OB Exam 3
lithium effects in breast feeding
hypotonia, hypothermia, cyanosis, electrocardiogram abnormalities (not recommended for breastfeeding mothers)
what can absent or minimal variability result from
hypoxemia and metabolic acidemia
what does hydrops fetalis result in
hypoxia
what do brachial plexus injuries result in
Erb duchenne paralysis involving c5 and c6 caused by stretching or pulling the head away from the shoulders
what events increase the likelihood of acute bilirubin encephalopathy
hypoxia, asphyxia, acidosis, hypothermia, hypoglycemia, sepsis, hypoalbuminemia
if hypoxemia is not corrected what can it turn into
hypoxua or asphyxia
when is ergonovine or methylergonovine contraindicated in treatment of uterine atony
if htn and cardiovascular disease are present
when can cardiac decompensation occur
if myocardial disease develops, valvular disease exists, or a congenital heart defect is present
when are gavage feedings stopped
if residual is greater than 50% of the feedings or if the residuals are not increasing and is not resumed until the infant can be assessed for a possible feeding intolerance
what are causes of diabetes
impaired insulin secretion: beta cells of pancreas are destroyed by auto immune process inadequate insulin action in target tissues at one or more points along the metabolic pathway
how should preterm infants be transferred from the birthing room
in a prewarmed incubator
when are alcohol related neurodevelopmental disorders or alcohol related birth defects usually detected
in school age children
where does jaundice first appear in infants
in the face and head and progresses to the toes
galactosemia
inability to convert galactose to glucose
complaints during postpartum psychosis
inability to move, stand or work, later suspiciousness, confusion, incoherence, irrational statements, obsessive concerns about baby's welfare
congenital rubella syndrome
includes cataracts or glaucoma, hearing loss, cardiac defects, IUGR, microphthalmia, hypotonia, dermatoglyphic abnormalities, bony radiolucencies, microcephaly, and brain wave anomalies
what is the standard practice for group B strep
includes giving prophylactic treatment to GBS positive mothers
enterovirus
includes poliovirus, coxsacklevirus, and echovirus
what does inefective endocarditis lead to
incompetence of heart valvues, congestive GF, cerebral emboli, and death
describe subluxation
incomplete dislocation of hip. Femoral head remains in contact with acetabulum but a stretched capsule and ligamentum teres causes the head of femur to be partially displaced
what can insufficient gas exchange in the post mature placenta lead to
increase the likelihood of intrauterine hypoxia, which can result in the passage of meconium in utero, thereby increased risk for meconium aspiration syndrome
what does polycythemia cause
increased blood viscosity thereby impairing the circulation
what causes preterm infants to be predisposed to hematologic problems
increased capillary fragility, increased tendency to bleed, decreased production of RBCs resulting from rapid decrease in erythropoiesis after birth loss of blood due to frequent sampling, decrease in RBC survival related to the relatively larger size of the red blood cell and its permeability to sodium and potassium
an increased sympathetic response results in what on a monitor strip
increased fetal heart rate
what is poor glycemic control around the time of conception associated with
increased incidence of miscarriage and fetal macrosomia
effects of cocaine during pregnancy
increased incidence of miscarriage, preterm labor, and placental abruption (intrauterine fetal demise), fetus can be of small size, lethargy, heart and brain anomalies
what cardiovascular changes occur during pregnancy
increased intravascular volume, decreased systemic vascular resistance, cardiac output changes occurring during labor and birth, intravascular volume changes that occur just after child birth
what do infants with subgaleal hemorrhage's bilirubin levels look like
increased levels can be seen as a result of breakdown of blood cells within the hematoma
what is priritic urticarial papules and plaques of pregnancy associated with
increased maternal weight gain, an increased rate of twin gestation, htn, and induction of labor
signs of stress on infant
increased metabolic rate, increased oxygen and caloric use, depression of the immune system
risks associated with lupus erythematosus
increased rate of miscarriage, nephritis, preeclampsia, possible need to give birth at preterm gestation, and an increased risk of cesarean, stillbirth, IUGR, preterm birth, bone demineralization, gestational diabetes, preeclampsia, premature ROM, IUGR
what can develop in severely distressed infants
irregular respiratory rate or increased heart rate
variability
irregular waves of fluctuations in the baseline FHR of two cycles per minute or greater
isoimmunization
Rh incompatibility occurs when an Rh negative mom has an Rh positive fetus who inherits the dominant Rh positive gene from the father
what does amphetamines use during pregnancy cause
SGA, prematurity, poor weight gain, and lethargy
if any of the components of rapid assessment are missing, what should be done
1. initial steps in stabilization: provide warmth by placing baby under radiant warmer,position head to open the airway, clear the airway with a bulb syringe or suction catheter, dry the baby, stimulate breathing, and reposition baby 2.ventilation 3. chest compressions 4. admin of epinephrine or volume expansion or both
what are the 3 primary conditions that appear to be involved in the etiology of NEC
1. intestinal ischemia that occurs as a result of asphyxia, hypoxia or evernts that cause a redistribution of blood flow away from GI tract 2. bacterial colonization of the initially sterile GI tract with harmful organisms prior to the establishment of normal intestinal flora 3. enteral feeding, feedings can provide a substrate for bacterial proliferation oor that feedings can increase intestinal oxygen demands during absorption and result in tissue hypoxia
what events could cause a woman to develop antibodies to Rh factor
1. previous pregnancy with Rh positive fetus 2. transfusion with Rh positive blood which causes immediate sensitizatoin 3. miscarriage or induced abortion after 8 or more weeks gestation 4. amniocentesis for any reason 5. premature seperation of placenta 6. external version 7. trauma
what findings support the diagnosis of pathological jaundice
1. serum bilirubin levels of greater than 5mg/dl in cord blood 2. clinical jaundice evident within 24hours 3. total serum bilirubin levels increasing by more than 5mg/dl in 24 hours or increasing at a rate of 0.5mg/dl/hr 4. a serum bilirubin level in a term newborn that exceeds 12.9 mg/dl at any time 5. any case of visible jaundice that persists for more than 14 days of life in a term infant
three part abbreviation for fetal position
1. the location of the presenting part 2. presenting part of the fetus 3. location of the presenting part in relation to the anterior, posterior, or transverse portion of the maternal pelves
what percent weight loss is acceptable in term babies
10%
when does the fetus begin to secrete its own insulin at levels adequate to use the glucose obtained by the mother
10th week gestation
what can nonnutritive sucking do during gavage feedings
it can improve oxygenation and can lead to lower energy expenditure with less restlessness, promotes weight gain and better sucking skills
what meds should be avoided in patients with MG
all meds that cause muscle relaxation, mag sulfate must not be administered to women with MG because it inhibits the release of acetylcholine and can trigger myasthenic crisis
effects of marijuana during pregnancy
altered uterine blood flow, altered maternal health behaviors
phenylketonuria
amino acid disorder resulting from deficiency of enzyme phenylalanine degydrogenase
what can potentiate noise induced hearing loss
aminoglycosides
where can parvo virus be isolated from
amniotic fluid, fetal blood, or tissues using DNA pCR assay
what is the prophylactic treatment for bacterial endocarditis for women in active labor who are moderate risk
amoxicillin 2g PO or ampicillin 2g IB or IM
what can e coli cause
amphalitis, diarrheal illness, pneumonia, peritonitis, UTI, and meningitis
what is the prophylactic treatment for bacterial endocarditis for women in active labor who are high risk
ampicillin 2g IV or IM plus gentamicin 1.5mg/kg (for penicillin allergic clients use vanc 1g IV or 1-2 hr plus gentamicin as before)
what is the usual treatment of newborns with GBS
ampicillin with aminoglycosides
treatment of ecoli infection
ampicillin, extended spectrum, cephalorsporing and an aminoglycoside continued for 7-10 days
myocardial infarction risk factors
an acute ischemic even increasing with age, chronic hypertension, diabetes, hypertesnive disorders or pregnancy, thrombophilias, postpartum infection
what is idiopathic or immune thrombocytopenic purpura (ITP)
an autoimmune disorder in which antiplatelet antibodies decrease the lifespan of the platelets
describe hemorrhagic (hypovolemic) shock:
an emergency situation in which the perfusion of body organs can become severly compromised and death can occur
describe talipes valgus clubfoot
an eversion or bending outward
what does overheating in an infant cause
an increase in oxygen and calorie consumption
what comes with LGA infants
an increased risk of birth injuries, asphyxia, and congenital anomalies such as heart effects
category B pregnancy risk
animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well controlled studies in pregnant women
imperforate anus
anorectal malformation, no anal opening
2 most important fontanels
anterior and posterior
how is a DVT treated
anticoagulant therapy, bed rest with affected leg elevated, analgesic IV heparin continues for 3-5 days or until sypmtoms resolve, oral anitcoagulant therapy continued for 3 months, prothrombin should be monitored
medical management of valve replacement
anticoagulation, clot removal surgery
medical management of PPD
antidepressant medication along with some form of psychotherapy
medical treatment of postpartum psychosis
antipsychotics and mood stabilizers
what is postpartum infection AKA puerperal infection
any clinical infection of the genital tract that occurs within 20 days after miscarriage or birth
fetal death
any death prior to birth after 20 weeks gestation
infant death
any live birth resulting in death during first year
miscarriage
any utero death prior to 20 weeks gestation
what does overheating of an infant lead to
apnea, tachycardia, and eventually bradycardia and consumption of calories that preterm infant cannot afford to expend
persistent pulmonary HTN of newborn
applied to combined findings of pulmonary htn, right to left shunting, and a structurally normal heart. Can occur as a single entity or as the main component of MAS, congenital diaphragmatic hernia, RDS, hyperviscosity syndrome, or neonatal pneumonia/sepsis
what is the basal IWL
approximately 20 ml/kg/day, significantly increased in preterm infants
what is the most common cause of hydrocephalus
aqueductal flow obstuction which prevents CSF from leaving head and flowing back into spinal collumn
what are the clinical signs of brachial plexus injuries
arm hangs limply at side, shoulder and arm adducted and internally rotated, elbow extended, forearm pronated wrist and fingers flexed, grasp reflex
when does insulin resistance begin
as early as 14-16 weeks
how often ben intrauterine transfusions be done
as often as every 2 weeks until fetus reaches pulmonary maturity
appendicitis
as pregnancy progresses the appendix is pushed upward and to the right from its usual anatomic location and rupture can occur
when is surgical repair of congenital diaphragmatic hernia performed
as soon as the infant is stable
major fetal complications of ICP
asphyxial events, meconium staining, stillbirth, preterm birth
what can the nausea and vomiting of early pregnancy do to influence diabetes
it may necessitate a decreased dose in insulin
what is the function of insulin
it regulates blood glucose levels by enabling glucose to enter adipose and muscle cells and be used for energy
s/s of hypocalcemia in the infant
jitters, irritability, convulsions, tachycardia, electrocardiogram changes
swansons caring theory 5 concepts
knowing, being with, doing for, enabling, maintaining belief
what are retroperitoneal hematomas caused by
laceration of one of the vessels attached to hypogastric artery, usually associated with rupture of c section scar
what can happen if there is adherence of the placenta to the myometrium
laceration of uterine wall can occur
what procedures for cholecystitis and cholelithiasis are acceptable during pregnancy
laproscopic and open cholecystectomy
third stage of labor
lasts from birth of fetus to birth of placenta
first stage of labor
lasts from onset of regular contractions to full effacement and dilation of cervix, latent active and transitional phase
second stage of labor
lasts from time cervix is fully dilated to the birth of the fetus, latent phase is passive fetal descent and active phase is pushing
what are risk factors for syphillis
late prenatal care, maternal substance abuse, crack cocaine use in mother or partner, multiple sexual partners, history of STI, poverty, homelessness, HIV
Patent ductus arteriosus
left to right shunt. Usually diagnosed and corrected during infancy. Complications of a PDA include those of VSD as well as endocarditis and pulmonary emboli. Medical management is the same as VD
bradycardia in infant
less than 110 for more than 10 minutes
posterior fontanel
lies at the junction of the sutures of the two parietal bones and the occipital bone and is triangular and closes at 6-8 weeks after birth
effects of transmission of varicella during early pregnancy
limb atrophy, neurologic abnormalities and limb atrophy, neurologic abnormalities and eye abnormalities, hydrocephalus, microcephalus
medical management of primary pulmonary hypertension
limit activity, avoid supine position, diuretics, O2, vasodilating meds
what should be done in the case of postpartum hemorrhage
limit physical activity and increase iron and protein
s/s of broken clavicle
limited arm movement, crepitus over bone, absence of moro reflex on affected side
complete inversion of the uterus
lining of fundus crosses through the cervical os and forms a mass in the vagina
what is first line treatment for psychosis during pregnancy
lithium
intrahepatic cholestasis of pregnancy ICP
liver disorder unique to pregnancy that is characterized by generalized pruritis. Itching commonly affects the palms and soles and worsens at night. No lesions. Elevated serum bile acids and elevated liver function tests. Jaundice may be present. Dark urine and light colored stools
coarction of aorta
localized narrowing of the aorta near the insertion of the ductus. Correct surgically before pregnancy if possible. Pregnancy is usually relatively safe and uncomplicated.
