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ob 12 13 14
| Term | Definition |
|---|---|
| newborn | neonate |
| head lag | the head will fall back because the newborn can not maintain neutral position of the head |
| moro reflex | if the crib is jarred infants draw their legs up and the arms fan out and then come toward midline in an embrace position |
| rooting reflex | causes the infant's head to turn in the direction of anything that touches the cheek |
| tonic neck reflex | disappears by the end of the 7th month postural reflex assumed by sleeping infants in a fencing position |
| dancing reflex | prancing movements of the legs seen when an infant is held upright on the exam table |
| molding | forming of fetal head to the size and shape of the birth canal |
| head circumference | normal range 32-36 cm |
| caput succedaneum | swelling of the soft tissues of the scalp it gradulally subsides without treatment |
| cephalhemotoma | collection of blodd beneath the periosteum of the cranial bone. It may be seen on one or both sides of the head but doesn't cross the suture line. Usually recedes within a few weeks without treatment |
| fontanelles | unossified spaces or soft spots on the cranium of a young infant. Protect the head during delivery by permitting the process of molding and allow for further brain growth during the next 1 1/2 years |
| anterior fontanelle | is diamond shaped and is locaated at the junction of the two parietal and two frontal bones. Usually cleses by age 12-18 months |
| posterior fontanelle | traingular and is located between the occipital and parietal bones it is small than the anterior fontanelle and is usually ossifed by the end of the 2nd month |
| visual stimulation | an important ingredient in newborn care. Toys that make sounds and have contrasting colors attract newborn |
| cross-eyed | most newborns appear cross-eyed because their eye muscle corrdination is not fully developed |
| eye color | at first eyes appear to be blue or gray the permanent coloring becomes fixed between ages 6 and 12 months |
| eyelid | are closed most of the time |
| tears | do not appear until approximately age 1- months because of the immaturity of the lacrimal gland ducts |
| ears | are well developed but small at birth ears are assessed for placement. An imaginary line drawn from the outer canthus of the eye should be even with the upper tip of the pinna fo the ear |
| hearing | hearing ability of the newborn is well developed at birth |
| amniotic fluid | presence of the amniotic fluid in the ear canal can diminish hearing, but normal drainage and sneezing that occur shortly after birth help clear the ear canal. Every newborn gets a hearing test before leaving hospital |
| mother's voice | ability to discriminate between the mother's voice and the voices of other may occur as early as age 3 days, hearing is an important to the development of normal speech |
| ALGO | hearing test used to mesuare infant hearing |
| circumference of the head | is mesured from the top of the eyebrow to the widest part of the occiupt |
| size of fontanelle | is obtained by measuring the widest point of the width and the widest point of the length adding the measurements together and dividing by 2 normal anterior fontaneele in a new born measures between 3.6 6 cm should appear flat with a contour of the skull |
| chest circumference | measuring tape is placed at the nipple line |
| ear position | the ears are assessed for placement because low set ears may indicate a congenital abnormality |
| cephalhematoma | appears as a lump on one side of the head`blood collects between the surface of the cranial bone and the periosteal membrane the swelling does not cross the suture lines |
| sleep | nwonate sleeps approximately 15 -20 hours a day |
| first reactive phase | during the first 30 minutes of life the newborn is alert and this is the best time to initiate bonding between the parent and newborn |
| sleep phase | during the next few hours of life teh infant gradually becomes sleepier and less responsive |
| second reactive phase | after a deep sleep the infant again becomes responsive and alert |
| stability phase | after age 24 hours the sleep wake patter becomes more stabilized the patter of sleep gradually develops into one in which the newborn is awake during the day and sleep during the night |
| quiet sleep | infant sleeps and does not monve |
| REM | respirations are more irregular eye movements are evident beneath the eyelid and limb an mouth movement may be seen |
| active alert | infant displays diffuse motor activity |
| quiet alert | infant is awake relaxed and quiet in this state is most responsive to testing and to bonding efforts |
| crying | infant's cry is accoompanied by vigorous motor activity of extremities |
| transitional | infant is moving between one of the previously described state the infant my be quiet and relaxed but not very responsive to the environment |
| newborn response to stress | Heart rate and respiratory rates change BP increases and blood glucose levels rise |
