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Pediatric Ch 14
Perinatal Injury or Congenital Malformation
| Question | Answer |
|---|---|
| A neural tube defect that is not visible externally in the lumbosacral area | Spinal Bifida Occulta |
| A woman who is 6 weeks’ pregnant tells the nurse that she is worried that the baby might have spina bifida because of a family history. The nurse's response regarding prenatal testing should be based on the knowledge that: | The concentration of alpha-fetoprotein in amniotic fluid can indicate the presence of the defect prenatally. |
| Possible bowel function in children born with a myelomeningocele? | Some degree of fecal continence can usually be achieved. |
| For a post-op child with myelomeningocele: A. Place on side to decrease spinal pressure. B. Apply heat for drying of the sac. C. Keep skin clean and dry to prevent irritation from diarrhea. D. Examine fontanels for signs of hydrocephalus. | C. Keep skin clean and dry to prevent irritation from diarrheal stools. |
| Which laboratory results would be a cause for concern if exhibited by an Rh-positive newborn 12 hours after birth? A. Direct Coombs: negative B. Hematocrit: 58% and Hemoglobin: 18 gm/dl C. Blood glucose level: 55 mg/dl D. RPR/VDRL: reactive | D. RPR/VDRL: reactive |
| What are the classifications of birth defects? | Malformations present at birth; metabolic defects (body chemistry); blood disorders; chromosomal abnormalities; and perinatal injury. |
| What is cleft palate? | a failure of the hard palate to fuse at the midline during the seventh to twelfth weeks of gestation |
| How is cleft palate treated? | operate between 1 year and 18 months so speech patterns are minimally affected-if surgery deferred, a dental-speech appliance may be used-should changed periodically as the child grows |
| How is clubfoot treated? | as soon as possible - Conservative = splinting/casting to hold the foot in the right position during infancy. Passive stretching exercises may also be recommended. If these methods are not effective by age 3 months, surgery may be indicated. |
| Describe how the Guthrie test is used to diagnose phenylketonuria | obtained from a simple heel stick. A few drops of capillary blood are placed on filter paper and mailed to the lab for screening. It is recommended that the blood be obtained after 48-72 hours of life, preferably after the ingestion of proteins. |
| When is RhoGAM administered? | RhoGAM is administered to Rh-negative mothers by the intramuscular route after a normal delivery, after an ectopic pregnancy, or after an abortion to prevent development of Rh-positive antibodies |
| birth defect | (319) abnormalities that appear at birth |
| cheiloplasty | (326) surgical repair for cleft lip |
| clubfoot | (328) congenital abnormality characterized by a foot that has been twisted inward or outward |
| congenital malformation | (320) defects present at birth |
| erythroblastosis fetalis | (336) erythro = red, blast = a formative cell, osis = disease condition – caused when and Rh negative mother and an Rh positive father produce an Rh positive fetus |
| habilitation | (323) learning (not relearning) to perform functions of life after surgery |
| hydrocephalus | (320) hydro = water, cephalo = head – condition characterized by an increase of cerebrospinal fluid (CSF) within the ventricles in the brain which causes pressure changes in the brain and an increase in head size |
| hyperbilirubinemia | (337) hyper = excess, bilis = bile, rubor = red, emia = blood – caused by the liver being unable to handle massive hemolysis, and bilirubin levels rise rapidly |
| kernicterus | (337) accumulation of bilirubin in the brain tissues |
| macrosomia | (343) macro= large, somia = body – due to mother’s diabetes |
| meconium aspiration syndrome | (342) group of symptoms that occur when the fetus or newborn aspirates meconium stained amniotic fluid into the lungs |
| meningocele | (322) meningo = membrane, cele = tumor – contains portions of the membranes and CSF |
| meningomyelocele | (322) a protrusion of the membranes and spinal cord through a cystic mass in the midline and the opening of the spine |
| myelodysplasia | (323) a group of central nervous system disorders characterized by malformation of the spinal cord |
| neonatal abstinence syndrome | (342) occurs when the mother takes drugs that cross the placenta and the fetus becomes addicted |
| Ortalini’s sign | (329) when the femoral head can be heard or felt slipping into the acetabulum |
| Pavlic harness | (329) immobilizes the infant in a frog like position |
| phototherapy | infant is placed in an incubator under florescent lights to reduce serum bilirubin levels |
| RhoGAM | (336) immunoglobin given to an Rh negative mother after delivery of an Rh positive fetus to prevent the maternal Rh immune response |
| shunt | (321) special tubing that allows fluid drainage |
| spica cast | (330) encircles the waist and extends to the ankles or toes |
| spina bifida | (323) divided spine – congenital embryonic neural tube defect in which there is an imperfect closure of the spinal vertebrae |
| transient tachypenia of the newborn (TTN) | (342) caused by slow absorption of the fluid in the lungs after birth |
| transillumination | (321) trans = across, illiminare = to enlighten – the inspection of a cavity or organ by passing a light through its walls – simple diagnostic procedure useful in visualizing fluid |
| What is an inborn error of metabolism | inherited disease that affects body chemistry |
| What does an inborn error of metabolism cause | an absence or deficiency of a substance necessary for cell metabolism |
| What is usually deficient with an inborn error of metabolism | an enzyme is usually deficient with an inborn error of metabolism |
| What is a disorder of the blood | a reduced or missing blood component or an inability of a component to function adequately |
| What are some examples of an inborn error of metabolism | cystic fibrosis, phenylketonuria, Tay-Sachs disease, family hypercholesterolemia |
| What are some examples of a blood disorder | sickle cell disease, hemophilia, thalassemia, defects of white blood cells and immune defense |
| What are some examples of chromosomal abnormalities | down syndrome, klinefelter's syndrome, turner's syndrome, trisomies 13 and 18 |
| What do most chromosomal abnormalities involve | some combonation of mental retardation and physical malformations that range from mild to fatal |
| What are some examples of malformations present at birth | structural defects such as hydrocephalus, spina bifida, congenital heart malformations, cleft lip and palate, clubfoot, developmental hip dysplasia, tracheoesophageal fistula, hypospadias |
| What are some examples of perinatal injuries | infections, drugs, maternal disorders, abnormalities due to unique pregnancy (Rh disease, difficult labor, prenature birth) |
| Which body system is often involved in congenital malformations | skeletal |
| What is often the effects of a congenital malformation on the skeletal system | missing, malformed, or duplicated limbs |
| What might newborns with Turner's or Klinefelter's syndrome have | impaired physical growth and sexual development |
| What is the most common cause of perinatal injury | premature birth |
| What did the March of Dimes say about birth defects | Few can be attributed to a single cause. The majority are thought to result from an interplay between environment and heredity, depending on inherited susceptibility, stage of pregnancy, and degree of environmental hazards |
| What is most often the cause of neural tube defects | failure of neural tube closure at either the cranial (top) or the caudal (lower) end of the spinal cord |
| Hydrocephalus is characterized by... | an increase of CSF in the brain ventricles which cause pressure changes in the brain and an increase in head size |
| What causes hydrocephalus | an imbalance between the production and absorption of CSF or improper ventricle formation |
