Test 2 M&B - GI, fetal assessment, musculoskeletal, normal newborn assessment, neuro
What mechanical factors lead to respiration of baby?
- Chest compression during birth leads to fluid expulsion and recoil leads to sucking in of air.
Kernicterus
- Chronic bilirubin encephalopathy. The brain tissue is stained with bilirubin.
Talipes equinovarus
- Club foot
What needs to be taught to parents of a child with hirschsprung's disease?
- Colostomy care
What does the hepatic system of the newborn do?
- Controls blood glucose levels, conjugates bilirubin, stores iron, breaks down red blood cells
Why does a breast fed baby have less risk of infection?
- It gets passive immunity from antibodies in the colostrum.
What is the difference between fetal hemoglobin and adult hemoglobin?
- It has greater affinity for oxygen
How do you know if a child has pyloric stenosis?
- Projectile vomiting due to reverse peristalsis.
Why are there complications with respirations after c-section?
- The fetal lung fluid isn't squeezed out.
What leg is hepatitis B injected in?
- The right leg
What occurs after period of sleep in a newborn?
- The second period of reactivity
Why are newborns at a high risk of jaundice?
- There is an increased hemolysis of red blood cells which drives up bilirubin.
Why are babies with diabetic mother's at risk for rebound hypoglycemia?
- They are used to producing more insulin
Why are people often noncompliant with scoliosis brace?
- They are very concerned with appearance.
What position should a child be placed in after feeding if the have GERD?
keep upright for 30 minutes after feeding
ketonuria
ketones in the urine due to diabetic ketoacidosis
nevus flammeus
permanent, flat, pink to dark reddish purple mark. May be associated with a syndrome. Treated with laser.
puerperium
post-partum
What are interventions for retention?
- Cast, traction
What initiates the first respirations of the baby?
- Chemical, mechanical factors, thermal and sensory
Serial casting
- Cast applied to hold foot in desired position. Changed every few weeks until maximum correction is achieved.
How many voids are expected in the first two days of life?
- 1 to 2 times
When should a breastfed baby receive iron supplementation?
- 4 to 6 months
What is normal blood glucose for a newborn?
- 40 to 60 on day one and 50 to 90 on day 2.
What interventions increase the incidence on insensible water losses?
- 478
How much blood does a new born baby have?
- 80-100 mL of blood per kilogram
When do we expect to see the first urine void?
- 99% void within the first 12 to 48 hours.
What is the big risk with the baby's temperature?
- A decrease in core temperature in snot evident until non shivering thermogenesis is over.
Dennis brown splint
- Abduction orthosis. Orthopedic specialist adjusts it to change the positioning of the foot. Is worn 24 hours a day.
How often should the baby void after day 2?
- About 6 times a day
What is the stomach capacity of the newborn?
- About 6mL per kG
Duchenne muscular dystrophy etiology?
- Absence of a protein on the muscle fiber
What are the priority concerns for diarrhea and vomiting?
- Acid-base balance, dehydration
How is clotting deficiency treated in the newborn?
- Administration of vitamin K intramuscularly.
What is the number one priority with cleft palate?
- Airway
What enzymes are contained in breast milk?
- Amylase and lipase
How is bilirubin removed after birth?
- Attaches to bilirubin binding sites and is conjugated in the liver to make it water soluble so that it can be treated in the urine.
What is hirschsprung's disease?
- Bowel lacks ganglionic cells that cause peristalsis so the bowel constricts. Megacolon is formed above the contraction
How is scoliosis treated?
- Braces. Rod placement, bone grafting, and spinal fusion.
Are the stools of the breastfed and formula fed baby different?
- Breast fed baby gets 4 or more poops during the day. Bottle fed baby will do around 2 stools per day.
Which newborns are at greater risk on nonphysiological jaundice?
- Breastfed. They get less fluid.
What is the risk of prolonged hypoxia in labor?
- CNS depression leads to a lack of stimulation of the respiratory system.
Nonshivering thermogenesis
- Can increase heat production by 100%. Brown fat is metabolized when lower environmental temp is noted by thermal receptors in the skin. Norepinephrine is released in brown fat and stimulates the metabolism.
What is true breast milk jaundice?
- Can occur later, at 3 to 4 months.
What nursing interventions should be provided for muscular dystrophy?
- Coordinate health care services. Maintain activity and self-care functions is key. Skin care. Maintain bladder and bowel functioning. Protect from respiratory infections. Teach dietary modifecation to decrease obesity.
Spica cast
- Covers lower half of body except perineal area.
What behavioral states might the nurse notice of the newborn?
- Deep or quiet sleep. Light or active sleep. Drowsy state. Quiet alert. Active alert. Crying.
What are the signs and symptoms of muscle dystrophy?
- Delayed walking. Progressive symmetric muscle wasting. Frequent falls. Easily tired when walking, running, or climbing stairs. Hypertrophied calves. Waddling wide based gait. Uses gower's maneuver to rise from the floor. Unable to walk independently by age 9-12.
Transcutaneous bilirubin
- Device can screen for high bilirubin by pressing on forehead.
What is the major problem with muscular dystrophy?
- Diaphragm weakens
What is the risk associated with metabolic acidosis in the newborn?
- Displacement of bilirubin by fatty acids can lead to jaundice.
Signs and symptoms of hirschsprung's disease?
- Distended stomach, liquid stool, foul odor of the breath
What must always be done when a child with a fracture enters the ED?
- Document and assess the fracture and consult social services for suspected child abuse.
What psychosocial interventions do the nurses do for the newborn?
- Document and observe the baby's behavioral sate.
What intervention must be given for meningitis?
- Droplet includes surgical mask, gloves and gown. Start antibiotic. Assess vital signs and behavior. Strict I and O. Monitor FOC. Bedrest, do not flex neck.
Gastrocolic reflex
- Eating stimulates the stomach to empty.
Why does metabolic acidosis happen more in newborn?
- Electrolytes balance is maintained primarily by the kidneys. Newborn kidneys do not function well.
What are nursing priorities for a patient in a spica cast?
- Elimination and protection of the cast. Positioning. Neurovascular assessment. Skin care. Hygiene.
Hyperbilirubinemia
- Excess bilirubin in the blood. Can be caused by reduced binding sites that allow the bilirubin to go to the liver. It isn't conjugated in the liver so is fat soluble, so can't be excreted.
What is inside of the baby's lungs in utero
- Fetal lung fluid
What is expected in the first period of reactivity?
- First hour after birth. May appear hungry, active, and routing. May have increased heart rate at 180 beats per minutes and increased respiration to about 80.
What reduces an infant's risk of infection?
- Full term and breast feeding
What are things that can cause delayed surfactant production?
- Gestational diabetes
Where does the newborn get glucose from for cold stress?
- Glycogen is stored in the liver.
Why is the newborn at risk for heat loss?
- Greater surface area to volume ratio, blood vessels close to skin surface, very little subcutaneous fat.
Acrocyantotic
- Hands and feet are blue
What can you do for airway in postoperative scoliosis patient?
- Have suction and trach equipment available. Log roll every two hours. Do not raise the head of the bed.
What is the normal blood count for a newborn?
- Hemoglobin 15-24 G/DL. HEmatocrit 44-70%. WBC 9,100 - 34,000/MM3.
What injection in the newborn is given only with parental consent?
- Hepatitis B
What are signs and symptoms of infection in the newborn?
- High or low WBC. Increase in immature leukocytes. Decrease in platelets. Subtle changes in feeding and behavior.
Retention
- Holding it in the right place until it has time to heal
Chemical factors that initiate respiration in baby?
- Hypoxia associated with normal birth. Increase in partial pressure of carbon dioxide and decrease in partial pressure of oxygen leads to decreasing pH. This acidotic state stimulate the respiratory center in the medulla causing diaphragm contraction.
Interventions for appendicitis?
- Ice to the abdomen, position on the right side sitting up. Do not use heat!
When can hyperthermia occur?
- If the warmer is too warm, usually because the probe falls off of the baby's skin.
Which immunoglobin is found in colostrum?
- IgA
What passive immunuglobin crosses the placenta and protects the infant for 6 months?
- IgG
What immunoglobin does not pass through the placenta and indicates infection in utero?
- IgM
Why are newborns more at risk for developing sepsis?
- Immune system is immature and leukocytes are inefficient. They will not likely have fever or increased white blood cells count.
What are the risks of cold stress
- Increased metabolism can lead to Hypoglycemia, Reduction in the production of surfactant and hypoxemia due to respiratory distress, and metabolic acidosis. Vasoconstriction can lead to vasoconstriction in the pulmonary vessels to revert back to fetal circulation (respiratory distress).
Why is gastroschisis so dangerous?
- Insensible fluid loss
Why does a full term baby have less risk of infection?
- It gets antibodies in utero.
What is the temperature thermoneutral zone?
- It should be a room temperature between 89.6 to 97.2 degrees for a naked baby. A fully dressed newborn it can be 75.2 to 80 degrees.
At what age is kidney function the same in babies as adults?
- It takes 1 to 2 years for the kidney function to reach full power to remove waste from their bodies.
What are the the interventions for gastroschisis?
- Keep them warm, NPO, apply bag to slowly compress intestines back in
What is the biggest challenge in care for a child in spica cast?
- Keeping the cast clean and dry
What is the function of surfactant
- Keeps alveoli open
What is the greatest risk with hyperbilirubinemia?
- Kernicterus
What could oligohydramnios indicate about the newborn?
- Lack of urine production in utero
What are the signs and symptoms of hip dysplasia?
- Limited abduction with possible click, asymmetry of gluteal and thigh fat folds when lying with legs extended, telescoping of thigh. Limp and abnormal gait in older child.
