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EXAM #3 - FAMILY
The Newborn
| Question | Answer |
|---|---|
| Small for Gestational Age | Weights less than 2,500 g (5 lb. 8 oz) at term . At or below 10th percentile. Assessment reveals decreased amount of breast tissue, sunken abdomen, wide skull sutures, poor muscle tone, thin umbilical cord. Complications can include decreased placental function in utero, perinatal asphyxia, hypothermia, hypoglycemia, polycythemia, and meconium aspiration. Risk factors can include maternal drug and alcohol abuse, hyperemesis guanidium |
| Large for Gestational Age | Weighs more than 4,000 g (8 lb. 13 oz). Above the 90th percentile. Appearance includes peeling skin, absent lanugo and vernix caseosa, creases will cover entire soles of feet. Umbilical cord will be thin, meconium-stained skin and fingernails. Complications include birth trauma, hypoglycemia, and jaundice secondary to hyperbilirubinemia. Risk factors include maternal diabetes, multiparity, prior history of macrosomia infant, postdate gestation, maternal obesity, male fetus, and genetics |
| Appropriate for Gestational Age | a newborn that falls between the 10th to 90th percentile |
| Low Birth Weight | 2,500 g (5.5 lb.) |
| Very Low Birth Weight | less than 1,500 g (3 lb. 5 oz.) |
| Extremely Low Birth Weight | less than 1,000 g (2 lb. 3 oz.) |
| Fetal Growth Depends on | GETETICS, PLACENTAL AND MATERNAL FACTORS |
| Transient Tachypnea | Benign, self-limited condition that can present in all infants of any gestational age, shortly after birth. Caused due to the delay in clearance of fetal lung fluid after birth, leading to ineffective gas exchange, respiratory distress, and tachypnea. Symptoms may include rapid breathing rate (over 60 per minute), grunting with breathing, flaring of nostrils, retractions |
| Respiratory Distress Syndrome | Most common lung disease in premature infants. Occurs because the lungs are underdeveloped, and they do not have enough surfactant. Signs are present at birth or within a few hours of birth, such as for expiratory grunting, shallow breathing, nasal flaring, chest wall retractions, seesaw respirations, and generalized cyanosis, fine inspiratory crackles. Chest X-Ray or lung ultrasound may reveal under-expansion, hypo-aeration, bell-shaped thorax, and a diffuse ground-glass like pattern |
| Persistent Pulmonary Hypertension | Symptoms include tachypnea within 12 hours after birth. Marked cyanosis, grunting, respiratory distress with tachypnea, and retractionsA systolic ejection harsh sound (tricuspid insufficiency murmur). Hypotension resulting from both heart failure and persistent hypoxemia. |
| Atelectasis | One of the problems that affect the preterm infant's breathing ability and adjustment to extrauterine life includes an unstable chest wall |
| Perinatal Asphyxia | Occurs when the baby does not receive enough oxygen before, during, or just after birth. Symptoms include Bluish or pale skin color, low HR, weak muscle tone and reflexes, weak cry, gasping or weak breathing, meconium in amniotic fluid. Immediate resuscitation is needed. Resuscitation should continue until the pulse is above 100 bpm, with a good healthy cry, good breathing efforts, pink mucous membranes and tongue. Resuscitation should STOP after 10 minutes if there is no detectable heart rate |
| Meconium Aspiration | is evidenced by the presence of green amniotic fluid with rupture of membranes during labor. There is green staining of the umbilical cord or fingernails. The newborn struggles with breathing by making respiratory efforts and bearing down with abdominal muscles to expel meconium. Manifested by barrel-shaped chest, prolonged tachypnea, progression from mild to severe respiratory distress, intercostal retractions, end-expiratory grunting, and cyanosis. |
| Neonatal Hemolytic Disease | disease of the newborn that occurs when pathological changes develop in the organs of the fetus secondary to severe anemia |
| Kernicterus | The deposition of unconjugated bilirubin in the brain cells and is associated with mental retardation. preventable neurological disorder characterized by encephalopathy, motor abnormalities, hearing and vision loss, and death |
| Congenital Hypothyroidism | large protruding tongue, slow reflexes, distended abdomen, large open posterior fontanel, Constipation , hypothermia, poor feeding, horse cry, dry skin, coarse hair, goiter, and jaundice |
| Preventricular-Intraventricular Hemorrhage Diagnostics | Cranial Ultrasound. |
| Phenylketonuria | Newborns appear normal at birth, but by six months of age they show signs of slow mental development |
| Neonatal Sepsis | Presence of bacterial, fungal, or viral microorganisms or their toxins in blood or other tissues in the newborn |
| Congenital Infection | Acquired in utero by vertical transmission with onset before birth |
| Early Onset Neonatal Infection | Acquired by vertical transmission in the perinatal period, either shortly before or during birth |
| Late Onset Neonatal Infection | Acquired by horizontal transmission in the nursery. |
| Hyperbillirubinemia | A condition in which total serum bilirubin level is above 5MG and is exhibited as jaundice. Symptoms include Jaundice (yellowing of the skin and eyes), Tea-colored urine, Clay-colored stool. ADIRECT COMBS TEST Identifies hemolytic disease of the newborn. HEMOGLOBIN CONCENTRATION For evidence of anemia and the blood type is done to determine Rh status, and any incompatibility with mother. It is characterized as the rapid destruction of RBC, jaundice, and lethargy |
| Esophageal Atresia | congenitally interrupted esophagus where the proximal and distal ends do not communicate. The upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm. First signs are seen shortly after birth and include frothy white bubbles in infants mouth, coughing or choking when feeding, blue color of skin, especially when feeding, difficulty breathing. |
| Tracheoesophageal Fistula | fistula is an abnormal communication between the trachea and esophagus. When associated with esophageal atresia, the fistula most commonly occurs between the distal esophageal segment and the trachea |
