CH 25: Acquired Conditions & Congenital Abnormalities in the Newborn

Bronchopulmonary Dysplasia

Neonatal chronic lung disease

pathological jaundice

occurs before 24 hours and may indicate early hemolysis

bilirubin-induced neurologic dysfunction (BIND)

occurs when serum bilirubin crosses the blood-brain barrier and binds to brain tissue, causing symptoms

Kernicterus

permanent, irreversible effects of BIND

Severe hyperbilirubinemia is classified as a serum bilirubin level above _______mg/dL?

25

The parents of a newborn are upset that their newborn needs treatment for ophthalmia neonatorum. The nurse should explain this is related to which maternal infection? Select all that apply. A) Chlamydia B) Gonorrhea C) Trichomonas D) Syphilis E) Candidiasis

A) Chlamydia B) Gonorrhea

A nurse identifies the urethral opening of a male newborn to be on the dorsum of the shaft of the penis. The nurse documents this finding as which of the following? A) Hypospadias B) Talipes equinovarus C) Hydrocephalus D) Omphalocele

A) Hypospadias The newborn has hypospadias. Hypospadias is a congenital anomaly in which the urethral opening is malpositioned. In hypospadias, the urethral opening is either placed dorsally on the top of the shaft of the penis or malpositioned ventrally. Talipes equinovarus is a congenital skeletal deformity with the foot in a downward and inward flexed position. Hydrocephalus is an anomaly with infants having an abnormally large head. Omphalocele is a congenital anomaly of the abdominal wall, in which the abdominal contents contained within the peritoneal sac protrude through the external abdominal surface at the base of the umbilical cord.

The nurse is assessing a newborn diagnosed with meconium aspiration. Which of the following would the nurse expect to assess? Select all that apply. A) Intercostal and substernal retractions B) Increased anteroposterior chest diameter C) Pink skin D) Respirations of 45 E) Tachycardia

A) Intercostal and substernal retractions B) Increased anteroposterior chest diameter

What would the nurse suspect in a premature newborn who has difficulty feeding and maintaining a stable temperature and is vomiting bile? A) Necrotizing enterocolitis B) Meconium aspiration syndrome C) Intraventricular hemorrhage D) Respiratory distress syndrome

A) Necrotizing enterocolitis Necrotizing enterocolitis is a disease that is characterized by inflammation in the bowels. It is generally idiopathic and results in difficulty feeding and maintaining thermoregulation, as well as vomiting of bile.

The nurse is conducting a class for pregnant women on problems associated with infections seen in women during gestation. One mother tells the nurse that she has never had chickenpox (varicella) and is worried she will contract it before she delivers. What would the nurse explain to this mother to ease her anxiety? A) She can receive her varicella vaccine immediately after delivery, followed by a second dose at her 6-week postpartum visit. B) The likelihood of her catching varicella is very slim, so tell her not to worry. C) She needs to let her physician know that she has not had varicella so she can get immunized at her next visit. D) Even if she does get varicella, her baby will be fine since varicella is not passed on to the fetus.

A) She can receive her varicella vaccine immediately after delivery, followed by a second dose at her 6-week postpartum visit. Varicella zoster is spread by respiratory droplets and is easily contracted if the mother is exposed. If the mother does contract varicella, especially from weeks 12 to 20 of gestation, it can be devastating to the fetus. Birth defects, central nervous system damage, low birth weight, cognitive delays and deafness can all occur. However, a mother cannot receive a varicella immunization during pregnancy since the immunization can cross the placenta and act like the actual disease, causing the same effects. The mother is immunized prior to discharge after delivery and at her 6-week postpartum visit.

A 36-week neonate born weighing 1,800 g has microcephaly and microophthalmia. Based on these findings, which risk factor might be expected in the maternal history? A) Use of alcohol B) Use of marijuana C) Gestational diabetes D) Positive group B streptococci

A) Use of alcohol The most common sign of the effects of alcohol on fetal development is retarded growth in weight, length, and head circumference. Intrauterine growth retardation isn't characteristic of marijuana use. Gestational diabetes usually produces large-for-gestational-age neonates. Positive group B streptococci isn't a relevant risk factor.

