Ch. 30 Study Guide
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| Air leakage into the middle are of the chest between the sternum & vertebral column | Pneumomendiastinum
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| Protrusion of meninges & spinal cord through a vertebral defect | Myelomeningocele
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| Intestines protruding into the cord | Omphalocele
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| Technique to oxygenate the blood while bypassing the lungs | Extracorporeal membrane oxygenation
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| Air leakage into the chest cavity | Pneumothorax
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| Removal of small amounts of blood & replacement with donor blood | Exchange transfusion
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| Abdominal defect with intestines protruding out | Gastroschisis
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| Protrusion of meninges through a spinal defect | Meningocele
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| What is primary apnea? | In primary apnea, the infant may respond to stimulation and oxygen when respirations cease.
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| What is secondary apnea? | In secondary apnea, the infant does not respond to stimulation and loses consciousness.
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| Which type of apnea is more more ominous & why? | Secondary apnea is more ominous because stimulation is not enough to reverse it, blood oxygen levels decrease further, and resuscitation must be started immediately to prevent permanent brain damage or death.
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| What is relationship among bilirubin, jaundice, bilirubin encephalopathy & kernicterus? | Bilirubin is waste product of excess RBC breakdown. Jaundice is staining of skin & sclerae by bilirubin. Bilirubin encephalopathy is acute condition from bilirubin in the brain--may lead to kernicterus. Kernicterus is chronic & permanent result of toxic
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| Why is phototherapy begun at lower bilirubin levels if the infant is preterm rather than full-term? | Bilirubin encephalopathy may occur at lower bilirubin levels in the preterm infant than in the term infant.
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| Explain phototherapy, why it is needed, how it works & what precautions are needed to prevent injury? | See pp. 807-808
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| What is purpose of an exchange transfusion? | Exchange transfusion replaces infant’s blood w high levels of bilirubin, unconjugated bilirubin, and sensitized RBC with blood that has normal levels. blood that replaces infant’s blood is not sensitive to circulating antibodies from mother that have des
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| Infants exposed @ birth receive immune globulin & immunization to prevent infection | Hepatitis B
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| Typically manifested by white patches in mouth that resemble milk curds | Candididiasis
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| Intellectual disability is associated with these infections | Cytomegalovirus
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| Antibiotic prophylaxis soon after birth can prevent blindness | Gonorrhea
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| Maternal antiviral treatment during pregnancy can markedly reduce transmission to infant | Group B strep infection
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| May cause eye infection or pneumonia | Length and head circumference are usually normal for the gestational age. The face is round, the skin is red, the body is obese, and muscle tone is poor. The infant is irritable and may have tremors when disturbed.
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| List factors that make newborns more vulnerable to sepsis neonatorum | Signs include jitteriness, tremors, diaphoresis, tachypnea, low temperature, poor muscle tone, and low glucose screening test levels
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| Compare early & late onset neonatal sepsis | When excessive erythrocytes break down, bilirubin is released more quickly than it can be eliminated by the liver.
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| How does the newborn manifest infection compared with an older child? | Signs of infection are often more subtle in infants than in older children. Signs include temperature instability, respiratory problems, and changes in feeding habits or behavior. (See “Critical to Remember: Signs of Sepsis in the Newborn.”)
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| Why is it particularly important to identify newborn sepsis early? | Early identification is important because shock can develop quickly.
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| What tests are usually performed when neonatal sepsis is suspected? | Culture of specimens from blood, urine, skin lesions, and cerebral spinal fluid,complete blood count, immunoglobulin M (1gM) levels ); C-reactive protein , chest radiography, blood glucose levels
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| What are tests purposes & how do they change in sepsis? | if diabetic woman has vascular changes, placental blood flow may be reduced, interfering with fetal growth. If no vascular changes, she transfers large amts nutrients to fetus & it secrets large amts insulin to metabolize glucosemacrosomia.
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| Why are tests for drug-levels often needed for antibiotics? | Blood is analyzed at the highest (peak) and lowest (trough) levels to provide a basis for any needed changes in dosage and to prevent toxic effects on body tissues.
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| How can diabetes cause both IUGR & LGA infants? | if diabetic woman has vascular changes, placental blood flow may be reduced, interfering with fetal growth. If no vascular changes, she transfers large amts nutrients to fetus & it secrets large amts insulin to metabolize glucose-->macrosomia.
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| Explain why Respiratory distress syndrome occurs in infants of diabetic mothers. | High fetal insulin levels interfere with surfactant production.
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| Explain why hypoglycemia occurs in infants of diabetic mothers. | Maternal glucose supply ends at birth, but the infant temporarily continues a high level of insulin production.
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| Explain why hypocalcemia occurs in infants of diabetic mothers. | Parathyroid hormone production is reduced
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| Explain why polycythemia occurs in infants of diabetic mothers. | Chronic fetal hypoxia stimulates production of more erythrocytes.
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| Describe typical appearance of a macrosomic infant of a diabetic mother(IDM). | Length and head circumference are usually normal for the gestational age. The face is round, the skin is red, the body is obese, and muscle tone is poor. The infant is irritable and may have tremors when disturbed.
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| List signs of neonatal hypoglycemia. | Signs include jitteriness, tremors, diaphoresis, tachypnea, low temperature, poor muscle tone, and low glucose screening test levels.
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| Why is the infant with polycythemia more likely to need phototherapy? | When excessive erythrocytes break down, bilirubin is released more quickly than it can be eliminated by the liver.
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| List infant behaviors that should cause a nurse to suspect prenatal drug exposure. | appear hungry, but suck & swallow poorly coordinated; hyperactive, increased muscle tone; regurgitation, vomiting, & diarrhea; signs typical of hypoglycemia but normal glucose level; restlessness; & irritability, fail to gain wt, & seizures
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| What care is appropriate for the infant with neonatal abstinence syndrome? | Decreased environmental stimulation; avoid disturbing unnecessarily; swaddling; frequent feedings; protection of the skin
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| Why are gavage feedings sometimes needed for the drug-exposed infant, even if born at term? | Infant has poor coordination of suck & swallow, reducing actual milk intake. At same time, energy expenditure is high bc of excess activity. Rapid respirations increase risk of aspiration if infant is bottle-fed.
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| What assistance with feedings does the mother of a drug-exposed infant need? | Decrease agitation by having feedings ready when awakens. Swaddle before begin to feed. Feed in area w/limited distractions & do not stimulate by talking/rocking. Support chin and cheeks to aid sucking, burp frequently.
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| Why would giving oxygen not improve cyanosis if the infant has a right-to-left shunt? | Blood flow to the lungs is decreased, and unoxygenated blood is mixed with oxygenated blood in the systemic circulation.
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