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RNC-Low Risk Perinatal

Terms in this set (199)

Infant cuff should be how much wider than the diameter of the limb being measured?
25-55%
3 categories of infant temperament
easy, difficult, slow to warm
This type of murmur is usually Grade 2-5. This murmur appears within hours of birth and is almost always the result of aortic and pulmonary stenosis or coarctation of the aorta
A loud systolic ejection murmur
A tightly fisted hand in which the thumb is firmly enclosed by the fingers. This may indicate neurologic abnormality
cortical thumb
Decreased cardiac output in a neonate can cause CHF or death within how many hours?
48
Which mechanism of heat loss is minimized through skin to skin?
conduction
HELLP patients most commonly present with what symptoms?
abdominal/epigastric pain, nausea, vomiting, and malaise
The anterior fontanelle should be
1-4 cm
The posterior fontanelle should be
less than 1 cm
What is the most common method of antenatal testing?
Non stress test
Common symptoms of clubbing
softening of nail beds, nails that form a sharper angle with the cuticle, bulging fingertip, and nails curve downward
How wide is the normal neonatal penis
0.9-1.3 cm
Fidelity
"promise keeping", may be derived from autonomy. The duty to keep promises may promote the greatest good or be seen as an obligation.
When you have a RH- mom with a RH+ baby the antenatal treatment includes
transfusion of the fetus with RH- blood
The length of kidneys in a normal sized neonate is
4.5-5 cm
What is the most frequently demonstrated reflex after birth?
The patellar reflex
Describe coldstress
it quickly depletes brown fat and glycogen stores resulting in increased metabolic needs, hypoxemia, hypoglycemia and increased oxygen consumption
What two types of deliveries lead to spinal cord injuries
cephalic or breech presentations can lead to spinal cord injuries because the vertebral axis becomes outstretched or there is over rotation of the body in relation to the head
True or False- Maternal Hepatitis C is a contradiction to breast feeding
false
3 key attributes for mutual relationships between parents and newborns
proximity, reciprocity, and commitment
Respiratory acidosis is reflected in values such as
ph <7.20 and Pc02 > 65
Contradictions to aerobic exercise during pregnancy
cervical insufficiency, restrictive lung disease, hemodynamically significant heart disease, and ruptured membranes
What nutrient are newborns most efficient in absorbing?
Monosaccharides such as glucose
Leukocoria
pupils appear white in color, can be the significant hallmark or ocular abnormality
Hypocalcemia occurs in what percent of preterm infants?
30-90%
At how many hours of life do most infants with serious infants present?
within 48 hours
The three most common complications of amniocentesis are
spontaneous abortion, fetal injury, and infection
How much weight do newborns gain
6-8 oz per week and 1 inch per month
Neonatal weight loss
infant lose up to 10% of birth weight but should regain it by 2 weeks of age
Ways to monitor systemic blood pressure in neonates
flush, palpitation, ultrasound, doppler, oscillometric meaurements
Premature Ventricular beats may result from
hypoxia, CHD, irritation caused by an invasive catheter, or a result of a surgical procediire
How soon should the initial gestational age exam be done on an infant?
within 48 hours of birth
Fragile X syndrome can present this way in males
large testes
What is Diaphallias
A duplicated penis. It is either classified as bifid or true.
Describe the normal neonate's testes
ovoid in shape, mobile and on average 1.4-1.6 cm
A short umbilical cord is associated with what?
pulmonary hypoplasia (shorter than 32 cm)
A long umbilical cord is associated with what?
prolapsed cord and fetal entrapment
Describe diamniotic/monochorionic twins
If division occurs between the fourth and eighth day following fertilization it will result in this type of twins. The chorion has already begun to develop, whereas the amnion has not. Therefor, each fetus will be surrounded by an amnion, but a single chorion will surround both fetus
Umbilical hernia
When intestine, fat, or fluid pushes through a weak spot or hole in a newborn's stomach muscles
Neonatal herpes has a mortality rate of what percent with disseminated disease?
