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35 Cards in this Set
- Front
- Back
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newborn and exams
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-PE should be done ASAP after birth
-more thorough exam within 24 hrs with parents present -exam prior to discharge -VS: axillary temp, BP, HR< RR -general appearance -skin -head, face (flaring), neck (webbing, clavicular fxs) |
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PE cont
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-chest: symmetry, resp effort, grunting
-heart: HR, murmurs, pulses (upper and lower) -abdomen (umbilicus- 1 vein 2 arteries) -genitals -anus: passage of meconium, anus patent -extremities -neuro: primitive reflexes |
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delivery room care
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1. clamp cord
2. thermoregulation: dry baby, hat, blanket, radiant warmer 3. Suction nose, mouth, stomach 4. APGAR score 1 min and 5 min 5. Erythromycin ointment to eyes 6. ID bracelet 7. Vit K 1 mg IM 8. Hb and Hct and glucose |
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Cicumcision
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advantages: cleanliness, dec risk of cancer of penis, UTI, STDs
disadvantages: bleeding, pain infx, cosmetic result |
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cord blood
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-blood type
-infxs -metabolic -genetic |
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hospital discharge
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-PE: full
-social services F/U prn -car seat -safety education -parent education: BF, infant care, jaundice, infxs, umbilical care, sleep position, peds F/U appt. |
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prolonged rupture of membranes
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-intact amniotic sac is barrier to infx
-premature rupture of membranes may result from vaginal/cervical infxs, abnml membranes, incompetent cervix -risk of infx increases with duration of membrane rupture. Eval mother for inx, fetus for distress, lung maturity -abxs for mom and infant |
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abruptio placentae
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-premature separation of normally implanted placenta. 1/120 births. Fetal death in 1/500 deliveries
-risk factors: maternal HTN, weakness of spiral arterioles -tx: monitoring of mom and fetus, delivery, transfusion |
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placenta previa
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-implantation of placenta over cervical os
-painless vaginal bleeding -dx with U/S -risk of preterm delivery |
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brachial plexis palsies
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-brachial plexus injuries may result from traction on head during delivery
-in Erb-Duchennes paralysis (injury to C5-C6 roots) arm is limp, adducted, internally rotated, extended, pronated at elbow flexed at wrist (Waiters tip posture) |
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Klumpke palsy
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-C8-T1 root
-arm and hand are flaccid -Tx: PT, ROM exercises, splinting -recovery in 3 months |
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clavicular fx
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-due to problem with delivery
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effects of labor and delivery on infant
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-ssx: dec spontaneous movement of arm, tenderness, crepitus, swelling, bony irregularity, absent Moro on affected side
-Tx: immobilization of arm and shoulder on affected side -excellent prognosis |
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prematurity
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-prior to 37th week
-assoc with low SEC, maternal age, maternal activity, maternal illness, multiple gestations, prior premature deliveries, OB factors, fetal conditions -nursery care include: regular newborn care, thermal control, monitoring, VS, O2 therapy, fluid requirements, feeding, prevention of infx, respiratory status monitoring |
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Respiratory distress syndrome (RDS) or Hyaline membrane disease (HMD)
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-caused by deficiency of surfactant
-SSX: respiratory distress, hypoxia, cyanosis, grunting -CXR: ground glass appearance -tx: supplemental O2, Iv fluids, surfactant, steroids to mom before delivery |
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Apnea
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-respiratory pause of >20 sec with cyanosis and bradycardia
-tx: O2, methyxanthines ie: theophylline, caffeine, CPAP, venitlation |
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intaventricular hemorrhage
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-20-30% of infants <31 weeks gestation. Germinal matrix of ventricles
-ssx: coma, hypoventilation, fixed pupils. bulging ant. fontanelle, hypotension, acidosis -dx: U/S of head -Tx: vol restoration during bleed, ventilation, O2 |
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necrotizing enterocolitis
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-GI emergency
-areas of intestine become necrotis -ssx: abdominal distension, vomiting, residuala, heme + stools, abdominal tenderness, temp instability, apnea, bradycardia |
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necrotizing enterocolitis
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-dx: abdominal film shows air in bowel wall (pneumatosis intestinalis)
-tx: NPO, NGT, O2, ventilation, fluid replacement, abx, removal of necrotic bowel -sepsis work up |
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retinopathy of prematurity
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-highest incidence in lower gestational age. Injury to retinal vessels
-Dx: eye exam at 4-6 wks of age -tx: cryotherapy, laser photocoagulation -prevention: careful O2 admin |
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hyperbilirubinemia: neonatal jaundice
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-common problem in neonates
-65% of infants develop jaundice in first week of life -serious complications if untreated (neurologic) -jaundice seen in week 1 of life in 60% of term infants and 80% of preterm infants -color form accumulation of unconjugated bili in skin -newborns are jaundiced when bili >7mg/dL |
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heme is released with...