Conduction
- Loss of heat to a cooler surface by direct skin contact.
Convection
- Loss of heat to cooler air currents
Radiation
- Loss of heat to cooler surfaces and objects not directly in contact with the skin
What problems with the cardiovascular system can occur if the newborn is hypoxic?
- Low levels of oxygen may constrict the pulmonary blood vessels.
What postoperative care will the nurse provide for scoliosis?
- Maintain airway, but you can't elevate the head of the bed. Do neurovascular assessment of lower extremities. Assess skin on bony prominences. Log roll every 2 hours. Teach passive and active ROM exercises. Encourage independence in ADL's. Incicison care. Provide with resources and possible scoliosis support group.
What are the goals of care for muscular dystrophy?
- Maintain ambulation and independence for as long as possible as muscle weakness progresses.
What are the priority interventions for traction?
- Make sure the weights are hanging freely. Nurses do not adjust the weights. No fraying ropes. Counter Traction must be provided.
What are the interventions for GERD?
- Medications, elevate the crib at an angle so the head of the bed is up, apnea is priority concern. Teach the parents CPR.
When does screening for scoliosis occur?
- Middle school
What is the priority goal of child with club foot
- Move to a normal and neutral position
What are the diagnostic tests used in muscular dystrophy?
- Muscle biopsy to look for protein dystrophin
What is the primary intervention if the baby is having blood sugar issues?
- NICU
What are the interventions for tracheosesophagial fistula?
- NPO right away, surgical reconstruction
Why do the intestines need to be put back in slowly?
- Need to make room in the abdominal cavity without decreasing breathing.
What is the difference between newborn blood volume and adult blood volume?
- Newborn has a higher blood volume by weight.
Is the newborn liver efficient at metabolizing drugs?
- No
Does the baby need supplemental iron?
- No it has 4-6 months of iron stored in it's liver.
Is parental consent needed for Vitamin K injection?
- No, it is given by law. Consent is only needed if the parents deny Vitamin K.
How do we protect surgical incision for cleft palate repair?
- No-nos, Logan's bar, sterile water for feeding, roll the swab to clean the suture line, elbow restraint. Tube feedings or gastrostomy tube.
What is the number two priority with cleft palate?
- Nutrition
How do you assess for hip dysplasia?
- Ortolani examination. Lay baby on the table, flex the legs up, abduct them and back down and around. Check for limited abduction. Turn baby over and check for symmetry of fat folds.
What is the priority risk for a patient with skeletal traction?
- Osteomyelitis
What is the risk with bottle feeding a newborn baby?
- Over feeding
What interventions can increase the incidence of fluid overload in a newborn?
- Over feeding, IV medication.
Why are blood counts higher in the newborn than the adult?
- Oxygen through the placenta is not very efficient.
What are the signs and symptoms of compartment syndrome?
- Paresthesia, pain, pallor, paralysis, pulselessness
Fat embolism
- Particles of fat carried through circulation lodge in lung capillaries causing pulmonary edema ... check slide
How is hip dysplasia treated?
- Pavlik harness to keep the leg tight in the acetabulum. Should be worn over clothes. Could need Bryants traction. Also may need spica cast.
What occurs after the first period of reactivity?
- Period of sleep or decreased activity
What babies will get accuchecks?
- Post term babies. Babies that are small for gestational age. Babies that are large for gestational age. Babies of diabetic mothers.
Who is more prone to cold stress?
- Preterm babies, small for gestational age, interuterine growth restriction babies.
What changes occur to the cardiovascular system with respirations in the newborn?
- Pulmonary blood vessels dilate in response to increased oxygenation.
Reduction
- Putting the bone in the right place
What newborn behavioral state is best for bonding?
- Quiet alert.
How are fractures treated?
- Reduction and retention
Tonic neck reflex
- Reflex where the newborn head turns to the side and arms follow
Relaxed cardiac sphincter
- Reflux and spitting up are common.
What does IgA protect?
- Respiratory tract and gastro intestinal tract
How does the newborn try to conserve heat?
- Rolls into a ball, cries, non-shivering thermogenesis, reduces blood supply to hands and feet
What are the manifestations of scoliosis?
- Seen in adolescents. Lateral curvature of the spine, uneven shoulders, waste is out of line, might walk with a limp. May have pain at the hip.
What are the treatments for club foot?
- Serial casting, dennis brown splint
What forms of tractions can be used?
- Skin or skeletal
Buck's traction
- Skin traction
Bryants traction
- Skin traction. Might be used to relax muscles that are too tight. The weights on the pullies as well as the child's buttocks being off of the bed are important for this traction. They must be on a very firm mattress. The nurse never removes the traction.
When do the bowels of the newborn begin to work?
- Sounds are present at 1 hour due to entrance of air.
What are the thermal and sensory factor that lead to respiration of baby?
- Stimulation of skin sensors lead to stimulation of respiration including pain.
What increases surfactant production?
- Stress during child birth
How do you know when the appendix ruptures?
- Sudden decrease in pain
What should be avoided if a child is dehydrated?
- Sugar
What is meconium?
- Tar like substance that is the digested materials from ......
What preoperative teaching should be given for scoliosis?
- Teach Incentive spirometer, what equipment might be used. Teach used of PCA or epidural block. Demonstrate log rolling and assist out of bed.
What should be taught to parents with a baby in a pavlik harness?
- Teach skin assessment. Teach to remove and apply harness. Only remove for bathing and skin checks.
What teaching should accompany dennis brown splint?
- The bar is not a handle. Do neurovascular checks. Provide tummy time. Support parent with coping.
Muscular dystrophy
- The degeneration of muscle fibers. It is progressive.
Why is the newborn at a risk of clotting deficiency?
- They do not have their own vitamin K, because it is made in the intestine with food and normal flora.
How do white blood cells change in a newborn compared to a baby that is 4-5 days?
- They drop from 9,100 to 34,000 to about 12,000
What is the difference between fetal red blood cell life span and that of adults?
- They have a shorter life span which leads to increased bilirubin.
Why are post gestational babies at risk for low blood sugar?
- They have less brown fat
How do you check for neurovascular in postoperative scoliosis patient
- Tingling, numbness, wiggle, color, pink, capillary refill in 2-3 seconds, warm to touch. Mainly look at lower extremities.
Who is most at risk of fracture?
- Toddlers
How is bilirubin removed in utero?
- Unconjugated bilirubin is transferred to the placenta.
How much weight can be lost due to normal diuresis after birth?
- Up to 10%
What is normal weight loss for a newborn?
- Up to 10%
Gower's maneuver?
- Use their hands to push themselves up
How do you know a child has tracheoesophageal fistula?
- Vomiting and drooling right away. Not projectile. Nasal and mouth regurgitation right after feeding.
What is the risk of the baby's long intestines?
- Water loss with diarrhea
What is the most important thing to asses with dehydration in children?
- Weight
When is meconium passed?
- Within the first 12 hours.
When is normal flora present in the newborn?
- Within the first few days
When is vitamin K give?
- Within two hours of birth in the left leg
Jaundice
- Yellowing of the skin due to excess bilirubin in the blood. Yellowing of the eyes.
Physiological jaundice
- normal and transient after the first 24 hours. The baby will not be yellow. Bilirubin levels will peak at 5-6 mg/dl when the newborn is 2 to 4 days old. Does not require treatment.
Nonphysiologica jaundice
- occurs within the first 24 hours.
What are some treatments for jaundice?
- phototherapy, formula
When are newborns more at risk of jaundice?
- pre term
Enterohepatic circuit p.475
- some conjugated bilirubin is unconjugated
What is measured in the TSB and Direct bilirubin test?
- total serum bilirubin shows conjugated and unconjugated together. Direct bilirubin test shows an estimate of the conjugated bilirubin.
How are carbohydrates counted for type 1 diabetes?
...
What are the signs and symptoms of hypoglycemia
...
What is the treatment for hypoglycemia in type 1 diabetes?
...
What should the patient with type 1 diabetes do if they get sick?
...
What treatments can be given for diarrhea
...
What is the recommended daily consumption of folic acid?
0.4 mg
How are carbohydrates counted for type 1 diabetes?
1 Carbohydrate equals 15 grams of carbohydrate. Young children consume 2 to 4 choices per meal. Older children and adolescents consume 6 to 8 choices per meal.
What are the preoperative nursing interventions for esophageal atresia repair?
1 Maintain airway with occasional aspiration via NG tub, elevate the HOB and give oxygen. 2 Keep NPO. 3.Thermoregulation to keep them warm. 4. Prophylactic antibiotic.
How is insulin used to balance out carbohydrates?
1 unit of insulin covers 8 grams of carbohydrates.
How does involution occur in the uterus?
Contractions of the uterus shortens muscle fibers. Protein catabolism.
When does spina bifida occur?
4th week of gestation
What interventions should be given to postpartum women regarding the endocrine system?
Contraception should be given. Weight loss will occur slowly.
What are normal blood glucose levels for toddlers and preschoolers?
100-180 before meals. 110 to 200 at bedtimes
What changes in WBC are expected during postpartum?
12000 during pregnancy to 25000 or 30000 post partum.
Reactive NST
2 accelerations of 15 beats per minutes lasting 15 seconds, associated with fetal movement. Indication of fetal well-being.
How is the biophysical profile scored?
2 points for each of the 5 or 4 points of the biophysical profile depending on whether the N S T was done.
What is longer-term development of affection between the infant and significant other?
attachment
When does surfactant start being produced?
24 to 25 weeks gestation.
When is a child likely to exhibit signs of a subdural hematoma?
24 to 48 hours
Negative O.C.T.
3 contractions in 10 minutes with no signs of late decelerations
What is the normal postpartum urine volume?