| Comfort scale | a 7 point scale that includes alerness calmness muscle tone movement facial tension and respiratory response and two physiologic items HR and mean arterial BP each items scored from 1 to 5 with a high score indication increased distress |
| CRIES | 10 point scale C cry R requires o2 I increased vital E expression on face S sleeplessness |
| FLACC | Pain tool measure the pain of infants parameters inculde face legs activity cry and consolability each scored from 0 to 2 higher score indicating increased distress |
| PIPP | premature infant pain profile is based on scales similar to CRIES this rates eye squeeze nasal labial furrow HR o2 saturation and the brow furrow on a 0-3 scale 21 indicating the worst level of pain |
| NIPS | neonatal infant pain scale rates facial expression arm movement cry leg movement respiration and arousal on a 0-2 scale with 7 indicating the worst level |
| NPASS | neonatal pain agitation and sedation scale very reliable and valid assessment tool even for premature infants on ventilators scores are given for crying or irritability behaviroal state facial expression tone of extremites VS and o2 saturation |
| pain relief in newborns | adequate pain relief in newborns who undergo painful procedures can reduce postoperative morbidity |
| evaluation of pain in the newborn | can be based on changes in VS and behavior of the infant and decreased o2 saturation rates |
| Swaddling | with the hand near the mough cuddling rocking noninvasive methods of pain relief for newbon infants |
| Morphine, fentanyl, and topical anesthetics | can be used for sever pain, must observe infants closely for side effects or sign of withdrawl when the medication is gradually decreased and then discontinued |
| conditioned responses | a conditioned response or reflex is one that is learned over time. It is an unconscious responcse to an external stimulus |
| first breath | when the umbilical cord is clamped and cut the lungs take on the function of breathing o2 and removing carbon dioxide. The first breath helps to expand the collapsed lung full expansion does not occur for several days |
| infant's cry | should be strong and healthy the most critical period for the newborn is the 1st hour of life |
| maintain a patentt airway | by positioning them on their back or side and dressing them in clothing that maintains warmth while allowing expansion of the lungs |
| suction | suction the mouth first to prevent inhalation and aspritaton of mucus during a gasp reflex which is stimulated by nasal suctioning |
| Apgar Score | is a standardized method of evaluating the newborn' condition immediatley after the delivery 5 objective signs are measured HR respiration muscle tone reflexes and color the score is obtained 1 minute after birth and again after 5 minutes |
| respiratory distress | may be evidenced by the rate and character of respirations color and general behavior Sternal rectractions are reported immediately |
| blood volume | newborn has approximatley 300 ml of circulatory blood volume |
| murmus | are caused by blood leaking through openings that have not yet closed. majority of heart murmurs are not serious but they should be checked periodically to rule out other pathological conditions |
| functional (innocent) murmurs | result from the sound of blood passing through normal valves |
| organic murmurs | caused by improper heart formation |
| heat regulating system | newborn has an unstable heat regulating system |
| normal newborn temp | 97.8-98.9 |
| body temp | is influenced by that of the room and by the number of blankets covering the infant |
| newborn's hands and feet | are not used as a guide to determine warmth because the infant's extremities are cooler the rest of the body |
| sweat glands | do not function effectively during the neonatal period, the newborn infant is at risk for developing an elevated temp if over dressed or if placed in a overheated environment. A red skin rash my develop in response to overheating. |
| rectal temp | when the temp is taken rectally the nurse must be gentle to avoid injuring the rectal mucose |
| acilla temp | daily routine temp are taken by axilla, |
| pulse rate and respirations | are counted before the temp is taken because infant is apt to cry when disturbed |
| Apical pulse | most accurate method of assessing the heart rate in the neonate |
| newborn's pulse | is irregular and rapid and varies from 110-160 beats min |
| newborn's BP | 80/46 |
| newborn's respirations | are approximately 30-60 breaths min |
| Nurse always reports | temp above 99.8 or below 97.1 pulse rate greater 160 or less 110 respirations greater then 60 or less then 30 noisy resp nasal flaring or chest retraction |
| infant's position | bones of the infant are easily molded by pressure the infant's position must be changed frequently if not bones of head can become flattened |
| muscular control | proceeds from head to foot and from the center of the body to the periphery head and neck muscles are 1st to come under control |