| When hydrocephalus is acquired (not present at birth) what is usually the cause | an obstruction such as a tumor, or a sequelae of infections (encephalities or meningitis), or perinatal hemorrhage |
| What determines the symptoms of hydrocephalus | the site of obstruction and the age at which it develops |
| How is hydrocephalus classified | noncommunicating or communicating |
| What causes noncommunicating hydrocephalus | obstruction of CSF flow from the brain ventricles to the subarachnoid space - when the tiny aqueduct of Sylvius is obstructed within the ventricles |
| What causes communicating hydrocephalus | when CSF is not obstructed in the brain ventricles but is inadequately absorbed in the subarachnoid space |
| What is the classic sign of hydrocephalus | increase in head size |
| What must happen if hydrocephalus forms in utero | a cesarean section delivery |
| In hydrocephalus, what happens at birth | the head enlarges rapidly, fontanelles bulge, cranial sutures seperate |
| Why do the cranial sutures seperate in an infant with hydrocephalus | to accommodate the enlarging mass |
| What is the physical appearance of a newborn with hydrocephalus | shiny scalp, dilated veins, setting sun sign of eyes |
| What is the setting sun sign of the eyes | pupils appear to be looking downward and the sclerae may be seen above the pupils |
| Is the setting sun sign visible in all cases of infants with hydrocephalus | No, only in advanced |
| What does a foreshortened occiput suggest | pathology of the 4th ventricle, with the brain stem protruding through the cervical canal |
| What is the Chiari malformation | a foreshortened occiput suggesting pathology of the 4th ventricle, with the brain stem protruding through the cervical canal |
| What is Dandy-Walker syndrome | hydrocephalus with a prominent occiput, usually involving atresia of the foramen of Luska and Magendie |
| Atresia | congenital absence or closure of a normal body opening or tubular structure |
| What are the symptoms of Dandy-Walker syndrome | prominent occiput, lethargy, thin body, poor extremity muscle tone, shrill and high pitched cry, irritablity, vomiting, anorexia, convulsions |
| What is the predominant symptom of hyrocephalus developing in an older child | headache with cognitive slowing, personality changes, spasticity, and other neurological signs |
| What is spasticity | the quality of moving or acting in spasms |
| Define neurological | pertaining to the nervous system |
| What is the nervous system | system of cells, tissues, and organs that regulates the body's responses to internal and external stimuli; portion of the vertebrate nervous system consisting of the brain and spinal cord |
| In hydrocephalus, what is transillumination used for | visualising areas of increased luminosity, indicating fluid |
| What is used for transillumination | a flashlight with a sponge-rubber collar and a dark room |
| What is a normal finding with transillumination, likely indicating there is no hydrocephalus | a small ring of light |
| What is an abnormal finding with transillumination, likely indicating hydrocephalus | a large halo effect |
| What visualization equipment is used for hydrocephalus | echoencephalography, computed tomography (CT), magnetic resonance imaging (MRI) |
| What is visualization equipment used for in suspected cases of hydrocephalus | to visualize enlarged ventricles and identify the area of obstruction |
| What type of proceedure is done to determine pressure and drain CSF | ventricular tap or puncture |
| Is clean or sterile technique used to perform a ventricular tap or puncture | sterile |
| What equipment is used for a ventricular tap or puncture | the same used for a lumbar puncture |
| What is done with drained CSF after a ventricular tap or puncture | a specime is labled and sent to the lab for analysis |
| Where is CSF formed | in the choroid plexus |
| How much total CSF is present in an infant and in an adult | 50ml and 150ml |
| What is the normal path of CSF in the brain | from lateral ventricles through foramen of Monro to third ventricle - through aqueduct of Sulvius to fourth ventricle - through the foramen of Luschka and Magendie to cisterns in the base of the brain - to the spinal canal - absorbed by arachnoid villi |
| What medications are used to reduce the production of CSF | acetazolamide and furosemide |
| What type of treatment is usually indicated in hydrocephalus | sugery |
| What is the purpose of surgery in hydrocephalus | to bypass, or shunt, the point of obstruction allowing the CSF to be carried to another point in the body to be absorbed and excreted |
| Where does a ventriculoperitoneal shunt redirect CSF to | peritoneal cavity |
| Define peritoneum | serous membrane lining the abdominal cavity |
| If the brain is not seriously damaged in hydrocephalus before surgery, what is the prognosis for the child | perserved mental function, slowed motor development |
| What are the usual types of complications regarding the shunt in hydrocephalus | mechanical or infetions |
| What is done if shunt infection persists with hydrocephalus | the shunt is removed |
| Where is pump for a ventriculoperitoneal shunt placed and why | behind the ear so that it can depressed intermittently to clear obstructions |
| What challenges may be present with preoperative care of a child with preoperative hydrocephalus | may be barely able to raise head, lack of appetite, tendency to vomit, poor infection resistence |
| Why does the nurse frequently change the position of an infant with preoperative hydrocephalus | to prevent hypostatic pneumonia and pressure sores |
| What causes hypostatic pneumonia | poor circulation in the lungs and remaining in one position too long |
| Which infants are most likely to develop hypostatic pneumonia | poorly nourished, weak, or those with a debiliting disease |
| What must ALWAYS be done when handling an infant with preoperative hydrocephalus | support the head |
| Describe the technique used for turning an infant with preoperative hydrocephalus | hold the head in the palm of one hand and rotate the head and body together to prevent strain on the neck |
| What parts of the nurse's body should support an infant with preoperative hydrocephalus when lifting | arm and chest |
| What parts of the infant's body are most likely to break down and what prevention is used | head, ears, bony prominences - lamb's wool pad and sponge rubber under the head |
| Which area does perspiration tend to collect in an infant with preoperative hydrocephalus | creases of the neck |
| When the nurse holds an infant with preoperative hydrocephalus for feeding, what technique is used | sit with the nurse's arm supported - calm - unhurried - quiet room |
| How is an infant with preoperative hydrocephalus positioned after feeding | side-lying |
| Why is it important not to disturb an infant with preoperative hydrocephalus after feeding | vomiting occurs easily |
| A nurse should make sure that daily care does not interfere with what for an infant with preoperative hydrocephalus | meals |
| What is observed, recorded, and reported for an infant with preoperative hydrocephalus | type and amounts of food, vomiting, skin condition, motor abilities, restlessness, irritability, V/S changes, fontanelle size, signs of bulging fontanelles, head circumference around the occiput, ICP signs, signs of cold or infection |
| What are the symptoms of increased pressure within the head | increase blood pressure, decrease pulse, decrease respirations |
| What is immediately reported to the charge nurse and recorded for an infant with preoperative hydrocephalus | signs of a cold or other infection |
| What is observed for in the care of a postoperative hydrocephalus patient | signs of ICP, infection at the operative site or along the shunt line, need for pain control management |
| What is a life threatening complication that sometimes necessitates shunt removal in an infant with postoperative hydrocephalus | bacterial infection |
