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OB - Spring 2016 > High Risk Newborn - Unit 4 > Flashcards

High Risk Newborn - Unit 4 Flashcards

1
Q

How old is a late preterm infant?

A

Born between 34w 7d and 37w 6 days.

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2
Q

late preterm infant, are they similar to preemies?

A

Yes! They may look physically better but they are still immature.

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3
Q

LPI- temp check every __ to __ hours.

A

3-4 hours.

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4
Q

LPI’s - can they eat right way?

A

Maybe - they have immature suck and swallow reflexes, shorter awake periods, and increased caloric need.

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5
Q

Should LPI’s go home early?

A

NO - they need as much time as possible - and a car seat test.

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6
Q

With the car seat test, do we add time?

A

YES - so PRMC to huntington, they’d have to be in the seat for ~110 minutes (time + 30 min)

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7
Q

what major things are LPI’s at risk for?

A

Respiratory disorders, temperature maintenance, hypoglycemia, hyperbilirubinemia, feeding difficulties, acidosis, infection.

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8
Q

preterm infants - born before the beginning of the ___ week.

A

38th.

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9
Q

what are causes of preterm infants?

A

risk factors for pregnancy problems.

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10
Q

Are there specific appearance/behavioral things for preterm infants?

A

Yes

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11
Q

What should the axillary temp be for a preterm infant?

A

97.3-98.4

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12
Q

do preterm infants have problems with fluid and electrolyte balance?

A

YES

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13
Q

Should babies have non-specific fluid running, like 1ml?

A

NO - VERY specific, to the 0.1 ml/hr mark.

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14
Q

what are some skin problems for babies?

A

fragile, permeable easily damaged. We need to assess frequently.

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15
Q

preterm infants - 3-10 greater incidence in premature infants than term infants. T/F?

A

TRUE

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16
Q

pain - are preterm infants at risk?

A

YES - use the NIPS pain scale.

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17
Q

are preterm infants at risk for stimulus overload?

A

YES - so schedule care together, promote rest, promote motor development, individualize care, etc.

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18
Q

when are infants typically ready for nipple feeding?

A

34-35 weeks.

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19
Q

If the baby has to go to the NICU, how can we help the parents?

A

Let them tour before, give them info, etc.

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20
Q

what is kangaroo care?

A

let the baby be in a diaper on parents chest!

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21
Q

what is respiratory distress syndrome?

A

caused by insufficient production of surfactant in the lungs.

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22
Q

What are some manifestations of RDS? Treatment?

A

tachypnea, tachycardia, nasal flaring, retractions, grunting, cyanosis, acidosis. Might need CPAP, surfactant, high frequency ventilators (kind of shakes the chest)

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23
Q

what is bronchopulmonary dysplasia?

A

aka Chronic Lung Disease - - damage to the infant’s lungs requires prolonged dependence on supplemental oxygen.

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24
Q

How is bronchopulmonary dysplasia manifested? Treated?

A

inability to be weaned from respiratory support of oxygen. Treated with diuretics and such.

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25
Q

What is an intraventricular hemorrhage?

A

BLeeding into and around the ventricles - comes form the fragile blood vessels and pressure increase - Graded 1-4 (1 = smallest, 4 is horrible).

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26
Q

what is retinopathy of prematurity?

A

Injury to the blood vessels in the eye. might cause blindness. High level of O2 is a risk factor.

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27
Q

what is necrotizing enterocolitis ?

A

Serious inflammatory condition of the intestinal tract. May lead to cellular death of areas of intestinal mucosa.

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28
Q

How does necrotizing enterocolitis manifest?

A

increased abdominal girth, gastric residuals, decreased/absent bowel sounds, loops of the bowel, vomiting, bile stained emesis, abdominal tenderness, signs of infection, occult blood in the stool, etc.

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29
Q

what is short bowel syndrome?

A

A bowel that is shorter than normal. Caused by surgical or congenital malformations. Malabsorption, diarrhea, and failure to thrive are manifestations.

30
Q

how old is a post-term infant?

A

born after the 42nd week of gestation.

31
Q

What are some issues with a post-term infant?

A

large baby, placental function decreases, poor oxygen reserves, they might get stuck when coming out, etc.

32
Q

what are some causes of a small for gestational age infant?

A

congenital malformation, chromosomal abnormalities, genetic factors, multiple gestations, fetal infections, poor placental function, diabetes, HTN, smoking/drugs/alcohol, severe malnutrition, etc

33
Q

Is it better than the better be small all around or have a big head and small body?

A

Big head, small body. Shows the problem occurred later.

34
Q

what causes an LGA baby?

A

multiparas, large parents, obese moms, ethnic groups, diabetes, etc.

35
Q

what is asphyxia?

A

insufficient oxygen and excess CO2 in the blood and tissues - may occur at any point. Results in ischemia.

36
Q

What are some maternal factors for asphyxia?

A

HTN, infection, drug use

37
Q

what are some placental factors for asphyxia?

A

Placenta previa, abruptio placentae, post maturity, etc.