up to 40%
Three main locations of pulmonary stenosis
valvular, subvalvular, supravalvular
physiological phimosis
non retractable foreskin
what fetal scalp ph indicates true acidosis
below 7.2
Where should chest circumference be measured in a neonate
under the arms and across the nipple line
Sinusoidal fetal heart rate patterns are associated with what?
severe asphyxia, RH isoimmunization, severe anemia, abrupto placentae, hemorrhage, and fetal acidosis
Decreased/minimal variability
0-5 bpm
moderate/average variability
6-25 bpm
marked variability
>25 bpm
Late decals are due to
uteroplacental insufficiency
Variable decelerations are associated with
cord compression
What separates cerebral hemispheres from the cerebellum
tentorium
How do you auscultate neonatal lungs?
you listen from right to left starting from the mid axilla line
What is a tap?
A sharp, well localized PMI. Usually associated with pressure overload
How is postural tone tested?
by the pull to sit test
What is the energy content of mature breast milk
60-75 kcal/dl
Non shivering thermogenesis
utilization of brown fate for heat production
What can urinary drainage from a urachal remnant lead to?
umbilical granuloma, redness, or swelling below the umbilicus
At what age should an infant be able to lift his head and hold it erect?
1-2 months
Name some milestones seen in infants at 1-2 months
Regard faces, follow objets through a visual field, smile spontaneously and recognize parents
What can an elevated 2nd trimester serum AFP indicate
there is a 10 fold increased risk of placental abruption
What is the most common pelvis in non white races
the anthropoid pelvis. It has the longest sacrum of the 4 types of pelvis and therefore the deepest pelvis
Balance hypospadias
exists when the urethral opening is ventrally situated at the base of the glans
Lotus birth
the cord is not cut and is left to naturally dry and separate at the umbilicus of the baby
What type of pelvis is considered the true female pelvis
the gynecoid pelvis is ideal for vaginal birth
How soon after discharge do newborns need to be seen by a pediatrician if discharge before 48 hours
within 72 hours of discharge
How often should infant temperature be checked
every 15 to 20 minutes until stable and then every 4 to 8 hours
Perinatal mortality rates for IUGR are how much greater than that of term infant
10-20 times
Peripheral cyanosis
blue color in hands, feet, and around mouth
How is the diagnosis of PPH confirmed
echocardiogram can confirm the presence of elevated pressures in the pulmonary artery
What are some responses to cold stress infant can use as adaptive mechanisms
peripheral vasoconstriction, increased muscle activity and flexed fetal positioning, increased metabolic rate and brown fate metabolism
Convection
heat lost to air or fluid around the infant that is cooler than the infant's temperature
Cystic hygromas
fluid filled cases are caused by blockages in the lymphatic system seen on neck or head
lightening
the settling of the fetal head into the brim of the pelvis
How much weight should an infant nippling gain?
20-30 g/day
Colostrum
has a higher specific gravity, protein, than breast milk
Marujuana is inked with what
acute nonlymphoblastic leukemia in childhood
Cryptochidism
seen in 30% of all preterm infants
Most myelomenigoele lesions occur where?
the lumbar spine
Eagle Barret syndrome
large flaccid, wrinkled, abdominal wall, undescended testes, and various GU malformations, and renal dysplasia
What is the primary fetal compensatory response to chronic hypoxia
slow fetal growth
Thrills
low frequency, palpable murmurs
Kramer's rule
approximation of the level of jaundice in a newborn
How long can pseudomenstraution cause discharge in infants
up to 2-4 weeks
Heave (or lift)
point of maximum impulse that is slow rising and diffuse associated with volume overload
Causitry
answers the question as to how a general moral precept is to be understood in similar sets of circumstances. The claims, grounds, and warrants of a particular case are compared with similar cases.