perinatal loss
losses associated with childbearing particularly those that occur after conception has occurred and woman recognizes she is pregnant
disenfranchised grief
losses that are not openly acknowledged and mourned publicly, limiting social support
mitral valve prolapse
mitrovalve leaflets prolapse into left atriu, during ventricular systole, allowing some back flow of blood
how is listeriosis transmitted
occurs transplacentally through ascending infection during birth
acute respiratory distress
occurs when lungs are unable to maintain levels of oxygen and carbon dioxide within normal limits
valve replacement
pregnant women with mechanical or bioprosthetic heart valves require specialized care
what does cocaine use cause in infants
prematurity, SGA, plaental or cerebral infarctions, hyperactivity, difficult to console, hypersensitivity to noise and external stimulus
what can early congenital syphillis result in
prematurity, any drops fetalis, and failure to thri, ve
sepsis
presence of microorganisms or their toxins in blood or other tissues
what is facial paralysis caused by
pressure on the facial nerve during birth
tocolysis
relaxation of uterus, used to manage fetal stress
pyelonephritis
renal infection and leading cause of septic shock during pregnancy, it develops most often during second trimester and is usually caused by e coli
clinical signs of birth trauma
bruising, edema, abrasions,absence limitation or asymmetry of movements, later can exhibit impaired mobility, respiratory distress, acute pain as a result of birth trauma, seizures and coma
what is used for methadone withdrawal
buprenophrine
when is surgical repair of cleft lip usually done
by 12 weeks of age
how does prenatal acquisition of infection occur
by organisms placentally transferred directly into the fetal circulation system or transmitted from infected amniotic fluid
how does the fetus compensate for anemia
by providing large numbers of immature erythrocytes to replace the hemolyzed ones "erythroblastosis fetalis"
how is the diagnosis of NEC confirmed
by radiographic exam that reveals bowel loop distention pneumatosis intestinalis pneumoperitoneum portal air or a combination of these
what is diagnostic of asymptomatic bacteriuria
clean voided urine specimen containing more than 100,000 organisms per milliliter is diagnostic
what is the primary contaminent in ELBW and LBW infants
coagulase-negative staph
what should be assessed during hemorrhagic shock
respirations, pulse, BP, skin, urine output, level of consciousness, mental status, central venous pressure
s/s of congenital diaphragmatic hernia
respiratory distress, cyanois, heart sounds shifted to right, low BP, abdomen scaphoid shaped, chest barrel shape
apnea in infants
respiratory pauses of greater than 20 seconds
Treatment of coarction of aorta
rest, htn meds, beta adrenergic blocking agents, vaginal birth is preferred
management of marfan syndrome
restricted activityn beta blockers, surgery, vaginal birth
how do conjunctival and retinal hemorrhages occur
result from rupture of capillaries caused by increased intracranial pressure during birth, usually resolves in 5 days
congenital diaphragmatic hernia
results from a defect in the formation of the diaphragm allowing abdominal organs to be displaced into thorasic cavity
exstophy
results from abnormal development of bladder urethra and urethral orifices. Bladder visible in suprapubic region with urine draining from it onto the neonates skin
why are preterm infants considered high risk
their organ systems are immature and they lack adequate nutrient reserve
what allows the diagnosis of macrosomia, hydrocephalus, and unusual presentation
ultra sound
when is extracorporeal membrane oxygenation contraindicated
under 34 weeks
when does hemolytic disease of the newborn occur
when blood groups of the mother and baby are different
subdural hemorrhage
collection of blood in subdural space, produced by stretching and tearing of the large veins in the tentoriu of the cerebellum the dural membrane that separeates the cerebrum from the cerebellum
1 cm below spines
+1
pulmonary embolism
complication of DVT occuring when part of a blood clot dislodges and is carried to the pulmonary artery where it occludes the artery, obstructing blood flow to the lungs
how is primary pulmonary hypertension diagnosed
electrocardiography, pregnancy is not advised with this condition
what is suggestive of cytomegalovirus
elevated levels of cord blood IgM
what is a diagnosis of toxoplasmosis in the neonate supported with
elevated levels of cord blood serum IgM
what should be suspected when brown stained amniotic fluid is present with listeriosis
endometritis
what is the third most common cause of viral outbreaks in the NICU
enterovirus
what is a neutral thermal environment
environment temp at which oxygen consumption is minimal but adequate to maintain body temp
symptoms of cholecystitis
epigastric or right upper quadrant pain is present, but the pain is usually more severe and prolonged and n/v and fever can be present
treatment of uterine inversion
ergonovine, methlergonoovine, and D&C
what are some soft tissue injuries
erythema, ecchymoses, petechiae, abrasion, lacerations and edema of face head buttocks and extremities
atresia
esophagus ends on a blind pouch, no continuous passageway to stomach
insensible water loss IWL
evaporative loss that occurs through the skin and through the respiratory tract
hydrocephalus
excess CSF inthe ventricles of the brain due to overproduction of a decrease in reabsorption
what can increased weight be from
excessive feeding or displaced fluid
what leads to dystocia in macrosomic infants
excessive shoulder size
1 cm above the spine
-1
what should preme's be able to demonstrate on discharge
-ability to raise head when prone and to hold the head parallel with the body -ability to cry vigorously when hungry -appropriate amount and pattern of weight gain according to growth curves -neurologic responses appropriate for corrected age -should be able to focus on examiner or parent's face and follow eyes
what compensatory mechanisms take place when postpartum hemorrhage occurs
-adrenal glands release catecholamines causing arterioles and venules in skin lungs GI liver and kidneys to contract -blood flow diverted to brain and hear and away from other organs including the uterus -accumulation of lactic acid and acidosis results from continued reduction in cellular oxygenation -acidosis causes arteriolar vasodilation -venule constrition -cell death
what are medical management tecniques for ITP
-control of platelet stability -woman likely treated with corticosteroids or IV immunoglobulin if diagnosed during pregnancy -platelet transfusions are given when there is significant risk of bleeding -spleenectomy may be needed if the ITP does not respond to medical management
what are techniques to medically manage hemorrhage
-establish 18g IV site -establish second site for fluids -to restore circulating blood volume a rapid IV infusion of crystalloid solution given at rate of 3ml for every 1 ml estimated blood loss -packed RBCs infused in woman actively bleeeding with no improvement
initial management of excessive postpartum bleeding due to uterine atony
-firm fundal massage: express any clots, eliminate bladder distention, continuous IV of oxytocin and lactated ringers or NS -misoprostol if atony doesn't resolve -methergine -denvative prostaglandin -rapid admin of crystalloid solutions or blood/blood products to restore vascular volume
what are signs of acute respiratory distress
-severe hypoxemia despite high levels of inspired oxygen with increase in pulmonary capillary permeability, a decrease in lung volume, and shunting of blood
what should the nurse assess and document in infants receiving parenteral fluids
-type and infusion rate of the solution, functional status of the infusion, equipment, including the tubing and infusion pump, infusion site for possible complications caloric intake, infant's response to therapy,
surgical management of PPH
-uterine tamponade (uterine packing or an intrauterine tamponade balloon) -bilateral uterine artery ligation -ligation of utero-ovarian arteries and infundibulopelvic vessels -arterial embolization
at level of spines
0
what should infants with gonococcal eye infection recieve
1 dose of ceftriaxone
aspirates of less than _____ can be refed to the infant
1 hour
4 types of pelvies
1. gynecoid: classic female 2. android: resembles male 3. anthropoid: oval shaped with wider anterior posterior 4. platypelloid: flat
3 degrees of DDH
1. acetabular dysplagia 2. subluxation 3. dislocation
what are the advantages of transport witht he baby in utero
1. associated neonatal morbidity and mortality are decreased 2. infant parent attachment is supported therby avoiding seperation of parents and infants
what percent oxygen is used for newborn resuscitation
21%
in term infants what is considered the upper limit for serum bilirubin
25mg/dl
how much does cardiac output increase during pregnancy
30-45%
late preterm infants are ____ more likely to develop hypoglycemia than term infants
3x
when is PPD most likely to occur
4 weeks after birth
the critically ill infant needs to have a venous hematocrit of more that ___ to maintain adequate oxygen carrying capacity
40%
treatment of inflammatory bowel disease
5 aminosalicylates, prednisone and 6 mercaptopurine or azathioprine are often prescribed, antibiotics may be necessary, folic acid supplementation because osteoporosis is common
what are panic disorders
5-15 minutes of intense episodes of fear or discomfort
in non breastfeeders, the return to prepregnancy insulin to carbohydrate balance takes how long
7-10 days
what are O2 sat for ELBW infants maintained at
88-93%
when is hematopoiesis well established in the fetus
9th week gestation
what blood glucose levels should be treated in late preterm infants
<40-45 mg/dL
what is the most common cause of hemolytic disease of the newborn
ABO incompatibility
what should be performed if meconium staining of the amniotic fluid is present
ET suctioning should be performed immediately
what is a fetus of a woman with seizure disorder at risk for
IUGR
s/s of cytomegalovirus
IUGR, microcephaly, seizures, lethargy, rash, jaundice, hepatosplenomegaly, anemia, thrombocytopenia, hyperbilirubinemia, intracranial periventricular calcification noted on xrays
____ and _____ require time to reach optimal levels after birth
IgA and IgM
what risks are associated with tobacco use during pregnancy
LBW, IUGR, SIDS, mortality, placenta previa, placental abruption, preterm premature rupture or membranes, ectopic pregnancy
what does heroine use in pregnancy cause
LBW, SGA, neonatal abstinence syndrome
risk factors for GBS development
LBW, preterm birth, rupture of membranes more than 18 hours, maternal fever, previous GBS infant, maternal GBS bacteriuria, use of intrauterine fetal monitoring, maternal age less than 20, hispanic or black
what infants are at the highest risk for hypoglyemia
LGA
medical management of lupus erythematosus