3000 mL per day
When is surfactant fully produced?
34 to 36 weeks of gestation
What is a moderate Apgar score?
4 to 6
Hirschsprungs Disease
A segment of the colon has a lack of nerve intervention
What changes occur to the mother's cardiovascular system during pregnancy?
45% more blood.
diastasis recti abdominis
A separation of abdominal musculature that commonly occurs after pregnancy.
When does the vagina finish involution?
6 to 10 weeks
When is menstruation expected to return postpartum?
6 to 10 weeks
What is the normal blood glucose level for a non-diabetic child?
70 to 110
What are normal blood glucose levels for school age children?
90 to 180 before meals. 100 to 180 at bedtime
What is attachment
A bond that endures over time that occurs through mutually satisfying experiences. There is reciprocity.
Logan bar
A butterfly bandage with a bar that protects the mouth area after cleft palate surgery.
What is the priority assessment done on the child with a head injury?
ABCDEs Airway, breathing, circulation, disability, and exposure
APGAR
Activity, pulse, grimace, appearance or skin color, respiration. Point values vary from 0 to 2 for each.
If a patient wants to put a special coin on the newborn's umbilicus, what should the nurse do?
Allow it after it has been properly cleaned. This is a Mexican American cultural tradition to promote healing.
AFP
Alpha-fetoprotein. It is a measurement of a protein produced by the yolk sac and the fetal liver. It diffuses from fetal plasma to fetal urine and is excreted in amniotic fluid. It can be found in amniocentesis or maternal blood draw.
What assessment will be found in a child with cerebral palsy
Alterations in muscle tone. Abnormal resistance. Keeps legs extended or crossed. Rigid and unbending. Abnormal posture. Do not crawl on knees, scoot on back. When try to walk, walk with toes first as in plantar flexion. Scissoring and extension (legs feet in plantar flexion). Persistent fetal position (>5 months).
What wound care measures can be done to prevent infection post cleft palate surgery??
Always give clear liquids following a feeding to reduce bacterial growth. Wash with sterile water or saline. Can roll a gentle cotton swab across suture lines, but no rubbing. May apply antibiotic ointment
What medications are used to treat bacterial meningitis?
Ampicillin, claforan, rocephin should be started immediately until the causative organism is determined.
What enzymes are available in breastmilk that the newborn is deficient in?
Amylase and lipase
How do uterine muscle cells decrease in size?
An enzyme breaks down proteins in hypertrophied cells.
what can happen during rectal exam of hirschprungs?
An explosion of gas and feces
How is omphalocele repaired?
An incision is made into the membrane and the bowel is checked for damage. Damaged parts are removed.
Why give botox for hirschprungs?
botox relaxes the lower area so the stool can come through.
How is anal stenosis treated?
Anal dilation
Episiotomy
Anesthesia is given and the perineum is cut midline when the baby is crowning.. Not usually performed anymore.
Carbamazephine, Tegretol
Anticonvulsant used to treat seizure. Give with food. Side effects include behavioral changes and decreased liver function.
Phenytoin, Dilantin
Anticonvulsant. Can be given IV push diluted with saline. Side effects include hyperplasia of the gums, Decreased level of consciousness and nystagmus. Teach good oral hygiene.
Anal stenosis
Anus is so narrow it is closed off
What would be 2 life threatening concerns related to the child born with a cleft lip and palate?
Aspiration and nutritional deficit leading to failure to thrive
What are the risks of GERD in an infant?
Aspiration pneumonia and apnea
What is the major concern for the nurse related to a child tracheoesophaeal atresia?
Aspiration, nutritional deficit
How is jaundice assessed and at what level would it be visible?
Assess every 8 to 12 hours by pushing to blanch skin at the end of nose or sternum. It will be visible when it reaches 5 or 6 mg/dl.
What should the nurse do if the uterus is deviated to the right or left?
Assess for a full bladder. Ask the patient to try to urinate.
What are the post-operative nursing interventions for esophageal atresia repair?
Assess respirations, keep warm, manage pain, maintain nutrition, I&O. daily weights, IV fluids
A woman who is 3 hours postpartum has had difficulty urinating. She finally urinates 100 mL. The initial nursing action is to ?
Assess the height of her fundus
What should the nurse do first, if the father of a postoperative cleft lip repair infant states that his infant is crying due to pain?
Assess the incision site and the patient's respirations
How should insulin be balanced with exercise?
Avoid exercise during insulin peak. Add an extra carbohydrate snack for each 56 to 60 minutes of exercise.
Extrusion reflex
BAby pushed the food out with the toungue
What happens to fetal lung fluid during birth?
Baby spits it out, or squishing the baby causes it to be absorbed into tissues.
Which meningitis is worse?
Bacterial
Symptoms of basilar fracture
Battle sign, raccoon eyes, rhinorrhea, otorrhea, hemotympanum
spina bifida occulta
Between LF and S1 vertebrae . May have no sensory or motor defects.
cephalhematoma
Bleed caused by trauma during birth. Will go away after a couple of weeks to a few months. Is firmer to the touch than edema. Develops 24 to 48 hours after birth. Does not cross the suture lines. There is an increased risk of jaundice.
When should the HCP be called following a head injury?
Bleeding that doesn't stop after 10 minutes or is oozing from the nose or ears. Younder than 2 years old. Trouble breathing. Vomitting or severe headache that won't go away. seizure. unconscious or confused. watery fluid coming from ear or nose. unequal pupils. difficult walking. hard to wake. slurred speech or blurred vision.
How is oxygen given during a seizure?
Blow oxygen towards their face
Depressed
Bone pressing downward, indented
Volvulus
Bowel twists on itself
What would the nurse assess in a patient with tracheosophageall atresia?
Bubbling and frothy mucus, vomiting, regurgitation, rattling sounds in the chest
Phenobarbital
CNS depressant used for seizure. Can cause necrosis at the IV site. Give with food PO. Common side effects are drowsy, lethargy, pink urine. Check liver function test. Should have medical alert bracelet.
What should parents be taught if their infant has GERD?
CPR
Why is packing or blowing of the nose contraindicated after a head injury?
CSF may leak from the nose
What is the most precise way to determine the head injury type?
CT or MRI
How is ICP diagnosed?
CT, MRI, lumbar puncture, serum and urine electrolytes, arterial blood gas, CBC, EEG, radiography
neurogenic bladder
Can be flaccid with no control over voiding. Can be hypertonic and will not open without intermittent clean catheterization.
What does "living ligature" mean?
Contractions of the uterus shortens muscle fibers and controls the bleeding by compressing and sealing off blood vessels
What nursing interventions should be done post operatively for spina bifida cystica?
Care of surgical sit. Monitor VS and neuro vital signs. Encourage contact with caregivers. Assess bowel and bladder function. Antibiotic therapy. Education.
How does autoregulation take place to control CPP?
Cerebral arteries change diameter. Increased PaCO2 produces vasodilation. Decresed PaCO2 produces vasoconstriction. Hypoxia causes vasodilation.
Coup injury
Cerebral injury sustained directly below the site of impact.
countrecoup injury
Cerebral injury sustained in the region or pole opposite the site of impact.
What is the purpose of chorionic villi sampling
Check for chromosomal abnormalities.
What is included in assessment of the newborn's eyes?
Check for inflammation. Symmetrical and equal in size. Slanting epicanthal folds in a non-asian infant may be a sign of down syndrome. Check for edema of the eyelids and subconjunctival hemorrhages from pressure during birth. Blue color of sclera indicates osteogenesis imperfecta.
What are the concerns about postpartum breasts?
Check for nodules, lumps, nipples are sore, reddened, blisters, cracks. Assess nipples for everted, flat, and inverted.
What should be assessed with the umbilical stump?
Check for the 3 blood vessels. If Wharton's jelly is thin, there may have been poor nourishment in utero. If there is a yellow-brown or green tinge, there may have been meconium released. There should be no redness or discharge.
What care is given post amniocentesis?
Check vital signs and FHR's Normal. Make sure there is no leakage of fluid from the site. Teach the patient to report lack of fetal movement, discharge or bleeding, abdominal pain, or fever.
What should be taught about exercise postpartum?
Check with the doctor about exercises, but walking is safe. Let the body return to pre-pregnant state before straining it.
What changes are anticipated in lumbar puncture results of a child with bacterial meningitis?
Cloudy, increased pressure, increased white blood cells count (greater than 100 per mL), decreased glucose, increased protein.
Amniocentesis
Collection of amniotic fluid for testing. Invasive procedure that requires a separate consent. Usually performed 14 to 16 weeks gestation, but as early as week 11. Looks for chromosomal abnormalities.
Down syndrome clinical manifestations
Congenital anomalies with cardiac and GI tract. Flat facial features, borad and flat nose, protruding tongue. Low set ears. upward slanting eyes. prominent epicanthial folds. Short hands with simian crease. hypotonia. neck short with extra fat spad. usually sterile.
3 C's of tracheosophageal atresia?
Coughing, choking, cyanosis
What is reduction
Cover the intestines in a sack to keep it moist and put pressure on bowl to push it in.
What is the most important thing to do to make sure your patient maintains nutrition status?
Daily weights
lochia alba
Day 11 to 21. yellowish white discharge.
What GI tract problems can be anticipated postpartum?
Decreased muscle tone and intra abdominal pressure. Prelabor diarrhea and decrease peristalsis. pre-delivery enema. dehydration. perineal tenderness, hemorrhoids, and episiotomy. Fear of bowel movement.
baclofen pump
Decreases spasticity in the muscles. Makes the muscles more hypotonic. May be intrathecal.
How can status epilepticus be treated?
Diazepam (Valium), larazepam (ativan), or midazolam (Versed) given IV.
