Ob-Peds Test 3

Front 1

High risk newborn def.

Back 1

Newborn at risk for morbidity or mortality due to immaturity, physical disorders, or birth injury.

Front 2

Identification of at-risk newborns

Back 2

Low SES (lack of access to healthcare, little or no PNC), toxin chemical, or drug exposure, polluted envir., diff. labor, maternal parity, age, preterm labor, illness, multiple gestation

Front 3

Fetal death rate

Back 3

Death of fetus weighing 500 g or more which is about 20 wks. EGA, reflects overall quality of healthcare of a nation

Front 4

Post term infant

Back 4

42+ wks, 5% have post maturity syndrome

Front 5

Post maturity syndrome

Back 5

hypoglycemia, meconium aspiration, polycythemia (incr. RBCs, compensatory r/t decr. O2), congenital abnormalities, seizures, cold stress

Front 6

Pre-term infant

Back 6

<37 weeks

Front 7

Preterm characteristics

Back 7

Translucent skin, lacking subq fat, pink, ruddy, or acrocyanotic, lanugo, large head, minimal ear cartilage, immature genitals, flaccid posture, weak cry, weak reflexes, jerky mov't, not corrdinated

Front 8

Preterm thermoregulation

Back 8

High ratio of BSA to body weight, lack of subq fat, skin thin, extension (not flexion) of extremeties, less ability for vasoconstriction, poor shivering

Front 9

IDM

Back 9

Infants of diabetic mothers, highest rate of congenital anomalies, macrosomia (excessive growth), incr. fetal insulin-acts as GH

Front 10

Complications of IDM

Back 10

Hypoglycemia, hypocalcemia, hyperbilirubinemia, birth trauma, polycythemia, RDS, congenital anomalies, risk for undiagnosed immaturity,

Front 11

Necrotizing enterocolitis

Back 11

NEC: shunting of blood from GI tract to heart and brain during crises, leaves bowel with decreased blood flow->necrosis. Feeding intolerance, vomiting and diarrhea, blood in stools, poor butrition,

Front 12

Respiratory Distress Syndrome

Back 12

Immature lungs, not enough surfactant, hypoxia due to incomplete gas exchange, resp. acidosis, metabolic acidosis, tachypnea, nasal flaring, grunting, decr. sats, retractions and cyanosis

Front 13

Tx and prevention of RDS

Back 13

Give mom steroids if expecting a preterm delivery (3 doses right before delivery) to help w/ surfactant prod.
Tx: oxygen therapy, mechanical ventilation

Front 14

Retinopathy of prematurity

Back 14

Injury to capillaries behind eyes, ischemia leads to spasms of vessels, need supplemental O2, too much O2 causes vasoconstriction->more damage. Hemorrhage, scarring, retinal detachment, and blindness. Tx: laser therapy

Front 15

Hyperbilirubinemia in preterm infant

Back 15

Hypoglycemia, anemia, hemorrhagic dz, inability to conjugate bilirubin (decr. liver enzymes)

Front 16

Preterm neurological system

Back 16

Lack of brain development, disturbed sleep cycles, defelop. will occur, just takes time, delayed reactivity, weaker responses

Front 17

Pre-term nutrition

Back 17

Higher caloric requirements (110-130 kcal/kg/day), higher protein needs, may need parental supplementation, poor sucking, may require gavage (tube feeding)

Front 18

Failure to thrive: two types

Back 18

Not growing
Organic: physiological cause (mechanical problem), drugs, short gut, etc...
Inorganic: maternal deprivation or parental deprivation, lack of nurture, emotional detachment from caregiver

Front 19

HIV exposed infant

Back 19

20-30% vertical transmission in untreated mothers, need c/s delivery if high viral load, otherwise, can be vaginal. Nevaripine med for newborn, can test positive as early as 18 mos. but show symptoms earlier, SGA, thrush, pneumonia

Front 20

Persistant fetal circulation

Back 20

Lack of normal changes in heart after birth, changes in pressure stimulate closing of the holes. Both exist to bypass lungs.

Front 21

Ductus arteriosus

Back 21

Pulmonary artery to aorta

Front 22

Foramen ovale

Back 22

RA-LA

Front 23

Clubbing

Back 23

implies severe congenital heart disease, which usually does not appear until after the first year of age

Front 24

Pulse an BP in infant

Back 24

take all bilaterally, hypotn and htn are both ABnormal, should be no diff. in BP in BUE and BLE

Front 25

Decreased pulmonary blood flow

Back 25

Obstructions to the lungs, results in a failure to oxygenate w/ little or no blood to collect and carry oxygen, cyanosis, don't need O2 supplementation->no blood to lungs

Front 26

Tetralogy of Fallot

Back 26

cardiac congenital anomaly w/ four parts: pulmonary stenosis, ventricular septal defect, overriding aorta, and RV hypertrophy.
Symptoms: cyanosis (tet spells), irritable, sleepy, bending the knees, assuming fetal position, squatting

Front 27

Pulmonary stenosis

Back 27

narrowing of the pulmonary valve, creating an obstruction of blood flow from the RV to PA