NSAIDs to treat arthralgia and glucocorticoids
when should be initiated at 32 weeks if a woman have cystic fibrosis
NST
when bleeding is continuous and there is no identifiable source what can be the cause
a caogulopathy
what is gestational diabetes mellitus
a carbohydrate intolerance with the onset or first recognition occurring during pregnancy
RhoGam
a commercial preparation of passive antibodies against the Rh factor that destroys any fetal RBCs in maternal circulation and blocks maternal circulation and blocks maternal antibody production
what can damage infant hearing
a constant decibel level of 90 or frequent decibel swings higher than 110 leading to longterm speech and language defecits
omphalocele
a covered defect of the unbilical ring into which varying amount of the abdominal organs can herniate. Ther peritoneal sac covering the defect can rupture during or after birth
infants born to women with diabetes tend to have what
a disproportionate increase in shoulder, trunk, and chest sizes that increases its risk for shoulder dystocia
what do forcep injuries look like
a linear configuration across both sides of the face, outlining placement of forceps
what is the germinal matrix
a loose network of cells abundantly supplied with tiny fragile thin walled vessels. It lies beneath the lining of the lateral ventricles
what is respiratory distress syndrome
a lung disorder usually affecting preterm infants. The incidence and severity increase as gestational age decreases. It is caused by a lack of pulmonary surfactant which leads to progressive atelectasis, loss of function residual capacity and ventilation perfusion imbalance with an uneven distribution of ventilation
what is TORCH
a multisystem disease caused by the protozoan toxoplasma gondi, parasite commonly found in cats dogs pigs sheep and cattle with cats being definitive corse (changing cat litter)
what does anemia result in
a reduction of the oxygen carrying capacity of the blood and because of this the heart tries to compensate by increasing the cardiac output which increases the workload of the heart and stresses ventricular function
eisenmenger syndrome
a right to left or bidirectional shunting that occurs either at atrial or ventricular level of the heart and is combined with elevated pulmonary vascular resistance and pregnancy should be avoided
what is von willebrand disase (VWD)
a type of hemophilia hereditary bleeding disorder that is rare but among most common congenital clotting defects in US women in childbearing age. It results from a deficiency or defect in blood clotting protein called VWF
TEF
abnoramal connectoin between the esophagys and trachea
ventricular septal defects
abnormal opening between left and right ventricle. Left to right shunt occurs. Usually diagnosed and corrected early in life. VSD not very common in pregnancy. For women with large VSD, there is an increased risk of arrythmias, HF, and pulmonary hypertension. Medical management includes rest and decreased activity as well as administration of anticoagulants
atrial septal defects
abnormal opening between the atria causing a left to right shunt. The woman is usually asymptomatic. Most likely will have an uncomplicated pregnancy. Right sided heart failure and arrythmias as pregnancy progresses as a result of increased plasma volume
tachycardia in infant
above 160 for more than 10 minutes
signs and symptoms of pyelonephritis
abrupt fever, shaking, chills, aching in lumbar area of back, anorexia and nausea vomiting
what can s aureus cause
abscesses, osteomyelitis, endocarditis, septic arthritis
ancephaly
absence of both cerebral hemispheres and the overlying skull, it is imcompatible with life it will be a still birth or a live birth with death occurring in a few days
what is responsible for the typical macrosomic infants
accelerated protein synthesis together with a deposition of excessive glycogen and fat stores
exhange transfusion
accommplished by alternately removing a small amount of the infants blood and replacing it with equal amounts of donor blood, it replaces RBCs that would otherwise be hemolyzed by circulating maternal antibodies, removes antibodies responsible for hemolysis, and corrects the anemia caused by hemolysis of the infant's sensitized RBCs and reduces serum bilirubin level in infants who have severe hyperbilirubinemia
high frequency ventilation
accomplished through the use of jet ventilators, oscillaotors, or high frequency flow interrupters
what are the types of epilepsy
acquired or idiopathic (specific cause is unknown)
how can transmission of varicella zoster occur
across placenta when the disease is contracted in the first half of pregnancy but is relatively infrequent
what is acute bilirubin encephaplopathy associated with
acute and long term signs of neruologic damage
bell palsy
acute idiopathic facial paralysis
necrotizing enterocolitis
acute inflammatory disease of GI mucosa, commonl complicated by bowel necrosis and perforation
category A pregnancy risk
adequate and well controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy
medical management of MI
admin 02,beta blockers, nitrates, heparin, sidelying position
treatments of VWD
admin desmopressin which promotes release of VWF and factor VIII, transfusion therapy with plasma products that have been treated for viruses and contain factor VIII and VWF. concentrates of antihemophiliac factor
strategies to prevent neonatal HIV
admin of antiviral meds during preg, admin of antiretrovirals to neonates for 6 weeks, elective cesarean for women with HIV viral loads greater than 1000 copis/ml
what does alcohol withdrawal treatment consist of
admin of benzodiazapines commonly chlordiazapoxide, diazepam, lorazepam, and oxazepam, thiamine replacements, haintenence of adequate hydration and electrolyte balance
when is incidence of endometritis increased
after cesarean
what type of soap use should be avoided in infants
alkaline-based soaps
what happens to maternal blood glucose levels when the placenta is delivered
expulsion of the placenta prompts drop in levels of circulating placental hormones, cortisol, and insulinase
describe class I of functional classification of organic heart disease
asymptomatic without limitation of physical activity
when is it recommended that Rh negative mothers receive RhoGam
at 28 weeks within 72 hours after deliver after an invasive prcedures
postpartum psychosis
auditory or visual hallucinations paranoid or grandiose delusions, elements of delerium or disorientation, extreme deficits in judgement accompanied by high levels of impulsivity that can contribute to increased risks of suicide or infanticide
myasthenia grais
autoimmune motor (muscle) endplate disorder that involves acetylcholine use, affects the motor function at the myoneural junction
marfan syndrome
autosomal dominant genetic disorder charaterized by generalized weakness of connective tissue resulting in joint deformities, ocular lens dislocation, and weakness of aortic wall and root
cystic fibrosis
autosomal recessive genetic disorder in which exocrine glands produce excessive viscous secretions which causes problems with both respiratory and digestive function
what are cues to overstimulation in an infant
averting gaze, hicupping, gagging, or regurgitating food, moving limbs in an uncoordinated fashion in response to noxious stimuli
baseline FHR
avg rate over 10 minutes that excludes periodic or episodic changes of the baseline that differ by more than 25 bpm, must be at least 2 min of detectable data in 10 minute period
why is the liver function and bilirubin clearance adversely affected in polycythemia
because extra RBCs produced in extramedullary foci (liver and spleen) in addition to the usual sites in bone marrow
why are late preterm infants at risk for hyperbilirubinemia
because of immaturity of liver, decreased gastric motility, and increased breakdown of RBCs. Less able to conjugate and excrete bilirubin
why is it believed that hypomagnesemia occurs
because of maternal renal losses that occur in DM
why are preterm infants at an increased risk for infection
because of shortage of stored maternal immunoglobulins, an impaired ability to make antibodies, and a compromised integumentary system
surfactant administration
before 34 weeks most infants do not produce enough surfactant to survive extrauterine life. As a result, lung compliance is decreased, and inadequate gas exchange occurs as the lungs become atelectatic and require greater pressure to expand
fourth stage of labor
begins with delivery of placenta and at least first 2 hours after birth
what is the most effective treatment for methamphetamine addiction
behavioral therapies such as cognitive behavioral and contingency management interventions
treatment for mitral valve prolapse
beta blockers are given to relieve chest pain, antibiotic prophyllaxis for bacterial endocarditis no longer recommended for women with uncomplicated MVP
where is insulin produced
beta cells in the islets of langerhorn which are in the pancreas
what is the normal respiratory pattern for infants
between 30-60
and idealized environment maintains infants normal body temp at what
between 97.9-99 degrees fehrenheit
what are the symptoms of cholelithiasis
bilary colic, epigastric or right upper quadrant pain that can radiate to the back and shoulders, pain may occur spontaneously or after eating a high fate meal
what can a depletion of weight and metabolic stores be caused by
birth asphyxia, increased respirations or respiratory effort, patent ductus arteriosus, hypothermic environment, invisible fluid loss, vomitting, diarrhea, dysfunctional absorption, growthdemands, inability to concentrate urine
cystitis
bladder infection characterized by dysuria, urgency, and frequency along with lower abdominal or suprapubic pain
what has protective effects against the development of NEC
breastmilk
what does bruising and swelling over the butt and genitalia result from
breech presentation
how to manage endometritis
broad spectrum IVS hydration, rest, pain relief
what associated with brith of a macrosomic infant contributes to high bilirubin levels
bruising
what is the most common symtptom of marfan syndrome
exrutiating chest pain
montevideo units
calculated by subtracting the baseline uterine pressure from the peak contraction pressure for each contraction that occurs in 10 minute period
how is unusual placental adherence diagnosed
can be diagnosed before birth using ultrasound and MRI but often not recognized til excessive bleeding after birth
how can accidental lacerations happen to a newborn
can be inflicted with a scalpel during cesarean or with scissors during episiotomy
effects of MDMA/ecstasy
can be toxic to nerve cell containing serotoning, transferred to fetus through placenta, increased risk of congenital anomalies in fetus and can cause long term problems with learning and memory
what are causes of a coagulopathy
can include pregnancy complications such as idiopathic or immune thrombocytopenic purpura, von willebrand disease, or DIC
what can cystitis lead to if not treated