| scarf sign | refers to the full term infants resistance to attempts to bring one elbow farther tan the midline of the chest no observed in the preterm infant |
| length of average newborn | 19-21.5 inches |
| weight loss | in the first 3-4 days after birth the infant loses about 5% to 10% of birth wieght |
| weight gain | infant will regain his or her birth weight by 10 days of age newborns are weighed at the same time each day |
| kidney function | at birth are nu fully developed the glomeruli are small renal blood flow is only about 1/3 that of the adult |
| voding | note 1st void if does not occur within the 1st 24 hr the HCP is notified keep accurate record of the frequency of all urination note changes is color and any unusual findings. have about 6 wet diapers a day |
| cryptorchidism | the testes of the male don't descend into teh scrotum before birth. Occasionally they remain in the abdomen or the inguinal canal. With proper surgical treatment the prognosis is good |
| location of the urethral opening | should be at the rip of the penis in newborns boys |
| disadvantages of circumcision | infection, hemorrhage, |
| benefits of circumcision | possible prevention of cancer fewer UTI and fewer occurrences of SDI |
| Hypospadias | opening of the urethra is on the under surface of the penis should not be circumcised bc skin may by needed for surgery |
| care of circumcised penis | keep area clean, change diaper, wash area with warm water avoid alcohol wipes, don't remove yellow crust, apply diaper loosely, report redness and bleeding or drainage, observe for at least six wet diapers per day |
| care of uncircumcised penis | avoid forcefully pulling back the foreskin, wash penis with water, white lumps are normal, toddler age gentle retraction after bathing be sure to replace foreskin, school age can be taught 2 gently retract foreskin for cleansing should be one once a week, |
| female genitalia | may b slightly swollen a thin white or blood tinged mucus may be discharged in normal is from hormonal withdrawal from mother |
| clean the vulva | from the ureathra to the anus using a clean cotton ball or different section of washcloth |
| skin of newborn | caucasian infants is red to dark pink, Afican american reddish brown Latin descent olive or yellowish tint |
| languo | fine hair which tends to dissapper during first week of life more evident in premature infants |
| vernix caseosa | cheese like substance that covers skin of newborn thought to protect the skin in utero |
| milia | white pinpoint pimples caused by the obstruction of sebaceous glands do not pop |
| jaundice | is characterized by a yellow tinge of the skin it caused by the destruction of excess red blood cells which the infant does not need now |
| physiological jaundice | becomes evident between 2 & 3rd days of life and lasts for about a week this is a normal process and is not harmful |
| pathological jaundice | appears in the 1st day of life is not normal and should be recorded and reported |
| powders | should not be used bc of high risk of aspiration of small particles |
| bathing | infant need only be bathed 2 or 3 times a week, temp of bath should be 100 f in warm room , |
| meconium | 1st stool, is dark greenish black thick and sticky and is passed 8 to 24 hrs after birth chart 1st meconium |
| infant's stomach | the capacity of the infant's stomach is about 90 ml or 3 oz |
| position after feeding | position the infant on the right side after feeding |
| vitamins | infant need extra vitamins C and D |
| preventing infectin | hand washing is most reliable precaution available. |
| preterm birth | is responsible for more deaths during the 1st year of like than any other single factor. Preterm also have higher % of birth defects, |
| gestational age | refers to the actual time from conception to birth hat the fetus remain in the uterus |
| preterm | infant less than 38 weeks |
| term infant | 38-42 weeks |
| post term infant | beyond 42 weeks |
| late preterm infant | infant also known as a ner term infant is born between 24-36 weeks and is also considered a high risk newborn regardless of birth weight |
| ballard scoring system | which is based on the infant's external characteristics and neurological development |
| characteristics of preterm infant | skin transparent or loose, superficial veins on ab and scalp, lack of subcutaneous fat, lanugo conering forehead shoulders, and arms, vernix caseosa abundant, extremities appear short, soles of feet have few creases, abdomen protrudes, nails are short, |
| causes of preterm birth | multiple births maternal illness, hazards of pregnancy, placental abnormalities, placenta previa, premature separaton of placenta from uterine wall |
| level of maturation | how well developed the infant is at birth, ability of organs to function outside the uterus |
| Respiratory Distress Syndrome RDS hyaline membrane disease | result of immature lungs, leads to decreased gas exchange |
| surfactant | is a fatty protein that is high in lecithin, its presence is necessary for the lings to absorb o2 begins to form 24 weeks gestation and by 34 weeks can take up to 1 hour doesn't happen right away, 30% neonats die to RDS |
