CH 8
What is the most common birth injury?
fracture of the clavicle, associated with difficult vertex/breech delivery of larger babies (>8 lbs 8 oz)
What blood glucose levels are considered hyperglycemic in full term and preterms?
full term >125 mg/dL; premi > 150 mg/dL
To further decrease the risk for Rh alloimmunization, RhoGam is administered at __________ to __________ weeks of gestation.
26 to 28 weeks
These are flat, light brown marks that are often associated with the autosomal dominant hereditary disorder neurofibromatosis.
café-au-lait spots, when coming in multiples
Edematous tissue above the bone; extends across sutures
caput succedaneum
Bleeding into the area between the periosteum and bone; does not cross the suture line
cephalhematoma
What is normal Calcium serum levels for neonates?
7.0 - 8.0 mg/dL
To be effective in preventing maternal sensitization to the Rh factor, the nurse must administer Rh immune globulin (RhoGam) to the Rh-negative mother within __________ _______________ after the first delivery or abortion and with each subsequent pregnancy.
72 hours
What sequelae is associated with brachial plexus injury? Treatment?
torticollis (tilting of head to one side and rotation of head to opposite side); massage, stimulation, and stretching programs
Postoperative nursing care for celft LIP?
avoid prone position, antibiotic ointment @ suture x3d followed by petroleum jelly for several weeks, H2O and diluted hydrogen peroxide to clean, gentle aspiration of secretions; excessive swallong = bleeding
The goal is to prevent hemorrhagic disease in the newborn by prophylactic administration of vitamin K (AquaMEPHYTON). How does the nurse correctly administer this drug?
Administer 0.5 to 1 mg into the vastus lateralis muscle or ventrogluteal muscle during the first 24 hours of life
List the risk factors that place the term and late-term infant at high risk for pathologic hyperbilirubinemia.
Appearance of clinical jaundice within 24 hours of birth; Bilirubin level in the high-risk zone; Gestational age 35 to 36 weeks; Exclusive breastfeeding; Maternal race (e.g., Asian or Asian American), Significant bruising or cephalhematoma; Blood group incompatibility with a positive direct Coombs test; Hereditary hemolytic disease; Sibling with prior case of jaundice
Which nationality often has the highest physiologic levels of bilirubin?
Asians (almost 2x that of B/W) and Greeks
a. Facial paralysis b. Brachial palsy c. Phrenic nerve paralysis Arm hangs limp, the shoulder and arm are adducted and internally rotated.
Brachial Palsy
a. Facial paralysis b. Brachial palsy c. Phrenic nerve paralysis Nursing care includes maintaining proper positioning and preventing contractures.
Brachial Palsy
These involve deeper vessels in the dermis and have a bluish-red color and poorly defined margins.
Cavernous venous hemangiomas
T/F Children with microcephaly have cognitive delays.
F, there is a decided relationship between the two but not all
T/F Petechiae upon a difficult delivery are normal manifestations and do not require evaluation.
F, they are normal manifestations but may indicate underlying bleeding disorder as well so they should be evaluated
What should be done if a newborn remains hypoglycemic (below 45 mg/dL) even after being bottle/breast fed?
IV dextrose infusion
The nurse is reviewing maternal laboratory results. The nurse knows that the __________________ ___________________ test monitors anti-Rh antibody titers.
Indirect Coombs
What are the s/sx of phrenic nerve paralysis?
OFTEN UNILATERAL; diaphragmatic paralysis (parodix chest movement, elevated diaphragm), respiratory distress
These lesions are pink, red, or purple and often thicken, darken, and proportionately enlarge as the child grows.
Port Wine Stains
Hemangiomas may also occur as part of the PHACE syndrome, which stands for:
Posterior fossa brain malformation, Hemangiomas (segmental cervicofacial), Arterial anomalies, Cardiac defects, Eye anomalies
Erythroblastosis fetalis is caused by __________ ________________________________.
Rh incompatibility
What is administered to prevent the development of maternal sensitization to the Rh factor after delivery of an Rh-positive infant?