can lead to ascending UTI if not treated
minimal enteral nutrition (MEN)
can provide only 1ml/hr. These feedings stimulate the GI system with minute amounts of breastmilk or formula, usually given via gavage so that when enteral feedings of greater volume begin, the GI system is primed for nutrient absorption
incomplete inversion of uterus
cannot be seen, smooth mass can be palpated through dilated cervix
what epilepsy meds should be avoided during pregnancy if possible
carbamazepine and valproate because their use is associated with neural tube defects
what anticonvulsants reduce the effectiveness of oral contraceptives
carbamazepine, primidone, pheobarbiatl, and phenytoin
describe type one diabetes
caused by pancreatic islet beta cell destruction prone to ketoacidosis and is an absolute insulin deficiency or can be caused by an immune process
acute bilirubin encephalopathy
caused by the deposition of bilirubin in the brain, especially within the basal ganglia, the cerebellum, and hippocampus, once albumin binding sites are saturated the bilirubin circulates as unconjugated which is highly lipid soluble and crosses BBB, it can reach toxic levels and become deposited in basal ganglia resulting in yellow staining of brain tissue and necrosis of neurons
what can result from an obstetric technique such as vacuum assisted birth, forceps, or from pressure of the fetal skull against maternal pelvis
cephalalhematoma
birth traumas occuring in infants born to mothers with diabetes
cephalhematoma, paralysis of facial nerve, fracture of clavicle or humerus, brachial plexus paralysis, phrenic nerve paralysis, invariability associated with diaphragmatic paralysis
what are very low birth weight babies at high risk for
cerebral palsy, borderline intelligence, and learning disabilities
descibe hypertrophic cardiomyopathy
characterized by a hypercontractile and thickened myocardium. ventricular walls are thickened as is the septum, which in severe cases results in outflow tract obstructions. mitral valve is poorly functioning
baby blues
characterized by mood swings, feelings of sadness and anxiety, crying, difficulty sleeping, and loss of appetite
inability to pass a suction catheter through the nose and into the pharynx is highly suggestive of what
choanal atresia
cholelithiasis
cholelithiasis is presence of gallstones in the gallbladder
systemic lupus erythematosus
chronic multisystem inflammatory disease that affects the skin, joints, kidneys, lungs, nervous system, liver and other body organs
kernictus
chronic or permanent results of bilirubin toxicity
bronchopulmonary dysplasia
chronic pulmonary condition occurring most commonly in preterm infants requiring mechanical ventilation
pruritic urticarial papules and plaques of pregnancy
classically appears in primigravidas during third trimester. Lesions usually appear first on the abdomen but spread to arms, thighs, back, and buttock
what bone is most commonly fractured during birth
clavicle
what is a leading cause of death in infants under 1 year old
congenital anomalies
what are infants at risk for when mothers have diabetes
congenital anomalies, macrosomia, birth trauma, perinatal asphyxia, stillbirth, preterm births, RDS, hypoglycemia, hypocalcemia, hypomagnesemia, cardiomyopathy,hyperbilirubinemia, polycythemia
maternal risk factors of microcephaly
congenital viral infections, chromosomal disorders, and malnutrition
peripartum cardiomyopathy
congestive HF with cardiomyopathy
what are some usual sites of local infection
conjunctiva and oral cavity
what does chlamydia cause in neonates
conjunctivitis and pneumonia, can cause eraly and late pregnancy loss, stillbirth, premature labor, postpartum endometritis
what do staph infections in infants present as
conjunctivitis with purulent eye drainage, skin lesions are typically small vesicles or pustules that are easily treated with topical antimicrobial agents, large fragile bullae containing clear fluid
primary pulmonary hypertension
constriction of the arteriolar vessels in the lungs, leading to an increase in the pulmonaryartery pressure, right ventricular hypertension, right ventricular hypertophy, and dilation, right ventricular failure with tricuspid regurgitation and ischemic congestoin
what happens if a coombs test is repeated at 28 weeks and the test is positive showing that sensitization has occurred
coombs test is repeated every 4-6 weeks to monitor the maternal antibody titer
corrected age
corrected by adding the gestational age of a preterm infant to the postnatal age
what are preterm formulas
cows milk based and whey and have an increased concentration of protein, calcium, and phosphorus
s/s of RDS
crackles, poor air exchange, pallor, use of accessory muscles, and apnea, unifrm reticulogranular appearance and air bronchograms
what is heard on auscultation in ARDS patients
crackles, rhonchi, wheezes, or a pleural friction rub
what does FAS manifest as
craniofacial anomalies including short eyelid opening, flat midface, flat upper lip groove, thin upper lip, micocephaly, hyperactivity, developmental delays, attention defecit
what are s/s of phrenic nerve injury
cyanosis and irregular thoracic respirations with no abdominal movement on inspiration and usually requires mechanical ventilatory support at risk on pneumonia
early neonatal death
death of a live born infant less than 7 days old
late neonatal death
deaths of live born infants between 7-28 days
what is the most common sign of septic shock
decreased BP, along with gray and mottled appearance, cool extremities, rapid irregular respirations and pulse
problems that can affect respiratory system of preterm infants
decreased number of functional alveoli, deficient surfactant levels, smaller lumen in respiratory systerm, greater collapsibility, obstruction or respiratory passageway, insufficient calcification of bony thorax, weak or absent gag reflex, immature friable capillaries in lungs, greater distance between functional alveoli and the capillary bed which can all produce respiratory distress or apnea
clinical signs of GMH-IVH
decreasing hematocrit, full anterior fontanel, changes in activity level, and decreased muscle tone (with a catastrophic incidence the infant can develop stupor, coma, resp distress that progresses to apnea, decerebrate posturing, and seizures)
what does bright red blood indicate
deep lacerations of the cervix
placenta increta
deep penetration of myometrium by the placenta
congenital anomalies
defect present at birth and can be caused by genetics or environmental factors defined as a structual or functional deviation from the normal pattern of development
hypoxemia
deficiency of oxygen in the arterial blood
what does marijuana use during pregnancy cause
deficit in attention, cognition, memory, and motor skills
subinvolution of the uterus
delaued return of the enlarged uterus to normal size and function
what is nitric oxide therapies
delivered as a gas, causes patent sustained pulmonary vasodilation in the pulmonary circulation
To be diagnosed with major depression at least five of the following signs must be present daily. What are the signs
depressed mood, spontaneous crying, markedly diminished interest in all activities, insomnia, weight changes, psychomotor retardation or agitation, fatigue, feelings of worthlessness or inappropriate guilt, diminished ability to concentrate, suicidal ideation
acture bilirubin encephalopathy
describes the acute central nervous system manifestations seen in the first weeks after birth
what are infants with myelomeningocele at increased risk for
developing latex sensitivity
what is the criteria for diagnosis of peripartum cardiomyopathy
development of congestive HF in last month of pregnancy or within the first 5 postpartum months, absence of heart disease before the last month of pregnancy, a left ventricular ejection fraction of less than 45% lack of another cause of HF
what is the most common endrocrine disorder associated with pregnancy
diabetes mellitus
what are atepartal or postpartal MIs most likely related to
diabetes, CAD, and lipid disorders
iron deficiency anemia diagnosis?
diagnosed by checking serum levels and H&H. Serum ferritin level reflects iron reserves. Less than 12 mcg/l and low hemoglobin indicates iron deficiency anemia
anterior fontanel
diamond shaped and lies at the juction of the sagittal coronal and frontal sutures and closes by 18 months after birth
what is the most common cause of spinal cord injury
difficult breech birth
what effects can postpartum depression have on a childs development
difficult infant and childhood terperment, attachment insecurity, increased risk of developmental delay, lower IQ scores
what can oral candidiasis cause
difficulty swallowing
effects of alcohol during pregnancy
direct teratogenic effects during the ebryonic and fetal stages of development, causes altered neurotransmitter levels in the brain, altered brain morphology and neuronal development and hypoxia, fetal alcohol syndrome, alcohol related birth defects, alcohol related neurodevelopmental disorders
sickle cell hemoglobinopathy
disease caused by presence of abnormal hemoglobin in the blood
epilepsy
disorder of the brain that causes recurrent seizures and is the most common major neurologic disorder accompanying pregnancy
retinopathy of prematurity
disorder that affects the developing retinal vessels of preterm infants.
pharmacological treatment of mitral valve stenosis
diuretics to prevent pulmonary edema, beta blockers or calcium channel blockers to prevent tachycardia, cardioversion may be needed for new onset A fib, chronic A fib may require digoxin and BB or CCB to control heart rate, anticoagulant therapy to prevent embolism. Reduce womans activity, restricting dietary sodium and monitor weight, provide adequate pain control
medical management of peripartum cardiomyopathy
diuretics, sodium and fluid restriction, afterload reducing agents, digoxin, anticoagulation
describe talipes calcaneus club foot
dorsiflexion in which toes are higher than heels
maternal insulin requirements may _____ by the end of pregnancy
double or quadruple
how does transmission of HIV most likely occur
during birth
symptoms of PE
dyspnea, tachypnea, tachycardia, apprehension, pleuritic chest pain, cough, hemoptysis, elevated temp, and syncope
s/s of kernicterus
dystonia with or without athetosis, deafness or severe hearing impairment, impaired occulomotor function, dental enamel dysplasia of deciduous teeth
what interventions should be performed for infants with suspected subgaleal hemorrhage
early detection is vital, take serial head circumference measurements and inspect back of head for edema and firm mass
what is avoided in the asphyxiated neonate with a low APGAR score
early enteral feeding to prevent bowel necrosis, nutrition is provided parenterally
s/s of subarachnoid hemorrhage
early onset of alternating depressoin and irritability with refractory seizures or apnes
what can a tight nuchal chord cause
eccymosis and petehiae over the head
if an infant with acute bilirubin encephalopathy survives it will usually have.....