| Manifestations of RDS | respirations increase to 60 or higher tachypnea, grunt like sounds, nasal flaring, cyanosis, intercostal and sternal retracitons, edema fatigue apnea mechanical vent may be neessary |
| Treatment for RDS | corticosteriods to stimulate lung maturity 1-2 days before delivery, preterm infants surfactant can be given via ET tube at birth, improvement in lung fuction is generally seen within 72 hours after administration |
| bronchopulmonary dysplasia | toxic response of the lung to oxygen therapy |
| apena | cessation of breathing for 20 sec or longer |
| bradycardia | heart rate of fewer than 100 beats min |
| how to help apnea | gentle rubbing of the feet ankles, back, suctioning of the nose and mouth, raising head to a semi-Fowler's position, ambu bag |
| neonatal hypoxia | inadequate o2 at teh cellular level in a newborn infant |
| pulse oximetry | the degree of hypoexmia can be detected by using a pulse ox normal reading of pule ox 92% |
| Surfactant production | can be altered during cold stress, hypoxia poor tissue perfusion, |
| sepsis | generalized infection of the blood stream |
| treatment of sepsis | administration of intravenous antimicrobials, maintenance of warmth and nutrition, and close monitoring of VS incubator separates the infant from other infants in the unit |
| poor control of body temp | preterm infant has lack of brown fat, excessive heat loss by radiation, heat regulating center is immature, sweat glands are not functioning, inactice, metabolism is high, |
| S/S cold stress | decreased skin temp, increased respiratory rate withh periods of apnea, bradycardia, mottling of skin, lethargy |
| cold stress | increases the need for o2 and glucose |
| skin temp | ingfant's skin temp will fall before ore temp falls |
| hypoglycemia | common among preterm infants levels lower than 40 in term and 30 in preterm |
| hypocalcemia | low calcium, |
| bleeding | preterm infants are more prone to bleeding than full term because their blood is deficient in prothrombin, fragile capillaries of the head are particulary susceptible to injury during delivery use vitamen K |
| retinopathy of prematurity | in which therd is separation and fibrosis of the retina which can lead to blindness caused by high oxygen levels of aterial blood, leading cause of blindness in newborns weighing less than 3.3 lbs |
| poor nutrition | stomach capacity is small, sphincter muscles both ends are immature, sucking swallowing reflexes are immature, ability to absorb fats is poor, inadequate store of nutrients , need for glucose and nutrients to promote growth, |
| necrotizing enterocolitis | acute inflammation of the bowel tha tleads to bowel necrosis, factors include diminished blood supply to the lining of the bowel wall because of hypoxia or sepis |
| S/S NEC | abdominal distention, bloody stools, diarrhea, and bilious vomitus, |
| Nursing care for NEC | observe VS maintaining infecton control techinquws and carefully resuming oral fluids as ordered. measuring the abdomen and listening for bowel sounds , antimicrobials & parenteral nutrition, surgical removal |
| urine output | should be between 1 & 3 ml |
| jaundice level | an increase of more than 5 mg in 24 hrs or a bilirubin level above 12.9 mg |
| breast milk jaundice | begins to be seen about the fourth day when the milk supply develops |
| breast milk and jaundice | the breast mil itself may inhibit conjugation of bilirubin and therfore formula may be subsitituted for 24 to 48 hours to reduce bilitubin levels |
| bilirubin level | typically peaks 3-5 days after birth |
| special needs | immediate needs are to clear the infant's airway and provide warthm |
| thermoregulation | involves maintaining a stable body tamp and preventing hypothermia and hyperthermia |
| kangaroo care | method of care for preterm infants that uses skin to skin contat |
| sucking and breathing | ability to corrdinate breathing sucking and swallowing does not develop before 34 weeks of gestation |
| positioning preterm newborn | on side or prone |
| problems are associated with postmaturity | asphyxia, meconium aspitation, poor nutritional status, increase red blood cell, difficult delivery because of size, birth defects, seizures, |
| physical characteristics of postterm infant | long and thin, skin is loose, little lanugo, or vernix, dry cracks, nails are long, thick head of hair |
| birth defects | abnormalities that are apparent at birth occur in 3-4% of all lives births |
| malformations | present at birth may also be known as congenital malformations |
| inborn erros | metabolism errors |
| chromosomal abnormalities | most involve retardation |
| neural tube defects | most often caused by failure of neural tube to close at either the cranial or the caudal end of the spinal cord |
| hydrocephalus | characterized by an increase in CSF within the ventricles of the brain causes pressure of the brain, increase in head size results from an imbalance between production and absorpition of CSF or improper formation ventricles |