Front 28

Overriding aorta

Back 28

aortic valve is enlarged and appears to arise from the right and left ventricles, in anatomical wrong position

Front 29

Tx of Tetralogy of Fallot

Back 29

Prostaglandin (hopefully will re-open ductus arteriosus and incr. pulm. flow), surgical repair, long-term follow-up needed

Front 30

D/O w/ increased pulmonary flow

Back 30

L and R sided connections-high pressure on L side shunts blood back to R and into lungs, may have CHF, R ventricular hypertrophy, tachypnea, tachycardia. Less blood in systemic circ.->Na and water retention, feeding problems, O2 NOT beneficial

Front 31

Atrial septal defects

Back 31

ASD: failure of foramen ovale to shut. Incr. blood vol. to RA->incr. to lungs. Can cause pulm. htn, CHF, atrial arrhythmias, and stroke. Some have spontaneous closure, but if not->surgery

Front 32

Ventricular septal defect

Back 32

Opening b/w RV and LV. Location and size determine severity. Admin. diuretics if CHF, organic failure to thrive, high calorie nutrients, NG feedings, antibiotics

Front 33

PDA

Back 33

Usually closes w/in first 15 hrs. of life. By 72 hrs, 95% have closed. Can re-open w/ hypoxemia. PDA most common in premies

Front 34

Objective data w/ PDA

Back 34

tachypnea and tachycardia, sweating, freq. resp. infections, greater fatigue, and/or poor G and D.

Front 35

Tx for PDA

Back 35

Antibiotic to prevent endocarditis and/or resp. infections, Indomethicin to constrict the muscle in wall of the PDA, for older kids, coils can be placed during cardiac cath

Front 36

Obstructive d/o

Back 36

Inability of the blood to pump into the peripheral circulation. Diminished pulses, poor color, slow cap refil, decr. output, poor circ.

Front 37

Coarctation of the aorta

Back 37

Narrowing of the aorta, where ductus arteriosus attaches->CHF

Front 38

Aortic stenosis

Back 38

problem w/ aortic valve, obstruction of flow from LV to aorta. Lightheadedness, fainting spells, esp. w/ exercise

Front 39

Pulmonary stenosis

Back 39

Obstruction of blood flow b/w RV and PA. Newborn w/ severe stenosis is an emergency. Tx w/ balloon dilatation or valve surgery

Front 40

Transposition of great vessels

Back 40

Aorta and PA attached to wrong ventricle. If opening b/w ventricles present, may get adequate oxygenation. Requires surgery. Give prostaglandins

Front 41

PGE1

Back 41

Tx: for htn, causes vasodilation and smooth muscle relaxation. Preserves a PDA. Report all s/e to physician

Front 42

Indomethicin

Back 42

Used to close a PDA. NSAID. Monitor for hypersensitivity

Front 43

What to do in case of poisoning

Back 43

1. Terminate exposure
2. Identify substance
3. Call poison control
4. Assess vital signs

Front 44

Gastric lavage

Back 44

For infants, comatose, or seizing children. Activated charcoal mixed w/ water or diet soda

Front 45

S/S of lead poisoning

Back 45

seizure, coma, death, mental retardation

Front 46

Tx of lead poisoning

Back 46

Chelation therapy, removes lead from blood. Drugs: British antilewisite, calcium disodium edetate

Front 47

Acute seizure

Back 47

Caused by fever, brain infection, lesion, tumor, or hemorrhage, edema, lead ingestion, f/e imbalance, alter. in metabolism (Diabetes, meningitis)

Front 48

Partial seizure

Back 48

Arise from cerebral cortex affecting frotnal, parietal, and temporal lobes. Localized motor, somatosensory, psychic or autonomic symptoms. Don't affect the whole body

Front 49

Simple partial seizure

Back 49

No loss of consciousness, simple symptoms, ex: eye mov't or head turning

Front 50

Complex partial seizure

Back 50

Loss of consciousness, psychomotor, begin w/ aura, repetition of activities (chewing, drooling, swallowing, repeating words)

Front 51

Partial seizures that generalize

Back 51

Simple or complex partial that become tonic-clonic seizure

Front 52

Atonic seizure

Back 52

Partial seizure w/ sudden loss of muscle tone (drop attack), may or may not lose consciousness

Front 53

Myoclonic seizure

Back 53

sudden brief contraction of muscles, no LOC or postichtal state

Front 54

Generalized seizures

Back 54

no aura, involve both brain hemispheres, may be assoc. w/ mental retardation or behavior learning problems prior to age 4.

Front 55

Tonic-clonic seizure

Back 55

(Grand-mal), occurs w/o warning:
Tonic phase: rolling of the eyes upward, LOC, may fall if standing, flex arms, legs, head and neck
Clonic: intense jerking mov't, oral secretions, incontinent, postictal phase

Front 56

Absence seizures

Back 56

(Petit-mal) Ryan's. May drop what they're holding, 5-10 sec.

Front 57

Highest priority nursing intervention after a seizure

Back 57

Give O2 and clear airway