A neonatal intensive care nurse is caring for a preterm newborn diagnosed with transient tachypnea who is NPO and receiving intravenous fluid therapy. When would the nurse expect the newborn to begin oral feedings? A) When the respiratory rate is 44 BPM. B) When the oxygen saturation level is at 92%. C) When serum glucose is 30 mg/dl (1.7 mmol). D) When intake and output correlate.

A) When the respiratory rate is 44 BPM. Nursing management of transient tachypnea of the newborn (TTN) is supportive with the administration of intravenous (IV) fluids and/or gavage feedings until the respiratory rate decreases enough to allow safe oral feeding. RR of 44 bpm is normal. The O2 sat level is too low to start oral feedings. The glucose levels indicates hypoglycemia. Intake and output measurements do not indicate the newborn will manage oral feedings.

The newborn nursery nurse suspects a newborn of having neonatal abstinence syndrome. What assessment findings would most correlate with the diagnosis? A) frequent yawning and sneezing B) vigorous rooting and feeding C) positive Babinski and Moro refelxes D) cyanotic discoloration of the hands and feet

A) frequent yawning and sneezing Manifestations of neonatal abstinence syndrome include: CNS dysfunction such as hyperactive reflexes resulting in exaggerated Babinski and Moro reflexes; hypertonic muscle tone and constant movement; metabolic, vasomotor, and respiratory disturbances with frequent yawning and sneezing; gastrointestinal dysfunction, including poor feeding; and frantic sucking or rooting. Acrocyanosis is a normal newborn finding which is cyanotic discoloration of the extrem

Cytomegalovirus infection can result in different congenital anomalies. It can also be transmitted via different routes. When discussing this infection with a pregnant woman, the nurse integrates understanding that permanent fetal disability can occur with which type of transmission of CMV? A) in utero transmission B) during birth transmission C) after birth transmission D) with any transmission

A) in utero transmission There are three time periods during which mother-to-child transmission can occur; however, permanent disability occurs only in association with in utero infection. Such disability can result from maternal infection during any point in the pregnancy, but more severe disabilities are usually associated with maternal infection during the first trimester.

A nurse is caring for a newborn with fetal alcohol spectrum disorder. What characteristic of the fetal alcohol spectrum disorder should the nurse assess for in the newborn? A) small head circumference B) decreased blood glucose level C) poor breathing pattern D) wide eyes

A) small head circumference The nurse should assess for small head circumference in a newborn being assessed for fetal alcohol spectrum disorder. Fetal alcohol spectrum disorder does not cause decreased blood glucose level, a poor breathing pattern, or wide eyes.

A neonate undergoing phototherapy treatment must be monitored for which adverse effect? A) Hyperglycemia B) Increased insensible water loss C) Severe decrease in platelet count D) Increased GI transit time

B) Increased insensible water loss Increased insensible water loss is due to absorbed photon energy from the lights. Hyperglycemia isn't a characteristic effect of phototherapy treatment. Phototherapy may cause a mild decrease in platelet count. GI transit time may decrease with use of phototherapy.

A newborn boy is diagnosed with esophageal atresia and tracheoesophageal fistula. After the nurse provides preoperative teaching, which statement indicates that the parents need additional teaching? A) "He'll need antibiotics for a bit after the surgery to prevent infection." B) "We can probably start feeding him with the bottle about a day after the surgery." C) "The head of his bed will be elevated to prevent him from aspirating." D) "We can give him a pacifier to help satisfy his need to suck."

B) "We can probably start feeding him with the bottle about a day after the surgery." Preoperatively, the newborn is at risk for pneumonitis due to aspiration of food and secretions. Antibiotics are typically given until the anastomosis is proven intact and patent. Oral feedings are usually started within a week after surgery once the esophageal anastomosis is proven to be intact and patent. Proper position with elevation of the head is important for the newborn with esophageal atresia and tracheoesophageal fistula because he is at risk for aspiration of food and secretions. Using a pacifier to provide nonnutritive sucking helps to meet the newborn's need to suck.