RhIg (RhoGAM); administered within 72 hours of delivery or at 26-28wk gestation via IM
Bullous impetigo
Staph a. infection characterized by easily-ruptured lesions filled with turbid fluid that rupture in 1-2d and leave a superficial red/moist/denuded area with little crusting
The priority nursing goal in the immediate care of a postoperative infant after repair of a cleft lip is to: a. keep the infant well hydrated. b. prevent vomiting. c. prevent trauma to operative site. d. administer medications to prevent drooling.
c. prevent trauma to operative site.
An infant suffers a fracture of the clavicle during birth. Which one of the following would the nurse expect to observe on the physical examination of this infant? a. Crepitus felt over the affected area b. Symmetric Moro reflex c. Complete fracture with overriding fragments d. Positive scarf sign
a. Crepitus felt over the affected area
What is the onset and s/sx of late onset hemorrhagic disease?
appears within 2-12 wk, occurs when breastfed infants don't get enough Vit K prophylaxis; intracranial hemorrhage, jaundice, failure to thrive, ecchymoses, GI/mucous membrane bleed
At what ages do the sutures and fontanels of children close?
at 8wk posterior fontanel closes, @ 18mo anterior fontanel closes, @ 12+ y.o. sutures close
Which one of the following statements about bilirubin encephalopathy is true? a. Development may be enhanced by metabolic acidosis, lowered albumin levels, intracranial infections, and increases in the metabolic demands for oxygen or glucose. b. It produces no permanent neurologic damage. c. Serum bilirubin levels alone can predict the risk for brain injury. d. It produces permanent liver damage by deposits of conjugated bilirubin within the cell.
a. Development may be enhanced by metabolic acidosis, lowered albumin levels, intracranial infections, and increases in the metabolic demands for oxygen or glucose; can produce permanent damage; injury level not predicted by bilirubin levels alone; damage by unconjugated deposits in brain cells
Which of the following statements about hypoglycemia in the newborn is true? a. Hypoglycemia is present when the newborn's blood glucose is lower than the baby's requirement for cellular energy and metabolism. b. In the healthy term infant who is born without complications, blood glucose is routinely monitored within 24 hours of birth to detect hypoglycemia. c. A plasma glucose level less than 60 mg/dl requires intervention in the term newborn. d. Pregnancy-induced hypertension and terbutaline administration have not been found to alter infant metabolism or increase the hypoglycemia risk in the newborn.
a. Hypoglycemia is present when the newborn's blood glucose is lower than the baby's requirement for cellular energy and metabolism
Which one of the following therapies should the nurse expect to implement for jaundice associated with breastfeeding? a. Increased frequency of breastfeedings b. Permanent discontinuation of breastfeedings c. Discontinuation of breastfeedings for 24 hours with the use of home phototherapy d. Increased frequency of breastfeedings and addition of caloric supplements
a. Increased frequency of breastfeedings
Which one of the following is true regarding diagnostic evaluations for bilirubin? a. Newborn levels of unconjugated bilirubin must exceed 5 mg/dl before jaundice is observable. b. Hyperbilirubinemia is defined as a serum bilirubin value above 8 mg/dl in full-term infants. c. When jaundice occurs before 24 hours of age, bilirubin level assessment is unnecessary. d. Transcutaneous bilirubinometry is an effective cutaneous measurement of bilirubin in full-term infants being treated with phototherapy.
a. Newborn levels of unconjugated bilirubin must exceed 5 mg/dl before jaundice is observable
Nursing care after surgery for the infant with craniosynostosis includes: a. careful monitoring of hematocrit and hemoglobin because of expected large blood loss during surgery. b. applying ice compresses for 5 minutes every hour because eyelids are often swollen shut. c. avoiding sedation and pain medications because neurologic status may be altered. d. avoiding supine positioning.
a. careful monitoring of hematocrit and hemoglobin because of expected large blood loss during surgery.
A newborn develops hyperbilirubinemia at 48 hours of age. The condition peaks at 72 hours and declines at about age 7 days. The most likely cause of this hyperbilirubinemia is: a. physiologic jaundice. b. pathologic jaundice. c. hemolytic disease of the newborn. d. breast milk jaundice.
a. physiologic jaundice.