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-Rh and ABO imcompatibility
-G6PD def -abnormalities of RBC's -sequestered blood -polycythemia |
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2 types of bili
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1. unconjugated: toxic to CNS, insoluble in water, binds to albumen
2. Direct: conjugated in liver, water sol, excreted in stool |
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physiologic jaundice
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-peak indirect bili of 8-12 mg/dL on DOL #3 and then falls
-form increased RBC vol or dec RBC survival, increased enterohepatic circulation |
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non-physiologic jaundice
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-Present in first 24 hours of life persisting > 8 days of life.
-Bili increases by > .5 mg/dL/hr -Lethargy, poor feeding, vomiting -HSM -anemia |
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hyperbilirubinemia ssx
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-jaundice begins on face and as levels increase, progresses to abdomen, feet
-infants may be lethargic with poor feeding -ddX: if present in first 24 hours of life, may be result of hemolysis, hemorrhage, sepsis, infection -if present in 2nd or 3rd day, usually physiologic -If present in first week of life, may be from breast feeding with decreased intake of milk and increased enterohepatic circulation. |
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diagnosing hyperbili
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-Total serum bilirubin to see level
Blood type, Rh, direct Coombs’ test to test for isoimmune hemolytic disease. Direct bilirubin if jaundiced beyond 2 weeks of life or signs of cholestasis. RBC morphology to see spherocytes Hematocrit to see polycythemia or hemorrhage |
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Kernicterus
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-bili encephalopathy characterized by yellow staining of the brain and injury to neurons
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treatment of hyperbili
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1. phototherapy
-applied continuously, maximal skin exposure -eye shields to prevent damage -monitor temp, hydration, bili level -rebound after stopping- recheck bili 2. exchange transfusion if phototherapy doesnt work 3. intravenous immune globulin |
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hypoglycemia in the newborn
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-glucose crosses placenta
-fetal glucose levels are 2/3 maternal levels -when umbilical cord is cut, glucose supply to infant stops and levels drop then stabilize -gluc level, 40 mg/dL in newborn requires eval and tx |
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hypoglycemia may result in...
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-jitteriness
-lethargy -apnea -tachycardia -resp distress -hypotonia -shock -cyanosis -seizures |
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respiratory distress in the term newborn
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-common sx
-one common cause is transient tachypnea of the newborn (TTN) -result of retained fetal lung fluid -assoc with mild to mod O2 requirement -infant born by C/S or shot labor. Resp. distress present from birth -CXR shows perihilar streaking and fluid fissures -usually resolves in 24 hours |
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meconium aspiration
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-infant usually full term or near full term
-fetal distress prior to delivery. meconium passed into amniotic fluid before delivery -ssx: resp distress from birth with barrel chest and coarse breath sounds -pneumonitis may require O2 and/or mechanical ventilation |
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meconium aspiration- CXR
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-coarse irregular infiltrates, hyperexpansion, =/- lobar infiltrates.
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meconium aspiration mgmt
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-supportive care
-ventilatory support as needed -infants at risk for penumonia or pneunothorax |