| What are the signs of an infection in a patient with postoperative hydrocephalus | increased V/S, poor feeding, vomiting, dilated pupils, decreased LOC, seizures |
| What may an internal flushing device in an infant with postoperative hydrocephalus be used for | ensure patency of the shunt tube when increased ICP is suspected |
| Why might the surgeon order that an infant with postoperative hydrocephalus have the shunt routinely depressed manually a certain number of times each day | to facilitate drainage |
| Describe how to depress a ventriculoperitoneal shunt in an infant with postoperative hydrocephalus | compress the antechamber or reservoir that is under the skin behind the ear |
| How is an infant with postoperative hydrocephalus positioned if the fontanelles are sunken and why | flat because too rapid a reduction of fluid may lead to seizures or cortical bleeding |
| How is an infant with postoperative hydrocephalus positioned if the fontanelles are bulging and why | in the semi-fowler's position to promote drainage of the ventricles through the shunt |
| In what way is an infant with postoperative hydrocephalus always positioned | in a way that avoids pressure on the operative site |
| How is a nurse to determine what position an infant with postoperative hydrocephalus is to be in and/or what activity level is appropriate | the surgeon leaves orders |
| What is assessed and recorded for an infant with postoperative hydrocephalus | skin condition, head and chest measurements, abdomen measured if peritoneal shunt is in place, signs of increased ICP, need for pain control, I&O, signs of fluid overload |
| What are the signs of increased ICP in an infant with postoperative hydrocephalus | high pitched cry, unequal pupil size, unequal pupil response to light, bulging fontanelles, irritability, lethargy, poor feeding, abnormal V/S |
| What are the signs of increased ICP in an older child with postoperative hydrocephalus | personality change, LOC change, headache unrelieved by OTCs |
| The parents of an infant with postoperative hydrocephalus are educated about... | shunt malfunction signs, how and when to pump the shunt, need for multidiciplinary follow-up care, community resources, special car seat |
| What are the signs of tube malfunction in the older child with postoperative hydrocephalus | signs of increased ICP = headache, lethargy, LOC change |
| What is the survival rate for infants with hydrocephalus who recieve early treatment | 80% |
| How many of the early treated infants with hydrocephalus result in normal physical and neurological function | 1/3 |
| What is another name for Spina Bifida | myelodysplasia |
| What does spina bifida/myelodysplasia refer to | a group of CSN disorders characterized by malformation of the spinal cord |
| What is spina bifida/myelodysplasia | a congenital embryonic neural tube defect in which there is an imperfect closure of the spinal vertabrae |
| Define bifida | divided spine |
| What are the forms of spina bifida/myelodysplasia | occulta and cystica |
| Define occulta | hidden |
| Define cystica | sac or cyst |
| Define spina bifida occulta | disorder in which the opening of the spinal vertabrae is small and there is no associated protrusion of structures |
| Define spina bifida cystica | development of a cystic mass in the midline of the opening in the spine |
| Which condition is a relatively minor variation of spina bifida/myelodysplasia | spina bifida occulta |
| Where does spina bifida occulta occur most commonly | at the L5 and S1 levels |
| What may mark the site of spina bifida occulta | tuft of hair, dimple, discoloration, lipoma (benign tumor composed mainly of fat cells) |
| Is treatment necessary for spina bifida occulta | only if there are neuromuscular symptoms |
| What are neuromuscular symptoms of spina bifida occulta that indicate treatment may be needed | progressive disturbances of gait (footdroop) or of bowel and bladder function |
| What are the two types of spina bifida cystica | meningocele and meningomyelocele |
| What is a meningocele | congenital hernia in which the meninges protrude through a defect in the spinal column |
| What does a meningocele contain | portions of membrane (meninges) and CSF |
| Define meninges | membranes covering the spinal cord and brain = dura, pia, and arachnoid mater |
| How big is a meningocele | size varies from the size of a walnut to the size of a newborn's head |
| Define meningomyelocele | protrusion of membrane and spinal cord through the opening of a congenital hernia protruding through a defect in the spinal column |
| What physical problems are associated with meningomyelocele | paralysis of the legs, poor control of bowel and bladder, hydrocephalus |
| How can spina bifida/myelodysplasia be detected prenatally | ultrasonography and testing for increased alpha-fetoprotein (AFP) in amniotic fluid |
| What prenatal treatment can reduce the risk of neural tube defects | daily multivitamin containing 0.4mg of folic acid taken before conception and continued until the 12th week of pregnancy (when basic neural tube development is complete) |
| How is spina bifida treated | surgical closure |
| What patient with a meningomyelocele may have excellent results | one with no weakness of the legs or sphinter involvement |
| Besides the physical problems, what are two reasons surgery may be indicated in a meningomyelocele patient | cosmetic purposes and to avoid infection |
| What type of approach is taken with spina bifida patients after surgery and why | multidisciplinary - the child may have difficulties associated with hydrocephalus, orthopedic problems, and problems with urinary and bowel function |
| What is used in place of rehabilitation for a patient with a meningomyelocele, and why | Habilitation because this patient is learning, not relearning |
| What is the goal of habilitation for a patient with a meningomyelocele | minimize disability, put to constructive use the unaffected parts of the body |
| What may help a child with correction of a meningomyelocele become mobile | wheelchair, braces, crutches, or other walking devices |
| What may help some children with a meningomyelocele become continent | implantation of an artificial urinary sphincter |
| Why is becoming continent, when possible, important | to avoid complications associated with constant urinary dribble |
| What medication may increase bladder storage | oxybutynin chloride (ditropan) |
| What does bowel training a child allow | timed bowel movements so that the child can avoid social rejection from bowel incontinence |
| What is used to help with bowel training | suppositories |
| What is the main objective of nursing care of patients with spina bifida/myelodysplasia | prevention of infection or injury to the sac, positioning to prevent pressure on the sac and the development of contractures, good skin care, adequate nutrition, accurate observations and charting, parent education, supervision, and habilitation |
| What does immediate care of a spina bifida sac consist of | the infant is placed in an incubator - moist sterile dressings of saline or an antibiotic solution may be ordered to prevent drying of the sac - protection of the sac if surgery is delayed - sterile environement to prevent infection |
| What is documented and recorded for a patient with spina bifida | size, area, tears to, or leakage from the sac - exremities for deformities and movement - head circumference - fontanelles - anal sphincter control - urine dribbling |
| The ____________ the defect on the spine, the ____________ the neurological deficit in a patient with spina bifida. | higher - greater |
| Why is head circumference measured in patients with spina bifida | to determine the possibility of associated hydrocephalus |
| What determines if there will be spasticity or paralysis of limbs with spina bifida | type and location of cyst |
| Why are fontanelles observed in children with spina bifida | to provide baseline data |
| What are the goals of positioning an infant with spina bifida | avoid pressure on the sac and prevent postural deformities |