Kernicterus
aka bilirubin-induced neurologic dysfunction; yellow staining of brain cells and brain cell necrosis resulting in chronic, permanent changes to brain secondary to bilirubin deposition
What are some teratogenic drugs?
alcohol, tobacco, antiepileptic medications (valproic acid, phenytoin), isotretinoin (Accutane), lithium, methotrexate, cocaine, and diethylstilbestrol
What is a brachial plexus injury?
an injury to the nerves caused by the alteration of the normal position/relationship of arm, shoulder, and neck; Moro reflex absent on affected side
What are the s/sx of HDN?
anemia, jaundice during first 24 hours of birth, hepatosplenomegaly, hydrops
What is the onset and s/sx of early hemorrhagic disease?
appears within 1-14 days; oozing from umbilicus/circumcision site, bloody/black stools, hematuria, ecchymoses, epistaxis, bleeding from puncture
In preparing the parents of a child with cleft palate, the nurse includes which of the following in the long-term family teaching plan? a. Explanation that tooth development will be delayed b. Guidelines to use for speech development c. Use of decongestants and acetaminophen to care for frequent upper respiratory tract symptoms d. All of the above
b. Guidelines to use for speech development
Therapeutic management for craniosynostosis is: a. placement of ventriculoperitoneal shunt. b. removal of neoplasm. c. release of fused sutures. d. supportive assistance for parents.
c. release of fused sutures; surgically performed
The nurse caring for the infant who has hypocalcemia and is receiving intravenous calcium gluconate recognizes that which one of the following is included in the care plan? a. The scalp veins are the preferred site for intravenous administration of calcium gluconate. b. Signs of acute hypercalcemia include vomiting and bradycardia. c. Rapid infusion administration is best tolerated by the infant. d. Calcium gluconate is compatible with sodium bicarbonate.
b. Signs of acute hypercalcemia include vomiting and bradycardia
Implementation of phototherapy for an infant with jaundice does not include: a. shielding the infant's eyes with an opaque mask. b. recognizing that once phototherapy has been started, visual assessment of jaundice increases in validity; therefore fewer serum bilirubin levels will be necessary. c. repositioning the infant frequently to expose all body surfaces to the light. d. assessing the infant for side effects, including loose, greenish stools; skin rashes; hyperthermia; dehydration; and increased metabolic rates.
b. recognizing that once phototherapy has been started, visual assessment of jaundice increases in validity; therefore fewer serum bilirubin levels will be necessary.
Intravenous immunoglobulin (IVIG) is effective in reducing bilirubin levels in infants: a. with Rh isoimmunization and ABO incompatibility. b. with breast-feed jaundice. c. who are late-term and term infants. d. when administered to the mother immediately before delivery.
b. with breast-feed jaundice.
What kind of hemangioma arrangement is associated with airway compromise?
beard-distribution hemangioma
When does surgery for craniofacial abnormalities usually occur?
before school age
At what blood glucose level should brest/bottle feeding be instituted? What is the goal?
below 36 mg/dL; to maintain above 45 mg/dL
What is erthema toxicum neonatorum? Tx?
benign, self-limiting eruption appearing in first 48 hours; pale yellow/white papules/pustules on erythematous base resembling flea bit; may disappear and reapper on different area; usually self-resolving in 5-7d
Cephalhematoma
bld-v rupture during delivery to produce bleeding into the area between bone and periosteum; normal at birth but increased size by 2nd/3rd day, self resolving in 2 weeks to 3 mo
What is hemorrhagic disease of the newborn?
bleeding disorder occurring as a result of vitamin K deficiency
Subgaleal hemorrhage
bleeding into subaleal compartment often due to instrumented delivery; watch for acute blood loss, may require blood replacement
What is the difference between breastfeeding and breast milk jaundice?
breastfeeding is early-onset (@ 2-4d) and is often a result of decrease in milk d/t unestablished milk supply, should be treated with continued feeding; breast milk jaundice is late-onset (@4d until 3-12wk) and caused by factors in the breast milk
Of the four infants described below, which one should the nurse recognize as being least likely to develop jaundice? a. An infant with subgaleal hemorrhage that is now resolving b. An infant with cephalhematoma that is now resolving c. An infant who has feedings started early, which will stimulate peristalsis and rapid passage of meconium d. An infant who is of Native American descent
c. An infant who has feedings started early, which will stimulate peristalsis and rapid passage of meconium; begins process of developing flora that will conjugate bilirubin
Which of the following statements regarding herpes simplex virus (HSV) is correct? a. Lesions take several weeks to ulcerate and crust over. b. The mother always has a history of symptoms of infection at the time of vaginal transmission. c. Approximately 86% to 90% of transmission occurs during delivery. d. It always manifests with some type of rash.