| S/S hydrocephalus | scalp is shiny and the veins are dilated, pupils of the eyes may appear to be looking downawrd and the sclera may be seen above the pupils aka setting sun |
| infant with hydrocephalus | infant is helpless and lethargic, body becomes thin, muscle tone of the extremities is often poor, cry is shrill and high pitched, irritability vomiting, and anorexia convulsion may occur older child headache cognitive slowind personality changes |
| transillumination | inspection of a cavity or organ by passing a light through its wall is a simple diagnostic tool useful in visualizingng fluid a small ring is normal but a large halo effect in not |
| treatment of hydrocephalus | uses of acetazolamide and furosemide reduces produciton of CSF , shunt |
| preoperative care hydrocephalus | child may be barely able to raise head mental developmetnis delayed lack of appetite, tendency to vomit position infant must be changed to prevent hypostatic pneumonia and pressure sores after feeding place in a side lying position infant not disturbed |
| observations to be recorded for hydrocephalus | type and amounts of food, any vomiting, condition of skin, motor abilities, restlessness, irritability, changes in VS, fontanelles are inspected for size, head circumfernce is measured, |
| systoms of increaased pressure within head | increase in BP and a decrease n pulse rate and respirations. Sighns of a cold or otehr infections are immediatley reported |
| postoperative nursing care hydrocephalus | positioning infant depends on if fontanelles are sunken, infant is kept flat becasue too rapid reduction of fluid may lead to seizures or cortical bleeding, if fontanelles are bulging infant placed in semi fowlers to promote drainage,prevent pressure |
| s/s of infection include | icrease in vital signs, poor feeding, vomiting, pupil dilation decreased levels of consciousness and seizures operative are is observed for signs of inflammation |
| position of the infant postoperative hydrocephalus | depends on several factors if fontalnelles are sunken in the infant is kept flat bc too rapid reduction of fluid may lead to seizures or cortical bleeding, if fontanells are bulging place in semi gowlers position to promote drainage |
| spina bifida, myelodysplasia | is a congenital embryonic neural tube defect in which there is an imperfect closure of the spinal verterbrae |
| spina bifida occulta | opening is small and there in no associated protrusion of structures,often goes undetected occurs most commonly at the L5 and S1 level, may be a tuft of hair,dimple,treatment no necessary unless neuromuscular symptoms appear disturbances of gait,footdrop, |
| spina bifida cystica | development of a cystic mass in the midline of the opening in the spine |
| meningocele | contains portions of the membranes and CSF the size varies from that of a walnut to that of a newborn's head |
| meningomyelocele | more serious is a protrusion of the membranes and spinal cord through opening, may be associated paralyis of the legs and poor control of bowel and bladder funtions |
| spina bifida | intake of a daily multivitamin contaning 0.4 mg of folic acid before conception can reduce the risk of neural tube defects such as spina bifda |
| habilitation | rather then rehab this term is used to describe treatment bc the pt is disabled from birth and there fore is learning not relearning aim is to minimize the child's disability and put to constructive use the unaffected parts of the body |
| nursing care for spina bifida | size and area of sac are checked for any tears or leakage, extremities are observed for deformities and movement, head circumference measured to ck 4 hydrocephalus,fontanelles observed to provide baseline,lack of anal sphincter control and dribbling urin |
| positioning infant with spina bifida | the goal is to prevent pressure on the sac and prevent pressure on the sac and pprevent postural deformities |
| latex allergy | many infants with spina bifida develop a latex allergy parents should be informed about latex products such as balloons |
| clift lip | result of the failure of the maxillary and median nasal processes to unite during embryonic develop between 7-8 weeks gestion appears more frequently in boys than girls |
| cheiloplasty | initial treatment fro cleft lip is a surgical repair by age 3 months when weight is established and is free of infectoin |
| postop care cheiloplasty | preventing infant from sucking and crying, never position on abdomen, prevennting infection, prevent injury to op sire by using elbow restaints, providing emotional needs by cuddling and other forms of affection provide appropriate pain relief |
| feeding after cheiloplasty | infant recieves feedings by dropper until wound is comppletely healded |
| cleft palate | failure of the hard palate to fuse at the midline during the 7-12week of gestation, separation froms a passageway between teh nasopharynx and nose, leads to infections of respiratory tract and middle ear, and hearing loss, speech difficulties |