| What does a nurse do in positioning a child with multiple deformities | gaurd against aggravating existing problems |
| How is an infant with spina bifida usually placed, and why | prone, with a pad between the legs to maintain abduction and couteract hip subluxation - small roll under ankles for foot position |
| What is the position used to provide relief for a child with spina bifida, and what is the disadvantage associated | a supported side-lying posture - reduces movement of the arms and flexes the hips |
| Who might provide a helpful cosultation for the child with spina bifida | physical therapy |
| When is surgery on a patient with spina bifida generally done | early |
| What does postoperative nursing care consist of in a patient with spina bifida and what are significant findings | neurological assessment, infection prevention - fontanelle status, signs of increased ICP |
| What is sometimes performed shortly after the closure of the spine | a shunt if hydrocephalus is present |
| What complications can be life threatening to a postoperative spina bifida patient | meningitis, pneumonia, UTI |
| Why is urological monitoring essential for a postoperative spina bifida patient | many of these infants have urinary incontinence |
| What is the purpose of the medication (possibly antibiotics?) routinely given to spina bifida patients | prevent UTI |
| How is the bladder emptied in infants with spina bifida | crede method - pressure applied above the symphysis pubis) |
| How might an older child with spina bifida empty the bladder | intermittent, clean self catheterization |
| Why is skin care a challenge with spina bifida patients | contant dribbling of feces and urine irritates the perineal area and can infect the sac or incision |
| What is necessary to prevent infection in patients with spina bifida | meticulous cleaning - dry, wrinkle free sheets, frequent cleaning, ointment (if ordered) or lotion, light massage, gentle movements |
| If closure of the defect in spina bifida is delayed, how is feeding accomplished | gavage |
| What stimulation is provided to spina bifida patients who can not be held | touch, talking (en face when possible), mobiles, movement of the incubator, soft music |
| What type of allergy do many spina bifida patients develop | latex |
| What products are parents of a child with spina bifida cautioned about | toys = koosh balls, baloons, tennis balls - adhesive strips - food = bananas, avocados, kiwi - pacifiers, nipples, water toys |
| What may be prescribed before and after surgery to prevent allergic reactions in spina bifida patients | antihistamines and steroids |
| What kind of gloves should be worn when caring for spina bifida patients | nitirle |
| What complicates bonding of parents and spina bifida patients | the infant being transferred to a large medical center |
| What should the nurse do if parents are repulsed by the cyst on an infant with spina bifida | provide understanding and support, recognize that this is a normal reaction, look for signs of grieving the loss of their "perfect baby," and provide resources with more information |
| What is a cleft lip and how is it characterized | failure of the maxillary and median nasal processes to unite during embryonic development (usually between 7 to 8 weeks gestation) - fissure or opening in the upper lip |
| What causes cleft lip | hereditary predisposition, environmental influences during oral development |
| Who appears to develop cleft lip most | girls, Asian and Native Americans |
| Who appears to develop cleft lip less commonly | African Americans |
| Where does cleft lip appear | one or both sides of the lip |
| What disorder may accompany a cleft lip | cleft palate |
| What is the initial treatment for a cleft lip | cheiloplasty |
| When is cheiloplasty performed | by 3 months of age |
| What is done before cheiloplasty | complete physical, routine blood tests, photographs (maybe), any signs of oral, systemic, or respiratory infection reported |
| Why might elbow restraints be ordered preoperatively for an infant with cleft lip | to prevent scratching and to get the infant used to them for after surgery |
| How is the preoperative cleft lip infant fed | an asepto syringe with a rubber tip, long nipple with a large hole attached to a squeeze bottle, or a medicine dropper |
| Why is an infant not fed with a bottle or put to breast after surgery for a cleft lip | sucking motions must be avoided to decrease tension on the suture line |
| For how long after a chleiloplasty is an infant fed by a dropper | 1 to 2 weeks until the wound is completely healed |
| What does postoperative nursing care for an infant with cleft lip entail | prevent sucking and crying, positioning, infection and scar prevention, operative site injury prevention, provide for emotional needs, pain relief |
| How is a postoperative patient with cleft lip positioned and why | never on the abdomen to avoid injury to the operative site |
| How is scarring and infection prevented following a cheiloplasty | gentle cleansing of the suture line to prevent crusts from forming |
| How is injury to the operative site prevented following a cheiloplasty | elbow restraints or a logan bow |
| What is a logan bow | a device used to immobilize the upper lip |
| How long is a logan bow used for | a short time postoperatively |
| How are and infant's emotional needs met after a cheiloplasty | cuddling and other forms of affection |
| How soon after surgery is an infant who has had a cheiloplasty fed | as soon as clear liquids are tolerated |
| What do you avoid while inserting the dropper into the mouth of an infant who has undergone cheiloplast | toiching the suture line and allowing sucking |
| How is aspiration prevented when feeding an infant from a dropper | placing a small amount of formula into the mouth and allowing time to swallow |
| How is formula and drainage cleaned from the mouth of an infant who has had cheiloplasty | mouth is cleansed by offering a small amount of sterile water - suture line is cleansed with saline solution and if prescribed an ointment is applied |
| What actions can be taken by the nurse during and after feeding to aid in a positive outcome for an infant who has had cheiloplasty | holding during feeding, frequent burping, placed in an infant seat or propped on the right side |
| What can a mother do to feel more confident about feeding her infant after discharge | feed the infant preoperatively and assist during hospitalization, if allowed |
| What is a cleft palate | a failure of the hard palate to fuse at the midline during the 7th to 12th weeks of gestation creating a passageway between the nasopharynx and the nose |
| In addition to complicating feedings, what can a cleft palate lead to | infections of the respiratory tract and middle ear that can result in hearling loss, speech difficulties later in life |
| How is cleft palate discovered | careful examination of the oral cavity and upper palate at birth |
| Why is feeding problematic for an infant with a cleft palate | the cleft prevents negative pressure from forming in the mouth, which is necessary for successful sucking |
| What are the goals of treatment/therapy for a cleft palate | cleft union - improved feeding, speech, dental development, and the nurturing of a positive self image |
| When do surgeons prefer to operate on a cleft palate, and why | between 1 year and 18 months so that speech patterns are minimally affected |
| What may be used if surgery for a cleft palate is deferred | a dental speech appliance |
| Treatment of the child with a cleft lip and palate requires multidisciplinary teamwork with... | psychologist, speech therapist, pediatric dentist, orthodontist, social worker, pediatrician |
| What is the public health nurse responsible for with a cleft palate patient | coordinating parental counseling and referral as needed |
| In a patient with a cleft palate, what sometimes requires more extensive attention than the repair | emotional problems |