c. Approximately 86% to 90% of transmission occurs during delivery
Birth injuries may occur during the delivery of the infant. Birth injuries are not usually the result of: a. forceful extraction. b. dystocia. c. excess amniotic fluid. d. breech presentations.
c. excess amniotic fluid
The term used to describe the yellow staining of the brain cells that can result in bilirubin encephalopathy is: a. jaundice. b. physiologic jaundice. c. kernicterus. d. icterus neonatorum.
c. kernicterus
What assessment finding is the nurse most likely to see in the infant as a result of hypoglycemia? a. Forceful, low-pitched cry b. Tachypnea c. Jitteriness, tremors, twitching d. Vomiting, refusal to eat
c. Jitteriness, tremors, twitching
Which one of the following birth injuries is most likely to need further evaluation? a. Subcutaneous fat necrosis b. Ecchymoses c. Petechiae d. Scleral hemorrhage
c. petechiae
Bruce, a full-term newborn, has symptomatic hypoglycemia and inability to tolerate oral feedings. An intravenous glucose infusion has been ordered. Which of the following does the nurse recognize as correct? a. Too rapid infusion of the hypertonic solution can cause intracellular overload. b. An initial bolus infusion of 10% dextrose will be given over a 10-minute interval, followed by continuous dextrose infusion for 24 hours. c. The infusion is maintained at the ordered flow rate via an intravenous pump with hourly intake charting to decrease the risk of circulatory overload. d. Termination of the glucose solution should be rapid to prevent hyperinsulinism.
c. The infusion is maintained at the ordered flow rate via an intravenous pump with hourly intake charting to decrease the risk of circulatory overload
Which of the following is not correct in describing erythema toxicum neonatorum? a. It is a benign, self-limiting rash that appears within the first 2 days of life. b. The rash is most obvious during crying episodes. c. The rash may be located on all areas of the body, including the soles of the feet and the palms of the hands. d. Lesions appear as 1- to 3-mm, white or pale yellow pustules with an erythematous base. Smears of the pustules show increased numbers of eosinophils and lowered numbers of neutrophils
c. The rash may be located on all areas of the body, including the soles of the feet and the palms of the hands; located anywhere on body EXCEPT soles and palms
Which feeding practices should be used for the infant with a cleft lip or palate? a. Use a large, hard nipple with a large hole. b. Use a normal nipple and position it sideways in the mouth. c. Use a special nipple, positioned so it is compressed by the infant's tongue and existing palate. d. Withhold breastfeeding until after surgical correction of the defect
c. Use a special nipple, positioned so it is compressed by the infant's tongue and existing palate.
What are the signs of a fractured clavicle?
crepitus, palpable spongy mass (localized edema and hematoma), limited use/malpositioning of affected arm, asymmetric Moro reflex
Infants at risk for early-onset hypocalcemia include: a. postterm infants. b. infants who develop jaundice. c. infants born to hypertensive mothers. d. small-for-gestational-age infants who experience perinatal hypoxia.
d. small-for-gestational-age infants who experience perinatal hypoxia.; also may be from baby born to a diabetic mother
Treatment for port-wine stain includes laser therapy. The teaching plan for treatment expectations includes which of the following? a. The lesion will have a bright pink appearance for 10 days after treatment. b. Expose the infant to sunlight for 15 minutes daily after treatments. c. Administer salicylates before each treatment for pain. d. After treatment, gently wash the area with water and dab it dry.
d. After treatment, gently wash the area with water and dab it dry.
Which of the following is acceptable in providing postoperative care for the infant with a cleft lip or palate? a. Use of tongue depressor in the mouth to assess surgical site b. Continuous elbow restraints to prevent injury c. Placement of infant in the prone position after cleft lip repair d. Position the infant in a side-lying position after cleft palate repair
d. Position the infant in a side-lying position after cleft palate repair
In preparing the nursing care plan for the infant born with craniofacial abnormalities, the nurse recognizes which of the following as true? a. Children with this deformity always have some cognitive impairment. b. Abnormalities include deformities involving the skull, facial bones, and neck. c. A helmet is often required after surgery to protect the operative site and bone grafts for 5 years. d. Surgical correction involves peeling the patient's face away from the skull and remolding the understructures.
d. Surgical correction involves peeling the patient's face away from the skull and remolding the understructures.