Damage of lower cervical and upper thoracic cord lesions results in
flaccidity of the legs and portions of the arms
Newborn light sleep
eyes closed with some eye movement seen under the lids, active body movement, and suckling possibly present
hymenal tag
small piece of pink tissue that protrudes between the labia, usually disappears after 3 weeks
foramen ovale
opening between the left and right atrium that evenly distributes the flow of blood in a fetus
What percent of fetal cardiac arrhythmias are due to irregular rhythm
90
Where is neonatal skin turgor best assessed
on the abdomen
Systole
the period when the heart contracts and the heart chambers eject blood
diastole
occurs following closure of the aortic ad pulmonic values, the onset occurs just after s2
Describe a preterm renal system
lack of selectiveness in filtration, decreased GFR and urine concentration (decreased ability)
How soon does fetal tachycardia present
by 6 hours of age
When should PPH be suspected
when a term neonate demonstrates atrial hypoxemia, cyanosis, and infants who do not improve their 02 level with administration of 100% 02
When does the fetal thyroid gland become functional
the end of the first trimester
How much of fetal cardiac output is located in the placenta?
40%
When is a teratogen most harmful
2-10 weeks after LNMP because of organogenesis
platypelloid
is the widest of all pelvic types and shallow which makes rotation and decent of the fetal head difficult
Extrophy
epispadias complex involves defects of the urinary tract and genital tracts, musculoskeletal system, and sometimes the intestinal tract
Infant cataracts
clouding of the eyes, natural lens by infection, metabolic problems, diabetes, trauma
Congenital diaphragmatic hernia
abdominal organs are displace into the thoracic cavity
Persistent pulmonary hypertension of the newborns
with PPHN the baby does not change over from fetal to normal circulation blood is forced away from the lungs due to high BP in the arteries that go to the lungs
Pneumothorax
air leaks out through holes in the lung tissues into spaces outside the lung airways
How soon can a newborn distinguish smells
by 5 days of age
Human placental lactogen
increases insulin resistance and also stimulates production of growth hormone
Normal umbilical cord
length is 30-100 cm, with an average diameter of 1.5-2 cm
Neonatal period
first 28 days of life
What is the primary function of the fetal lungs
support the production of amniotic fluid
Neonatal encephalopothy
a result of asphyxia. Milf encephalaopothy is associated with irritability, jitteriness, and hyper alertness
Exteroceptive reflexes
sup. abdominal reflexes, plantar, grasping, and rooting
proprioceptive reflexes
includes gross motor reflexes such as the moro reflex
Falx laceration
occurs with bleeding from the superior sagittal sinus-> hematoma develops in the cerebral fissures
Average neonate penile length
3.5 cm
Name two things that can lead to priapism
polycythemia and birth trauma
how long does it take a circumcision to heal
7-10 days
deontological approach
moral sign without regards to consequences
A preterm neonates quality of movement is characterized but what two things
tremors and jitteriness
What is the average birth weight for twins
2330 g born at 35.3 weeks
What is the first and most common neurologic presentation thats associated with hemorrhage in superficial cerebral veins
hyper irritability and hyper alert appearance
What is premature ventricular beats marked by
an early beat arising from a supra ventricular focus
What position should a preterm infant in respiratory distress be put in
prone for better oxygenation
When are blood glucose lowest in a neonate post birth
1-2 hours post birth, levels stabilize at 3-4 hours
milaria
white/yellow papule are most common with neonates who are overheated
Hydrocephalus
occurs as a result of inflammation of the arachnoid vili, which absorbs cerebrospinal fluid
How long is infant vaginal bleeding or discharge considered normal
up to 10 days
What forms the uveal tract
the iris, ciliary body and choriod
Describe the closing of the ductus arteriousus
This functionally closes within the first day of life due to decreasing pressure in the pulmonary vasculature and increased pressure in the aorta
Normal infant BP
80-90/ 40-50
Justice
the right to fair treatment and the right to privacy. this includes confidentiality