extrapyramidal movemenet disorder, gaze abnormalities, auditory disturbances, cognitive impairment, enamel dysplagia of deciduous teeth
what do bruises of the face result from
facial presentation
patent ductus
failure of closure of ductus arteriosus
spina bifida
failure of neural tube closure
symptoms of primary pulmonary hypertension
fatigue, SOB, dyspnea on exertion,
dislocatoin
femoral head loses contact with acetabulum and is displaced posteriorly and superiorly over the fibrocartilagenous rim. Ligamentum teres is elongated and taut
what can recurrent pyelo cause
fetal death and IUGR
stillbirth
fetal death that occurs at 20 weeks or later
what can meconium staining amniotic fluid be indicative of
fetal distress, especially if vertex is present
hydrops fetalis
fetus has marked anemia, cardiac decompensation, cardiomegaly, and hepatosplenomegaly
symptoms of endometritis
fever, increased pulse rate, chills, anorexia, nausea, fatigue lethargy, pelvic pain, uterine tenderness, foul smelling profuse lochia, leukocytosis and increased RBC sedimentation rate
s/s of enterovirus
fever, irritability, lethargy, poor feedings, rash, respiratory symptoms, GI symptoms
s/s of spinal shock
flaccid extremities, diaphragmatic breathing, paralyzed abdominal movements, atonic sphincter, distended bladder
what happens in hydrops fetalis
fluid leaks out of intravascular space resulting in generalized edema, as well as effusions into peritoneal, pericardial, pleural spaces
what is the most common cause of magaloblastic anemia during pregnancy
folate deficiency anemia
if untreated what can neonatal chlamydial conjunctivitis result in
follicular conjunctivitis with conjunctival scarring and corneal microgranulations
what is the STABLE program
for post resuscitation and posttransport stabilization care of sick infants
partial liquid ventilation
for severe RDS can improve outcomes, perfluorocarbon liquids is instilled into the lungs durng gaseous ventilation, beneficial to the surfactant deficient or immature lung because it reduces or eliminates surface tension, improves oxygenation through the recreation of a fetal lung environment and helps reexpand atelectactic areas
when is the critical period for the cardiovascular system
from week 3 of embryonic development to week 8
what marks the end of the first stage of labor
full cervical dilation
treatment of cytomegalovirus
ganciclovir decreases neurologic sequelae in particular sensorineural hearing loss
septicemia
generalized infection in bloodstream, pneumonia is most common
puritis gravidarum
generalized itching without the presence of rash. Associated with twin gestation, fertility treatment,diabetes, and nulliparity
risk factors for hyperbilirubinemia
gestational age less than 37 weeks, exclusive breastfeeding, previous sibling requiring phototherapy, predischarge transcutaneous bilirubin level in high risk zone, cephalhematoma or significant bruising, blood incompatability with positive direct antiglobulin test, other known hemolytic disease, east asian race
treatment of ICP
giving ursodeoxycholic acid and monitoring of liver function tests
treatment of MG
glucocorticoids and acetylcholinesterase inhibitors, monitor blood glucose values becuase hyperglycemia may result from corticosteroid therapy, thymectomy may result in remission of the disease but is best performed after pregnancy, plasmapheresis or IVIG therapy for severe weakness
what happens when insulin is inefficient or ineffective
glucose accumulates in the bloodstream resulting in hyperglycemia
what should you give hypoglycemic infants born to mothers with diabetes
glucose even if they are not symptomatic
early deceleratoin
gradual (onset to lowest point greater than 30 seconds) decreased in and return to baseline FHR associated with contractions,thought to be caused by fetal head compressing. They are benign
manic episodes include at least three of the following
grandiosity, decreased need for sleep, pressured speech, flight of ideas, dis tractability, psychomotor agitation, excessive involvement in pleasurable activities without regard for negative consequences
what occurs with severe listeriosis infection
granulomatosis, infantiseptica
what is the leading cause of neonatal morbidity and mortality in US
group B streptococcus
what are two serotypes of enterovirus that most commonly affect neonates and can be transmitted transplacentally or through exposure to maternal blood or secretions during birth
group b coxsackievirus and echo virus
s/s of HIV in infants
growth failure, parotitis, and recurrent or persistent upper respiratory tract infection, lymphadenopathy and hepatosplenomegaly is common, high fever, chronic diarrhea, dermatitis, interstitial pneumonitis, thrush, AIDs defining opprotunistic infections
s/s of herpes simplex
growth restriction, skin lesions and scarring, severe psychomotor delays with intracranial calcifications, microcephaly, hypertonicity and seizures
microcephaly
head circumference that measures two or more standard deviations below the mean for age and sex, brain growth usually restrited and cognitive impairment is common
what is the most common result of rubella
hearing loss
increased _____ size is often found in infants born to mothers with diabetes
heart
whatare the most common congenital anomalies
heart disease, neural tube defects, cleft lip and palate, club foot, developmental dysplagia of hip
what is considered severe anemia
hemoglobin on less than 6-8
what women are at risk for flate deficiencies
hemoglobinopathies, those who take anticonvulsants or pregnant with multifetal gestations
what can anticonvulasnts cause in neonates
hemorrhagic disorders which cause vitamin K deficiency
what are common with early congenital syphillis
hepatosplenomegaly, jaundice, anemia, leukocytosis, thrombocytopenia
encephalocele
herniation of brain and meninges through a skull defect usually in the occipital area
myelomeningocele
herniation of meninges and spinal cord at site of defect with or without skin or vertebral covering. The sac can tear easily allowing CSf to leak out and providing and entry to infectious organisms into CNS because the nerves are involves there are motor and sensory defecits below the lesion
meningocele
herniation of meninges at the site of the defect with skin or vertebral covering
gastroschisis
herniation of the bowel through a defect in the abdominal wall to the right of the umbilical cord, no membranes cover the contents
beta thalassemia
heterozygous
what is moderate variability
highly predictive of normal fetal acid balance
cooleys thalassemia
homozygous
Complications of coarction of aorta
htn, CHF, ineffective endocarditis, CVA, aortic dissection, aneurysm, and rupture.
women with pregestational DM are at risk for what
htn, preeclampsia, cesarean birth, and maternal mortality
what is recommended for LBW preterm infants for food
human milk with fortifier because it increases weight gain and improves mineralization better than non fortified human milk
what are clinical symptoms ascribed to T gondii
hydrocephalus, chorioretinitis, and cerebral calcifications
what does hyperglycemia cause
hyperosmolarity of the blood which attracts intracellular fluid into the vasculature which results in dehydration and expanded blood volume
hypoglycemia in infants causes what
hyperplasia of fetal pancreas occurs resulting in hyperinsulinemia
what are the two types of cardiomyopathy
hypertrophic and nonhypertrophic
what are women with insulin dependent diabetes prone to during the first trimester
hypoglycemia
what are macrosomic infants at risk for
hypoglycemia, hypocalcemia, hyperviscosity, and hyperbilirubinemia
what is jitteriness in infants a sign of
hypomagnesemia, hypocalcemia, and hypoglycemia
what should be avoided at all costs with eisenmenger syndrome
hypotension and cesarian sectoin whenever possible
sighns of shock or hypovolemia
hypotension, cap refill greater than 3 seconds, continued respiratory distress despite provision of oxygen and ventilation
s/s of hydrocephalus
increasing frontal-occipital circumference because the head circumference is at an abnormal rate as a result of the increased CSF pressure, sutures are widened and the fontanels are full or bulging and tense
describe a depressed skull fracture
indentation without laceration, ping pong ball indentations can occur during difficult births from pressure of the fetal head on bony pelvis, can also occur as a result of injudicious application of forceps, many resolve without intervention but surgery may be required in presence of bone fragmenets or signs of increased intracranial pressure
parenteral nutrition indication?
