
1 minute of age 5 minutes of age every 5 minutesuntil stable |
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What are the overall scores ranges for APGAR and what are their meanings? |
Ø 0-3indicates severe distress Ø 4-6indicates moderate difficulty Ø 7-10indicates the baby is adjusting to extrauterine life without difficulty |
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What are thefive acronyms for sizes related to high risk newborns or newborns with greaterthan average morbidity/mortality? |
Ø LBW= low birth weight Ø VLBW/ELBW= very low birth rate/extremely low birth weight Ø SGA= small gestational age Ø IUGR= intrauterine growth retardation Ø LGA= large gestational age |
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What ages ofnewborns are related to high risk newborns or newborns with greater thanaverage morbidity/mortality? |
Ø Preterm Ø Post-term |
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What is bilirubin? |
Ø Bilirubinis a breakdown product of hemoglobin secondary to red blood cell destruction |
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Describe the path of bilirubin from unconjugated to conjugated. |
1. RBCis destroyed and unconjugated (unreduced or insoluble) bilirubin isreleased into the blood stream 2. Bilirubintravels to the liver an changed into conjugated (reduced or soluble) 3. Bilirubinis excreted in bile 4. Bilirubinis eliminated in the stool and urine |
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Where does bilirubin go when there is excess? |
Ø Itis stored in the tissue |
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How does anexcess of bilirubin present? |
Jaundice a.k.a. icterus |
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What 3 places would the jaundice present? |
1. Skin 2. Sclera 3. Nails |
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What sort of cells is bilirubin especially toxic to? |
Neurons |
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What is kernicterus? |
Bilirubin induced brain dysfunction |
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What are S&S of kernicterus/bilirubin encephalopathy? |
CNS depression or excitement |
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What permanent conditions can result from chronic encephalopathy? |
1. Cerebral palsy 2. Attention deficit disorder 3. Attention deficit hyperactivity disorder |
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What things could cause hyperbilirubinemia to occur? (think about how these are ordered re: order of development) |
1. Genetics (especially Native & Asian)
2. Birth Injury (cephalahematoma) 3. Breast feeding 4. Physiologic jaundice (happens 2-3 days post-birth) 5. Liver issues (secreting conjugated bilirubin) 6. Random diseases (hypothyroid, hemolytic disease a.k.a. G6PD) 6. |
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What is physiologic jaundice? |
Jaundice not associated with a pathophys process. Mild and usually self-limited |
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What's the main concern with jaundice presenting in the first 24 hours? |
Sepsis & hemolytic disease |
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What is early breast feeding jaundice caused by? |
Jaundice caused by insufficient production/intake of breast milk |
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When does early breast feeding jaundice occur? |
First 3 days of life |
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When does late (breast milk) jaundice occur? |
After 4-7 days of life |
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What is late (breast milk) jaundice caused by? |
no real identifiable cause other than indirect hyperbilirubinemia. |
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Are there concerns for late (breast milk) jaundice? |
Not really bc it rarely causes kernicterus in full-term infants. |
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How long can late (breast milk) jaundice last? |
3-13 weeks |
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What are characteristics of hyperbilirubinemia s/t hemolytic disease in the newborn? |
Abnormally rapid rate of RBC destruction = increases in bilirubin |
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How does hyperbilirubinemia s/t hemolytic disease happen? (think about what is going to make a newborn's cells lyse) |
Rh incompatibility when mom is Rh- and baby is Rh + ABO incompatible when mom is O & baby is A or B |
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What are some factors we are going to consider when evaluating hyperbilirubinemia (i.e. how do we decide he has it and what do we need to know to treat it?) |
Serum blood levels (hemolysis ==> increased levels) When did it appear? (early or late/breast feeding or breast milk) EGA = Estimated gestational age How many days old? Family hx How is the baby being fed? Progression of serial serum bilirubin levels (taking multiple levels) |
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How do we know that the kid has non-physiologic hyperbilirubinemia? |
Jaundice in first 24 hours Jaundice persists in term babies ==> lasts longer than 2 wks for bottle-fed Serum bilirubin increases 5 mg/dL/day conjugated/direct bilirubin levels > 1.5-2.0 mg/dL LAB VALUES: TERM BABIES: > 12.9 mg/dL PRETERM: > 15 mg/dL BREAST FED: > 15 mg/dL |
