Mcn2 Unit 5 Continuation: Care Of The High Risk Newborn

Front 1

isoimmunization / Rh sensitization / hemolytic dse of the fetus

Back 1

Rh incompatibility also called

Front 2

Rh incompatibility

Back 2

when Rh- woman who has experienced Rh isoimmunization subsequently gets pregnant with an Rh+ fetus.

Front 3

begins to break down fetal RBCs -> hemolysis

Back 3

what happens when maternal atb cross placenta to fetal circulation

Front 4

Rh factor

Back 4

a type of protein on the outside of your red blood cells, inherited protein found on surface of the RBC

Front 5

inherit the Rh factor from father

Back 5

a fetus becomes Rh+

Front 6

acquired anti-Rh atb in incompatible BT

Back 6

1st child in no danger unless mother has

Front 7

clump together, or agglutinate = hemolysis, or destruction of RBCs - erythroblastosis fetalis, or hemolytic disease of the NB

Back 7

when foreign RBCs are attacked

Front 8

4 complications of Rh incompatibility

Back 8

pathological jaundice

hydrops fetalis

kernicterus

death

Front 9

erythrocyte

Back 9

normal blodo cell is called

Front 10

spherocyte

Back 10

erytrocytes that are sphere-shaped

Front 11

hydrops fetalis

Back 11

a life-threatening condition abnormal amounts of fluid accumulate in two or more body areas of an unborn baby.

Front 12

abdomen, around the heart or lungs, under the skin

Back 12

where does fluid build-up in hydrops fetalis most commonly occur (4)

Front 13

kernicterus

Back 13

a type of brain damage that can result from high levels of bilirubin in a baby's blood.

Front 14

> athetoid cerebral palsy

> hearing loss

> vision and teeth problems

> intellectual disabilities

Back 14

what can kernicterus cause (5)

Front 15

bilirubin encephalopathy

Back 15

kernicterus is also a name for

Front 16

Immunoglobulin injection / RhoGAM

Back 16

treatment for Rh incompatibility

Front 17

28th weeks pregnancy AND within 72 hours after delivery

Back 17

Rho Ig is given at what time

Front 18

desensitizes the mother’s blood to Rh (+) blood

Back 18

Injection of immune globulin at 28th weeks of pregnancy is for

Front 19

This is helpful for future pregnancy.

Back 19

Injection of immune globulin within 72 hours after delivery is for

Front 20

- ammniocentesis to determine severity

- intrauterine fetal transfusion

- early induction of labor

- direct transfusion of RBC & exchange transfusion of the NB

- control fluid retention & congestive failure

Back 20

treatment for hydrops fetalis (5)

Front 21

mother = type O

fetus = A, B, AB

Back 21

ABO Incompatibility is an immune reaction that occurs when mother has ty pe __ blood & fetus has type ____ blood.

Front 22

ABO incompatibility

Back 22

occurs more frequently than Rh incompatibility, causes less severe problems, rarely results in hemolytic disease severe enough to be clinically diagnosed and treated

Front 23

phenotype A (type A blood)

Back 23

> has anti-B antibodies

> negative reaction when mixed with B, AB blood

Front 24

phenotype B (type B blood)

Back 24

> has anti-A antibodies> negative reaction when mixed with A, AB blood

Front 25

phenotype AB (type AB blood)

Back 25

> has no antibodies> no negative reactions when mixed with other ABO blood

Front 26

phenotype O (type O blood)

Back 26

> has both anti-A and anti-B antibodies> negative reaction when mixed with A, B, AB blood

Front 27

sprinkles

Back 27

antigens on the cell surface are sometimes called

Front 28

Rh less common, ABO more common

Back 28

Rh incompatibility vs ABO incompability

FREQUENCY

Front 29

Rh = Rh-

ABO = O

Back 29

Rh incompatibility vs ABO incompabilityBLOOD GROUP: MOTHER

Front 30

Rh = Rh+

ABO = A or B

Back 30

Rh incompatibility vs ABO incompabilityBLOOD GROUP: FETUS

Front 31

Rh = rare

ABO = common

Back 31

Rh incompatibility vs ABO incompabilityFirst born frequency?

Front 32

Rh = more severe

ABO = no increase

Back 32

Rh incompatibility vs ABO incompabilityLater pregnancies severity?

Front 33

Rh = moderate to severe

ABO = mild

Back 33

Rh incompatibility vs ABO incompabilityJaundice severity?

Front 34

Rh = frequent

ABO = rare

Back 34

Rh incompatibility vs ABO incompabilityHydrops fetalis frequency?

Front 35

Rh = frequently severe

ABO = rare

Back 35

Rh incompatibility vs ABO incompabilityanemia frequency/severity?

Front 36

Rh = frequent

ABO = common

Back 36

Rh incompatibility vs ABO incompabilityAscites frequency?

Front 37

Rh = frequent

ABO = common

Back 37

Rh incompatibility vs ABO incompabilityHepatosplenomegaly frequency?

Front 38

Rh = erythroblastosis

ABO = spherocytosis

Back 38

Rh incompatibility vs ABO incompabilityblood smear?