| treatment of the child with cleft lip and palate | requires multidisciplinary teamwork with surgeon, pediatrician, pediatric dentist, orthodontist, nurse, psychologist, speech therapist and social worker |
| high resolution ultrasound | can detect cleft palate by 13 weeks gestation |
| suctioning the mouth | should be avoided in infants who have a cleft plate repair |
| oral hygiene | cleft palate the mouth is kept clean at all times . feedings are followed by a little water. The physician may prescribe a mild antiseptic mouth wash |
| club foot | one of the most common deformities of teh sketal system is a congenital anomalyy characterized by a foot that has been twisted inward or outward many mild forms are caused by improper position in the uterus, and these clear up with manipulative exercies. |
| True club foot | does not respond to simple exercise |
| treatment club foot | splinting or casting to hold foot in right position is carried out during infancy, passive stretching exercise may also be recommended if not fixed by age 3 months surgery may be indicated |
| cast care | the toes are left exposed for observation, check for capillary refill and signs of poor circulaton pallor cyanosis swelling colness numbness pain or burning |
| hip dysplasia | head of femur is partly or completely displaced as a result of a shallow hip socket |
| barlow's test | is performed by a physician to detect an unstable hip in the newborn. Physician adducts and extends the hips while stabilizing the pelvis and may feel the dislocation occur as the femur leaves teh acetabulum |
| ortolani's sign | fell and hear the femoral head slip back into the acetabulum under gentle pressure |
| treatment | a triple thick diaper may be used in teh newborn to maintain a frog like abduction of the legs until a pavlik harness can be fitted properly |
| Pavlik harness | is used with infants aged 1-6 months to maintain hips in a position of flexion and abuction |
| early signs of dislocation of the right hip | limitation of abduction asymmetry of skin folds shortening of femur |
| spica cast | encircles the waist and extends to the ankles or toes, firm plastic covered pillows are requierd are placed beneath the curvatures of cast for support |
| metabolic defects | infant with an inborn error of metabolism has a genetic defect that may not be apparent before birth |
| PKU | genetic disorder caused by the faulty metabolism of the phenylalanine an amino acid that is essential to life and is found in all protein foods it can increase to as high as 20X the normal amnt Its by product phenylpyruvic acid appears in the urine |
| Pku | by the time urine test is postive brain damage has already occurred |
| guthrie blood test | widely used and is currently considered the most reliable test for PKU the blood is obtained after 48-72 hours of life |
| phenylalanine blood levels | between 2-10 mg/dl level below 2 may resul in growth retardation whereas levels above 10 can result in significant brain damage |
| children with PKU | must avoid the sweetener aspartame nutra sweet because it is converted to phenylalanice in the body intake of most meat dairy products and diet drinks must be restricted |
| Maple Syrup Urine Disease | is caused by a defect in the metabolism of branched chain amino acids. It causes marked serum elevations of leucine isoleucine and valine, results in scidosis cerebral degeneration and death within 2wks if left untreated |
| infant with maple syrup urine disease | appears healthy at birth but soon develops feeding difficulties loss of moro reflex, hupotonia, irregular respirations, and convulsions |
| characteristic of maple syrup diaease | infant's urine sweat and earwax have a characteristic sweet or maple syrup order. This is caused by ketoacidosis, urine contains high levels of leucine and valine, confirmed by blood and urine test |
| treatment maple syrup diaease | inital treatment consists of removing these amino acids, this is accomplished by hydraton and peritoneal dialysis to decrese serum levels. Pt placed on lifelong diet low in amino acids |
| galactosemia | the body is unable to use the carbohydrates galactose and laxtose the result is an increase in teh amount of galactose in blood galactosemia nd in the urine galactosure can cause cirrhosis of liver, cataracts, mental retardation is left untreated |
| manifestations of galactosemia | begin abruptly and worsen gradually, early signs consist of lethargy, vomiting, hypotonia, diarrhea, and failure to thrive. |
| treatment and nursing care galactosemia | milk and lactose containing products are eliminated from the diet, nursing mother must discontinue breast feeding, lactose free formulas and those with a soy-protein base are subsituted |
| down syndrome | common chromosomal abnormalities, increase to 1 in 365 to births among children of mothers age of 35 years or older |
| trisomy 21 syndrome | most common type, are 3 number 21 chromosomes rather than the normal 2 |
| mosaicism | when nondisjunction occurs late in development both normal and abnormal cells are present in the newborn pt tend to be less severely affected in physical apperance and intelligence |