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What are the lab values for non-physiologic hyperbilirubinemia |
LAB VALUES: TERM BABIES: > 12.9 mg/dL PRETERM: > 15 mg/dL BREAST FED: > 15 mg/dL |
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What is the main therapy to treat hyperbilirubinemia? |
phototherapy |
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How does phototherapy work? |
Promotes bilirubin excretion by helping to conjugate bilirubin |
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What are the types? |
Bili blanket Overhead light |
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What is the nurse keeping in mind with phototherapy? |
Frequent turns Protect eyes with shield ==> Remove shield every 4 hours Monitor temperature Adequate feeding Discharge teaching |
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What would cause the baby to pass meconium into the amniotic fluid? |
stress (specifically intrauterine stress) |
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What can happen if the meconium is aspirated during delivery? |
Respiratory distress ==> respiratory failure |
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What are 3 bad things that happen because of meconium aspiration? |
Airway obstruction Chemical pneumonitis (lung inflammation from inhaling irritants) Surfactant dysfunction |
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How are we going to manage meconium aspiration? (think: what would we do for respiratory failure, how do we fix lack of surfactant, how would we fix the infection, and what does infection do that we need to treat?) |
Ventilator support (resp failure) Exogenous surfactant (through intubation tube probably) Systemic antibiotics (fight infection) Thermoregulation (fever that would come with with infection) IV fluids |
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What are three morbidity/mortality concerns with sepsis in the baby? |
Meningitis Permanent brain defects Death |
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What is sepsis? |
General blood infection |
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What are sources of prenatal sepsis? |
Ruptured membranes Crosses placenta |
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What are sources of perinatal sepsis? |
Direct contact with GI/GU organisms from mom. E Coli Group B strep |
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What is the treatment for a febrile neonate less than one month old? |
Complete evaluation and admission |
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What is the treatment for febrile neonate between 1 and 2 months old? |
No admission if: Appears healthy + Benign labs + Focus of infection |
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What are the S&S of sepsis? (think about how someone is going to look/act/feel when they're super sick) |
Fever ==> >100.4 F / 38 C or hypothermia Activity level changes ==> irritable/lethargy Feeding pattern changes (nausea?) Apnea Color changes (pale? cyanosis?) Vomit/diarrhea Urine output changes |
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Remember to look at the whole child when evaluating for sepsis because the S&S can be vague and non-specific! |
Remember to look at the whole child when evaluating for sepsis because the S&S can be vague and non-specific! |
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What are some ways that a newborn might have a toxic appearance? (think about breathing, color, activity) |
Lethargy Poor perfusion Hyper or Hypoventilation Cyanosis |
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How is diagnosis made for toxicity? |
Labs & x-ray (chest x-ray) |
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What are some examples of the labs we will see for toxicity? (think about which fluids we want to look at) |
CBC Blood culture Cath for urine culture and analysis Spinal tap for CSF count & culture |
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How do we treat a septic neonate? |
Antibiotics after all lab work is complete Positive cultures might = 12-21 days of antibiotics |
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Important to remember that ill appearing infants should be treated as septic until proven otherwise! |
Important to remember that ill appearing infants should be treated as septic until proven otherwise! |
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When are kids most at-risk for SIDS? |
2-4 months 95% occur by 6 months |
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What are birth/baby factors correlated with SIDS? |
Preterm babies LBW = low birth weight Multiple births Neonates w/low APGAR scores |
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What are mom-related risks for SIDS? |
Young Cigarette smokers Poor prenatal care Substance abuse |
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What is the sleep environment that increases risk for SIDS? |
Prone sleeping (face down) soft pillow & bedding Non infant sleep surface (anything not the crib) Co sleeping with adults Tobacco smoke exposure |
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How do feeding habits influence SIDS? |
Lower incidence in breast-fed babies Pacifiers might protect against it |
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How do we care for a family with a SIDS death? |
Empathetic & non-judgemental Discussion of autopsy Present baby to family |
