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65 Cards in this Set
- Front
- Back
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Causes vasospasm and constriction
Decreased placental blood flow Increased CO2 inactivated fetal Hgb Decreases fetal O2 Increases low birth weight and Prematurity Increases SIDS and Pneumonia ADHD and short attention spans? |
Nicotine
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Permanent
Growth and Development lags (physical & mental) CNS dysfunction Facial Anomalies Need for long term support Broad nasal bridge Short palpebral fissure Short upturned noses Flat midface Epcanthal folds Absent filtrum Small jaws? |
Fetal Alcohol Syndrome/Effects
Neonatal Abstinence Syndrome (Withdrawal) |
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Often used with marijuana/cocaine/heroin
Withdrawal sighns may take 3-4 days or up to 10-15 days and last for weeks or months? |
Opiates
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Intrauterine asphyxia, intrauterine infection, alterations in birth weight, low apgars, respiratory distress, jaundice, congenital anomalies and growth retardation, behavioral abnormalities, withdrawal?
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Greatest risks to drug dependent infants (list 1)
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Often SGA, fetus gets greater effect from cocaine then mom, increased risks of >ICP, neonatal tremors/tachycardia, marked irritability and muscle rigidity, HTN, >startle reflex, dificult to console, poor feeders/diarrhea, poor suck/swallow, failure to thrive?
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Greatest risks to drug dependent infants (list 2)
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Swaddle, rock upright, quiet, dim environment, organize care, taper drugs slowly - valium, phenobarbital, tincture of paregoric?
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Pain nursing care of drug dependent infants
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Frequent feeds, slow feeders, monitor respiratory rate?
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Nutrition nursing care of drug dependent infants
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Protect bony prominences and perineum?
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Skin nursing care of drug dependent infants
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Altered Nutrition
Sleep pattern disturbance Altered Parenting Ineffective family coping? |
Nursing Diagnosis to consider for drug dependent infants
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Limit sensory stimulation in?
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Drug dependenct infants
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Referral, support, observe behaviors and be a role model for how to handle their baby?
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Parenting support in the NICU
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What is the Nic for the Abuse/Protection/Support of the child as it goes out into the world?
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NIC 6402
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Hyperactivity
Hyperirritability (persistent shrill cry) Increased muscle tone Exaggerated reflexes Tremors and myoclonic jerks Sneezing, hiccups, yawning Short, unquiet sleep Fever (accompanies the increased neuromuscular activities) |
Central nervous system signs of a drug dependent infant
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Tachypnea (>60 breaths per minute)
Excessive secretions |
Repiratory signs of a drug dependent infant
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Disorganizd, vigorous suck
Vomiting Drooling Sensitive gag reflex Hyperphagia Diarrhea Abdominal cramping Poor feeding (<15ml on first day, takes longer than 30 minutes per feeding)? |
Gastrointestinal signs of a drug dependent infant
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Stuffy nose, yawning, sneezing
Flushing Sweating Sudden, circumoral pallor? |
Vasomotor signs of a drug dependent infant
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Excoriated buttocks, knees, elbows
Facial scratches Pressure-point abrasions |
Cutaneous signs of a drug dependent infant
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Neonates experience pain by __ weeks.
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28
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Tuck
Glucose sucking Kangaroo Care Massage/stroke Adjust stimulus to gestational age/condition |
Containment measures in the NICU
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Kangaroo care?
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Skin-to-skin
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What is the NIC for Touch?
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5460
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What is the NIC for Kangaroo Care?
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6840
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What is the NIC for Developmental Care?
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6824
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What is the NOC for Pain?
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2102
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Usually periventricular and is most common in <32 weeks
Increased CO2 and associated with RDS Increased cerebral blood flow in fragil vascular network? |
Intra-cranial Hemorrhage
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Avoid clustering activities
Allow rest Avoid stimuli Prevent pain Regulate B/P Suctioning increses ICP, so minimize suctioning Screen those at risk with ultrasound May require shunts? |
Nursing Care for Intra-Cranial Hemorrhage
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What is the NOC for Neurological Status?