Which of the following statements about phototherapy is false? a. For phototherapy to be effective, the infant's skin must be fully exposed to an adequate amount of light or irradiance. b. The initiation of phototherapy should always be based on clinical judgment rather than serum bilirubin levels alone. c. For best results, the goal of phototherapy is to increase irradiance to the 460-490 nm band. d. The color of the infant's skin influences the efficacy of phototherapy, with darker-skinned infants needing double or intensive therapy.
d. The color of the infant's skin influences the efficacy of phototherapy, with darker-skinned infants needing double or intensive therapy.
Which one of the following statements concerning impetigo is not correct and should be omitted by the nurse from the teaching plan? a. Impetigo is treated with oral antibiotics and topical application of mupirocin (Bactroban). b. Impetigo is an eruption of vesicular lesions that occurs on skin that has not been traumatized. c. Distribution of impetigo lesions usually occurs on the perineum, trunk, face, and buttocks. d. The infected child or infant must be isolated from others until all lesions have healed.
d. The infected child or infant must be isolated from others until all lesions have healed.
The nurse is assessing Sarah, a neonate born at home, and observes slight blood oozing from the umbilicus. What is the most likely cause of Sarah's hemorrhagic disease? a. The neonate was born with an anatomically immature liver. b. Coagulation factors (II, VII, IX, X) are deactivated in the neonate. c. Vitamin K was administered to the neonate shortly after birth. d. The newborn was born with a sterile intestine and was unable to synthesize vitamin K until feedings began.
d. The newborn was born with a sterile intestine and was unable to synthesize vitamin K until feedings began.
Nursing care for soft tissue injury is typically not directed toward: a. assessing the injury. b. preventing breakdown and infection. c. providing explanations and reassurance to the parents. d. explaining the need for careful follow-up of injury after the infant's discharge.
d. explaining the need for careful follow-up of injury after the infant's discharge; record accurate description of injury
What is and how does Erb palsy (Erb-Duchenne paralysis) occur? S/sx?
damage to upper plexus d/t stretching/pulling away of shoulder from head; affected arm lies limply alongside body, extended elbow, internally rotated and adducted should, pronated forearm, no Moro reflex
What kind of birthmarks demand further inspection?
darker, more extensive/larger, irregular, growing (in number or size) lesions
The test performed postnatally to detect antibodies attached to the circulating erythrocytes of affected infants is called the _____________________ _____________________ test.
direct Coombs
What is the difference between early and late onset hypocalcemia?
early onset seen in first 48 hours of life; late-onset seen by day 3-4 and d/t baby being fed cow milk
Bilirubin Encephalopathy
early varying degrees of acute symptoms of bilirubin toxicity resulting from the deposition of unconjugated bilirubin in brain cells
Nursing care for hemangiomas/birthmarks after laser tx?
edu that birthmark will have purple/black appearance for 7-10 days then red then fade; avoid trauma/picking of lesion (trim kids' nails); wash and dab dry; protect from sun for several weeks; NO SALICYLATES
a. Facial paralysis b. Brachial palsy c. Phrenic nerve paralysis Artificial tears are instilled to prevent drying.
facial paralysis
a. Facial paralysis b. Brachial palsy c. Phrenic nerve paralysis Nursing care is aimed at aiding the infant in sucking and the mother with feeding techniques.
facial paralysis
a. Facial paralysis b. Brachial palsy c. Phrenic nerve paralysis The eye cannot close completely on the affected side; the corner of the mouth droops, and an absence of forehead wrinkling occurs.
facial paralysis
a. Facial paralysis b. Brachial palsy c. Phrenic nerve paralysis This type of paralysis is caused by injury to cranial nerve VII.
facial paralysis
What are some treatment options for hemangiomas?
flashlamp pulsed dye laser to lighten/clear the lesion, systemic prednisone to deter further growth
Nursing care management post-op after a surgery to correct craniofacial abnormalities?