38
Q

What are some fetal factors for asphyxia?

A

cord problems, infection, premature birth, multifetal gestation

39
Q

does anaerobic metabolism or aerobic metabolism occur for asphyxia?

A

Anaerobic, which produces lactic acid, thus causing metabolic acidosis/respiratory acidosis from CO2

40
Q

Asphyxia - vasoconstriction doesn’t happen. T/F?

A

FALSE - it does, but it constricts so only the brain/heart/adrenal glands get perfused.

41
Q

what are some manifestations of asphyxia?

A

Rapid respirations followed by no respirations.

42
Q

What infants are at risk for asphyxia?

A

Complications during labor/birth/etc. Narcotics/naloxone as well.

43
Q

what is the difference between primary and secondary apnea?

A

Primary = you can stimulate the babies and it’s all better.

Secondary - you can’t. Start resuscitation efforts.

44
Q

what is transient tachypnea of the newborn?

A

Rapid respirations soon after birth from inadequate absorption of fetal lung fluid.

45
Q

what causes TTN?

A

possible delayed absorption of lung fluid.

46
Q

How does TTN manifest?

A

tachypnea within 6 hours of birth - - - grunting, flaring, retracting, mild cyanosis - - - Xrays show hyperinflation, streaking, fluid, etc.

47
Q

How do we manage TTN?

A

O2, gavage feeding, antibiotics until sepsis is ruled out.

48
Q

what is meconium aspiration syndrome?

A

Obstruction/chemical pneumonitis and air trapping caused by meconium in the lungs.

49
Q

How does MAS manifest?

A

respiratory distress (tachy, cyanotic, retractions, nasal flaring, grunting, rales, barrel chest)

50
Q

how do we manage MAS?

A

suctioning at delivery, respiratory support, ECMO

51
Q

what is persistent pulmonary hypertension of the newborn/

A

pulmonary vasoconstriction after birth and causes increased vascular resistance in the lungs?

52
Q

What causes PPHN?

A

term or post term, inadequate oxygenation due to vasoconstriction in the pulmonary artery/vessels/increased resistance in the lungs/rise in pressure of right side of heart. Right to left shunt of blood also happens, along with metabolic acidosis that also causes more vasoconstriction.

53
Q

When does PPHN occur? signs?

A

within 12 hours of birth - manifests with tachypnea, respiratory distress, progressive cyanosis, decreased O2 sat, decreased ph, decreased pao2, increased PaC02

54
Q

how do we manage PPHN?

A

fix underlying cause of poor oxygenation and relieve pulmonary vasoconstriction, sedation, inhaled nitric oxide or ECMO

55
Q

what is pathologic jaundice?

A

Nonphyiologic jaundice - may be seen in first 24 hours of life. High bili!

56
Q

What is the most common cause of hyperbili?

A

maternal/fetal blood incompatibility.

57
Q

how do we treat hyperbili?

A

coombs or DAT test, TcB and TSB levels, phototherapy, exchange transfusions

58
Q

what is the difference between early and late onset sepsis?

A

early - within first 23 hours.

Late = 8-90 days after birth!

59
Q

Neonatal mortality rate is _ X higher than that of infants born to mothers without diabetes.

A

5

60
Q

long term diabetes can cause vascular changes causing fetal growth restriction. T/F?

A

True

61
Q

polycythemia - HgB level greater than 22g/dl and a hct greater than 65% - T/F/

A

TRUE

62
Q

what are some manifestations of polycythemia? treatment?

A

plethoric color, lethargy, poor tone, tremors, abdominal distention, decreased bowel sounds, poor feeding, hypoglycemia, respiratory distress, hyperbili, etc

Support and treat with possible partial exchange transfusion.

63
Q

what is hypocalcemia?

A

total serum concentration less than 7.

64
Q

what is the difference between early and late onset hypocalcemia?

A 
early = first 72 hours.
Late = 1 week.
65
Q

what causes early onset hypocalcemia?

Late onset?

A

early - asphyxia, IDM, maternal anticonvulsant therapy, delayed nutrition.
late = hyperpathyroidism, malabsorption, low mangesium levels, diuretic therapy, rickets.

66
Q

what are some manifestations of hypocalcemia? management things?

A

irritability, jitteriness, poor feeding, high pitched cry, muscle twitching, apnea, seizures, electrocardiographic changes.

Treated with lab test of calcium serum level and IV calcium gluconate.

67
Q

what is PKU?

A

Genetic disorder that causes CNS injury. Caused by issues with converting phenylalanine to tyrosine. musty odor of urine/vomting/etc are manifestations.

68
Q

when is the PKU diet started?

A

3 weeks after birth and for life.

69
Q

what are some manifestations of cardiac defects?

A

Cyanosis, murmurs, fatigue, tachypnea, slow weight gain, diaphoresis.

70
Q

is PDA cyanotic or acyanotic?

A

Acyanotic.

71
Q

transposition of the greater vessels - cyanotic or not?

A

CYANOTIC.

OB - Spring 2016 (18 decks)

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