| translocation | a piece of chromosome in pair 21 beaks away and ataches itself to another chromosome |
| screening for down syndrome | is offered during the 1st trimester of pregnancy and includes an ultrasound assessment of the thickness of the fetal nuchal fold and absence of the casal bone |
| Signs of downs | which are apparent at birth are close set and upward slanting eyes small head, round face, falt nose, protuding tongue that interfers with sucking and mouth breathing, hands of infant are short and thick wide space between 1st and 2nd toe |
| simian crease | deep straight line across thepalm in down syndrome infant |
| infant with downs | their resistance to infections poor and they are prone to respiratory and ear infections as well as speech and hearing problems |
| downs syndorme | infant should be warmly wrapped hypotonicity of muscles contributes causes respiratory problems and excess mucus accumulation, also cause constipation which can be controlled by dier |
| erythroblastosis fetalis | is a disorder that becomes apparent in fetal life or soon after birth caused when RH- mother and an Rh - father produce an Rh+ fetus |
| RhoGam | im ingection is given to the mothhr within 72 hours of delivery of an Rh positive infant may also be given to the woman at 28 weeks of gestation |
| RhoGam | is also administerd when appropriate after a spontaneous or therapeutic abortion, after amniocenteses and to women who have bleeding during pregnancy because fetal blood my leak into the mother circulation at these times |
| kernicterus | accumulation of bilirubin in the brain tissues may cause serious brain damage and permanent disablility |
| pathological jaundice | occurs on the first day of life and necessitates prompt intervention |
| phototherapy | is discontinued when the bilirubin level declines to 14 mg/dl |
| intracranial hemorrhage | most common type of birth injury may result from trauma or anoxia occurs more ofeten in preterm infant |
| s/s intracranial hemorrhage | poor muscle tone lethargy poor sucking reflex respiratory distress cyanosis twitching forceful vomiting high pitched shrill cry convulsions fontanelle may be tense and undr pressure rather then soft pupil of one eye is likely to be small the other large |
| treatment intracranial hemorrhage | newborn placed in an incubator which alows proper temp control. handled gently, head is elevated prophylactic antibiotics and vitamins |
| vitamin K | control bleeding |
| if a convulsion occurs | diagnosing exact location of bleeding, were arms legs or face involved, was right or left side was convulsion mild or sever, condition b/4 and after seizure |
| TTN | usually occurs after a c section or an un eventful vaginal delivery, characterized by tachypnea chest retraction grunting mild cyanosis distinct feature condition is that it tpically resolves suddenly after 3 days |
| meconium aspiration sysndrome | is a group of symptoms that occur when the fetus or newborn aspirates is a group symptoms that occur when the fetus or newborn aspirates meconium stained amniotic fluid into the lungs |
| amnioinfusion | meconium aspiraton can be prevented by giving to mother |
| MAS | respiratory distress in primary symptom inculing nasal flaring retraction cyanosis grunting rales and rhonchi tachypnea |
| treatment MAS | includes supportive care with warmth supplemental oxygen and energy conserving plans of care intubation and mechanical ventilation may be necessary |
| neonatal abstinence syndrome | occurs when the fetus has prenatal exposure to drugs such as opiates amphetamines or tranquilizers or multiple illicit drugs while in utero |
| s/s neonatal abstinence syndrome | body tremors, hyperirritability, wakeeefulness,diarrhea, poor feeding , sneezing and yawing |
| meconium testing | may be more accurate then noenatal urine |
| treatment abstinence syndrome | providing a quiet environment with swaddling, refuction of external stimuli and close observation for seizuers phenobarbital paregoris and tincture of opium an iv fluids are often prescrived |
| diabetes in the mother | presents various problems for the newborn these are detemined by the deverity and duration fo the disease in mother the degree of conrol of the conditions and gestational age of the inftant |
| macrosomia | large for gestation age infant is prone to injuries at birth because of size |
| characteristic of baby | cushingoid appearance, face is round and puffy infant appears lethargix |
| after delivery | infant often has low blood lucose levels because of the abrupt loss of maternal glucose and hypertrophy of the pancreatic islet cells, which results in temporary overproduction of insulin |
| some infants born to a mother with severe diabetes | may be small for gestational age because of poor placental perfusion these infants suffer from hypoglycemia hupocalcemi and hyperbilirubinemia |
| nursing care of infant of a diabetic mother | includes close monitoring of VS early feeding and frequent assessment of blood glucose levels |
Created by:
ahorsley