What are the interventions for a child or infant with GERD?
Dietary management, frequent burping, position changes, avoid excessive handling after feeding.
Maple syrup urine
Disorder of amino-acid metabolism
Nonreactive NST
Do not have 2 accelerations of 15 beats per minute. Does not indicate fetal well-being.
What nursing interventions should be provided for the PlastiBell?
Do not put petroleum jelly on. Put diaper on loosely. Teach parents that the plastibell ring should fall off in 7 to 14 days. Assess for bleeding for two hours. Should void in 6 - 8 hours.
What post operative teaching should be provided after treatment of imperforate anus?
Do not take rectal temperature.
When checking a woman's fundus 24 hours after cesarean birth of her third baby, the nurse finds her fundus at the level of her umbilicus, firm and in the midline. The appropriate nursing action relate to the assessment is to?
Document the normal assessment
Why do we slowly put the bowel back in?
Don't want to cause problems with intestinal blockage and kinking. Must give lungs and diaphragm time to adjust.
How is PKU usually diagnosed?
During newborn screening which is required by state low. It is tested after the infant has fed and ingested protein about 48 hours after birth. Will shows elevated levels of plasma phenylalanine.
Why is there an increased thrombus formation risk in postpartum women?
During pregnancy, plasma fibrinogen increases . Plasminogen does not rise.
how is a seizure diagnosed?
EEG, CT or MRI, Lumbar puncture, CBC, metabolic screen for glucose, phosphorus and lead levels.
What are the methods of pain relief for circumcision?
EMLA cream, acetamiophen, sucking, nerve block
caput succedaneum
Edema caused by pressure during birth. Goes away on it's own. Apparent at birth.
Why might a patient have headache postpartum?
Electrolyte changes. Spinal headache. Preeclampsia.
What is the procedure for NST
Electronic fetal monitor is applied. Fetal movements might be documented.
What is the AFP for?
Elevated levels of AFP may be indicative of open neural tube defects because the aFP leaks out of the fetal circulation into the amniotic fluid and other chromosomal abnormalities can be indicated by low AFP.
Steps of attachment
Enface, explore with fingertips, hand and palmar contact, whole arms
What are the two types of intracranial hemorrhage?
Epidural and subdural
Esophageal Atresia
Esophagus doesn't develop as a continuous tube. It is a blind pouch
What are the complications of omphalocele?
bowel obstruction, infection, decreased respiration
What should be done if the patient has a nonreactive NST?
Extend the test for 30 minutes. If it is still nonreactive, try once more. If it is still nonreactive, due contraction stress test or physical profile.
decerebrate posturing
Extension of the upper extremities with internal rotation of the upper arm and wrist. Indicates damage to more areas of the brain, such as diencephalon, midbrain, or pons.
what are the diagnostic tests for hydrocephalus
FOC, MRI and CT, Skull x-ray, transillumination.
Enface
Face to face, eye to eye contact with infant.
Cleft lip and pallet
Failure of maxillary and median nasal processes to fuse during embryonic development
What is the major sign or symptom of imperforate anus?
Failure to pass meconium. Fistula between bowel and bladder can put stool in urine.
What are the negatives to the NST?
False positives in well oxygenated term fetus
How is diabetes diagnosed?
Fasting plasma glucose greater than 126. 2 hour plasma glucose greater than 200. Elevated glycosylated hemoglobin greater than 7.5/
What are the signs and symptoms of celiac disease?
Fat, calorie, carbohydrate and vitamin deficiencies. Severe dehydration with celiac crisis.
homan's sign
Flex the foot to check for pain in the calf. Not done much anymore because it could discharge the clot. No risk of clot dislodging if the patient ambulates.
abscence seizures
Formerly called petit mal seizures, absence seizures are very brief episodes of altered consciousness. Typically, no muscle activity occurs except for upward rolling of the eyes. The child has a blank facial expression. Absence seizures last only 5 to 10 seconds or less,
Why do people with spina bifida have an increased risk of latex allergy?
Frequent exposure due to catheterizations, shunt placements, and other operations.
FOC
Frontal occipital circumferance
What are the major complications of GERD in a child?
Gastric bleeding and apnea
How is nutrition maintained post-operatively for esophageal atresia?
Gastrostomy tube feedings, that can be taught to the parent.
How are contractions stimulated in O C T?
Give pitocin or nipple stimulation
What non-medication interventions can be given for post-operative cleft palate pain?
Give them to their parents, rock
What are the two main forms of circumcision?
Gomco clamp and PlastiBell
What medications can be given for GERD?
H2 histamine receptor antagonists, proton-pump inhibitors, antacids, prokinetic agents
Intussuception
bowel telescopes inside itself to cause bowel obstruction
What preoperative interventions are the most important with an infant with a cleft palate?
Help with feeding. Can use long soft bottle nipple, latham device, help with pumping breast milk, tube feeding, feed very slowly, bubble frequently, support the parents
Omphalocele
Herniation of the abdominal contents through the umbilical chord.
Gastroschisis
Herniation of the abdominal contents to the side of the abdominal wall. Intestines are not covered. Patient has a scaffoid abdomen.
What are pre-operative treatments of herniated intestine?
Hydration with IV fluids, assess vital signs, pulse oximetry, put in isolette or radiant warmer, OG suction, reduction
Why are infants more likely to have closed head injury?
Immature musculoskeletal system and large head to body ratio.
When is surgical repair of esophageal atresia performed?
Immediately
When does the fundal assessment first happen?
Immediately after delivery. It should be a little below the umbilicus and be really hard.
What are the nursing interventions for DKA?
IV fluids first, IV insulin. Wean the patient off of insulin when clinically stable. Electrolyte replacement.
How are tremors differentiated from seizures in a newborn?
If the extremity is flexed and held, the tremor should stop in a newborn.
What should be done if the postpartum patient can't urinate?
In and out cath
Who do you consult when you are not feeling well after childbirth
In the post-partum, you see your OB
Where in the bowel does hirshsprung's occur
In the sigmoid colon
brudzinski sign
In the supine position, bending the head towards the chest causes involuntary hip and knee flexion. Sign of meningitis.
What do late decelerations indicate?
Inadequate fetal oxygen reserves. When contractions occur, the fetus may have acidosis, which decreases the fetal heart rate and persists after the contraction.
What should patients be taught about GI issues postpartum?
Increase fluids and fiber. Take your colace.
What are the clinical manifestations of hydrocephalus
Increased FOC. Frontal enlargement or bossing. Head larger than face. Translucent skin. Wide palpable suture lines. Bulging fontanels. wide bridge between eyes. behavior changes.
What complications is the child with cerebral palsy?
Increased incidence of respiratory infection, muscle contractures, skin breakdown, injury
Nutrition issues with CP
Increased metabolism so increased risk for failure to thrive. Extended extrusion reflex and other tongue and swallowing difficulty. Encourage finger foods.
What metabolic findings will be found in cerebral palsey?
Increased metabolism. Will have low body mass.
Hydrocephalus
Increased production or decreased absorption of CSF which accumulates in the ventricular system.
What pulse is concerning for a post partum patient?
Increased, could indicate hemorrhage
What is the significance of a shill or high-pitched cry in a newborn?
Indicates neurological disorder or other problems
What are post operative complications for hirschprungs?
Infection, blockage due to strictures
What complications can we anticipate from cleft palate surgery?
Infection, scarring, respiratory distress, ear infection, impaired verbal communication
What is bonding
Initial attraction felt by parents to baby. Allow attachment to be felt by all members of the family.
What is the goal of treatment of type I diabetes?
Insulin therapy to replace the insuling the child in no longer able to make. Lower blood glucose levels and stabilize them. Eliminate ketones in the urine.
What should be taught about rifampin?
It colors the urine and sweat red-orange and can stain contact lenses
Why is nasogastric tube contraindicated in a child with a basilar skull fracture?
It could be introduced into the brain.
What is conjugated bilirubin?
It is also called direct bilirubin. It has been made watersoluble by the liver and can be excreted.
When is CP diagnosed
It is difficult to diagnose the extent until the child is old enough to try to pull up and walk.
What is the intervention for a child with PKU?
Keep serum phenylalanin level at 2 to 6 mg/dl by avoiding all natural proteins and drinking special shakes.
Why is gastroschisis more dangerous than oomphalocele?
It is not covered so fluid and body heat are being lost. There is a higher risk of infection.
What is the point of maximum impulse?
It is where the apex of the heart can be best heard, because the heart is closes to the chest wall.
What is anticipated in the postpartum perineum?
It may be stretched or lacerated. There might be edema, bruising, or episiotomy.
Why should aggressive passive hyperventilation be avoided in patients with increased ICP?
It may lead to cerebral vosoconstriction which will decrease cerebral blood flow to ischmia levels
What changes in BP should be anticipated post partum?
It should remain stable
What changes might be seen in lumbar spinal glucose levels in meningitis?
It will decrease due to increased metabolism by the brain and bacteria
What are the signs and symptoms of CP in an infant
Jittery (easily startled) Weak cry (difficult to comfort) Experience difficulty with eating (muscle control of tongue and swallow reflex) Uncoordinated or involuntary movements (twitching and spasticity) Abnormal newborn reflexes - prolonged
What interventions are used for the infant with spina bifida cystica?
Keep the sac moist and sterile. Protect from feces and urine. Maintain in prone position with legs in abduction. Keep in isolette. Put on latex precautions.
What are the expectations when assessing the female neonate genitalia?
Labia majora covers the clitoris and labia minora. Labia may be dark and pseudomenstruation may occur due to mother's hormones. Labia may have edema and there may be white mucous vaginal discharge.
