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LRN RNC

Terms in this set (81)

L/S ratio (lecithin/sphinomyelin)
test of fetal lung maturity
0.5:1 early inpregnancy
1:1 at 30-32 weeks
2:1 at 35 weeks (fully mature)
not accurant for IDM or mec/blood stained fluid
PG (phosphatidylglycerol)
test of fetal lung maturity
a part of surfactant, its presence is a sign of fetal lung maturity
appears at 36 weeks (or 35 weeks for IDM)
Reactive NST (non-stress test)
2+ accelerations in fetal heart rate 15 bpm above baseline for 15+ seconds in 20-40 minutes
(normal, reassuring result)
nonreactive NST (non-stress test)
0-1 acceleration of fetal heart rate in 40 minutes
(abnormal, concerning result)
biophysical profile
test of fetal status
includes non-stress test (NST), respirations, movement, tone, and amniotic fluid value
score 10 - normal no risk
score 6 - possible asphyxia
score 4 - repeat test same day and if 6 or less should induce delivery
score <4 - deliver immediately
triple screening
used to detect neural tube defects at 15-16 weeks
serum AFT (alpha-fetoprotein) in the second trimester
ultrasound
amniocentesis (checking amniotic AFT)
HELLP syndrome
hemolysis, elevated liver enzymes, low platelet count
pain in upper right quadrant, flu-like symptoms
congenital and neonatal infections
CHEAP TORCHES:
Chickenpox (varicella)
Hepatitis (B, C, & E)
Enterovirus (polio)
AIDS (HIV)
Parvovirus
Toxoplasmosis
Other (GBC, Candida, Listeria, TB)
Rubella (measles)
Cytomegalovirus [most common]
Herpes Simplex Virus (HSV)
Every other STD (Chlamydia, gonorrhea, papilloma)
Syphilis

exposure to these in utero (especially 1st trimester) may cause miscarriage or congenital defects
HSV
primary outbreak has 50% chance of transmission
should deliver c/s within 4-6 hrs after rupture

signs of neo infection:
skin, eye, membrane blistering DOL 10-12
encephalitis (lethargy, seizures)
organ failure
Hepatitis B vaccine
schedule: hospital discharge, 2 months, 6 months
premature schedule: 2000g or 2 mo
give immunoglobulin injection within 12 hours if mother is positive
Hepatitis C
rarely transmitted to baby, 75% clear virus by 2 years
Hepatitis E
20% mortality, highest risk of fetal complications and death
vertical transmission
from parent to child
HIV/AIDS
antivirals for mom during pregnancy
elective cesarean before rupture
antivirals for baby for 6 weeks (give within 12 hours of birth)
avoid breastfeeding
toxoplasmosis
caught through undercooked meat, unpasturized goat milk, cat feces
fetal CNS anomalies, miscarriage, death
GBS (group B streptococcus)
all pregnant women are screened around 36 weeks
need at least 4 hours of antibiotic treatment before delivery
14 days of IV amp & gent for baby to prevent sepsis
chorioamnionitis
risk of sepsis for mother and baby, more likely in PPROM, commonly caused by E. coli
maternal symptoms: fever, tachycardia, hypotension, uterine tenderness, elevated WBC
grand multiparity
five or more pregnancies >20 weeks
polyhydramnios
>500 ml amniotic fluid
increased risk of preterm delivery

associated with:
EA, TEF, duodenal atresia
anencephaly
CNS anomilies that impair swallow reflex
hydrops
twin to twin transfusion
macrosomia
chromosomal abnormalities
skeletal malformations
risk of prolapsed cord and placental abruption
oligohydramnios
<500 ml amniotic fluid
after 20 weeks most of the amniotic fluid is excreted by the baby

associated with:
urinary tract anomalies (renal ageneiss, polycystic kidneys, obstruction uropathy)
pulmonary hypoplasia
pressure deformities such as club foot
compression of umbilical cord, hypoxia
meconium staining
post term gestation
PPROM, leaking fluid
fetomaternal hemorrhage
>30 ml fetal blood enters into maternal bloodstream
Kleihaure-Betke tests for presence of fetal hemogolbin in maternal blood

risk factors:
trauma
abruption
placental tumors
3rd trimester amniocentesis
hydrops
twins
preterm
37 weeks
post-term
>42 weeks
Naegele's rule
add 7 days to LMP, subtract 3 months, add 1 year
malpresentation
cephalic:
military - head erect and neck not flexed, usually self corrects
brow - neck extended, increases diameter of head (risk of tracheal damage)
face - neck severely extended (risk of neck damage)