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0909
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Neonate with congenital defects is at risk for altered growth and development on a?
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Genetic basis
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What is the Nic for Newborn Monitoring concerning the Neonate with Congenital Defects?
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6890
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What is the Nic for Surveillance concerning the Neonate with Congenital Defects?
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6650
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Gland either absent or non functioning, retarded physical and mental development
Mandatory testing S/S evident by 3-6 (by now time has been lost that is why testing is mandatory) Require daily hormone replacement? |
Hypothyroidism
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(autosomal recessive)
Lack the enzyme to convert galactose into glucose Results in cataracts, mental retardation or death Require galactose free diet and formula Signs - lethargy, hypotonia, diarrhea/vomiting, hepatomegaly, cirrhosis? |
Galactosemia
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S/S are lethargy, hypoglycemia, hypotonia, diarrhea and vomiting, failure to thrive
enlarge liver, jaundice, cirrhosis, cataracts, mental retardation Toxic levels destroy body cells in vital organs can die as quickly as 3 days if endetected Screening test Buetler Test from cord blood if history in family? |
Galactosemia
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(autosomal recessive)
Lack the enzyme to convert phenylalanine into tyrosine Results in severe mental retardation Seizure Atopic dermatitis Test after feeding Requre phenylalanine free diet/formula Lofenlac? |
Phenylketonuria
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1 in 10, - 25,000 in the USA
More common in northern European descent, blonde hair, blue eyes Decreased pigmentation S/S by six months of age Should have milk for at least 24 hrs or 120cc (may need repeating)? |
Phenylketonuria
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(autosomal recessive)
Lack the enzyme needed for lipid metabolism Results in mental retardation, blindness, death by 3-5 years from malnutrition and pneumonia S/S - extreme Moro reflex, hypotonia Genetic counseling for parents? |
Tay-Sachs
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Occuring along the spine and the brain stem?
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Head to Tail/Flipper Variations
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Trisomy 21 (Down Syndrome)
Occurs in 1/800 biths, in moms over 35yrs can be as high as 1/100 Nondisjuction, translocation, mosaicism Results in mental retardation and heart defects Signs - hypotonia, low set ears, big tongue, simian crease, eye folds, short broad hands |
Head to Tail/Flipper Variations
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Lack of fusion of the posterior suface of the embryo related to Nutritional Deficiency?
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Neural Tube Defects
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Medulla without cerebral hemispheres, occurs before day 26
Difficult birth, due to unengaged head or breech position Stillborn Death Elective terminations? |
Anencephaly
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CSF obstructed flow or reabsorbsion
Ventricles enlarge Check head circumference, prevent skin breakdown, prevent infection Support and position VP shunts? |
Hydrocephalus
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Slow brain growth resulting in mental retardation
Differs from craniosyntosis - normal brain with fused sutures History of maternal infection - Rubella, CMV, Toxoplasmosis, severe malnutrition, anoxia Small head circumference, check for increasing ICP |
Microcephaly
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Meninges herniated vs myelomeningocele which includes spinal cord and nerve roots
Prevent pressure, infection Keep sac moist with saline sterile dressing Check head circumference Check fo lower extremity movement Check elimination |
Meningocele
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Benign without protruding sac
Common at L5 to S1 Look for dimple or tuft of hair Use correct terminology Maybe dermoid cyst or hemangioma Mildest form? |
Spina bifida occulta
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Obstruction of the posterior nares to the pharynx
Can be membranous or bony prominence Unilateral or bilateral Cyanotic at rest Attempts to mout breath, snorting or retracting Difficult feeders? |
Choanal Atresia
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Because they have excess thick mucous
Hold mouth closed and alternately compress each nostril Attempt to pass NG tube Use oral airway, keep mouth open Gavage feeding Treatment is either peircing or surgical removal This is related to? |
Choanal Atresia
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Failure of the maxillary process to fuse in intra-uterine life
Polygenic Prevent aspiration/infection Use adaptive feeding devices Feed upright, burp often Clean lips and palate Surgical repair? |
Clef lip/Clep Palate
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Abnormal separation of the trachea & esophagus (5 types)
Associated with Polyhdramnios Signs - mucous, bubbles, cyanosis, RDS with first feeding Catheter won't pass to stomach Prevent aspiration, pneumonia, dehydration Elevate HOB, right sided position, suction Prevent crying Humidify air, hydrate baby Protect the skin if esophagostomy is done Repair usually requires multiple surgeries? |
Tracheal Esophageal Fistula
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Abdominal organs protrude into the chest through a defect in the diaphragm
Causing cardiac compression and pneumothorax Risk of permanent pulmonary hypertension Risk of patent ductus and patent foramen Severe RDS The infant will have a flat abdomen and a barrel chest and absent breath sounds The infant needs an endotracheal tube/vent, not a mask NGT Place upright on affected side Possible echmo Prep for surgery? |
Diaphragmatic Hernia
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Aorta and pulmonary artery trade places, RV goes to aorta, LV goes to PA?
