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34 Cards in this Set

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Why is phototherapy begun at lower bilirubin levels if the infant is preterm rather than full term?
Bilirubin encephalopathy is more likely to occur at lower bilirubin levels in the preterm infant than in the term infant.
Which is more ominous, primary or secondary apnea? Why?
Secondary apnea is more ominous because stimulation is not enough to reverse it, blood oxygen levels decrease further, and the infant loses consciousness.
What is jaundice?
Jaundice is the staining of the skin and sclerae by bilirubin.
Explain respiratory distress syndrome in the infant of a diabetic mother.
High fetal insulin levels interfere with surfactant production.
What is bilirubin encephalopathy?
Bilirubin encephalopathy is an extension of kernicterus to include damage to brain tissue by the bilirubin staining.
What is kernicterus?
Kernicterus occurs when the bilirubin levels are high enough to stain the brain tissue.
What is bilirubin?
Bilirubin is the waste product of excess erythrocyte breakdown after birth.
Which neonatal infection(s) is mental retardation normally associated with?
Cytomegalovirus, herpes (with disseminated infection), rubella, and toxoplasmosis.
What antibiotic may be given to high-risk mothers in labor or to infant after birth?
Group B streptococcal infection.
What is the purpose of an exchange transfusion?
Exchange transfusion replaces the infant's blood that has high levels of bilirubin, low erythrocytes, and many sensitized erythrocytes with blood that has normal levels of these components. Also, the blood that replaces the infant's blood isnot sensitive to the circulating antibodies from the mother that have destroyed the infant's own erythrocytes.
Which neonatal infection is typically manifested by white patches in the mouth that resemble milk curds?
Candidiasis, which may also occur in the infant with AIDS.
Antibiotic prophylaxis soon after birth an prevent blindness in what neonatal infection(s)?
Gonorrhea, chlamydia
Maternal antiviral treatment during pregnancy can reduce transmission to infant in which neonatal infection(s)?
Human immunodeficiency virus/ AIDS
Why are tests for drug levels often needed for antibiotics?
Blood is analyzed at the highest (peak) and the lowest (trough) levels to provide a basis for any needed changes in dosage and to prevent toxic effects on body tissues.
List factors that make newborns more vulnerable to sepsis neonatorum.
Immune system immaturity, with a slower reaction to invading organisms; poor localization of infection that allows more extensive spread of infection; less effective blood-brain barrier.
Why is it particularly important to identify newborn sepsis early?
Septic shock can develop quickly.
What are the characteristics of early-onset sepsis?
Early-onset sepsis is related to prolonged rupture of membranes, prolonged labor, or chorioamnionitis; it begins within 24 hours of birth and progresses more rapidly. Mortality is 15% to 20%. It often involves the respiratory system or central nervous system.
How can diabetes cause both intrauterine growth restriction and large-for-gestational-age infants?
If the diabetic woman has vascular changes, placental blood flow may be reduced, interfering with fetal growth. If the diabetic woman does not have vascular changes and her glucose levels are poorly controlled, she transfers large amounts of nutrients to the fetus. The fetus secretes large amounts of insulin to metabolize these nutrients, resulting in macrosomia.
What are the characteristics of Late-onset sepsis?
Late-onset sepsis develops after 1 week and is caused by exposure to organisms after birth. It usually involves the central nervous system. Mortality is 10% to 20% with frequent long-term effects.
Which neonatal infection(s) is preventable through immunization?
Hepatitis B, rubella
If meconium is present in the amniotic fluid, the infant's mouth and pharynx should be suctioned after the head is born but before the rest of the body. The primary reason for this action is to
a. limit transfer of infectious substances to the lower airways
b. reduce the likelihood that secondary apnea will occur
c. prevent persistence of abnormal cardiac shunts
d. avoid drawing meconium into the lower airways with the first breath
d
List infant behaviors that should cause a nurse to suspect prenatal drug exposure.
Infants appear hungry, but suck and swallow are poorly coordinated; frequent regurgitation, vomiting, and diarrhea; signs typical of hypoglycemia but with a normal blood glucose level; restlessness; failure to gain weight.
Why is th IDM infant more likely to need phototherapy?
A high hematocrit level before birth means there are more erythrocytes to break down and release bilirubin. The high bilirubin load cannot be elimated quickly by the liver.
Explain the complication polycythemia in the infant of a diabetic mother.
Poor oxygenation requires that the fetus make more erythrocytes.
Explain the complication hypocalcemia in the infant of a diabetic mother.
Parathyroid hormone production is reduced.
Explain hypoglycemia in the infant of a diabetic mother.
Maternal glucose supply ends, but the infant temporarily continues a high level of insulin production.
What blood glucose level indicates hypoglycemia in the newborn?
Glucose screening test results of less than 45 mg/dl indicate hypoglycemia.
List signs of neonatal hypoglycemia.
Signs include jitteriness, tremors, diaphoresis, rapid respirations, low temperature, poor muscle tone.
Describe the typical appearance of a macrosomic infant of a diabetic mother (IDM).
Length and head circumference are usually normal for the gestational age. The face is round and red, the body is obese, and muscle tone is poor. The infant is irritable and may have tremors when disturbed.
Why are gavage feedings sometimes needed for the drug-exposed infant, even if born at term?
The infant has poor coordination of suck and swallow, reducing actual milk intake. At the same time, energy expenditure is high because of excess activity.
Nalaxone for neonatal use is supplied in 1 mg/ml vials. The correct volume of nalaxone for a neonate weighing 5 pounds, 2 ounces is approximately
a. 0.1 ml
b. 0.2 ml
c. 0.3 ml
d. 0.4 ml
b
How does the newborn manifest infection compared with an older child?
Signs of infection are often subtle. They include temperature instability, respiratory problems, changes in feeding habits or behavior.
What is the difference between primary and secondary apnea?
In primary apnea, the infant may respond to stimulation when respirations cease. In secondary apnea, the infant does not respond to stimulation and loses consciousness.
Infants receiving phototherapy should be fed every 2 to 3 hours to
a. promote excretion of bilirubin from the bowel
b. prevent development of hypothermia
c. increase the lifespan of fetal erythrocytes in the blood
d. increase renal and liver perfusion
a