A nurse is assigned to care for a newborn with hyperbilirubinemia. The newborn is relatively large in size and shows signs of listlessness. What most likely occurred? A) The infant's mother must have had a long labor. B) The infant's mother probably had diabetes. C) The infant may have experienced birth trauma. D) The infant may have been exposed to alcohol during pregnancy.

B) The infant's mother probably had diabetes. The nurse should know that the infant's mother more than likely had/has diabetes. The large size of the infant born to a mother with diabetes is secondary to exposure to high levels of maternal glucose crossing the placenta into the fetal circulation. Common problems among infants of mothers with diabetes include macrosomia, respiratory distress syndrome, birth trauma, hypoglycemia, hypocalcemia and hypomagnesemia, polycythemia, hyperbilirubinemia, and congenital anomalies. Listlessness is also a common symptom noted in these infants. Infants born to clients who use alcohol during pregnancy, infants who have experienced birth traumas, or infants whose mothers have had long labors are not known to exhibit these particular characteristics, although these conditions do not produce very positive pregnancy outcomes. Infants with fetal alcohol syndrome or alcohol exposure during pregnancy do not usually have hypoglycemia problems.

A nurse in the newborn nursery has noticed that an infant is frothing and appears to have excessive drooling. Further assessment reveals that the baby has episodes of respiratory distress with choking and cyanosis. What disorder should the nurse suspect based on these findings? A) cleft palate B) esophageal atresia C) cleft lip D) coarctation of the aorta

B) esophageal atresia Any swallowed mucus or fluid enters the blind pouch of the esophagus when a newborn suffers from esophageal atresia. The newborn with this disorder will have frothing, excessive drooling, and periods of respiratory distress with choking and cyanosis. If this happens no feedings should be given until the newborn has been examined.

A nurse is conducting an in-service presentation to a group of perinatal nurses about sexually transmitted infections and their effect on pregnancy. The nurse determines that the teaching was successful when the group identifies which infection as being responsible for ophthalmia neonatorum? A) syphilis B) gonorrhea C) chlamydia D) HPV

B) gonorrhea Infection with gonorrhea during pregnancy can cause ophthalmia neonatorum in the newborn from birth through an infected birth canal. Infection with syphilis can cause congenital syphilis in the neonate. Infection with chlamydia can lead to conjunctivitis or pneumonia in the newborn. Exposure to HPV during birth is associated with laryngeal papillomas.

A nurse is presenting a review class for a group of neonatal nurses on the different types of congenital heart disease in infants. The group demonstrates a need for additional teaching when they identify which condition as an example of increased pulmonary blood flow (left-to-right shunting)? A) atrial septal defect B) tetralogy of Fallot C) ventricular septal defect D) patent ductus arteriosus

B) tetralogy of Fallot Tetralogy of Fallot is a congenital heart condition that results from decreased, not increased, pulmonary blood flow. Atrial septal defect, ventricular septal defect, and patent ductus arteriosus are heart conditions that involve increased blood flow from higher pressure (left side of heart) to lower pressure (right side of heart), resulting in left-to-right shunting.

The parents of an 8-month-old tell the nurse that they have a fear that the infant will develop sudden infant death syndrome (SIDS). What is the best response by the nurse? A) "There is no need to worry about it, because it is unexpected and cannot be prevented." B) "I don't blame you. I worried about it when I had my children." C) "Infants who die from SIDS are usually 2 to 4 months old, but I understand your concern." D) "Be sure you place the infant on the abdomen while sleeping."

C) "Infants who die from SIDS are usually 2 to 4 months old, but I understand your concern." Infants who die from SIDS are usually 2 to 4 months old, although some deaths have occurred during the first and second week of life. Few infants older than 6 months die from SIDS.

The nurse teaches the parents of a newborn with hyperbilirubinemia about home phototherapy using bilirubin lights. Which statement indicates that the teaching was successful? A) "We'll place the lights so that they are about 5 inches above our baby at all times." B) "We will turn him every ½ hour to make sure that his whole body is exposed." C) "We'll take off the patches on his eyes when we're feeding him so he can look at us." D) "We should see reddened areas on his skin, which means the treatment is working."