indicated for infants who are unable to obtain sufficient fluids or calories by enteral feedings
agoraphobia
individuals restrict activity outside of the home or insist on being accompanied by another individual due to fear of having a panic attack where help is unavailable
cold stress
infant tries to conserve heat and burns more calories causing metabolic system to go into overdrive
infants born to mothers who smoke are at an increased risk for what
infantile colic, asthma, childhood obesity
what does erythromycin administration increase the risk for in infants
infantile hypertrophic pyloric stenosis
when is nasal cannula used for oxygen administration
infants requiring low flow amounts of oxygen can use nasal cannula. It works well for infants who are recuperating but still require supplemental O2
when is continuous positive airway pressure therapy used for oxygen administration
infants who are unable to maintain an adequate PaO2 despite the administration of O2 by hood or nasal cannula. CPAP infuses O2 or air under a preset pressure by means of nasal prongs or a face mask
endometritis
infection of uterine lining, most common postpartum infection
inefective endocarditis
inflammation of innermost lining of endocardium of heart caused by invasion of microorganism
cholecystitis
inflammation of the gallbladder that usually is caused when a gallstone obstructs a cystic duct
amnioinfusion
infusion of room temp isotonic fluids into utreine cavity if the volume amniotic low, used to relieve intermittent umbilical cord compressions that results in variable decelerations and hypoxemia
thalassemia
insufficient amounts of hemoglobin produced to fill the RBCs. it is a hereditary abnormal synthesis of alpha or beta chains of hemoglobin
what can surfactant insufficiency be caused by
insufficient surfactant production, abnormal composition and function, disruption of surfactant production, or a combination of these factors
describe type 2 diabetes
insulin resistance and usually relative insulin deficiency
PPD
intense and pervasive sadness with severe and labile mood swings, intense fears , anger, anxiety, and despondency that persist past the baby's first few weeks are not normal of post partum blues
how is brachial plexus injury treated
intermittent immobilization across upper abdomen, proper positioning, ROM exercises, gentle manupulation
SSRI effects on pregnancy and birth
intrauterine fetal demise and miscarriage physical malformations, persistent pulmonary physical malformations, persistent pulmonary hypertension on the newborn, poor neonatal adaptation syndrome, neonatal seizures, cardiac defects
what may be performed prior to 26 weeks to repair myelomeningocele
intrauterine fetal surgery
what is the only acceptable therapy for parvovirus
intrauterine transfusion to treat anemia
what is done immediately after birth to infants with congenital diaphragmatic hernia
intubated and ventilated
describe talipes varus club foot
inversion or bending inward
what are primary powers
involuntary uterine contractions
superficial venous thrombosis
involvement of the superficial saphenous venous system
explain extracorporeal membrane oxygenation
involves modified heart lung machine, blood is shunted from a catheter in the right atrium or right internal jugular vein by gravity to a servo regulated roller pump, pumped through a small heat exchanger, where it is warmed, and then return to the systemic circulation via a major artery such as the carotid artery to the aortic arch, it provides oxygen to the circulation allowing the lungs to rest and decrease pulmonary hypertensoin and hypoxemia in such conditions as persistent pulmonary htn of the newborn congenital diaphragmatic hernia, sepsis, meconiu, aspiration, and severe pneumonia
what is the majority of anemia caused by
iron deficienty
what should you avoid when you have sickle cell hemoglobinopathy
iron supplementation, even in prenatal vitamins
s/s of neonatal abstinence syndrome
irregular respirations, tachypnea, apnea, nasal flaring, chest retractions, intermittent cyanosis, rhiorrhea, nasal congestion, irritability tremors, shrill cry, incessant crying, hyperactivity, disturbed sleep pattern, seizure hypertonicity, increased DTR, exaggerated moro, frequent yawning, sneezing, tearing, excessive generalized sweating, mottling, fever, abnormal feeding patterns, uncoordinated and ineffective suck and swallow reflexes, incessant hunger, frantic sucking, refusal to fee, vomiting, regurgitation
what does damage to the lower plexus (klumpke paralysis) result in
lower arm paralysis, the wrist and hand are flaccid and the grasp is absent, and DTR are present, dependent edema and cyanosis can occur in affected hand
what can cause dystocia
macrosomia, multifetal gestation, abnormal or difficult presentation, and congenital anomalies
epispadius
males who have widened pubic symphysis and spadelike penis with urethral opening on top of penis
what is the initial management of retained placenta
manual seperation
what is uterine atony
marked hypotonia of the uterus
risk factors or peripartum cardiomyopathy
maternal age greater than 35, multifetal gestation, preeclampsia, gestational htn, muliparity, african descent, prolonged tocolytic therapy
what are factors exposing infant to birth injuries
maternal age less than 16 or greater than 35, primigravida, uterine dysfunction that leads to prolonged or precipitous labor, preterm or postterm labor, and cepalopelvic disproportion
describe indirect coombs
maternal blood serum is mixed with Rh positive RBCs. If there is clumping that is indicative of sensitization, a level of 1:8 rarely results in fetal jeopardy, if reaches 1:16 amniocentesis is performed to determine optical density of amniotic fluid to estimate hemolytic process in the fetus
what causes prlonged declerations
maternal hyptension, uterine tachysystole, or rupture extreme placental insufficiency and prolonged cord compression
what must be true for internal monitoring to take place
membranes must be ruptured, cervix dilated 2-3 cm, presenting part low enough to allow placement of the spiral electrode or IUPC or both
what does late onset listeriosis manifest as
meningitis, treated with ampicillin and aminoglycosides
what is the therapy of choice for heroine
methadone
gavage feedings
method of providing nourishment to the infant who is compromised by respiratory distress, too immature to have a coordinated suck swallow reflex, or who is easily fatigued by sucking
4 criteria used to measure the seriousness of a suicidal plan
method, availability, specificity, lethality
what are early onset infections usually caused by
microorganisms fro normal flora of vaginal tract
what all hallmark signs of mitral valve prolapse
midsystolic click and late systolic murmur (some have atypical chest pain that occurs at rest and is not resolved with nitrates also may have anxiety, palpitations, dyspnea on exertion, and syncope)
describe occulta spina bifida
milder form, posterior portion of laminae fails to close but spinal cord and meninges do not protrude through the defect and there is no abnormality of the spinal cord, nerve roots or meninges skin typically covers the opening of the spinal cord ends of the spinal cord terminate in fatty tissue birth mark or hairy patch over defect
describe acetabular dysplagia
mildest form neither subluxation nor dislocatioin, there is a delay in acetabular development
what makes it hard for infants to regulate their body temp
minimal insulation sub q fat, limited brown fat stores, fragile capillaries, decreased or absent reflex control of skin capillaries, inadequate muscle mass activity, poor muscle tone, immature temp regulation center in the brain
what poor outcomes are caused from sickle cell hemoglobinopathy
miscarriage, IUGR, stillbrith
what can parvovirus during pregnancy result in
miscarriage, fetal anemia, hydrops fetalis, IUGR, and still birth
what is anxiety during pregnancy associated with
miscarriage, preterm birth and birth complications
what can listeriosis cause
miscarriage, preterm birth, and still birth
what can cytomegalovirus result in
miscarriage, stillbirth, or congenital or neonatal cytomegalix inclusion disease
CV changes with marfan syndrome
mitral valve prolapse, mitral regurgitation, aortic regurgitation, aortic root dilation, possible dissection or rupture of aortic roots
what happens if a coombs test is repeated at 28 weeks and the results remain negative
mom is given IM Rho(D) immune globulin
care of subarachnoid hemorrhage
monitor ventilatory and IV therapy, observe and manage seizures prevent increased ICP, minimal handling
tetralogy of fallot
most common cyanotic herat disease observed during pregnancy. Components include VSD, pulmonary stenosis, overriding aorta, right ventricular hypertrophy, leading to a right to left shunt, late third trimester is most dangerous
describe linear skull fracture
most common in parietal bones, requires no treatment, usually of no significance
esophageal atresia and trachoesophageal fistula
most life threatening anomalies associated with the esophagus
ductus arteriosus
muscular contractile structure in the fetus connecting the left pulmonary artery and the dorsal aorta, diverting blood to the placenta for gas exchange. The duct constricts after birth as oxygenation, the levels of circulating prostaglandins, and the muscle mass increase
when is mechanical ventilation used for oxygen administration
must be implemented if other methods of therapy cannot correct abnormalities in oxygenation -indicated whenever blood gas values demonstrate severe hypoxemia or severe hypercapnea -intubation and ventilation can be needed for infants who have apnea with bradycardia, ineffective respiratory effort, shock, asphyxia, infection, meconuym aspiration syndrome, respiratory distress, or congenital defects that affect ventilation
symptoms of lupus erythematosus
myalgias, fatigue, weight change, fevers
severe clinical symptoms of enterovirus
myocarditis, meningitis, respiratory distress, and hepatitis, or death due to multi-organ involvement
describe nonhypertrophic cardiomyopathy
myocardium is poorly contractile and overstretched the ventricles are larger and no outflow obstruction is found. Most infants are asymptomatic, but severe outflow obstruction can cause CVHF
the use of ________ is contraindicated in infants born to narcotic addicts because it can cause severe signs and symptoms of narcotic abstinence syndrome and seizure
naloxone
aortic stenosis
narrowing of opening of the aortic valve leading to an obstruction to left venticular ejection. Most women who develop this do so after childbearing years
mitral valve stenosis
narrowing of the mitral valve caused by stiffening of valve leaflets which obstruct blood flow from the left atrium to the left ventricle and results from rheumatic heart disease
what can result from ITP
neonatal thrombocytopenia
what do surviving infants of GBS typically have
neurologic damage
what can cytomegalovirus cause
neurologic problems like cognitive disabilities, hearing loss, or visual impairment
complications of syphillis
neurosyphillis, deafness, hutchinson teeth, sabershins, joint involvement, saddle nose, gumas, interstitial keratitis, rhagades, frontal bossing, mullberry molars
are preterm infants able to sweat
no
are there meds to treat parvovirus
no
are there vaccine for nonpolio enteroviruses
no
do petechiae and ecchymosis blanch
no
does IgM cross the placenta
no
does eye prophylaxis for gonorrhea prevent systemic infection
no
does insulin cross the placenta
no
is an Rh negative fetus with an Rh+ mother in any danger
no
what is used to determine the infant's risk for development of hyperbilirubinemia
nomogram
_____ _______ are among the most common viruses that infect humans
nonpolio enteroviruses
prolapsed inversion of the uterus
obvious, large red rounded mass protrudes 20-30cm outside introitus
when do subgaleal hemorrhages occur
occurs as a result of forceps that compress and then drag the head through the pelvic outlet, can occur with midforceps birth and vacuum extractions
DVT
occurs most often in lower extremities, involvement varies but can extend from the foot to the gliofemoral region
describe spina bifida manifesta
occurs primarily in the lumbar or lumbosacral region and includes meningocels and myelomeningocele, neurologic function tends to be normal unless other abnormalities are present
germinal matrix hemorrhage- intravscular hemorrhage
one of the most common types of brain injuries in neonates, it is the most common type of intracranial hemorrhage, occurring almost exclusively in preterm infants
what is used to treat chlamydial conjunctivitis