| What can be frustrating about development with a cleft palate | irregular tooth errution, difficult and tense initial feedings, drooling, delayed speech, intermittent hospitalization and frequent appointments |
| At what prenatal time period can cleft palate be detected by high resolution ultrasound | 13 weeks |
| In a developing child with a cleft palate, what can be sensed that can be detrimental to self image | parent's feelings |
| What are some community referals that can be offered to families of children with a cleft palate | American Cleft Palate Association, Cleft Palate Foundation, March of Dimes Birth Defect Foundation, and state programs for children with special needs |
| How is postoperative nutrition facilitated for cleft palate repair | fluids by cup or gravity feeder, progressive diet starting with clear fluids, soft diet by discharge, diet is advanced only on consultation with the physician |
| What should be avoided postoperatively regarding nutrition in a cleft palate repair | hot foods and liquids (prevents operative site injury), straw, touching the roof of the mouth with a spoon (or anything avoidable) |
| What is used to keep the fingers of the child who has a cleft palate repair away from the mouth | elbow restraints |
| What does oral care after a cleft palate repair consist of | a little bit of water after feedings and a mild antiseptic mouthwash (if ordered) |
| How should a nurse talk with a child who has had a cleft lip repair | slowly and distinctly and encourage the child to pronounce words correctly |
| Who should be consulted in cases of children who have undergone extensive repairs for a cleft palate or who have associated deafness and what will they do | speech therapist - evaluate the child and assist the parents in specific activities that facilitate speech development |
| What is the point of diversion when being used with a child who has had a cleft palate repair | to keep the child from crying |
| What are complications that may accompany a cleft palate | ear infections and dental decay |
| When should parents take a child with a cleft palate to the doctor regarding ear aches | at the first sign |
| What is the stable goal of long term care of the infant with a cleft palate | to promote optimal growth and development and establish positive self esteem |
| What is one of the most common skeletal deformities characterized by a foot that has been twisted inward or outward | Clubfoot |
| What causes mild forms of clubfoot | improper postition in the uterus |
| How is mild clubfoot rectified | manipulative exercises |
| Does true clubfoot respond to manipulative exercises | No |
| Define talus | heel |
| Define pes | foot |
| When is treatment for clubfoot started | as early as possible |
| Why is treatment for clubfoot started as early as possible | so the bones and muscles don't continue to develop abnormally |
| What type of treatment is carried out during infancy for clubfoot | conservative - splinting or casting to hold the foot in the right position - passive stretching exercises may be recommended |
| When is surgery for club foot most likely to be indicated | if conservative methods are not effective by 3 months |
| What are parents of an infant with clubfloot instructed about | developmental behavior, clinical aspects of care, cast care |
| What are casts made out of | plaster or synthetic materials such as fiberglass or polyurethane |
| What is a plaster cast made from | crinoline with powdered plastic in its meshwork |
| How is a plaster cast made | the crinoline is placed in warm water before being applied over cotton wadding or a stockinet and the wet plaster of paris hardens as it dries |
| How does a plaster cast dry and how long does it take | from the inside out - 24 to 48 hours |
| How is the cast care performed before a cast is dry | casts are left uncovered and protected from pressures that could cause a depression and the palms of the hands are used to lift |
| What are the toes, leg, and cast of a casted leg assessed for | capilary refil, signs of poor circulation, pallor, cyanosis, swelling, coldness, numbness, pain, burning, skin irritation, toe movement, evidence of bleeding |
| Why are adhesive petals placed around the edge of a cast | to prevent skin irritation |
| What options might the physician utilize if circulation of the casted leg becomes impaired | split the cast to relieve pressure, remove and replace |
| Why is it important for parents to know how to assess circulation of a casted infant's leg | because an infant grows rapidly and it may need to be replaced |
| When would a nurse observe around a cast for evidence of bleeding | if surgery on tendons and bones has been performed |
| What is done of a discolored area appears on the cast | it is circled and the time is recorded so that further bleeding can be assessed, and the patient's V/S are checked and compared with preoperative readings |
| How often is the cast changed for a patient with clubfoot and why | every 3 weeks to bring the foot gradually into position |
| What may be indicated when the final cast is removed from a patient with clubfoot | exercise and special shoes |
| Why do nurses review growth and development in a patient with clubfoot | to compare it to other children in the patient's age range to anticipate problems and educate caretakers |
| What does a nurse do if it is suspected that the parents of a child with clubfoot need financial help | make a social service referral |
| What must parents of orthopedic patients be educated about | orthopedic devices, cast care, exercise, hygeine, and treatment goals, importance of clinic visits |
| What is hip dysplasia | a broad description applied to various degrees of deformity |
| What type of deformity does developmental hip dysplasia refer to | the head of the femur is partially or completely dislocated or subluxed |
| Define acetabulum | hip socket |
| What causes developmental hip dysplaia | heredity and environmental factors, hip malformations, joint laxity, breech position, maternal hormones |
| What is the danger if developmental hip dysplasia is not detected and treated early | a child beginning to walk can cause complete dislocation |
| Which cultures have a high risk for infants being born with developmental hip dysplasia | cultures that snugly wrap infants with hips in adduction and extension |
| Which cultures have a lowered risk for infants born with developmental hip dysplasia | those that carry the infants straddled on the mother's waist with hips flexed and widely abducted |
| When is a dislocation of the hip commonly discovered | at a periodic health exam during the first or second month of life |
| How does a physician discover hip displaysia during a periodic health exam | infant is put on the back with knees and hips flexed, a normal thigh is pressed backwards to almost touch the table, displaced hip can be pressed only partially back-lower knee on displaced side-deeper asymmetrical skin folds-one buttock higher when prone |
| What is the most reliable sign of a dislocated hip | limited abduction of the leg on the affected side |
| How and why is Barlow's test performed | to detect an unstable hip, the physician adducts and extends the hips while stabalizing the pelvis and may feel a dislocation occur as the femur leaves the acetabulum |
| What is Ortolani's sign or click | the physician can hear and feel the femoral head slip into the acetabulum of a dislocated hip under gentle pressure |
| How does a child with developmental hip dysplasia and no treatment walk | with a limp |
| Is bilateral or unilateral hip dislocation more common | unilateral |
| Is developmental hip dysplasia more common in boys or girls | 7 times more likely in girls |
| When does treatment of developmental hip dysplasia begin | immediately |
| What is the initial treatment of developmental hip dysplasia | maintain the hips in constant flexion and abduction for 4 to 8 weeks to keep the head of the femur withing the hip socket |