help adjust with body image, helmet worn to protect operative site/bone graft for 6mo-2yr
Hyperbilirubinemia in the first 24 hours of life is most often the result of what?
hemolytic disease of the newborn (HDN)
How should an infant with CL/CP be fed?
hold infant upright with head supported; squeezing cheeks together to decrese cleft lip for anterior lip seal; if CL and bottle fed, use one with a wider base; if CP pump milk and use adapted bottle; don't fear noises heard/fear choking (unless eyebrows raised and forhead wrinkled), nonnutritive sucking after bottle feed,
________________________________ is an excessive accumulation of bilirubin in the blood and is characterized by ____________________, a yellow discoloration of the skin.
hyperbilirubinemia; jaundice
Which of the following nursing interventions are recognized as appropriate for the infant with hypoglycemia? i. Institute early bottle-feeding or breastfeeding. ii. Increase environmental stimulants. iii. Protect from cold stress and respiratory difficulty that predispose the infant to decreased blood glucose levels. iv. Force early oral glucose feedings, avoiding formula and breast milk until the newborn is stable.
i. Institute early bottle-feeding or breastfeeding; iii. Protect from cold stress and respiratory difficulty that predispose the infant to decreased blood glucose levels
Full-term infants at risk for hypoglycemia shortly after birth include which of the following? i. Those born to diabetic mothers ii. Those who are small for gestational age iii. Those with perinatal hypoxia
i. Those born to diabetic mothers ii. Those who are small for gestational age iii. Those with perinatal hypoxia
Nursing care management for craniosynostosis?
if bone surgery, monitor H&H for blood loss and help parents ID blood donor if needed; if endoscopic, molding helmet 23hr/day x3-4mo; gentle cleansing of swollen eyelids post-op
How can the pattern of onset indicate if jaundice is physiologic or not?
if within first 24hr probably pathologic; if appears on day 2-3, peaks on day 3-5, and declines on day 5-7 probably physiologic
Tx for hypocalcemia?
in early-onset usually self-resolving within 3 days; 10% Ca gluconate IV slowly (fast may cause dysrhythmias) over 10-30 minutes or oral calcium
What are the early signs of subgaleal hemorrhage?
incerasing edema/head circumference and a firm mass on head/back of neck, boggy fluctuant mass over scalp that crossess the suture line and moves as the baby is repositioned, decreasing Hct/increasing bilirubin, changing LOC
These are red, rubbery nodules with a rough surface that are recognized as tumors that involve only capillaries.
infantile/strawberry/capillary hemangiomas; self resolve, but may take 5-9 years
RhoGam is administered only to the mother by the _____________________________ route.
intramuscular
What are the treatment options for isoimmunization both during AP and PP?
intrauterine transfusion (infusing blood into fetus' umbilical vein) or exhange tranfusion PP (infant's blood removed in small volumes and replaced with compatible, Rh- blood)
Exposure to Rh antigen with significant antibody formation occurring and causing a sensitivity response is known as ______________________.
isoimmunization
What are some side effects of phototherapy?
loose, greenish stools; mild hyperthermia; priapism; transient skin rashes; self-resolving "rebound" hyperbilirubinemia upon termination; bronze baby syndrome
What are the signs of facial paralysis? Treatment?
loss of movement on affected side (drooping, inability to close eye, no wrinkling of forehead); spontaneously resolves in days-months
The most common blood group incompatibility in the neonate occurs when the mother has type __________ blood and the infant has either type __________ or type _______________________ blood.
mom has type O and the infant has either A or B
Problems of Rh incompatibility may arise when the mother is _________ ______________ and the infant is ______ ______________.
mom is Rh- and infant is Rh+
Caput succedaneum
most common scalp lesion; serum/blood that has accumulated over the bone presenting as a vaguely outlined area of edematous tissue situated over the portion of the scalp that presents in a vertex delivery; swelling subsides within a few days
Which of the following are most likely to be associated with further complications: localized superficial IH, segmental IH, multifocal hemangiomans?
multifocal and localized superficial IH are less likely; segmental IH more likely to cause organ compromise etc
Postoperative nursing care for celft PALATE?
