OB Exam 3

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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


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