Lactogenesis 3
occurs at the end of lactogenesis 2 until weaning. Involves the formation of large amounts of breast milk
myelomenigocele
associated with spina bifida where there is a bilateral broadening of the vertebrae or absence of the vertebral arches
Standard lab values in a term neonate
hemoglobin-14.5-22.5
hematocrit- 48-69%
glucose-40-60 mg/dl
WBC- 9,000-30,000
Pneumonia
most common form of neonatal infection. treatments are acyclovir and ganciclovir
Early/congenital neonatal sepsis presents
within 24 to 72 hours after birth
Describe Congestive Heart failure
infant is tachypenic, tachycardic, has increased R effort, rales
Evaporation
heat loss from water from the skin and mucus membrane
radiation
heat loss from warm skin surfaces to a cooler object not in contact with the newborn (light source)
Conduction
loss of heat to a cooler object in direct contact with neonate (cold scale, stethoscope)
convection
loss of heat moving or at the skin surface (oven)
Ventral septal defects
is the most common cause of CHF
Tetralogy of fallot
4 things:VSD, overriding of the ascending aorta, obstruction of the R ventricular out flow tract, R ventricular hypertrophy
Infant has "tet" spells-cyanosis, irritability, pallor, and tachypenia
Coarctation of the aorta
murmur is heard on the back only, distant lower pulses, and there is constriction of the aorta at the junction of the aortic arch and descending aorta in vicinity of the ductus arteriousus
Polycythemia and hyperviscosity
results from chronic hypoxia in utero, twin/placental transfusion, maternal hemorrhage
s/s: plethora, cyanosis, neurological aberrations
treatment: partial exchange transfusion w plasma to decrease hematocrit
Edwards syndrome
also called trisomy 18, infant is growth restricted, has prominent occiput, rotated malformed ears, clenched hands, and apneic spells
Mild Gestational hypertension and mild pre ecclampsia
BP> 140/90 proteinuria 1+ on a dipstick, urine output >25-30 ml, placental perfusion reduced
Severe Gestational hypertension and pre ecclampsia
BP rises to greater than 160/110, proteinuria 3+, urine is 400-500 ml/24 hour, headache, persistent photophobia, IUGR, and non reassuring fetal heart tones
Interpretation of non stress test
reactive: 2 accelerations in a 20 minute period, each lasting at least 15 seconds and peaking at least 15 beats/min above baseline
non reactive: a test that does not produce 2 or more accelerations in a 20 minute period
An absent moro reflex can indicate
kernicterus ( bilirubin encephalopathy)
Indirect coomns test
performed on mothers blood (usually rh-) for free flowing antibodies against foreign red blood cells
diaphragmatic hernia
scaphoid abdomen w decreased left sided lung sounds, intubates & OG tube
Inguinal hernia
reducible swelling of the scrotum, failure of the processes vaginalis to involute
Apgar score
rapid assessment of the newborns transition to extrauterine life based on heart rate, respiratory rate, muscle tone, reflex irritability, and color
Quad screen
added to triple screen for accuracy in detecting trisomy 21 in women under 35 years of age
Tripe screen
done between 16 and 18 weeks, measures MSAFP, HCG and unconjugated estriol in maternal blood
If an infant demonstrates weak or absent femoral pulses they might have
Hip displasia, coarctation of the aorta
What will be seen in the CSF for herpes s. meningitis
increased RBCS, normal glucose, and elevated protein
post asphyxia in a newborn would be reflected in
acidosis, low bicarb, and hypoglyclemia
preterms primarily lose heat by
convection and evaporation
What are the two components of lung surfactant
lecithin and syringomyelin
Lab ordred for ambiguous genitalia
karyotype
hypertrophic pyloric stenosis
sx are projectile nonbillious vomiting with a desire to feed. Infant will be dehydrated and constipated. Palpable olive live nodular mass over epigastric RUG area
Neonatal seizures
sx eyelid fluttering, bicycling, swimming, lip smacking, sucking, or other oral tics, apnea episodes and ocular deviation
what is is the series of events in NEC
hypoxia- bacterial invasion- inflammation-gangrene-perforation
Congenital Rubella
manifestations are IUGR/SGA, jaundice, papular rash (blueberry muffin rash) cataracts, retinopathy, congenital heart defects with machinery murmur
there is no treatment