C) "We'll take off the patches on his eyes when we're feeding him so he can look at us." The lights are to be positioned about 12 to 30 inches above the newborn. The newborn is turned every 2 hours while under the bilirubin lights. Eye patches are removed during feedings so that the newborn can interact with the caregiver. Evidence of effectiveness is indicated by loose, green stools indicating that the bilirubin is being broken down.

By preventing fetal distress during the intrapartum period, which condition is less likely? A) Hemolytic disease of the newborn B) Transient tachypnea of the newborn C) Meconium aspiration syndrome D) Neonatal abstinence syndrome

C) Meconium aspiration syndrome A primary cause of meconium aspiration syndrome is fetal distress. Meconium is the thick, pasty, greenish black substance that is present in the fetal bowel. When the fetus releases the meconium in utero, the fetus can inhale the meconium into the lungs causing respiratory distress. Hemolytic disease of the newborn is caused by blood incompatibility. Transient tachypnea of the newborn is from fluid in the fetal lungs. Neonatal abstinence syndrome is caused by maternal use of drugs or alcohol.

A newborn is discharged from a healthcare center following treatment for bronchopulmonary dysplasia. Which of the following interventions would be most important for the home care nurse to do when caring for this newborn? A) Administering surfactant on a weekly basis B) Monitoring the arterial blood gas level C) Monitoring oxygen saturation levels weekly D) Administering intravenous antibiotics

C) Monitoring oxygen saturation levels weekly Newborns treated and discharged for bronchopulmonary dysplasia require home healthcare. The nurses providing home healthcare must monitor the oxygen saturation level weekly in infants, which should be in the range of 94-95 %. Surfactant therapy is given to preterm infants with respiratory distress syndrome to reduce the lung surface tension. Monitoring of arterial blood gas levels and administering intravenous antibiotics may be necessary but only if additional complications arise.

The nurse is performing a cardiac assessment on a newborn and hears a loud, harsh murmur associated with a systolic thrill. What congenital heart defect does the nurse suspect? A) Atrial septal defect B) Patent ductus arteriosus C) Ventricular septal defect D) Coarctation of the aorta

C) Ventricular septal defect Small, isolated defects are usually asymptomatic and often are discovered during a routine physical examination. A characteristic loud, harsh murmur associated with a systolic thrill occasionally is heard on examination.

The nurse is performing a cardiac assessment on a newborn and hears a loud, harsh murmur associated with a systolic thrill. What congenital heart defect does the nurse suspect? A) septal defect B) Patent ductus arteriosus C) Ventricular septal defect D) Coarctation of the aorta

C) Ventricular septal defect Small, isolated defects are usually asymptomatic and often are discovered during a routine physical examination. A characteristic loud, harsh murmur associated with a systolic thrill occasionally is heard on examination.

The community health nurse is teaching sexually transmitted infections to a high school health class. The nurse determines that the teaching was successful when the group identifies what potential cause for intellectual disability in the newborn? A) trichomoniasis B) chlamydia C) herpes type II (genital herpes) D) human papillomavirus

C) herpes type II (genital herpes) Herpes type II (genital herpes) contamination at birth may cause intellectual disability, premature birth, low birth weight, blindness, or death. Human papillomavirus or venereal warts may result in the development of warts in the throat (laryngeal papillomatosis) of the newborn; these are uncommon but life-threatening. Chlamydia can cause eye infections (neonatal conjunctivitis), pneumonia, low birth weight, increased risk of premature rupture of the membranes (PROM), preterm birth, and stillbirth. Trichomoniasis causes low birth-weight, increased risk of PROM, and preterm birth.

A nurse is caring for a newborn whose chest X-ray reveals marked hyperaeration mixed with areas of atelectasis. The infant's arterial blood gas analysis indicates metabolic acidosis. For which dangerous condition should the nurse prepare when providing care to this newborn? A) choanal atresia B) diaphragmatic hernia C) meconium aspiration syndrome D) pneumonia

C) meconium aspiration syndrome The nurse should assess for meconium aspiration syndrome in the newborn. Meconium aspiration involves patchy, fluffy infiltrates unevenly distributed throughout the lungs and marked hyperaeration mixed with areas of atelectasis that can be seen through chest X-rays. Direct visualization of the vocal cords for meconium staining using a laryngoscope can confirm aspiration. Lung auscultation typically reveals coarse crackles and rhonchi. Arterial blood gas analysis will indicate metabolic acidosis with a low blood pH, decreased PaO2, and increased PaCO2. Newborns with choanal atresia, diaphragmatic hernia, and pneumonia do not exhibit to exhibit these manifestations.

