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Pediatric Ch 14

Perinatal Injury or Congenital Malformation

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
Created by: futurenurse