Congenital CMV infection
manifestations: baby looks ill within hours of birth, jaundice, IUGR/SGA, microcephaly, rash, jaundice, chorioentitits, learning disabilities- can be treated with prolonged ganciclovir
HSV
manifestations are skin vesicles (esp eyes and mouth) some cases will have encephalitis , and septic appearance- treatment is high dose of acyclovir (60 mg/kg/d)
Congenital syphyillis
manifestations are jaundice, snuffles, mucocutaneous lesions of palms and soles, periostitis, mulberry molars and hutchinson disease- Pen G is treatment
Congenital tocoplasmosis
manifestations are hydrocephalus, calcifications on MRI
ankloglossia
tongue tie
spina bifida
common in 10-20% of otherwise healthy people
when does the AAP recommend screening for delay and disabilities
9 months
Causes of uterine atony
multiple gestation, prolonged labor, chorioamnionitis, fibroids, and polyhrdramnios
A baby's head makes up about what percent of body length
25%
monozygotic twins
identical twins originate from 1 zygote that divided around the end of the first week of pregnancy
dizygotic twins
fraternal twins; results from the fertilization of two ova
Sturge-Weber syndrome
involves the fifth cranial nerve, port wine stain could indicate this
The most frequent mechanism of heat loss in a newborn
evaporation
When should resuscitation be started in the delivery room
immediately, if respirations are absent or ineffective immediately
What sequence should the activities occur for initial resuscitation of the infant
Dry infant, place infant under preheated radiant warmer, suction mouth, position infant's head, suction nose
quiet sleep
quiet sleep without movement except for sudden, jerky movements; hard to awaken from this state
active sleep
eyes are closed with some eye movement seen under lids, active body movements, sucking might be present
drowsy
eyes open or closed, lids usually heavy; active body movements with occasional fussing
alert inactivity
alert with eyes open, attentive to close objects; little body movements
fussing
alert inactivity with mild, agitated vocalizations
crying
eyes tightly closed at times with crying, thrashing, and movements of head and extremities
Signs the neonate might have diaphragmatic hernia
respiratory distress, decreased breath sounds on affected side, presence of scaphoid abdomen, hyper extended chest, PMI shifted to the right
unconjugated or indirect bilirubin
Fat soluble, toxic to tissues
Conjugated or direct bilirubin
water soluble, nontoxic to tissues
the best indicator of an infant's need for oxygen
Arterial Pa02
4 facts about RDS
characterized by atelectasis, acidosis perpetuates the decreased production of surfactant, it may be induced by hypothermia in a preterm infant, usually resolves within 72 hours
When suctioning the neonate born through meconium stained amniotic fluid, what would be suctioned first
oropharynx and nasopharynx before the infant's body is delivered.
An infant with PPHN and a PDA is at risk for developing
Pulmonary hemorrhage
Chest compressions are indicated whenever the heart rate is below 60 bpm, despite
at least 30 seconds of effective positive pressure ventilation
Babies with Robin Syndrome who have upper airway obstruction may be helped by placing an NG tube and positioning the,
on their abdomens (prone)
MR SOPA
Mask readjustment and reposition the the head. Suction mouth and nose and Open mouth. Increase preassure. And use alternative airway (ET tube or lyryngeal mask airway)
Endotracheal tube placement may be indicated during neonatal resuscitation if
initial ET suctioning of non vigorous meconium stained newborn, if bag-mask ventilation is ineffective or prolonged, when chest compressions are performed, for special circumstances such as congentical diaphragmatic hernia or extremely low birth weight.
selected drugs excreted in breast milk
Acetaminophen (Datril, Tylenol, Darvocet, Excedrin)
Alcohol(ethanol)
Aspirin (bayer, Anacin, Bufferin, Fiorinal, Empirin)
Caffiene, Cocaine, Codeine, Heroin, Ibuprofen (Advil,Nuprin, Motrin), Indomethacin (Indocin), Toradol, Marujuana, Medoxyprogesterone acetate (Dep-Provera), Meperidien (demerol, mepergan), Methadone, Morphine, Naproxen (eleve), oxycodone, Phenobarbital Phenytoin (Dilantin), Propylthiouracil, thyroid and thyroxine, tolbutamide (orinase)
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