breech
shoulder - extreme risk of uterine rupture, cesarean required
compound - two presenting parts, increased chance of laceration
meconium stain
if infant is crying - suction mouth nose and throat
if RDS - intubate and suction trachea, consider suctioning stomach contents
early decels
caused by head compressions, normal
late & variable decels
caused by cord compressions, OEL
300 calories
additional calorie needs per day during 2nd and 3rd trimesters
gravida
any pregnancy (including current), regardless of duration/outcome
nulligravida
a woman who has never been pregnant
primigravida
a woman who is pregnant for the first time
multigravida
woman in her second or subsequent pregnancy
para
delivery of live or stillborn baby >20 weeks
nullipara
a woman who has not given birth at more than 20 weeks gestation
primapara
a woman who has given birth one time >20 weeks gestation
multipara
woman who has given birth to two or more children
grand multipara
A woman who has delivered 5 or more babies at more than 20 weeks gestation
gestation
number of weeks since the first day of the last mestrual period (LMP)
abortion
death of fetus <20 weeks
stillbirth
death of fetus >20 weeks
calcium
10.4-17.6 days 0-10
9-11 up to 2 years
sodium
133-146
potassium
2.7-5.9
blood gas pH
7.26-7.44
blood gas PaCO2
35-45
blood gas PaO2
>80
blood gas HCO3
22-28
blood gas SaO2
>92-95%
hemoglobin
14.5-22.5
hematocrit
48-69%
3 days 44-75%
2 months 28-42%
reticulocyte count
0.5-1.5%
platelets
150,000-400,000
Thyroid Stimulating Hormone (TSH)
<20 mIU/L
Non-shivering thermogenesis (NST)
oxidation of brown fat to create heat
conduction
heat transfer between solid objects of different temperatures in contact with each other
(baby placed on cold scale)
convection
transfer of heat through air currents
(hot air circulating in incubator warms infant)
radiation
heat transferred between two objects that are not in contact
(radiant warmer uses infrared rays to heat infant)
evaporation
loss of heat that occurs when moisture evaporates from the surface of skin, bigger problem for infants <31 weeks with less keratin in their skin
(wet baby loses more heat than a dry baby)
hypertension
most likely a renal cause
term: systolic >90 diastolic >60
preterm: systolic >80 diastolic >50
MAP should be > or = gestational age
widened S2 split
ASD
tetralogy of fallot
pulmonary stenosis
Ebstein's anomaly
absent S2 split
pulmonary atresia or stenosis
aortic atresia or stenosis
PPHN (persistent pulmonary hyptertension)
Cyanotic congenital heart disease
decreased pulmonary blood flow:
tetralogy of fallot
tricuspid atresia

mixed blood flow:
Ebstein's anomaly
hypoplastic left heart (HLH)
total anomalous pulmonary venous return (TAPVR)
transposition of the great arteries (TGA)
truncus arteriousus
Acyanotic congenital heart defects
increased pulmonary flow:
atrial septal defect (ASD)
atrioventricular canal defect (AV canal)
patent ductus arteriosus (PDA)
ventricular septal defect (VSD)

obstructed ventricular blood flow:
aortic stenosis
coarctation of the aorita
pulmonic stenosis
tetralogy of fallot (4 defects)
ventricular septal defect (VSD)
pulmonic stenosis
overriding aorta
right ventricular hypertrophy
tx surgery
Transposition of the Great Arteries (TGA)
A defect in which the great vessels are reversed; the aorta is connected to the right ventricle, and the pulmonary artery is connected to the left ventricle
oxygenated blood circulates to the lungs, deoxygenated blood circulates to the body
tx prostins, surgery
patent ductus arteriosus (PDA)
duct between the aorta and the pulmonary artery remains open after birth, L -> R shunt
machine-like murmur
tx indomethacin, ligation, coil, tylenol
ventricular septal defect (VSD)
opening between right and left ventricules
risk for bacterial endocarditis & pulmonary infections
tx lasix, ACE inhibitors, surgery
coarctation of the aorta (CoA)
narrowing/stricture of the aorta
difference in upper and lower blood pressures
tx prostins, balloon angioplasty, surgery
atrial septal defect (ASD)
opening between the atria
tx cardiac cath, surgery
shock
inadequate perfusion to meet metabolic needs of the body
1. hypotension
2. hypoxemia
3. metabolic acidosis
atropine
T = makes you more Tachycardic
adenosine
ADE = AED restarts the heart
persistent pulmonary hypertension (PPHN)
pulmonary vascular pressure remains high enough after birth that blood continues to bypass the lungs through the PFO and PDA, results in decreased oxygenation of circulating blood
PaO2
titration to maintain 50-80 mmHg
caput succedaneum
collection of fluid under the skin, swelling crosses suture lines
complications are rare
cephalohematoma
collection of blood below the periosteum, swelling does not cross suture lines
complications: jaundice, anemia, hypovolemia
cystic hygroma
fluid filled cyst in newborn's head or neck caused by a blockage of the lymphatic system
usually caused by fetal exposure to drugs, infection, or genetic syndrome
immature to total neutrophil ratio (I:T)
>0.2 indicates sepsis
I:T = % bands / (% bands + % segs)
bands
immature neutrophils
segs
mature neutrophils
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