oral erythromycin or azithromycin
what route is preferred for gavage feedings
orogastric
what is given immediately after birth to prevent hemorrhage
oxytocin
what are drugs to manage hemorrhage
oxytocin, misoprostol, methhylergonovine, methylprostaglandin, dinoprostone
what is the most common symptom of hematomas
pain
symptoms of thromboembolic disorders
pain and tenderness in lower extremity, warmth, redness, enlarged hardened vein over site
how do hypothermic infants appear
pale, mottled, the skin is cool to the touch, especially the extremities, increased respiratory effort, respiratory distress with apnea, tachycardia, bradycardia, and central cyanosis
drug and alcohol 4 P's screening
parents, partner, past, pregnancy did either parent have a problem with alcohol or drugs, does your partner, have you in the past, in the month before you knew you were pregnant how many cigs did you smoke and how much did you drink
what do spurts of blood with clots indicate
partial placenta seperation
5 p's of labor and birth
passenger, passageway, power, positoin of the mother, psychologi response
multiple sclerosis
patchy demyelinization of the spinal cord and CNS, may be a viral disorder
what does failure of blood to clot indicate
pathological condition of coagulopathy such as DIC
what people usually develop type 2 diabetes
people who are obese in the abdomen, sedentery, family history, puberty, HTN, prior gestational diabetes
placenta percreta
perforation of the uterus by the placenta
asymptomatic bacteriuria
persistent presence of bacteria within the urinary tract of women with no symptoms
what almost always occurs as a component of brachial plexus injury
phrenic nerve injury
what does surgical correction of hydrocephalus involve
placement of a shunt that goes from the ventricles of the brain usually to the peritoneum to allow the drainage of excess CSF
what is retained placenta
placenta has not been delivered in 30 minutes after birth
what are risk factors for unusual placenta adherence
placenta previa, prior uterine surgery, endometrial defects, submucosal fibroids, parity, maternal age
what is the most common cause of fetal death when the mother survives trauma
placental abruption
what is postmaturity in infants associate with
placental insufficiency, resulting in a fetus that has a wasted appearance because of loss of subcutaneous fat and muscle mass, dry cracked parchmanet like skin
describe talipes equinus club foot
plantar flexion in which toes are lower than heals
what can you put on extremely low birth weight infants to decrease heat and water loss
polyethylenne bag
what do fetuses with congenital diagphragmatic hernia tend to have
polyhydramnios
what frequently occurs during the third trimester in women with diaetes
polyhydramnios which can lead to placental abruption, uterine dysfunctoin, and postpartum hemorrhage
what classic signs of type 2 DM
polyuria, polydipsia, polyphagia
what does PEEP stand for
positive end expiratory pressure
choanal atresia
posterior nares can be blocked by a bony or soft tissues obstruction. Baby can display signs or respiratory distress and cyanosis or pallor that are relieved whenever the infant is crying
what are women with sickle cell hemoglobinopathy at risk for
preeclampsi, IU fetal death, preterm birth and low birth weight infants, postpartum endometritis, UTI
women with nephropathy and htn are at an increased risk for what
preeclampsia
what has maternal use of SSRIs been associated with
preterm birth and LBW
what is iron deficiency anemia associated with
preterm birth and LBW infants
what is asymptomatic bacteriuria associated with
preterm birth and low birth weight
risk factors for e coli infection
preterm birth, LBW, maternal infection, prolonged ruptured membranes
what does tobacco use during pregnancy often cause
preterm birth, SIDS, birth defects, prematurity, LBW, increased risk for bronchitis, pneumonia, developmental delays
what is t gondii associated with
preterm birth, growth restriction, microcephaly, hydrocephaly, microphthalmos, chorioretinitis, CNS, calcification, thrombocytopenia, jaundice, and fever
what is asthma associated with
preterm birth, preeclampsia, SGA, IUGR, increased rate of cesarean
effects of untreated depression
preterm birth, small head circumference, low APGAR
infants born to women with inflammatory bowel disease are at a higher risk of what
pretermbirth, low birth weight and SGA
management of bronchopulmonary dysplasia
prevention of prematurity and RDS, antenatal steroids prophylactic surfactant, avoidvance of mechancial vetilation, use of CPAP, gentle vetilation in the delivery room, admin of vit A
management of GMH-IVH
prevention of preterm birht, birth trauma, and hypoxic ischemic injury intervention to decrease risk of bleeding and supportive care to infants with bleeding episodes
what causes icterus and jaundice
primarily the accumulatoin of unconjugated bilirubin in the skin, a breakdown product of hemoglobin formed after its release from hemolyzed red blood cells
what are some problems commonly faced by late preterm infnts
problems with thermoregulation, hypoglycemia, hyperbilirubinemia, feedings, sepsis respiratory function
risk factors for facial paralysis
prolonged second stage of labor and forcep assisted birth
what must you do when myelomeningocele is present
protect protruding sac from injury
etiology of bronchopulmonary dysplasia
pulmonary immaturity, surfactant insufficiency, lung injury and stretch, barotrauma, inflammation caused by oxygen exposure, fluid overload, ligation of a PDA, familial predisposition
conmplications associated with mechanical ventillatoin
pulmonary interstitian emphysema, pneumothorax, and chronic lung disease
what happens in ARDS
pulse rate increases to compensate for respiratory insufficiency of any origin, an initial increase in BP occurs as cardiac output increases in an attempt to supply tissues with oxygen. BP decreases when lung damage is severe
what are characteristics of hemorrhagic shock
rapid shallow breathing, rapid weak and irregular pulse, cool pale and clammy skin, lethargy, anxiety
generalized anxiety
realistic problem but the degree of worry is more intense than appropriate, occurs for at least 6 months
heart transplantatioin
recommended that pregnancy be avoided for at least 1 year after the transplant
what are the signs of sickle cell hemoglobinopathy
recurrent attacks of fever and pain most often in abdomen, joints, or extremities
what are symptoms of VWD
recurrent bleeding episodes, bruising easily, prolonged bleeding time, factor VIII deficiency, bleeding from mucus membranes
PTSD
reexperiencing traumatic event, persistant avoidance of stimuli, numbing, difficulty sleeping, irritability, angry outbursts, difficulty concentrating, hypervigilance, exaggerated startle response
what is a birth/trauma injury
refers to physical injury sustained by a neonate during labor and birth
station
relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spines and is a measure of the degree of descent of the presenting part of the fetus through the birth canal
chiari malformation
results from improper development and downward displacement of the hind brain into the cervical spinal canal which blocks CSF from communicating with spinal collumn and results in hydrocephalus
what is a VTE
results from the formation of a blood clot or clots inside a blood vesserl and is caused by inflammation or partial obstruction of the vessel
laryngeal web
results from the icomplete separation of the two sides of the larynx and is most often between vocal chords, surgical emergency such that perforation of the web using an endotrachial tube can be life saving
septic shock
results from the toxins released into the blood stream
pathologic jaundice
results of an increased level of total serum billirubin that if left untreated can result in acute bilirubin encephalopathy or kernicterus
symptoms of appendicitis
right lower quadrant abdominal pain, n/v, fever, tachycardia, dry tongue, localized abdominal tenderness
in the first trimester of pregnancy what is metabolic status influenced by
rising levels of estrogen and progesterone that stimulates beta cells of the pancrease to increase insulin production and promotes increased peripheral use of glucose while fasting levels are reduced by approximately 10%
what causes increases in insulin resistance during the second stage of labor
rising levels of hCGomatotropin, estrogen, progesterone, prolactin, cortisol, and insulinase
s/s of syphillis
rough, cracked, mucocutaneous lesions of the lips and heal to form circumoral radiating scars called rhagades
typical appearance of LGA infants
rounded chubby body a plethoric or flushed complexion, enlarged internal organs and increased body fat especially around shoulders
maternal factors associated with increased incidence of CHDS
rubella and cytomegalovirus, ingestion of lithium warfarin or anticonvulsants, alcohol intake, poor nutrition, radiation exposure, metabolic disorders such as DM, systemic lupus, age older than 40, obesity, and smoking
what does the STABLE acronym stand for
s: sugar and safe care (safety IV fluids hypoglycemia, hyperglycemia umbillical caths t: termperature (hypothermia) a: airway (respiratory distress, CPAP) b: blood pressure l: lab work (related to infection/sepsis) e: emotional support
what are the sutures of the fetal skull
sagittal, lambdoidal, coronal, and frontal
signs of respiratory distress
seasaw breathing pattern, retractions, flaring nares, expiratory grunting, apneic spells, color progresses from pink to circumoral cyanosis and tehn generalized cyanosis
what will provide a patent airway in choanal atresia
securing an oral airway into posterior pharynx and maintaining prone position will provide patent airway
what do most antipsychotic drugs cause
sedation and orthostatic hypotension, constipation, dry mouth, blurred vision, tachycardia, urinary retention, weight gain, agranulocytosis, akathisia, dystonias, parkinson like symptoms, tardive dyskinesia, dystonias, neuroleptic malignant syndrome
how should you feed a baby with increased intracranial pressure
semi-reclining position
what are signs or early onset listeriosis
sepsis like symptoms, acute respiratory distress, pneumonia, menengitis, and myocarditis
s/s of e coli infection
sepsis, fever, temp instability, apnea, cyanosis, jaundice, hepatomegaly, lethargy, irritability, vomiting, abdominal distention, and diarrhea
perinatal mood disorders
set of disorders that can occur any time during pregnancy as well as in the first ear postpartum and can include depression, anxiety, OCD, PTSD, and postpartum psychosis
what can ITP cause
severe hemorrhage after cesarean birth or cervical/vaginallacerations
the way the fetus moves through the birth canal is determined by
size of fetal, fetal presentation, fetal lie, fetal attitude, and fetal position
what is another name for parvovirus B19
slapped cheeks illness
placental accreta
slight penetration of myometrium by the placenta
what is maternal obesity linked to
spina bifida, cardiac defects, diaphragmatic hernia, hypospadius, omphalocele, anorectal atresia, and limb reductions
what are brainstem and high cervical cord injury likely to result in
still birth and rapid death
what can viral infections that are acquired perinatally cause
stillbirth, intrauterine infection, congenital malformations, acute diseases
category X pregnancy risk
studies in animals or humans have demonstrated fetal anomalies and there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience and the risk involved in use of drug in pregnancy clearly outweigh benefit
what can late PPH be a result of
subinvolution of uterus, endometrium, or retained placental fragments
clinical signs of bells palsy
sudden development of unilateral facial weakness with maximal weakness within 48 hours after onset, pain surrounding the ear, difficulty closing the eye on the affected side, hyperacusis, loss of taste
treatment for encephalopathy
surgical repai and shunting to relieve hydrocephalus, unless a major brain malformation is present
class IV of functional classification or organic heart disease
symptomatic with inability to carry on any physical activity without discomfort
class III of functional classification or organic heart disease
symptomatic with marked limitation of activity
class II of functional classification of organic heart disease
symptomatic with slight limitation of activity
S/S of PDA
systolic murmur, active precordium, bounding peripheral pulses, tachycaria, tachypnea, crackles, hepatomegaly, cardic enlargement and pulmonary edema
S/S of bronchopulmonary dysplasia