Taking in
Lasts a day or less. patient is dependent and passive. She makes no decisions. Mother's primary needs are her own, food and sleep. She may talk a lot about her labor and delivery experience.
What should you do if you notice your lochia has large clots?
Leave it in the toilet so the nurse can check it. If it is very watery and easily broken it is not of concern. If it is more solid, it might be placental tissue.
What should the nurse teach the child about lumbar puncture?
Lie on your side with body bent and knees and chin touching. Nurse will hugg the knees to the chin. The HCP will rub the back with cool liquid. The child might feel a pinch or sting as the needle is inserted. Teh child must remain still.
Maternal fetal medicine specialist
MFM. Does not deliver babies, but does check using ultrasound or other tests for maternal-fetal health.
What are the 4 types of skull fracture
Linear, depressed, basilar, comminuted
How should the heart rate be assessed in a newborn?
Listen for a full minute and then every 30 minutes.
What is the main intervention during taking in?
Listen to mother's interpretation of events of the delivery to make them more meaningful and clarify any misconceptions.
How do you feed a baby with cleft palate?
Longer softer nipple, can be fed breast milk from pump.
What should be done if the fundus is boggy?
Massage until firm. Do not over massage.
M S A F P
Maternal serum A F P
What is the purpose of the lumbar puncture?
Measure pressure and obtain specimen of the cerebrospinal fluid
What's the difference between ICP and meningeal irritation?
Meningeal irritation has Headache, photophobia, nuchal rigidity, opisthotonic position, positive kernig's sign, positive brudzinski's sign.
What nursing intervention must accompany lumbar puncture?
Monitor the child's cardiorespiratory status.
What nursing interventions accompany a shunt?
Monitor vital signs and neurological status. Assess functioning of the shunt. Assess operative site. Assess for infection. Position of patient away from the shunt. Activity of patient. promote nutrition. avoid constipation. Educate to wear a helmet.
What are the benefits and risks to the proportionally long intestines in the newborn?
More surface area for absorption but more prone to water loss should diarrhea develop.
What is the leading cause of death in children beyond infancy?
Multiple trauma
Why is blood glucose monitored when a patient has increased ICP?
Must maintain normal levels and prevent further increases in metabolic demands.
What interventions should be performed for peritonitis?
NG tube for suction, lay on right side and upright,
What are other signs and symptoms of pyloric stenosis
NG tube for suction, projectile vomiting, constant hunger, visible peristaltic waves, hypertrophied pylorus, distended abdomen
What are the parameters of the biophysical profile (BPP)?
NST, fetal breathing movements, gross fetal movements, fetal tone, amniotic fluid volume
Pyloric stenosis
Narrowing of the pyloric sphincter with delayed emptying of the stomach
Nuchal rigidity
Neck rigidity
What CST interpretation is reassuring?
Negative
What are the results for O.C.T.
Negative or positive
How is gestational age of the newborn assessed?
New ballard score is based on neuromuscular and physical characteristics. Skin . Plantar creases. Lanugo. breasts. eyes and ears. development of genitalia..
Treatment and nursing care for celiac disease
No gluten including wheat, rye, barley and oats.
What interventions can be given for gas distention?
No ice, increase warm/hot fluids, increase walking, rocking chair, anti flatus drugs. Advance diet slowly.
What parent teaching is most important during post operative teaching for hirschprungs?
No rectal thermometers or enemas. Colostomy care
What teaching should accompany breastfeeding?
No soap on nipples, wash with water only. wear a supportive bra. The entire nipple and areola should be in the baby's mouth. Teach different positions. No timing. Relax to allow for let-down. Express colostrum from the nipples after feeding.
What is contraindicated postoperatively for cleft palate repair?
No straws, pacifiers, brushing teeth, or feeding orally.
closed head injury
Nonpenetrating injury
How do we know a child is doing well after esophageal atresia
Normal growth, normal stools
Biophysical profile
Not invasive. Ultrasound assessment of the baby done by a specialist to score the baby on elements of 1. fetal breathing movement, 2. fetal movement of body or limbs. 3. fetal tone with extension and flexion. 4. amniotic fluid volume. Might be combined with N S T.
What special care must be given with a 4th decree laceration of the perineum?
Nothing can go in the rectum including enema or suppository.
meningitis
inflammation of the meninges of the brain that results from pathogen entering the CNS
Focal seizures
Occur in one part of the brain and may or may not alter consciousness
Generalized seizure
Occur over the entire brain and do alter consciousness
Letting go
Occurs at about 2 weeks. grieves loss of infant as separate from body. Grieves loss of lifestyle. Loses fantasy baby and accepts real baby.
Taking hold
Occurs day 1. Time for teaching about the infant. Patient is ready to take on mothering responsibilities.
Postpartum blues
Occurs first few days after delivery. Mother may experience tearfulness, anorexia, difficulty sleeping. Lasts 10 - 14 days. It is considered normal.
Engrossment
Part of father-infant interaction. sense of absorption and preoccupation with the infant.
erythromycin ointment
Ophthalmic antibiotic. Prophylaxis against N Gonorrhoeae. It is required b law. A ribbon is applied to the lower conjunctival sac of each eye within 1 hour after birth. Hold tube horizontally to prevent injury. Wipe away excess ointment after 1 minute.
How is esophageal atresia diagnosed?
Orogastric placement, ultrasound, radiopaque catheter inserted in the esophagus to illuminate defect on x-ray
Mannitol
Osmotic diuretic. Hypertonic that causes a shift of fluid from extravascular into vascular where it can be eliminated by the kidney. Primary medication used for ICP in adults and pediatrics.
What pulses should be assessed in the neonate
PMI at the third to fourth intercostal space lateral to the midclavicular line. brachial, femoral, and pedal pulses.
What are associated risks for CP?
PReterm, birth asphyxia, low apgar, poor feeder, weak cry, abusive head trauma, intrauterine anoxia.
What are the signs and symptoms of bowel obstruction from volvulus
Pain Abdominal distention Tachycardia Bilious vomiting
What are signs and symptoms of bowel obstruction from Intussuception
Pain Vomiting Stools - resemble currant jelly, bloody mucus Sausage shape abdominal mass Dehydration Can lead to shock and sepsis
Signs and symptoms of intussusception?
Paroxysms o f pain occur and subside and then progress to more constant severe pain. vomit. currant jelly stool. sausage shaped abdominal mass.
What are the risks of abusive head trauma or closed head injury?
Partial or total blindness, hearing loss, seizures, developmental delays, impaired intellect, speech and learning difficulties, problems with memory and attention, cerebral palsy
Impalement injury
Penetrating injury caused by piercing of the scalp, skull, or brain by a sharp object
Open head injury
Penetrating injury in which there is a break in the integrity of the barrier between the outside environment and the intracranial cavity.
What is the relationship between the maternal history and the current problem that might clue the nurse into the fact that the infant may have esophageal atresia?
Polyhydramnios
What are the clinical manifestations of hyperglycemia
Polyuria, polydypsia, polyphagia. Fatigue - unexplained. Weight Loss (gradual, over several weeks). Blurred vision. Headache. Hunger. Kussmaul respirations. Coma.
What are the signs and symptoms of ICP in an infant?
Poor feeding or vomiting • Irritability or restlessness • Lethargy • Bulging fontanel • High-pitched cry • Increased head circumference • Separation of cranial sutures • Distended scalp veins • Eyes deviated downward ("setting-sun" sign) • Increased or decreased response to pain
Postinjury alteration in antidiuretic hormone
Possibly as a result of injury to the hypothalamus or posterior pituitary, the child can exhibit signs of excess ADH (syndrome of inappropriate antidiuretic hormone [SIADH]) or deficient ADH (diabetes insipidus) (see Chapter 51).
What is the etiology of spina bifida
Possibly genetic. May be linked to folic acid deficiency.
What aspects are assessed for the New Ballard Score?
Posture, square window, arm recoil, popliteal angle, scarf sign, heel to ear. The more flexible and relexive the muscles are, the younger the gestational age.
What can the parents of a patient who is about to have surgery for a cleft lip, do prior to surgery to prepare the infant?
Practice putting elbow restraints on the infant for 15 minutes 5 times a day, so that he is used to them.
How would herniation of the intestine be diagnosed?
Prenatal ultrasound and positive alpha-fetoprotein can lead to early diagnosis. Failure of descent during stage 2 of labor.
Increased intracranial pressure
Pressure that is sustained at 20 millimeters mercury or higher for 5 minutes or longer.
What nursing care should be provided with a child with CP?
Prevent injury and provide safety by padding things. Maintain mobility and prevent disuse through orthopedics. Relax muscles. Maintain nutrition. Maximize communication ability. Maintain growth and development.
What are the primary concerns when a neonate has a spina bifida cystica?
Prevention of rupture of the sack and infection.
What is the major sign of pyloric stenosis
Projectile vomiting due to reverse peristalsis of the stomach
Reglan
Prokinetic agent, give 30 minutes before meals and at bedtime. STrengthens lower esophageal sphincter and increases stomach emptying.
What does square window refer to?
Push the palm of the hand towards the forearm. The more the palm goes towards the forearm, the more developed the neonate is.
What should be done post surgical correction of pyloric stenosis?
Put head up and begin feeding with clear liquids. Give electrolyte solution at 4-6 hours with active bowel sound.
What should be done to protect the suture line postoperatively for cleft palate?
Put the patient in a No-No, elbow restraint. Logan bar
How is omphalocele a risk for respiration reduction in infants
Putting the bowel back in will reduce the room that the lungs and diaphragm have to expand, so they must adjust slowly
What nursing interventions can be performed for ICP?