A nurse is performing a newborn assessment and notices a small dimple on the sacral area. The infant has a normal neurological assessment and moves all extremities well. What does the nurse suspect that the dimple indicates? A) a normal spinal closure B) spina bifida with menigocele C) spina bifida occulta D) spina bifida with myelomeningocele

C) spina bifida occulta Spina bifida occulta is a bony defect that occurs without soft-tissue involvement. A dimple in the skin or a tuft of hair over the site may arouse suspicion of its presence, or it may be overlooked entirely.

Which assessment findings are most prominent in the infant with Tetralogy of Fallot and significant pulmonary stenosis? A) rregular heart rate, fatigue, pink tinged skin B) Dry mucous membranes, poor urine output C) Poor weight gain, nausea, decreased muscle tone D) Dyspnea on limited exertion, fatigue, cyanosis

D) Dyspnea on limited exertion, fatigue, cyanosis The infant with Tetralogy of Fallot and significant pulmonary stenosis exhibits prominent signs of dyspnea, fatigue and cyanosis. Other symptoms include feeding difficulties and poor weight gain, retarded growth and development and breathlessness. Irregular heartrate, dry mucous membranes, nausea and decreased muscle tone may be present in some form but are not the prominent signs.

A client with group AB blood whose husband has group O blood has just given birth. Which complication or test result is a major sign of ABO blood incompatibility that the nurse should look for when assessing this neonate? A) Negative Coombs' test B) Bleeding from the nose or ear C) Jaundice after the first 24 hours of life D) Jaundice within the first 24 hours of life

D) Jaundice within the first 24 hours of life The neonate with an ABO blood incompatibility with its mother will have jaundice within the first 24 hours of life. The neonate would have a positive Coombs' test result. Jaundice after the first 24 hours of life is physiologic jaundice. Bleeding from the nose and ear should be investigated for possible causes but probably isn't related to ABO incompatibility.

The nurse is assessing a newborn suspected of having meconium aspiration syndrome. What sign or symptom would be most suggestive of this condition? A) High-pitched, shrill cry B) bile-stained emesis C) intermittent tachypnea D) expiratory grunting

D) expiratory grunting Expiratory grunting, a barrel-shaped chest with an increased anterior-posterior chest diameter, prolonged tachypnea, progression from mild-to-severe respiratory distress, intercostal retractions, cyanosis, surfactant dysfunction, airway obstruction, hypoxia, and chemical pneumonitis with inflammation of pulmonary tissues are seen in a newborn with meconium aspiration syndrome. A high-pitched cry may be noted in periventricular hemorrhage/intraventricular hemorrhage. Bile-stained emesis occurs in necrotizing enterocolitis. Intermittent tachypnea can be indicative of transient tachypnea of the newborn or any mild respiratory distress problem.

A woman gives birth to a healthy newborn. As part of the newborn's care, the nurse instills erythromycin ophthalmic ointment as a preventive measure for which sexually transmitted infection (STI)? A) genital herpes B) hepatitis B C) syphilis D) gonorrhea

D) gonorrhea To prevent gonococcal ophthalmia neonatorum, erythromycin or tetracycline ophthalmic ointment is instilled into the eyes of all newborns. This action is required by law in most states. The ointment is not used to prevent conditions related to genital herpes, hepatitis B, or syphilis.

BPD

bronchopulmonary dysplasia occurs from artificial resp support

myelomeningocele

protrusion of the membranes of the brain or spinal cord through a defect in the cranium or vertebral column

ECMO (extracorporeal membrane oxygenation)

takes blood out of the lungs, oxygenates it & puts it back in the lungs

Physiologic Jaundice of the Newborn

unconjugated hyperbilirubinemia; begins on day three