tachypnea, retractions, nasal flaring, increased work of breathing, activity intolerance to handling and feeding and tachycardia
what can bring on hypertensive crisis
taking lots of OTC meds or eating foods with tyramine
engagement
term used to indicate that the largest transverse diameter of the presenting part has passed through the maternal pelvic brim or inlet into the true pelvis and usually corresponds to a station 0
what has helped decrease the incident at RDS
the administration of antenatal steroids to the mother and surfactant replacement
dual diagnosis
the coexistence of substance abuse and another psychiatric disorder
perinatal bereavement
the complex emotional responses experienced by women and men beginning immediatley after the death of an expected child through miscarriage stillbirth, neonatal death, or termination of pregnancy for fetal pneumonia
what happens in polycythemia that incrases the risk for hyperbilirubinemia
the greater number of red blood cells to be hemolyzed increases the potential bilirubin load that the neonate must clear
what does intrauterine transfusion involve
the infusion of Rh negative, type o blood into the umbilical vein
biparietal diameter
the largest transverse diameter and an important indicator of fetal head size
define postpartum hemorrhage
the loss of 500 ml or more of blood after vaginal birth and 1000ml or more after cesarean
what happens when fetal RBCs that contain the Rh antigen pass through the placenta into maternal circulation of an RH negative woman
the maternal immune system produces antibodies against the foreign fetal antigens and maternal sensitization can occur
presentation
the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor
what is PPP defined by
the presence of one or more episodes of abnormally elevated energy levels, cognition and mood swings and one ore more depressive episodes and is clinically referred to as mania
what compromises lung capacity in RDS
the presence of proteinaceous material and epitherlial debris in the airway which causes pulmonary vascular resistance increases which can lead to right to left shunting and a reopening of the ductus arteriosus and foramen ovale
grief
the profound state of sadness and despair that accompanies a loss
attitude
the relation of the fetal body parts to one another
lie
the relation of the long axis of the fetus to the long axis of the mother
position
the relationship of a reference point on the presenting part to the four quadrants of the mothers pelvis
bereavement
the state of being without a valued other, especially by death
category C pregnancy risk
there is positive evidence of human fetal risk based on adverse reactions data from investigations or marketing experience or studies in humans but potential benefits may warrant use
what happens if a person receives and incompatible blood type
they will form antibodies against the antigen in that blood with agglutinatoin occurring as the antibodies in the plasma mix with the antigens of the different blood group
what does rapid assessment identify
those born at term with no evidence of meconium or infection in amniotic fluid, those who are breathing and crying and those with good muscle tone
what infants are considered postmature
those older than 42 weeks
who are those at risk of inefective endocarditis
those with congenital heart lesions, degenerative valve disease, intracardiac devices, IV drugs
what type of prenatal vitamins are recommended for women with epilepsy
those with vitamin D because anticonvulsants meds interfere with production of the active form of the vitamin
what are diagnostic findings of ITP
thrombocytopenia, capillary fragility, increased bleeding time
what can petechiae or pinpoint hemorrhagic areas acquired during birth can extend over the upper portion of trunk and face be if it lasts more than 2 days
thrombocytopenic purpura
what is the definitive diagnosis of PDA
through echocardiogram which can visualize a PDS and measure amount of blood shunting across it
how is surfactant administered
through endotracheal tube
how is glucose transported across the placenta
through the process of carrier mediated facilitated diffusion
where can coagulase negative staph occur in infants
through the umbilical stump, the skin, mucous membranes, respiratory, nervous, urinary, and GI systems
how can herpes simplex be acquired
through transplacental infection, ascending infection by way of birth canal, direct contamination during birth, direct transmission from infected person
resting tone
tone of the uterus after a contraction either soft or hard
what anticonvulsant should not be prescribed if a woman is breastfeeding
topiramate
hyperbillitubinemia
total serum bilirubin level in the blood is increased
what does TORCH stand for
toxoplasmosis, other, rubella, cytomegalovirus, and herpes simplex
what usually causes phrenic nerve injury
traction on the neck and arm during birth
how does transmissoin of Hep B occur
transplacentally, serum to serum, and by contact with contaminated urine, feces, saliva, semen, or vaginal secretions during birth, and through breast milk is mother is positive for HBsAg
what can acute respiratory distress result from
trauma, pneumonia, sepsis, aspiration of gastric contents, fat emboli, acute pancreatitis, and drug overdose, amniotic fluid embolism, air embolism, tocolytic therapy, asthma, thromboembolism, DIC, pyelonephritis, preeclampsia, hemorrhage, blood transfusion reactions, peripartum cardiomyopathy
what it the leading cause of death in women of childbearing age
traume
medical management of thromboembolic disorders
treat with analgesia, elevation of affected leg,tedhose, heat applied locally
treatment for t gondii
treatment with pyrimethamine, comvined with oral sulfadiazine, folic acid, and continue treatment for 1 year
inversion of uterus
turning inside out, can be incomplete, complete, or prolonged
name the bones of the fetal skull
two parietal bones, two temporal bones, the frontal bone, and the occipital bone
what type of blood is used for transfusion so maternal antibodies still present in the infant do not hemolyze the transfused blood
type O Rh negative
inflammatory bowel disease
ulcerative colitis and crohns
DVT symptoms
unliateral pain, calf tenderness, swelling, redness, warmth, positive homans signs
during the first week of extrauterine how much weight can a preterm infant lose
up to 15% of its body weight
what are the principle pathways for generalized infectons
upper airway and GI tract
what does hyperglycemia result in
urinary loss of glucose that can cause osmotic diuresis which increases the risk of dehydration
what are most commonly used for drug screens
urine, meconium, and hair
what are some intrapartum events that result in injury
use of internal monitoring of FHR, collection of fetal scalp blood for acid base assessment
gastrostomy feeding
used for infants with neurologic problems or certain congenital malformations that require long term tube feedings, involves surgical placement of a tube through the skin of the abdomen into the stomach, tube is then taped in upright position to prevent rauma to the incision site, after site heals the nurse initiates small bolus feedings per physician orders, feedings by gravity are done over 20-30 minutes
when is a hood used for oxygen administration
used to admin oxygen to infants who do not require mechanical pressure support
what is nitric oxide therapy used for
used to decrease or reverse pulmonary htn, pulmonary vasoconstriction, acidosis, and hypoxemia in term and late preterm infants with conditions such as persistent pulmonary htn, meconium aspiration, pneumonia, sepsis, and congenital diaphragmatic hernia
what is extracorporeal membrane oxygenation use for
used to support life and allow treatment of intractable hypoxemia due to severe cardiac or respiratory failure
how can infants get syphillis
usually infected in utero by transplacental infection but infection of amniotic fluid can occur, infant can contract syphillis during contact with an active genital lesion at birth
what can an edematous fetus and placenta cause
uterine rupture
signs of placental abruption
uterine tenderness or pain, uterine irritability, uterine contractions, vaginal bleeding, leaking amniotic fluid, FHR change
hypospadius
utethra opens on under side of penis
what meds are given for ARDS
vasoactive agents, inotropi agents, corticosteroids
what is the likely origin of dark red blood
venous origin
what are the primary causes of thromboembolic disorders
venous stasis and hypercoagulation (cesarean doubles the risk)
medical management of PDA
ventilatory support, fluid restirction, admin of indomethacin or ibuprofen (these cause prostaglandin synthesis and cause the PDA to constrict), fluid restirction and diuretic therapy to decrease CV volume overload, or surgical ligation if necessary
what are the most common types of heart defects
ventricular septal defects
how does the fetus metabolize caffeine
very slowly
variable deceleration
visually abrupt decrease in FHR below the baseline the decrease is at least 15 bpm below baseline lasts 15 seconds and returns in less than 2 minutes caused by compression of umbillical cord
prolonged deceleration
visually apparent decrease in FHR of at least 15 bpm decreased baseline and llasting mroe than 2 min but less than 10 caused when the mechanisms responsible for late or variable decelerations last for an extended period
late deceleration
visually apparent gradual decrease in and return to baseline FHR associated with UCS onset occcurs during peak of contraction usually does not return to baseline after contraction associated with uteroplacental insufficiency
accelerations
visually apparent increase in FHR above the baseline rate with peak at least 15 bpm above baseline and lasts 15 seconds or more with return to baseline less than 2 minutes from beginning of acceleratoin
what are secondary powers
voluntary bearing down
classical s/s of increased intracranial pressure
vomiting, lethargy, and irritability
symptoms of multiple sclerosis
weakness of one or both lower extremities, visual complaints, loss of coordination, may have difficulty pushing
what are risk factors for brachial plexus injury
weight above 4000g, vaginal breech birth, forceps or vaccum, maternal diabetes, prolonged second stage of labor
what is fetal macrosomia
weight more than 4000-4500g or greater than the 90th percentile
when is surfactant administered as soon as possible
when RDS is present
when do hemolytic disorders occur
when maternal antibodies are present naturally or form in response to an antigen from the fetal blood crossing the placenta and entering maternal circulation. Maternal IgG's cross placenta causing hemolysis of fetal RBCs
ferguson reflex
when the presenting part of the fetus reaches the perineal floor mechanical stretching occurs and the stretch receptors in the posterior vagina cause release of exogenous oxytocin that triggers maternal urge to bear down
lightening
when the uterus sinks downward and forward about 2 weeks before term and fetus presenting parts sink into the true pelvis
when can you not transfer before birth
when there is imminent birth or unanticipated problems
when does germinal matrix hemorrhage occur
when tiny blood vessels rupture, the hemorrhage can extend into the lateral ventricles then to the 3rd and 4th ventricles the subarachnoid space and even into the white matter of the brain, large clots can develop and create outflow obstruction from the ventricles
scalded skin syndrome
widespread bullous lesions that easily rupture with fever and irritability
symptoms of MG in pregnancy
with MG in pregnancy as the uterus enlarges respirations may be compromised, fatigue may not be well tolerated
how can gavage feedings be done
with an intermittently placed tube providing a bolus feeding or continuously through an indwelling catheter (those who cannot tolerate bolus feedings are given continuous feedings)
what are the ADA classifications of diabetes
with or without vascular complications
when can sunusoidal patterns occur on fetal monitoring strips
with severe fetal anemia
neonatal abstinence syndrome
withdrawal symptoms characterized by symptoms of CNS irritability, respiratory distress, GI dysfunction, automatic dysfunctoin
when should the Rh negative mother with Rh+ baby receive Rho(D)
within 72 hours of birth to prevent her from producing antibodies to fetal blood cells that entered her blood stream during birth
when should eye prophylaxis be administered for gonorrhea
within the first hour after birth to prevent opthalmia neonatorum
are pregnant women with diabetes mellitus considered high risk?
yes