Raise the head of the bed to 30 degrees and maintain normothermia, low semi fowlers. Glucose monitoring. Hypertonic IV solution for hypovolemia. Avoid patient coughing. When burping the baby, don't put pressure on the jugular. Monitor I and O. Decrease stimuli.
central neurogenic hyperventilation
Rapid rate despite notmal arterial blood gas values. Indicates midbrain or pontine involvement.
What are the results for an NST test
Reactive or nonreactive
The claiming process
Recognizing certain features and attribute them to other family members.
How to assess the perineum
Redness, edema or swelling, ecchymosis or bruising, drainage, approximated. R-E-E-D-A
What is the L/S ratio for
Show fetal lung development. Components of surfactant. Should be 2 to 1 at 35 weeks if lungs are mature.
What interventions can be performed during the seizure?
Remain calm, ease child to the ground, turn child to the side, clear the environment, do not attempt to restrain. Stay bedside and call out for a nurse. Document length of seizure.
What changes are expected in a postpartum cervix?
Remains soft and flabby. Appears bruised and may have lacerations. It will no longer be a perfect little hole.
How can the nurse help support the family with an infant with a cleft palate?
Remind the parents that its an operable defect. Show photographs of corrected clefts.
Chorionic Villi Sampling
Removal of small tissue specimen from the fetal portion of the placenta. It should be about 10 to 13 weeks gestation. Has led to more miscarriages and limb reductions.
What nursing interventions should be provided for gomco clamp?
Remove infant from restrain. squeeze petroleum jelly over the circumcision site to prevent the diaper from sticking. Place a small piece of gauze over the area. Assess for urination, bleeding, and infection. Assess for two hours
puerperal phases
Restorative phases that mother go throuhg to replenish the energy lost during labor and attain comfort in their new role. Includes taking-in, taking-hold, and letting-go.
Postpartum vaccine
Rhogam, Rubella, Pertussis
How is the infant identified?
Scan the band and the parents' bands, foot prints, hand prints, distinguishing marks.
What nursing technique must the nurse include when assessing the male neonate genitals and expected normal findings and variations?
Scrotum may be pendulous, dark and edematous. hydrocele may occur and resolve. Palpate for testes. Check for the meatus. Do not retract the foreskin.
What is the significance of the simian crease?
Seen with downs syndrome, but not diagnostic. Long crease that crosses entire hand.
What are the complications of PKU?
Seizure disorder. Untreatable intellectual impairment. Delayed development. Behavioral, emotional and social problems.
How is cleft lip and palate treated
Several surgeries
Twelve hours after birth, a mother lies in bed resting. Although she will be discharged in another 12 hours, she does not ask about her baby or provide any care. What is the probably reason for her behavior?
She is still in the taking-in phase of maternal adaption.
What are the steps to regeneration of the endometrium?
Shedding of decidua and exfoliation and healing of the placental site.
What should be taught about sleep?
Sleep when the baby sleeps
How should a toddler be fed after cleft palate repair?
Soft, bland baby food. Sit upright. Use a spoon.
What can cause increased intracranial pressure?
Space occupying lesions in the brain. Swelling from head trauma, infection, or hypoxic episode. Overproduction of fluid. Malabsorption of fluid. Communication problem within the system. Aneurysm within the brain and acute liver failure.
How should the fundus be assessed postpartum?
Support the lower portion with one hand and palpate the fundus with the other to prevent prolapse of the uterus. Prolapse is more of a concern after many births.
What are abnormal reflex findings in a neonate?
Stiffening of the body, pulling away from contact, arching back may all indicated CNS injury.
What causes bacterial meningitis?
Streptococcus, Neisseria meningitides, E coli
How is lactation stimulated?
Sucking infants transmits message to hypothalamus, which sends the message to anterior pituitary, which stimulates prolactin..... check the slide
How is nutrition maintained post cleft palate operation?
Syringe feeding with a tubes
How does the infant with omphalocele maintain nutrition?
TPN
What are the signs of respiratory distress in a neonate?
Tachypnea after the first hour. Nasal flaring. Grunting. Gasping. retractions. Central cyanosis. Period of apnea more than 20 seconds with change in heart rate or color. see-saw or paradoxical respirations. asymmetry.
How does the uterus placement and size change post partum?
The fundus is midline and at level of Umbilicus shortly after delivery. It decreases about 1 FB per day, U-1. It should not be palpable after 14 days.
Postpartum phases by Rubin
Taking in, taking - hold , letting go
How is bonding with parents promoted post esophageal atresia surgery?
Teach them how to provide care
What changes in temperature should be anticipated post partum?
Temperature might have a slight elevation of up to 100.4 because of dehydration and increase basal body metabolism. AFter 24 hours, the temperature should be norma.
lochia
The bleeding that happens after childbirth. The decidua sheds the top layer.
Phenylketonuria (PKU)
The body cannot breakdown phenylalanine found in proteins and artificial sweateners.
Involution
The process of things returning to their normal size during postpartum period
Why isn't there a scar where the placenta was?
The endometrium heals by exfoliation over 6 weeks.
Why is polyhydramnios a sign of esophageal atresia?
The fetus does not consume amniotic fluid
Signs and symptoms of celiac disease
The intestinal damage can cause: Diarrhea and vomiting. Steatorrhea. Abdominal distention. Failure to grow, wasting of extremities. The intestinal irritation can cause stomach pain, especially after eating. Anemia. Irritability .
What is tested in the posture for gestational age?
The more developed the infant, the more flexed the limbs should be.
Fetal kick counts
The mother should assess fetal movements called kick counts each day. Fetal movement is associated with the condition of the fetus.
What does arm recoil refer to?
The neonates arms are fully flexed at the elbow and then brought straight down to the side. The angle at which they return to flexion is measured. The more flexed, the greater the gestational age.
What should we assess about the nipple during breast feeding?
The nipple should not come out of the baby's mouth compressed.
What is recommended when performing an ultrasound?
The patient should have a full bladder during early ultrasound. Place the patient on the back with a towel roll under one hip to keep pressure off of the vena cava.
Why might a lumbar puncture be avoided to test the ICP?
The sudden decreased in CF could lead to herniation of the brain.
How does orogastric placement diagnose esophageal atresia?
The tube is measured mouth to ear to sternum, but the baby does not take much of the length.
What is important assessment data on a patient that has just had shunt?
The two biggies are ICP and infection.
Afterpains
There is pain of intermittent contractions for approximately 3 days. It will be increased for multipara, overdistended uterus, and breast feeding.
What is the difference between the lochia after a normal delivery and a c-section?
There should be more after a normal delivery.
What changes in RBC are expected postpartum?
There will be blood loss, but the hemoglobin and hematocrit should not reduce much, because of the reduction in plasma.
Why shouldn't newborns have complex carbohydrates?
They don't produce much amylase until they're about 4 months old.
cerebral perfusion pressure (CPP)
controls cerebral blood flow. The difference between the mean arterial blood pressure and the intracranial pressure.
How is esophageal atresia repaired?
Thoracotomy and anastomosis,
What special care should be given if someone is bottle feeding?
Tight bra, cold packs, and cabbage leaves.
What are treatments for ICP?
Treat underlying cause. Intraventricular catheter to drain CSF and administer medications. Osmotic diuretic, sedations and analgesia, anticonvulsant.
What does the amniocentesis test
Triple test is the AFP, hCG and unconjugated estrogen. Lecitihin/spingomyelin ratio.
chordocentesis
Umbilical chord sampling to aspirate a little fetal blood. Checks for RH disease.
What position should an infant with cleft palate be placed in after and during feeding?
Upright
What is brick dust?
Uric acid crystals in the diaper. Is normal.
What is the most common problem in the urinary system in postpartum
Urinary retention related to loss of elasticity and diminished bladder tone, loss of sensation from trauma, drugs, anesthesia, urethra edematous.
Diazepam, Valium and lorazepam, Ativan
Used for status epilepticus. Diazepam can be given directly into the vein, not through tubing, or as a rectal gel.
ventriculoatrial shunt
Used in older children. drains the fluid from ventricles to the right atrium of the heart.
Breck feeder
Used to feed postoperatively for cleft lip. Place in the side of the mouth to avoid infant sucking.
When is ovulation expected to return postpartum?
Usually after the first cycle. Ovulation can precede menstruation.
How is cleft lip and palate diagnosed?
Visual or a gloved finger in the mouth during newborn assessment
What are the clinical manifestations of spina bifida cystica?
Visualization of defect, motor sensory, reflex and sphincter abnormalities. Flaccid paralysis of legs. abnormalities of bowel and bladder.
What nursing assessments are important for DKA
Vital signs, leval of consciousness, hydration, hourly monitoring of blood sugar.
Aquamephyton
Vitamin K, fat soluble vitamin. Promotes clotting factors. PRevents hemorrhage. Photoreactive. Give IM in leg.
What are the clinical manifestattions of PKU
Vomiting. Musty or Mousey body and urine odor. Irritability, hyperactivity. Tremors, jerky movements of extremities. Eczema.
Why is pain medication administered postpartum
Want the patient very mobile and able to take care of the infant.
What teaching should accompany suppression of lactation?
Wear a tight-fitting bra or binder. Do not express milk from the breasts, take a shower with back to the warm... check slide
What are signs of dehydration in an infant?
Weight loss, depressed anterior fontanel, decreased blood pressure
What discharge teaching should be provided postpartum?
What vaccines are needed. Signs of postpartum complications. Infant care teaching.
PAlmar reflex
When infant's hand is touched at the base of the fingers, it will close into a tight fist.
Moro reflex
When infant's head and trunk are lowered, the arms and legs extend and abduct.
sucking reflex
When mouth or palate is touched by the finger, the infant begins to suck.
When is the oxytocin challenge test performed?