| How does constant flexion and abduction of the hip correct dyslplasia | constant pressure enlarges and deepens the acetabulum |
| What is used to hold a newborn with developmental hip dysplasia in the corrective position | a triple thick diaper until a pavlick harness is properly fitted for infants aged 1 to 8 months |
| Why and how does treatment of developmental hip dysplasia change if discovered after 2 months of age | soft tissue contractures prevent hip stabilization and longer term immobilization may be required |
| What might be necessary if hip dislocation is severe or undetected until the child begins to walk | traction |
| Once muscle spasms from severe or late detected developmental hip dysplasia are overcome, how is the treament progressed | a body spica cast holds the child in a froglike position |
| How long does patient with severe or late detected hip dyslpasia remain in a spica cast | usually 5 to 9 months |
| How often is a body spica cast replaced for a patient with severe or late detected developmental hip dyslpasia | every 6 weeks |
| When might surgery for developmental hip dysplasia be indicated | in infants more than 18 months of age |
| What is the purpose of surgery in a patient with hip dysplasia | open reduction of the dislocation or repair of the shelf of the hip bone |
| What keeps the patient's femur in the correct position after surgery for developmental hip dysplasia | a cast |
| When does the nurse most likely observe for hip dysplasia | during the bath |
| What signs might the nurse notice that indicate developmental hip dysplasia | variation in buttock size when prone, unequal leg length, only one leg kicking, asymmetrical skin folds |
| What does the nurse note during a well baby visit for older children in regards to hip dysplasia | posture and gait |
| Which infants are able to stay at home during treatment for developmental hip dysplasia | those who progress well with the pavlick harness |
| How is a child admitted to the hospital with a diagnosis of developmental hip dysplasia treated | with as much personal attention as possible to set the pattern for future hospitalizations |
| How does a body spica cast fit | it encirles the waist and extends to the ankles or toes |
| Why are firm plastic covered pillows necessary for patients with body spica casts | to support the cast curvatures |
| What type of bedpan is used for toilet trained patients in a body spica cast | fracture |
| How is the bed of a body spica cast patient positioned, and why | slightly elevated so that urine or feces drain away from the body of the cast |
| Why can't pillows be used to elevate the head or shoulders of a child in a body spica cast | it thrusts the chest against the cast and causes discomfort or respiratory difficulty |
| What is an untoilet trained child in a body spica cast lain on | a bradford frame |
| When may infants in a body spica cast be held on the lap | after the cast has dried |
| Why is it important to observe for nonverbal cues of pain in younger children and to ask about pain in older children | unrelieved pain, especially after a few days may indicate compartment syndrome that appears in a group of muscles and fascia where an increased pressure in a closed space may disrupt circulation in the space |
| When two nurses are turning a child in a body cast, where are the hands of the nurse that is closest to the child placed after the child has been moved to the edge of the bed | one hand under the head and back and one hand under the leg part of the cast |
| What position should the older child in a spica cast be in to eat and why | on the abdomen to facilitate swallowing and self feeding |
| How is itching relieved in a child with a body spica cast | a strip of gauze is under the cast and can be moved gently back and forth |
| How is the scratching gauze replaced when it becomes dirty | a clean one is tied to the end of it and pulled through the cast |
| What kind of referral should be made upon discharge for a child with developmental hip dysplasia in a body spica cast | home health care |
| If an infant has an inborn error of metabolism that is not apparent before birth, when is it most likely to be detected | as the infant adjusts to the birth process and begins to ingest nourishment |
| What symptoms should be reported to avoid long term or life threatening sequelae related to an inborn error of metabolism | lethergy, poor feeding, hypotonia, unique odor to body or urine, tachypnea, and vomiting |
| What does PKU stand for | Phenylketonuria |
| What is classic phenylketonuria | a genetic disorder caused by faulty metabolism of phenylalanine |
| What is phenylalanine | an amino acid essential to life and found in all protein foods |
| What causes classic phenylketonuria | an autosomal recessive gene |
| What blood levels of phenylalanine are associated with classic phenylketonuria (PKU) | above 20mg/dl |
| What does the hepatic enzyme phenylalanine hydrolase normally do | converts phenylalanine into tryosine |
| What does the hepatic enzyme phenylalanine hydrolase do with classic phenylketonuria (PKU) | nothing...it is missing |
| What happens when an infant with classic phenylketonuria (PKU)is fed formula | phenylalanine begins to accumulate in the blood increasing to as high as 20 times the normal amount |
| What is the by product of phenylalanine | phenylpyruvic acid |
| When does phenylpyruvic acid appear in the urine of an infant with classic phenylketonuria (PKU) | within the first weeks of life |
| What are the effects of classic phenylketonuria if not detected and treated even before phnylpyruvic acid appears in urine | severe mental retardation |
| If not treated, when does the infant with classic phenylketonuria (PKU) begin to show delayed development | 4 to 6 months of age |
| What are the late signs of classic phenylketonuria (PKU) | failure to thrive, eczema, musty odor, personality disorder, seizures |
| What are less severe forms of phenylketoneuria called | atypical PKU and mild hyperphenylalaninemia |
| What are the physical characteristics of children that typically have PKU | blonde hair, blue eyes |
| Why do children that typically have PKU have blonde hair and blue eyes | tryosine, which is missing in children with phenylketonuria, is necessary for the production of melanin |
| What is the most reliable test to detect classic phenylketonuria(PKU) | Guthrie blood test |
| How is a sample for the Guthrie test obtained | capillary heel stick blood is placed on filter paper and mailed to the lab |
| When is a sample for the Guthrie test obtained | after 48 to 72 hours of life, preferrably after the ingestion of protein to reduce the possibility of a false negative result) |
| Due to early discharges, when may the Guthrie test be repeated | within 2 weeks |
| Where can an infant be tested for classic phenylketonuria(PKU) | at home by a public health nurse or at a clinic or physician's office |
| What are the optimum levels of phenylalanine | between 2 and 10 mg/dl |
| What will phenylalanine levels below 2 mg/dl cause | growth retardation |
| What will phenylalanine levels above 10 mg/dl cause | brain damage |
| What is the treatment for classic phenylketonuria(PKU) | close dietary management and frequent evaluations of blood phenylalanine levels |
| How do infants with classic phenylketonuria(PKU) get the protein needed for growth and tissue repair | Lofenalac or Phenex-1, sustitute formulas |
| How do children with phenylketonuria (PKU) get the protein needed for growth and tissue repair | Phenyl-Free is introduced between 3 and 8 years |
| How do adolescents get the protein needed for growth and tissue repair | Phenex-2 |
| Can infants with classic phenylketonuria(PKU) be breastfed | there is a low phenylalanine content in breast milk and infants can be partially breastfed and supplemented with Lofenalac while blood levels are monitored |
| When and what type of solid foods are added to the diet of a child with classic phenylketonuria(PKU) | at the same age that solid foods are added for children without PKU - foods low in phenylalanine |
