OB-Peds Test 3
Terms
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- High risk newborn def.
- Newborn at risk for morbidity or mortality due to immaturity, physical disorders, or birth injury.
- Identification of at-risk newborns
- 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
- Fetal death rate
- Death of fetus weighing 500 g or more which is about 20 wks. EGA, reflects overall quality of healthcare of a nation
- Post term infant
- 42+ wks, 5% have post maturity syndrome
- Post maturity syndrome
- hypoglycemia, meconium aspiration, polycythemia (incr. RBCs, compensatory r/t decr. O2), congenital abnormalities, seizures, cold stress
- Pre-term infant
- <37 weeks
- Preterm characteristics
- 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
- Preterm thermoregulation
- High ratio of BSA to body weight, lack of subq fat, skin thin, extension (not flexion) of extremeties, less ability for vasoconstriction, poor shivering
- IDM
- Infants of diabetic mothers, highest rate of congenital anomalies, macrosomia (excessive growth), incr. fetal insulin-acts as GH
- Complications of IDM
- Hypoglycemia, hypocalcemia, hyperbilirubinemia, birth trauma, polycythemia, RDS, congenital anomalies, risk for undiagnosed immaturity,
- Necrotizing enterocolitis
- 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,
- Respiratory Distress Syndrome
- Immature lungs, not enough surfactant, hypoxia due to incomplete gas exchange, resp. acidosis, metabolic acidosis, tachypnea, nasal flaring, grunting, decr. sats, retractions and cyanosis
- Tx and prevention of RDS
-
Give mom steroids if expecting a preterm delivery (3 doses right before delivery) to help w/ surfactant prod.
Tx: oxygen therapy, mechanical ventilation - Retinopathy of prematurity
- 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
- Hyperbilirubinemia in preterm infant
- Hypoglycemia, anemia, hemorrhagic dz, inability to conjugate bilirubin (decr. liver enzymes)
- Preterm neurological system
- Lack of brain development, disturbed sleep cycles, defelop. will occur, just takes time, delayed reactivity, weaker responses
- Pre-term nutrition
- Higher caloric requirements (110-130 kcal/kg/day), higher protein needs, may need parental supplementation, poor sucking, may require gavage (tube feeding)
- Failure to thrive: two types
-
Not growing
Organic: physiological cause (mechanical problem), drugs, short gut, etc...
Inorganic: maternal deprivation or parental deprivation, lack of nurture, emotional detachment from caregiver - HIV exposed infant
- 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
- Persistant fetal circulation
- Lack of normal changes in heart after birth, changes in pressure stimulate closing of the holes. Both exist to bypass lungs.
- Ductus arteriosus
- Pulmonary artery to aorta
- Foramen ovale
- RA-LA
- Clubbing
- implies severe congenital heart disease, which usually does not appear until after the first year of age
- Pulse an BP in infant
- take all bilaterally, hypotn and htn are both ABnormal, should be no diff. in BP in BUE and BLE
- Decreased pulmonary blood flow
- 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
- Tetralogy of Fallot
-
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 - Pulmonary stenosis
- Obstruction of blood flow b/w RV and PA. Newborn w/ severe stenosis is an emergency. Tx w/ balloon dilatation or valve surgery
- Overriding aorta
- aortic valve is enlarged and appears to arise from the right and left ventricles, in anatomical wrong position
- Tx of Tetralogy of Fallot
- Prostaglandin (hopefully will re-open ductus arteriosus and incr. pulm. flow), surgical repair, long-term follow-up needed
- D/O w/ increased pulmonary flow
- 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
- Atrial septal defects
- 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
- Ventricular septal defect
- 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
- PDA
- 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
- Objective data w/ PDA
- tachypnea and tachycardia, sweating, freq. resp. infections, greater fatigue, and/or poor G and D.
- Tx for PDA
- 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
- Obstructive d/o
- Inability of the blood to pump into the peripheral circulation. Diminished pulses, poor color, slow cap refil, decr. output, poor circ.
- Coarctation of the aorta
- Narrowing of the aorta, where ductus arteriosus attaches->CHF
- Aortic stenosis
- problem w/ aortic valve, obstruction of flow from LV to aorta. Lightheadedness, fainting spells, esp. w/ exercise
- Transposition of great vessels
- Aorta and PA attached to wrong ventricle. If opening b/w ventricles present, may get adequate oxygenation. Requires surgery. Give prostaglandins
- PGE1
- Tx: for htn, causes vasodilation and smooth muscle relaxation. Preserves a PDA. Report all s/e to physician
- Indomethicin
- Used to close a PDA. NSAID. Monitor for hypersensitivity
- What to do in case of poisoning
-
1. Terminate exposure
2. Identify substance
3. Call poison control
4. Assess vital signs - Gastric lavage
- For infants, comatose, or seizing children. Activated charcoal mixed w/ water or diet soda
- S/S of lead poisoning
- seizure, coma, death, mental retardation
- Tx of lead poisoning
- Chelation therapy, removes lead from blood. Drugs: British antilewisite, calcium disodium edetate
- Acute seizure
- Caused by fever, brain infection, lesion, tumor, or hemorrhage, edema, lead ingestion, f/e imbalance, alter. in metabolism (Diabetes, meningitis)
- Partial seizure
- Arise from cerebral cortex affecting frotnal, parietal, and temporal lobes. Localized motor, somatosensory, psychic or autonomic symptoms. Don't affect the whole body
- Simple partial seizure
- No loss of consciousness, simple symptoms, ex: eye mov't or head turning
- Complex partial seizure
- Loss of consciousness, psychomotor, begin w/ aura, repetition of activities (chewing, drooling, swallowing, repeating words)
- Partial seizures that generalize
- Simple or complex partial that become tonic-clonic seizure
- Atonic seizure
- Partial seizure w/ sudden loss of muscle tone (drop attack), may or may not lose consciousness
- Myoclonic seizure
- sudden brief contraction of muscles, no LOC or postichtal state
- Generalized seizures
- no aura, involve both brain hemispheres, may be assoc. w/ mental retardation or behavior learning problems prior to age 4.
- Tonic-clonic seizure
-
(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 - Absence seizures
- (Petit-mal) Ryan's. May drop what they're holding, 5-10 sec.
- Highest priority nursing intervention after a seizure
- Give O2 and clear airway