When the NST findings are nonreactive
When does discharge teaching begin?
When the patient enters labor and delivery
When is the child usually diagnosed?
When they are in diabetic ketoacidosis
Subinvolution
When things do not go back to their normal size during the postpartum period
When is shunt failure most likely?
Within 2 months of placement.
When should the newborn have audible bowel sounds?
Within the first hour as air enters the digestive tract.
How are carbohydrates counted for type 1 diabetes?
\
opisthotonic position
a rigid c shape to the body.
What number of veins should the umbilical stump have?
a single large vein
What are the clinical manifestation for appendicitis?
abdominal cramps and generalized pain, fever, and nausea progresses to abdominal pain, vomiting, acute pain on lower right of abdomen.
What other intervention must be given with amniocentesis?
abdominal ultrasound
Tay-Sach disease
abnormal build-up of ganglosides (fatty subtances) in brain. Occurs more in Jewish population
How do you know when pyloric stenosis has improved
absence of visible gastric peristaltic waves and projectile vomiting
What is the small intestine used for?
absorption of nutrients
What maternal postpartum adaptations must occur?
accepting the new normal. Must appreciate the new body, and the new family. Redefining roles. Role conflict.
Do you have acidosis or alkalosis with diarrhea?
acidosis
Do you have acidosis or alkalosis with vomiting?
alkalosis
How is spina bifida cystica detected prenatally?
alpha fetoprotein elevation. Ultrasound.
Ultrasounds
an instrument which uses reflective sound waves as they travel in tissue to visualize structures in the body. Noninvasive and painless. May take 20 to 30 minutes.
What are the normal vital signs of the neonate?
axillary temperature of 97.7 to 99.6. Pulse of 120 to 160 or 180 if crying. Respirations of 30 to 60 and symmetrical. Blood pressure of 65 to 95 over 30 to 60.
how is intussusception diagnosed?
barium enema or air enema. may also treat the problem.
What treatment is given for children with type 1 diabets?
basal insulin adminstered once a day at bedtime or twice a day. Bolus given through out the day based on diet and blood glucose levels..
antepartum
before birth
widened pulse pressure
bigger difference between systolic and diastolic. Late sign of neurodefecit.
mongolian
birthmark that is bluish gray and resembles a bruise. usually disappear in the first few years of life.
How is choanal atresia assessed?
block one nostril at a time and auscultate. Put catheter through each nostril.
choanal atresia
blockage or narrowing on or both nasal passages by none or tissue.
Epidural hemorrhage
blood accumulates between the dura and skull. Arterial damage is the usual type of injury so it develops rapidly.
Subdural hemorrhage
blood accumulates between the dura and the cerebrum. A subdural hemorrhage is usually caused by an injury to a vein and can be acute or chronic.
hemotympanum
blood behind the eardrum
Myoclonic seizure
brief, random contractions of muscle group, followed by loss of muscle tone and forward falling.
Galactosemia
carbohydrate metabolic dysfunction related to the liver enzyme (GALT) deficiency
What needs to be monitored in an infant with GERD?
cardiac for risk of bradycardia, and apnea
What cardiovascular changes occur postpartum?
cardiac output is increased due to the return to central circulation of the uteroplacental blood flow.
tonic-clonic seizures
cause abrupt arrest of activity and impairment of consciousness. tonic phase has sustained, generalized stiffening of muscles for 10-20 seconds. The clonic phase is symmetrical and rhythmic, consisting of alternating contraction and relaxation of major muscle groups.
Atonic seizure
cause an abrupt loss of postural tone, impairment of consciousness, confusion, lethargy, and sleep.
Cerebral palsy
chronic, nonprogressive disorder of posture and movement. Abnormality in the extrapyramidal or pyramidal motor system. makes it difficult to control muscles.
cerebrospinal fluid
clear liquid produced in the choroid plexus of the ventricles at approximately 0.3 to 0.4 milliliters per minute.
Spina Bifida
congenital neural tube defect characterized by incomplete closure of the vertebrae and neural tube during fetal developments.
strabismus
cross eyes, common in newborns. Should not last beyond 3 or 4 months.
What interventions should be taught for diastasis recti abdominis?
exercises will help to improve abdominal muscle tone.
melasma
dark face
linea nigra
dark line on the belly, will fade
lochia rubra
day 1 to 3. blood with small pieces of decidua and mucus.
lochia serosa
day 4 to 10. pink or pinkish brown serous exudate with cervical mucus.
Signs and symptoms of moderate to severe head injury
decreased LOC, vital signs changes, signs of increased ICP, retinal hemorrhage, hemiparesis, and papilledema
oligohydramnios
decreased amniotic fluid. Indicates hypoxemia or other fetal compromise. fetal kidneys and lungs produce most amniotic fluid.
Why would the cardiac functions need to be monitored with DKA?
decreased potassium can lead to arrhythmias due to electrolyte imbalance
constipation
delay or difficulty in defecation that has been present for 2 or more weeks.
harlequin color change
distinct color division with one side of the body deep pink or red and the other half pale. benign. Usually found in low birth weight neonates
To help the postpartum woman avoid constipation, the nurse should teach her to?
drink at least 2500 mL of noncaffeinated fluids daily
intrapartum
during birth
What other complications can occur with cleft lip and palate?
ear problems, speech impediment, teeth, bone structure of the face
What changes might be seen in the vagina postpartum?
edema, bruising, vaginal lacerations. Rugae is gone.
What type of isolation will the patient with diarrhea be on?
enteric
How frequently should the postpartum patient void?
every 3-4 hours.
What is the risk of treating GERD with antacids?
excessive antacids can lead to toxicity
What are concerning assessments of lochia?
excessive, offensive odor, large pieces of tissue, lack of lochia, lack of color change.
How does the cardiac output return to normal postpartum?
excretion of excess extracellular fluid through diuresis and diaphoresis.
spina bifida cystica
extensive defect with a range of sensory and motor impairments
What diet should be taught to patients postpartum?
extra 700 calories if lactating. Diet should be high in protein, vitamin C, and fiber. Increase fluids.
What are the 3 main part of the glascow coma scale?
eye opening, verbal response, motor response. Maximum points are 15, and minimum is 3.
What organ besides the brain might show hemorrhage in a child with abusive head trauma?
eyes
What are the cardinal signs of hirschprungs?
failure to pass meconium, constipation
What are the leading causes of TBI amongst children?
falls and motor vehicle crash
Celiac disease
immune reaction to gluten. Over time, the inflammation damages the intestine 's lining and causes malnutrition
encopresis
fecal incontinence, can be associated with chronic constipation
signs and symptoms of meningitis in infant and preschool-age child
fever, poor feeding, vomiting, irritability, seizures, a highpitched cry, a bulging anterior fontanel, and lethargy. Nuchal rigidity is a late sign.
lanugo
fine soft hair that covers the fetus during intrauterine life.
What should a fontanel feel like
flat, soft, and firm
decorticate posturing
flexion of the upper extremities and extension of lower extremities. Indicates injury to cerebral hemispheres.
What intervention must the nurse perform if the patient has excess ADH?
fluid restriction
Basilar
fracture of the base of the skull
comminuted
fragmentation of the bone into many pieces or a multiple fracture line.
Wharton's jelly
gelatinous substance within the umbilical cord also present in vitreous humor of the eyeball, largely made up of mucopolysaccharides.
What information is placed on the infant ID band?
gender, date and time of birth, delivering physician, mother's name and hospital number, number imprinted on the plastic band.
What is enteric isolation?
gloves and gown. Wash hands with soap.
What does peeling and cracking skin indicate in a neonate?
greater gestational age
What serum glucose indicates DKA?
greater than 250
At what point is a patient considered to have hemorrhage?
greater than 500 mL for vaginal delivery. Greater than 1000 mL for a c-section.
What are normal blood gas levels for PaO2?
greater than 80
What is the concern if BP falls postpartum?
hemorrhage
What does a fixed, dilated pupil indicate in the unconscious child?
herniation of the center section of the brain or transtentorial herniation
What interventions should be done to decrease risk of thrombus in postpartum women?
homan's sign, early ambulation, SCD
Oxytocin
hormone released during breastfeeding and uterine contraction. Given to patients after delivery to help contract the uterus.
What are the treatments for intussuception?
hydorstatic reduction or surgery
What are the complications of meningitis?
hydrocephalus, vision and hearing loss, delayed growth and development, seizures, subdural effusions, and cranial nerve palsy.
How do you know when the appendix has ruptured?
immediate relief of pain
What are the signs and symptoms of hirschprungs?
impaction, ribbon like stools, vomiting, reluctance to breath, abdominal distention, foul odor of breath
celiac disease
inability to digest gliadin. Glutamine accumulates in the intestines and has a toxic effect on the mucosal cells. Leads to atrophy of villi and decrease in absorptive surface.
What potential complications occur after esophageal atresia?
infection, scarring, malnutrition
What are the signs of symptoms of bowel obstruction
increased abdominal girth, rigidity, pain, feces in emesis, absence of bowel sounds.
What is the primary symptom of pediatric metabolic acidosis?
increased respiratory rate and effort.
Cushing's response
increased systolic blood pressure with widening pulse pressure, bradycardia, and a change in respiratory rate and patter. Apparent just before or at the time of brainstem herniation. Late signs of incrased ICP.
What does it mean to bubble frequently?
infants with cleft palate should be burped frequently
intussusception
invagination of a section of the intestine into the distal bowel that causes bowel obstruction. Most common cause of intestinal obstruction in children ages 3 months to 6 years. Emergency.
plasma fibrinogen
is a glycoprotein in vertebrates that helps in the formation of blood clots. It rises from 200 - 400 in nulliparous women to 300 to 600 in parous women
How does sedation help with ICP
it decreases metabolism in the brain which decreases the amount of blood in the brain.