observe for obstruction/hemorrhage/larygneal spasm; face mask for O2, tongue taped to cheek; clear liquids x24hr followed by liquid diet x2wk and soft diet @ 6wk, avoid rigid utensls, elbow restraints, opiates and acetaminophin
How is microcephaly defined?
occipitofrontal circumference (OFC) more than 3 standard deviations below mean for age and sex
What are s/sx of hypoglycemia in a newborn?
often asymptomatic; jitteriness, tremors, twitching, seizures, coma
What can the increased ICP associated with some forms of craniosynostosis result in?
optic atrophy and eventual blindness
Nursing care for bullous impetigo
oral/topical antibiotics (mupirocin, Bactroban), elbow restraints/mittens to prevent scratching
What are the s/sx of lower brachial palsy?
paralyzed hand muscles (wrist drop and relaxed fingers), no Moro reflex
How is hyperbilirubinemia treated?
phototherapy; exchange transfusions, phenobarbital, IV Ig (usually only with hemolytic disease); early initiation and frequent breastfeeding (q1.5-2hrs)
a. Facial paralysis b. Brachial palsy c. Phrenic nerve paralysis Nursing care is aimed at assisting the infant with respiratory complications.
phrenic nerve paralysis
a. Facial paralysis b. Brachial palsy c. Phrenic nerve paralysis This causes diaphragmatic paralysis, with respiratory distress as the most common sign of injury; injury is usually unilateral, with affected side of lung not expanding.
phrenic nerve paralysis
a. Facial paralysis b. Brachial palsy c. Phrenic nerve paralysis This usually disappears spontaneously in a few days but may take several months.
phrenic nerve paralysis
Icterus Neonatorum
physiologic, self-limited (usually resolves in about 7 days) and mild jaundice d/t ↑ RBC with shorter life span and immature liver's inability to conjugate bilirubin
Craniosynostosis
premature closure at birth of 1+ cranial sutures
What is the difference between primary and secondary craniosynostosis?
primary is a result of abnormal skull dvp; secondary involves failure of brain growth and expansion
What is the nursing care management for a fractured clavicle?
proper alignment, support upper/lower back, don't pull up from arms, clavicle at > 60 degrees and elbow flexed at >90 degrees for 7-10 days for immobilization
Nursing care for brachial palsy?
proper positioning of affected arm, immobilization?, passive ROM, supportive splints/braces to prevent wrist contractures, undress starting with unaffected arm, redress starting with affected arm, "football" position to hold baby
What is the treatment/recovery of brachial palsy injury?
recovery within 3-6 months spontaneously; tx aimed at preventing contractures and maintaining correct placement, otherwise surgery to relieve pressure; avulsion results in permanent damage
What is Pierre Robin sequence (PRS) characterized by? Nursing management?
retroposition and largeness of tongue causing occlussion of airway/resp distress; avoid supine positioning
Nursing care for hemangiomas/birthmarks?
show before-after pics of other kids, have parents take progress pictures
Which head trauma injuries can result in serious trauma?
subdural hematoma and intracranial hemorrhage
Bleeding into the potential space that contains loosely arranged connective tissue
subgaleal hemorrhage
Nursing care for facial paralysis?
teach mother to aid infant in sucking, may use rubber nipple with large hole (breastfeeding NOT contraindicated); artificial tears/tape eye shut
What are the s/sx of late-onset hypocalcemia?
tetany by 3-4wk; twitching, tremors, irritability, seizures, tachycardia, high-pitched cries
Tx of oral candidiasis?
usually self-resolving, but may take as long as 2 months; good hygiene, fungicide (nystatin, Mycostatin) q6hr x2wk AFTER feedings
What is the difference between a vascular tumor and an infantile hemangioma (IH)/aka strawberry hemangiomas?
vascular tumor fully formed at birth and may involute over time; IH typically grows after birth
What are the symptoms of bronze baby syndrome? Cause?
when serum, urine, and skin turn grayish brown several hours after an infant is placed under phototherapy
What are some signs of newborns affected by herpes?
within first 5-6 weeks of life, poor feeding, lethargy, fever, irritability, w/wo characteristic vesicle/pustule on erythematous base that ulcerates and crusts
What are the signs of bilirubin encephalopathy?
↓ activity, ↑ lethargy, irritability, poor feeding, temp instability, high-pitched cry