| Who might be consulted to guide and support parents in maintaining the dietary regimen of a child with PKU | a dietitian |
| The intake of most of what foods must be restricted for patients with phenylketonuria | meat, dairy, diet drinks |
| What artificial sweetner is converted to phenylalanine in the body | aspartame/nutrasweet |
| Phenylalanine levels greater than ____ in pregnant women can affect embryo development | 6mg/dl |
| What causes maple syrup urine disease | a defect in the metabolism of branched chain amino acids that causes marked serum elevations of leucine, isoleucine, and valine resulting in acidosis, cerebral degeneration, and death within 2 weeks if untreated |
| How does maple syrup urine disease manifest | a seemingly healthy infant soon develops feeding difficulties, loss of the moro reflex, hypotonia, irregular respirations, and convulsions |
| How is the urine, sweat, and earwax of infant's with maple syrup urine disease affected | it has a characteristic sweet or maple syrup odor |
| What causes the sweet odor in maple syrup urine disease | ketoacidosis |
| How is diagnosis of maple syrup urine disease confirmed | blood and urine tests |
| What is the initial treatment of maple syrup urine disease | removing the amino acids leucine, isoleucine, and valine and their metabolites from the tissues of the body with peritoneal dialysis and hydration |
| How long does a patient with maple syrup urine disease stay on a diet low in leucine, isoleucine, and valine | lifelong starting with a special infant formula |
| What are exacerbations of maple syrup urine disease usually caused by | infection |
| What is galactosemia | condition when the body has a missing or defective enzyme and is unable to use the carbohydrates galactose and lactose |
| What does the disturbance in the process of the normally occurring chemical reaction where the enzyme that is missing in galactosemia should convert galactose to glucose cause | galactosemia (galactose in blood, galactosuria (galactose in urine), liver cirrhosis, cataracts, mental retardation |
| What can't breastmilk or regular formula be given toinfants with galactosemia | galactose is in milk sugar |
| What are the early signs of galactosemia | lethargy, vomiting, hypotonia, diahrrea, and failure to thrive - jaundice may be present |
| How is diagnosis of galactosemia made | by observing galactosuria, galactosemia, and evidence of decreased enzyme activity in RBCs |
| What is the treatment for galactosemia | breastmilk, typical formulas, and milk are eliminated from the diet and replaced with lactose free and soy protein based formulas |
| What are the risk factors for down syndrome | mothers over 35, fathers over 55 |
| If the first infant of a young mother has down syndrome will future children have down syndrome | subsequent children are usually free of the defect |
| Define phenotype | genetic makeup |
| What are the phenotypes of down syndrome | trisomy 21, mosaicism, translocation of a chromosome |
| Which down syndrom phenotype is most common | trisomy 21 |
| What is the chromosomal abnormality present in down syndrome trisomy 21 | there are 3 # 21 chromosomes instead of the normal 2 which results in nondisjunction |
| Define nondisjunction | meiosis in which there is a failure of paired chromosomes to separate; results in an abnormal number of chromosomes in the daughter cells |
| In down syndrome trisomy 21, what determines how many cells will be affected | the earlier in the embryo's development, the greater the number of cells affected |
| What is the abnormality in down syndrome phenotype mosaicism | nondisjunction occuring late in development and resulting both normal and abnormal cells to be present in the newborn |
| What occurs in the chromosomal abnormality of down syndrome phenotype translocation | a piece of chromosome in pair 21 breaks away and attaches itself to another chromosome |
| Which down syndrome phenotype results in the patient being less severely affected in appearance and intelligence | mosaicism |
| When is prenatal screening for down syndrome offered | 15 weeks gestation |
| What do down syndrom screening tests look for | alpha fetoprotein (AFP), unconjugated estriol, human chorionic gonadotrophin (hCG) |
| What is the down syndrome screening called | triple test |
| What is the most accurate methods of prenatal screening and what is the risk of having them | amniocenteses and chorionic villus sampling - they are invasive and carry a risk for pregnancy loss |
| What might a clinician see on ultrasound to alert to the possibility of down syndrome | increased nuclei skinfold thickness |
| How is down syndrome diagnosed | by clinical manifestations - close set and upward slanting eyes, small head, round face, flat nose, protruding tongue that interferes with sucking, mouth breathing, short thick hands, curved little finger, simian crease, wide space between 1st & 2nd toes |
| Why is the infant with down syndrome able to assume unusual positions | undeveloped muscles and loose joints |
| What type or internal deformities are often associated with down syndrome | congenital heart deformities |
| What medical difficulties do children with down syndrome face | poor infection resistance, respiratory and ear infections, speech and hearing problems, acute leukemia, alzheimer's disease |
| What causes the limp, flaccid posture of a down syndrome infant and what else does it cause | hypotonicity of the muscles - difficult holding and postioning and contributes to heat loss, respiratory problems and excess mucus accumulation, constipation |
| What type of emotion should the nurse show to the parents of a down syndrome child | empathy |
| What is done to facilitate bonding of parents and a down syndrome child | involved in care and planning for the infant from the start |
| Who should be included in discussions about the down syndrome newborn | siblings |
| What causes eythroblastosis fetalis | small leaks that may allow the fetal blood of an Rh positive fetus with an Rh negative mother and an Rh positive father to enter maternal circulation and sensitize the mother |
| Define sensitiziation | aka isoimmunization = mothers body produces antibodies that cross the placenta and destroy the blood cells of the fetus |
| What does isoimmunization/sensitization cause | anemia and possible heart failure in the fetus |
| What medication is given to women at risk for sensitization/isoimmunozation | RhoGAM/Rh immune globulin |
| What is ABO incompatibility | hemolytic disease with symptoms similar to those of erythroblastosis - O blood type mother with an A or B blood type fetus |
| What is the treatment for ABO incompatibility | the same as for erythroblastosis fetalis = RhoGAM |
| Why are subsequent children at greater risk of developing erythroblastosis fetalis | the mother accumulates antibodies with each pregnancy |
| What is the gravest form of erythroblastosis fetalis | hydrops fetalis |
| What does hydrops fetalis cause | anemia, heart failure, fetal hypoxia, anasarca (edema) |
| What is done to prevent hemolytic disease in the newborn | extensive maternal health history, blood titers of the mother, indirect coombs test on the mother's blood, RhoGAM at 28 weeks gestation and within 72 hours of birth |
| What is of particular interest regarding a maternal history to prevent hemolytic disease | previous Rh sensitizations, ectopic pregnancies, abortion, blood transfusion, children who developed jaundice or anemia neonatally |
| How is a hemolytic disease of the newborn diagnosed | by amniocentises and bilirubin levls of amniotic fluid |
| What can be done to allow a fetus with a hemolytic disease to remain in utero until the lungs mature | intrauterine fetal transfusions |
| How can fetal RhD status be assessed noninvasively | via free maternal plasma DNA |
| Besides 28 weeks gestation and within 72 hours of birth, when might RhoGAM be administered | after abortion, amniocentesis, or to women who have bleeding during pregnancy |