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Tranposition of the great vessels
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When the left ventricle lacks musculature and cannot operate effectively
The infant fails quickly May give prostaglandin Staged repair or transplant/high mortality rate Death without correction? |
Hypoplastic Left Heart
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4 defects, cyanotic with mild to sever pulmonary flow obstruction
VSD, Pulmonary Stenosis, Overriding Aorta, Hypertrophy of RV? |
Tetrology of Fallot
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Acyanotic, (left-right), loud murmur
Spontaneous closure Surgical repair needed in 15%? |
Ventral Septal Defects
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What does VSD stand for?
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Ventral Septal Defects
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Acyanotic, bp/p disparity, upper extremities greater than lower extremities
CHF Surgical repair required? |
Coactation of the Aorta
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Acyanotic, left to right
Common in ill premies Increases systolic BP Murmur Give prostaglandin inhibitors (Indomethacin) to trigger closure Surgical repair? |
Patent Ductus Arteriosus
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Rduce O2 demands/conserve energy
Maintain k/calories and fluid balance Prevent infection Feed slowly over 30 to 45 minutes? |
Cardia Care Goals
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Cyanosis disproportionate to RDS
Oxygen does not improve right to left shunts Ashen grey color Murmurs Tachycardia, tachypnea Unequal BP's and pulses? |
Signs of cardiac disease
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Content of abdomen protrudes at the base of the cord (may have closed transparent sac)
Herniated abdominal organs Cover with moist sterile saline dressing or silastic pouch used NGT/TPN for feeding Surgical repair? |
Omphalocele
Abdominal wall defect |
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Content of abdomen protrudes at the away from the cord (may have closed transparent sac)
Herniated abdominal organs Cover with moist sterile saline dressing or silastic pouch used NGT/TPN for feeding Surgical repair? |
Gastroschisis
Abdominal wall defect |
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Occurs with malformed pelvis or penis
Cover with moist sterile saline dressing Wrap symphysis Don't separate legs with a diaper May need artificial bladder? |
Extrophy of the bladder
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Look for uneven leg length/skin folds
Perform ortlani and barlow tests Rotate legs with diapers Ultimate splint, harness, cast or surgery Often caused by breech presentation? |
Congenital Hip Dysplasia
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Serial casting and splinting
Caused often by intrauterine position? |
Club Foot
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Misplace opening of urethra
May be accompanied by a short chordae Don't circumcise Testosterone cream until surgical repair If extensive check for gender error? |
Hypospadius/Epispadius
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Milestone progression within 2 months
Endurance - energy enables activity Muscle function adequate for movement Neurostatus - ability to receive, process and respond to internal and external stimuli Nutrition - provides energy to meet cellular demands Pain - managed Sleep - extent and patterns noted Thermoregulation - balance heat production and loss Growth - normal percentatges increase in body weight and height ? |
Expected outcomes of child development for the infant with a birth defect?
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