Front 39

Rh = strongly positive

ABO = weakly positive or negative

Back 39

Rh incompatibility vs ABO incompabilityDirect Coomb's Test

Front 40

DCT = anti-Ig is directly added to patient RBCs

ICT = patient plasma is added to test RBC, followed by addition og anti-human IG

Back 40

DCT vs ICT

Front 41

> Polycythemia

> Cephalhematoma

> TORCH infections

> diazepam and pitocin use in labor

> Prematurity

> Gestational age of 34-36 weeks

> Hemolysis from ABO/Rh incom

> Macrosomic infant from GDM mom

> Delayed cord clamping = ^^ rbc volume

> Acidosis

> Delayed meconium passage

> Siblings who had significant jaundice

> Inadequate breastfeeding

> Ethnicity

> Male gender

Back 41

factors that can predispose a neonate to hyperbilirubinemia

Front 42

Polycythemia

Back 42

abnormally high concentration of RBCs

Front 43

Acidosis

Back 43

Decreased albumin binding sites to transport unconjugated bilirubin to the liver due to

Front 44

Delayed meconium passage

Back 44

increases the amount of bilirubin that returns to the unconjugated state and can be absorbed by the intestinal mucosa due to

Front 45

inadequate breastfeeding can lead to

Back 45

leading to dehydration, decreased caloric intake, weight loss, and delayed passage of meconium

Front 46

Ethnicity where hyperbilirubinemia is common

Back 46

> Asian American

> Mediterreanean

> Native American

Front 47

nursing assessment for jaundice

Back 47

> mucous mem

> sclera

> bodily fluids for yellowishness

Front 48

dev't of jaundice and risk for kernicterus

Back 48

> pallor> excessive bruising> dehydration

can lead to

Front 49

> ascites

> congestive heart failure

> edema

> pallor

> jaundice

> hepatosplenomegaly

> hydramnios

> thick placenta

> dilation of umbilical vein

Back 49

clinical manifestations of neonatal jaundice

Front 50

Direct Coombs Test / Antiglobulin testing

Back 50

> used to detect presence of atb against circulating RBCs in the body, which then induce hemolysis> to identify HDN

> used to detect presence of atb against circulating RBCs in the body, which then induce hemolysis> to identify HDN

Front 51

newborn’s RBC have been coated with atb & thus are sensitized

Back 51

(+) DCT results indicate that

Front 52

Hemoglobin concentration

Back 52

Dx test used for evidence of anemia

Front 53

Blood type

Back 53

Dx test used to determine Rh status and any incompatibility of the newborn

Front 54

Total serum protein

Back 54

Dx test used to detect reduced binding capacity of albumin

Front 55

Reticulocyte count

Back 55

Dx test used to identify an elevated level indicating increased hemolysis

Front 56

Nursing Dx for blood incompatibilities

Back 56

> Neonatal jaundice related to Difficulty transitioning to extrauterine life > Risk for injury [effects of treatment] related to

> Risk factors of physical properties of phototherapy and effects on body regulatory mechanisms

> Invasive procedure (exchange transfusion) Abnormal blood profile

> Neonatal jaundice related to Difficulty transitioning to extrauterine life > Risk for injury [effects of treatment] related to > Risk factors of physical properties of phototherapy and effects on body regulatory mechanisms > Invasive procedure (exchange transfusion) Abnormal blood profile > Chemical imbalances> Deficient knowledge [learning need] regarding condition prognosis related to Lack of exposure or recall and information misinterpretation > Risk for infection related to invasive procedure (exchange transfusion) > Risk for impaired attachment related to - SAME AS MAS

> Neonatal jaundice related to Difficulty transitioning to extrauterine life > Risk for injury [effects of treatment] related to > Risk factors of physical properties of phototherapy and effects on body regulatory mechanisms > Invasive procedure (exchange transfusion) Abnormal blood profile > Chemical imbalances> Deficient knowledge [learning need] regarding condition prognosis related to Lack of exposure or recall and information misinterpretation > Risk for infection related to invasive procedure (exchange transfusion) > Risk for impaired attachment related to - SAME AS MAS

> Chemical imbalances> Deficient knowledge [learning need] regarding condition prognosis related to Lack of exposure or recall and information misinterpretation

> Risk for infection related to invasive procedure (exchange transfusion)

> Risk for impaired attachment related to - SAME AS MAS

Front 57

Therapeutic management

Back 57

> Document timing of jaundice onset - essential to differentiate b/n physiologic (>24 hours) & pathologic

> Promote & support successful breastfeeding

> Establish nursery protocols for identifying jaundice, including when a serum bilirubin can be ordered by a nurse

> Measure total serum bilirubin on jaundiced infants in the first 24h

> Interpret all bilirubin levels according to infant’s age in hours

> labs over visual estimate

> infants <38weeks = high-risk

> Provide parents with written & oral information about jaundice at discharge

> Follow-up care & referrals should be based on time of discharge and risk

> Empower parents to make appropriate decisions once home

Front 58

Therapeutic management: Phototherapy

Back 58

> Support parents, encouraging them to interact with their infant.

> Support breastfeeding with one-onone instruction & patience.

> Place infants on their back to expose as much naked skin as possible.

> Provide eye care/protection every time infant is exposed to light.

> Check temperature & environment around infant to prevent overheating.

> Take daily weights ax dehydration

Front 59

Jaundice

Back 59

deposition of bilirubin in dermal & subcutaneous tissue.

Front 60

N. processing of bilirubin in liver -

conjugated to glucuronic acid by UGT enzyme -->

excreted into the bile & removed via the gut.

A. excretion is low/does not work well/ overwhelm by amount of bilirubin = hyperbilirubenemia & jaundice

Back 60

short pathophy of hyperbilirubinemia and jaundice

Front 61

2 treatment for neonatal jaundice

Back 61

> phototherapy

> exchange transfusion

Front 62

phototherapy

Back 62

used to treat newborn jaundice by making it easier for your baby's liver to break down & remove the bilirubin from baby's blood.

Front 63

Photo-oxidation

Back 63

process involved in phototherapy, in which it adds oxygen to the bilirubin so it dissolves easily in water

Front 64

exchange transfusion

Back 64

> provides rapid reduction of circulating bilirubin, so it could represent appropriate treatment in many cases of severe hyperbilirubinemia in the neonatal period.

> involves removal of the infant's blood and simultaneous replacement with compatible donor blood