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OB-Peds Test 3


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

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