| How is RhoGAM administered | IM injection |
| What does RhoGAM do and what can it not do | prevent the development of Rh+ antibodies - has no effect on existing antibodies |
| How does erythroblastosis fetalis manifest | anemia, pathological jaundice, possible enlargement of the liver and spleen, shock, heart failure, opisthotonos postioning (arched back), seizures |
| How are hemolytic diseases treated in the newborn | drug therapy, phototherapy, possible exchange transfusions |
| How is phototherapy carried out | the newborn is placed in an incubator under a bank of fluorescent lights with eyes protected |
| How is intensive phototherapy carried out for a term infant | fluorescent lights are placed within 10cm of a naked infant in a bassinet possibly with 2 or 3 fiberoptic pads under the body |
| How is intensive phototherapy carried out for a preterm infant | standard light source are above an incubator and 1 fiberoptic pad is under the infant |
| What may increase the effectiveness of intense phototherapy | lining the sides of incubator with aluminum foil or a white sheet |
| When is phototherapy discontinued | when bilirubin levels drop to 14mg/dl |
| What are the contraindications for phototherapy | infants with a history of congenital porphyria or that are being given photosensitizing medications |
| When is an exchange transfusion typically indicated | when phototherapy fails to keep bilirubin at acceptable levels |
| Where is the catheter inserted for a newborn exchange infusion | unbilical vein |
| How much blood is initially withdrawn from a newborn during an exchange transfusion | 10 t0 20 ml |
| What type of blood is given to a newborn during an exchange transfusion | Rh negative |
| How much donor blood is given to a newborn during an exchange transfusion | twice the infant blood volume - 500ml limit |
| How much of an infant's blood will have been replaced after a second exchange transfusion | 85% |
| Why might a newborn undergoing exchange tranfusions for a hemolytic disease be given antibiotics | to prevent infection |
| What is the nurse responsible for during the care of a newborn with a hemolytic disease | observing color, reporting 1st or 2nd day jaundice, applying wet sterile compresses to the umbilicus until transfusion completes, stressing prenatal care to mother for future, educating parents, assisting physician |
| What new drug is under study for approval by the FDA that is designed to treat hyperbilirinemia thus eliminating the need for exchange transfusions and possibly phototherapy | mesoporphyrin |
| What infant is a candidate for immediate exhange transfusion with fresh whole blood | one born with cardiac failure and edema as a result of hemolutic disease |
| With home phototherapy, what do parents record | temp, weight, I&O, stools, feedings |
| What is the most common type of birth injury | intracranial hemorrhage |
| What causes intracranial hemorrhage | trauma or anoxia |
| Intracranial hemorrhage occurs more often in ______ infants because _________. | preterm - blood vessels are more fragile |
| What happens during intracranial hemorrhage | blood vessels within the skull are broken and bleeding into the brain occurs |
| What may be noted when an intracranial hemorrhage diagnosis is made | specific location of the hemorrhage |
| During what type of deliveries may intracranial hemorrhage occur | precipitate, prolonged, or large head compared to mom's pelvis |
| What are the signs of intracranial hemorrhage | poor muscle tone, lethargy, poor suck, respiratory distress, cyanosis, twitching, forceful vomiting, high pitched shrill cry, convulsions, opisthonotic posturing, tense fontanelles, one dilated and once constricted pupil |
| What are the outcomes of intracranial hemorrhage | mild symptoms = good chance of complete recovery, extensive hemorrhage = possible residual efects such as cerebral palsy or mental retardation, massive hemorrhage = death |
| How is an intracranial hemorrhage diagnosis established | delivery history, computed tomography (CT), MRI, increased CSF, and symptoms and course of disease |
| What is the treatment for intracranial hemorrhage | incubator and continuous observation |
| Why is a newborn with an intracranial hemorrhage placed in an incubator | temerature control, easy oxygen administration |
| How is newborn with an intracranial hemorrhage handled | gently and as little as possible |
| How is a newborn with an intracranial hemorrhage positioned | elevated head |
| What might the physician prescribe to a newborn with an intracranial hemorrhage and why | vitamin K to control bleeding, and phenobarbitol if twitching or convulsions are present, prophylactic antibiotics and vitamins |
| What are essential nursing duties or a newborn with an intracranial hemorrhage | neurochecks, V/S monitoring, head circumference measuring, fontanelle palpating |
| If a convulsion occurs in a newborn with an intracranial hemorrhage, what aids the physician in diagnosing the exact location of the bleeding | were arms legs or face involved, right or left side of body, mild or severe convulsion, length of convulsion, condition before and after |
| When does transient tachypnea of the newborn (TTN) usually occur | after a cesarean section or an uneventful vaginal delivery of a term infant |
| What are the characteristics of transient tachypnea of the newborn (TTN) | tachypnea, chest retractions, grunting, mild cyanosis |
| What is another name for transient tachypnea of the newborn (TTN) | respiratory distress syndrome type II |
| When does transient tachypnea of the newborn (TTN) typically resolve | suddenly after 3 days |
| What causes transient tachypnea of the newborn (TTN) | slow absorption of fluid in the lungs |
| What is the treatment for transient tachypnea of the newborn (TTN) | provide warmth, conserve energy, supplement oxygen |
| What is meconium aspiration syndrome (MAS) | group of symptoms that occur when the fetus or newborn aspirates meconium |
| What is the primary symptom of meconium aspiration syndrome (MAS) | respiratory distress including nasal flaring, retractions, cyanosis, grunting, rales, ronchi |
| What is the treatment for meconium aspiration syndrome (MAS) | provide warmth, conserve energy, supplement oxygen |
| Where does an infant with meconium aspiration syndrome go | NICU |
| When does neonatal abstinence syndrome occur | when the fetus has prenatal exposure to drugs (opiates, amphetamines, tranquillizers, multiple illicit drugs) |
| What are the principle signs of neonatal abstinence syndrome | body tremors, hyperirritability - may also have wakefulness, diarrhea, poor feeding, sneezing, yawning |
| What is the most accurate specimen to test for neonatal abstinence syndrome | meconium |
| What determines the problems for an infant with a diabetic mother | severity and duration of disease in mom, degree of control, gestational age of infant |
| What is the appearance of an infant with a mom that has poorly controlled diabetes | round, puffy cushingoid face - lethargic - large |
| What might a large infant with a diabetic mother suffer from | developmental deficits, respiratory distress syndrome, congenital anomalies |
| What might a small infant with a diabetic mother suffer from | hypoglycemia, hypocalcemia, hyperbillirubinemia |
| What causes an infant with a diabetic mother to have macrosomia | maternal hyperglycemia transfers large amounts of glucose to the fetus and fetal hyperinsulinism creates an excess production of protein and fatty acids |
| What causes an infant with a diabetic mother to be small for gestational age | poor placental perfusion |
| What defines hypoglycemia in the first days of life | blood glucose levels below 40mg/dl |
| Nursing care of an infant with a diabetic mother: What is watched for, and what is done by the nurse? | signs of irritability, tremors, respiratory distress - monitor V/S, early feeding, freequent blood glucose assessment for the first 2 days of life |
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