| Gastroschisis | A herniation of abdominal contents through an abdominal wall defect. Hole next to belly button. Intestines not covered by protective sac |
| Omphalocele | A defect of the umbilical ring that allows evisceration of abdominal contents into an external peritoneal SAC. Hole in belly button. Intestines covered by protective sac |
| Maple Syrup Urine Disease | lethargic, poor feeding, vomiting, weight loss, seizures, shrill cry, shallow respirations, loss of reflexes, and coma |
| Imperforate Anus | a rare birth defect that includes the absence or abnormal location of a normal anal opening (anus) and is identified in the newborn period. The rectum may end in a blind pouch, not connected to the color, or it may have fistulas (openings) between the rectum and perineum. Malformations occur during early fetal development and may be associated with other congenital anomalies. |
| Bladder Exstrophy | Rare developmental abnormality that is present at birth in which the bladder and related structures are turned inside out through an opening in the abdominal wall. A midline closure defect occurs during the embryonic period of gestation, leaving the bladder open and exposed outside of the abdomen |
| Prematurity Regarding Oxygenation | Respiratory Manifestations include tachypnea, grunting, nasal flaring, retractions, cyanosis, decreased oxygen saturation, decreased oxygen levels, and abnormal arterial blood gas (ABG) values. MANAGEMENT is Providing Respiratory Support. LUNG SURFACTANT – beractant (Survanta) |
| beractant (Survanta) | Restores naturally-occurring lung surfactant to improve lung compliance. Used to prevent or treat respiratory distress syndrome in the preterm infant. Givenintratracheally in the first 48 hours of life. Suction infant's airway before giving, delay suctioning after, for as long as possible. Assess RR, ABGs, & color BEFORE ADMINISTRATION. Change infant's position every 2 hours to promote flow to both lungs. Monitor ABGs after administration. Monitor for side effects including transient bradycardia or rales |
| Meconium Aspiration Treatment | Vasopressors are used to reduce the risk of shunting blood from right to left through the patent ductus arteriosus. This helps prevents pulmonary hypertension. When vasopressors are administered, the nurse monitors the blood pressure and the mean arterial pressure frequently and titrates the drugs to keep the blood pressure and mean arterial pressure within the prescribed parameters. |
| Hyperbillirubinemia Treatment | PHOTOTHERAPY. Lights will be positioned about 12-30 inches away from the newborn. The newborn should be repositioned every 2 hours. Eye patches will be worn to protect the eyes, but they should be removed during feeding to promote eye contact and bonding. Loose, green stools indicate the bilirubin is being broke down |
| Physiological Jaundice | Most common – occurs after 24 hours of birth, then gradually declines over the next week |
| Pathological Jaundice | Manifests within 24 hours of birth – typically has an underlying cause that needs to be addressed |
| Maternal Substance Abuse | Infants display irritability, hypertonicity, a high-pitched cry, vomiting, diarrhea, respiratory distress, disturbed sleeping, sneezing, diaphoresis, fever, poor sucking, tremors, and seizures. Possibility of intrauterine growth restriction, prematurity, neurobehavioral and neurophysiologic dysfunction, birth defects, infections, and long-term developmental sequelae |
| Fetal Alcohol Syndrome | is a lifelong yet completely preventable set of physical, mental, and neurobehavioral birth defects. It is the leading cause of intellectual disability in the United States. Newborns typically present with inadequate sucking reflex and poor appetite, microcephaly, abnormally small eyes, fetal growth restriction, epicanthal folds, a thin upper lip, the missing vertical groove of the upper lip, and a short-upturned nose. |
| Neonatal Abstinence Syndrome | Symptoms typically include CNS dysfunction of hyperactive reflexes, restlessness, shrill high-pitched cry, and disturbed sleep ability. Metabolic and respiratory disturbances include frequent yawning, sweating, frequent sneezing, and tachypnea. The GI disturbances include loose or watery stools. |
| Effects of Alcohol Use | growth deficiencies, facial abnormalities, CNS impairment, behavioral disorders, and abnormal intellectual development |
| Effects of Caffeine Use | decreased iron absorption, increased risk of anemia |
| Effects of Nicotine Use | produce uteroplacental blood flow, decrease birth weight, abortion, prematurity, placental abruption. low birth weight, small for gestational age, SIDS |
| Effects of Cocaine Use | vessel constriction, tachycardia, hypertension, placental abruption, abortion, prune belly syndrome, smaller head circumference, piercing cry, GI tract abnormalities |
| Effects of Narcotic Use | neonatal abstinence syndrome, preterm labor, intrauterine growth restriction, and preeclampsia |
| Effects of Sedative Use | respiratory problems, feeding difficulties, disturbed sleep |
| Effects of Marijuana Use | altered responses to visual stimuli, sleep pattern abnormalities, photophobia |
| Effects of Methamphetamines Use | frantic fist sucking, high pitched cry, and significant lassitude |
| Effects of Heroin Use | stiff and hyperextended positioning, limb defects, ambiguous genitalia |
| Smoking In Pregnancy | Increases the risk of spontaneous abortion, preterm labor/birth, fetal growth restriction, low-birth weight, low fetal iron stores, SIDS. Cognitive Deficits especially in language, reading, and vocabulary, but also poorer performances on tests of reasoning & memory. |
| PERINATAL & CHILDHOOD RISKS of Smoking During Pregnancy | Cleft Lip & Palate, Club Foot, Asthma, Middle Ear Infections, Reduced Head Circumference, Altered Brain Stem Development, Cerebral Palsy, Researchers have also reported behavior problems such as increased activity, ADHD, impulsivity, opposition, and aggression |
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