What do malformation or low-set ears indicate?
it may indicate chromosomal abnormalities.
why do rectal biopsy for diagnosis of hirschprungs?
lack of ganglionic cells in mucosa
Type I diabetes
lack of insulin
mottling
lacy, red or blue marbling of the skin of neonate
What level of glucose is considered low for a newborn?
less than 40
What are normal blood gas levels for PaCO2?
less than 45
What foods should be avoided in PKU?
meats, fish, eggs, cheese, milk, legumes and aspartame.
What integumentary problems can occur postpartum?
melasma, linea nigra, striae gravidarum, and hair loss
What is the primary concern with pediatric diarrhea?
metabolic acidosis due to loss of bicarbonate
What electrolyte imbalance may occur with vomiting?
metabolic alkalosis
What condition can pyloric stenosis lead to?
metabolic alkalosis and failure to thrive
Pyramidal motor system
motor cortex, basal ganglia, cerbellum
meningocele
neural tube defect has outpouching with meninges in it.
myelomeningocele
neural tube defect has outpouching with part of the spinal cord in it. May cause paralysis and incontinence.
Non-stress test
observation of fetal heart rate associated with fetal movement. It should increase with movement. The test is based on the knowledge that when the fetus has adequate oxygenation and an intact CNS, there are acceleration of the Fetal Heart Rate with movement.
glargine, lantus
once a day basal insulin
OCT
oxytocin challenge test. Contraction stress test. Assess placental insufficiencies. Electronic fetal monitor is attached.
What interventions should be provided for a patient with seizure disorder in the hospital?
padded rails, bed in the lowest position, suction and airway at bedside, possible helmet. Do not take oral temperature.
What are the interventions for uncomplicated appendicitis?
pain medication, position for comfort, Start NPO and prepare for surgery
Dyspareunia
painful sex
Cheyne-stokes respiration
pattern of increaseing rate and depth and then decreasing rate and depth with a pause of variable length.
Missile injury
penetrating injury of the skull or brain, most often caused by a bullet
What is the major complication to anticipate with appendicitis?
peritonitis
Cafe au lait spots
permanent light brown birthmarks. six or more spots larger than 0.5 cm are associated with neurofibromatosis.
Contusions
petechial hemorrhages along the superficial aspects of the brain. may occur at the site of impact or remote from the direct impact.
A newborn is rooming in with his teenage mother, who is watching TV. The nurse notes that the baby is awake and quiet. The best nursing action is to?
pick the baby up and point out his alert behaviors to the mother.
signs and symptoms of meningitis in neonate
poor feeding; poor sucking; vomiting; diarrhea; poor muscle tone; weak cry; hypothermia or hyperthermia; apnea; seizures; sepsis; disseminated intravascular coagulation (DIC); a full, tense, and bulging fontanel; and lethargy.
What interventions should be given for postpartum pain?
position in the prone position. Analgesia administered an hour before breastfeeding. Encourage early ambulation.
What is the concern if BP increases postpartum?
preeclampsia, will also effect deep tendon reflexes.
What should the nurse include when assessing the infant's mouth?
presence of teeth, epstein pearls, tongue size and movement, thrush, cleft lip or palate.
What do fused eyelids indicate?
preterm neonate less than 26 to 28 weeks.
Why must peaks and troughs be monitored when treating for meningitis?
prevent ototoxicity and nephrotoxicity from aminoglycosides
Maternal role attainment
primary concept of this theory is the developmental and interactional process, which occurs over a period of time. In the process, the mother bonds with the infant, acquires competence in general caretaking tasks, and then comes to express joy and pleasure in her role as a mother.
apneustic breathing
prolonged inspiration and expiration.
status epilepticus
prolonged seizure activity lasting 30 minutes or more. a medical emergency
What eye dysfunctions are associated with increased ICP?
ptosis, ovoid pupil, blurry vision, diplopia, decreased visual acuity, fixed or sluggish pupil dilation. Deviated eyes.
Lispro, aspart
rapid acting insulin
What diagnostic test would be done for hirschprungs?
rectal exam, barium enema, rectal biopsy, anal rectal pressure monitor
What are the skin assessments that indicate a preterm infant?
red, sticky, fragile, with little subcutaneous fat and visible veins. More lanugo at 32 to 36 weeks.
What are the goals of treatment for ICP?
reduce the volume of CSF, preserve cerebral metabolic function, avoid increase in ICP.
How is GERD assessed in an infant?
regurgitation almost immediately after each feeding, hiccoughing, recurrent otitis media, excessive crying and irritability, weight loss, failure to thrive
What nursing interventions should follow a seizure
reorient. Provide place to rest. Document. Notify HCP.
Positive O.C.T.
repetitive persistent late decelerations occurring with more than half the contractions
endoscopic third ventriculostomy
rerouting of CSF around obstructed ventricular by creating a small opening inthe floor of the third ventricle.
What are surgical interventions for hirschprungs?
resection of bowel, colostomy, botox injection, rectal irrigations
What is compartment syndrome?
results from bleeding or swelling after an injury. The dangerously high pressure in compartment syndrome impedes the flow of blood to and from the affected tissues. It can be an emergency, requiring surgery to prevent permanent injury.
What is given prophylactically to people who were in close contact with patient with H. influenzae or N. meningitidis?
rifampin
nervus simplex
salmon patch or stork bite. flat, pink discoloration from dilated capillaries. disappear by age 2, but may persist at nape of the neck.
What may be the presenting signs in an infant with head injury?
scalp hematoma or seizure
aura
sensation that precedes seizure
How is celiac disease diagnosed?
serology antibody screening, intestinal biopsy
Early signs of meningitis in child and adolescent
severe headache, photophobia, nuchal rigidity, fever, altered level of consciousness (lethargy, irritability), decreased appetite, vomiting, diarrhea, agitation, and drowsiness. Muscle or joint pain and purpura may be noted.
Vagus nerve stimulation
significantly reduce the number and intensity of seizures in many children. A generator is implanted in the chest wall, and a wire is clipped to the vagus nerve to deliver electrical impulses to the brain.
What interventions can be given for perineum, vagina, and rectum postpartum?
sitz bath, analgesia, ice, witch hazel. Do not give ice for too long.
Intrathecal baclofen
skeletal muscle relaxant. May be administered via infusion pump to treat severe spasticity in children with CP.
fetal tone
small or fine body movements such as limb or hand extension
epstein pearls
small, white, hard cysts are a form of milia and disappear without treatment within a few weeks.
Linear
straight-line fracture, dura not involved
nevus vasculosus
strawberry hemangioma. consist of enlarged capillaries in the outer layers of the skin. Usually located on the head. May grow larger for 5 to 6 months and then regres over several years.
Stria gravidarum
stretch marks, will fade but not completely
babinski reflex
stroking the lateral sole of the infant's foot from heel forward and across the ball of the foot. Causes toes to flare outward.
What emergency equipment should we have when a child has ICP?
suction tray, intubation tray, oxygen
What position gives relief to a spinal headache?
supine position.
The best position for the post operative infant after cleft palate repair?
supine to protect the site
How is imperforate anus treated?
surgery
What is done to treat spina bifida cystica?
surgery
What are the treatments for volvulus?
surgery, probably need to resect the portions of bowel on.
How does status epilepticus cause neuronal injury?
the metabolic rate of the CNS increases which depeletes glucose stores and increase oxygen consumption. It can cause lactic acidosis, altered blood-brain barrier, and increased ICP/
Why are generalized tonic clonic seizures rare in neonates?
they lack myelinization
postpartum
time after you give birth for 6 weeks
Concussion
transient and reversible neuronal dysfunction with instantaneous loss of awareness and responsiveness
ketogenic diet
treatment option for children with epilepsy. The diet is essentially carbohydrate-free, composed mostly of fat, and produces a state of ketosis that is thought to control seizures. This diet is very strict and considered mainly for children with epilepsy that is refractory to conventional treatment. Side effects include constipation, dehydration, vitamin deficiency, and kidney or gall stones
ventriculoperitoneal shunt
tube leading from the ventricles out of the skill and passing under the skin to the peritoneal cavity
humulin, ultralente
twice daily basal insulin
What number of arteries should the umbilical stump have?
two arteries.
Boggy uterus
uterus is not contracting down and can cause postpartum hemorrhage.
Rhogam
vaccine for RH negative mother with RH positive baby before and after birth.
What are the uses of the fetal ultrasound?
validates the pregnancy. Determines how advanced the pregnancy is. Detects congenital anomalies and problems. can locate the placenta. Assess fetal viability through heartbeat and breathing movements. Diagnoses cardiac problems. Detects fetal presentation and number of fetuses.
What independent nursing action can be done to aid episiotomy healing in the woman who is 24 hours postpartum?
warm sitz baths taken four times per day
What should be assessed first with pyloric stenosis?
weight
What is the average weight, length and head circumference of a newborn?
weight of 2500 to 4000 grams. length of 48 to 53 cm. Head circumference of 30 to 36 centimeters.
What foods need to be avoided for celiac disease?
wheat, barley, rye
kernig sign
when the thigh is flexed toward the abdomen, pain prevents complete extension of the leg. Sign of meningitis.
milia
white cysts about 1 millimeter in size caused by sebaceous gland secretions.
erythema toxicum
white or yellow papules or vesicles with a red base. rash appears during first 24-48 hours after birth and up to 3 months of age.
What are the signs and symptoms of ICP in the child?
• Headache • Diplopia • Mood swings • Slurred speech • Papilledema (after 48 hr) • Altered level of consciousness • Nausea and vomiting, especially in the morning
