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161 Cards in this Set
- Front
- Back
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LBW
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Low birth weight <2500g
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VLBW
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very low birth weight <1500g
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ELBW
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extremely low birth weight <1000g
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AGA
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appropriate for gestational age infant
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SGA
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small for gestational age infant, falls below the 10th percentile
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IUGR
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intrauterine growth retardation
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LGA
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Large for gestational age, greater than 90th percentile
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Preterm
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less than 37 weeks gestation
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postmature
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greater than 42 weeks gestation
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Live Birth
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Birth in which the neonate manifest any heartbeat, breathes, or displays voluntary movement, regardless of gestational age
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Fetal Death
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death of a fetus after 20 weeks gestation and before delivery, with absence of any signs of life after birth.
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Neonatal Death
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occurs in the first 27 days of life
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Perinatal mortality
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total number of neonatal deaths/1000 live births
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HELLP syndrome
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hemolysis, elevated liver enzymes, and low platelet count (associated with preeclampsia)
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Risk factors for preterm infants
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- gestational hypertension
- multiple pregnancy - HELLP - Premature dilation of the cervix - Placental or umbilical cord conditions that affect the fetus reception of nutrients |
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When is an infant's suck reflex absent?
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Below 33 weeks
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Signs and symptoms of respiratory distress in newborn
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- Flaring of the nares
- Expiratory grunting - Retractions of the chest - Increasing resp effort: paradoxical breathing patterns, tachypnea, apnea, cyanosis. |
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Interventions for RDS
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- O2 therapy
- surfactant administration |
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Surfactant
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surface-active phospholipid secreted by alveolar epithelium at about the 24th week gestation
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Preterm infants prior to 32 weeks...
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do not have adequate amounts of pulmonary surfactant to survive extrauterine life .
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What may a deficiency in surfactant be caused by?
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- Insufficient surfactant production
- Abnormal composition and function - Disruption of surfactant - A combination of any of the above |
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What are some possible adverse reactions to surfactant?
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Transient bradycardia, rales (manufactured artificially)
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Nursing implications when using survanta
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- suction infant before administration
- assess infant's resp rate, rhythm, ABGs, and color prior to admin. - ensure proper ET tube placement - change position during admin to encourage drug to flow to both lungs - assess infant's resp rate, rhythm, ABGs, and color after admin - do not suction ET tube for 1 hour after admin to avoid removing the drug |
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Why is it important to monitor O2 blood levels carefully with oxygen replacement?
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O2 therapy at high rates can cause retinal detachment and broken retinal vessels/capillaries. It's not unusual for preterm infants to require glassess.
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What is chronic lung disease (CLD)?
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It's a chronic pulmonary complication from immature resp system and prolonged ventiliation/O2 therapy.
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S/s of CLD
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- Tachypnea
- Retraction - Nasal flaring - Increased work of breathing - Exercise intolerance (feeding and handling) - Tachycardia |
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Why are infants at risk for heat loss?
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- Limited stores of brown fat**.
- Large surface area in relation to weight. |
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How is body temp controlled?
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Using a neutral thermal environment (NTE), such as an incubator or radiant warmer.
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What is a common sign of neonatal infection?
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hypothermia
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What are some complications of prematurity?
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- Respiratory distress syndrome (RDS)
- Patent Ductus Arteriosus (PDA) - Periventricular-Intraventricular Hemorrhage (PV-IVH) - Necrotizing Entercolitis (NEC) |
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What is RSD (respiratory distress syndrome) caused by?
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A lack of pulmonary surfactant.
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What is a clinical symptom of RDS?
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Respiratory or mixed acidosis, increased CO2. RDS usually presents itself immediately or within 6 hours.
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Why does the ductus arteriosus remain open during fetal life?
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Because it is stimulated by prostaglandins (PGE) from the placenta and low oxygen level of fetal blood.
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What are some menstrual disorders?
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- amenorrhea
- hypogonadotropic amenorrhea - dysmenorrhea - secondary dysmenorrhea - premenstrual syndrome (PMS) - alterations in cyclic bleeding - endometriosis |
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Amenorrhea
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Absence of menstrual flow, most often the result of pregnancy.
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Hypogonadotropic amenorrhea
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Problem in the central hypothalamic-pituitary axis. Results from hypothalamic suppression.
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Dysmenorrhea
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Pain during or shortly before menstruation.
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Primary dysmenorrhea
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Abnormally increased uterine activity. Non-steroidal anti-inflammatory drug is used to alleviate discomfort.
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Secondary dysmenorrhea
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Acquired menstrual pain. Secondary dysmenorrhea is pain that is caused by a disorder in the woman's reproductive organs. Pain from secondary dysmenorrhea usually begins earlier in the menstrual cycle and lasts longer than common menstrual cramps.
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Premenstrual syndrome (PMS)
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Cyclic symptoms occurring in luteal phase of menstrual cycle. It's a cluster of physical, psychologic, and behavioral symptoms.
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Premenstrual dysphoric disorder (PDD)
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It's a severe variant of PMS. Women with PMDD find that it has a very disruptive effect on their lives.
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What are some treatments for PMS?
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- diet and exercise
- herbal therapies |
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Alterations in cyclic bleeding
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It's dysfunctional uterine bleeding.
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Endometriosis
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The presence and growth of endometrial tissue outside of the uterus. The major symptoms are dysmenorrhea and deep pelvic dyspareunia (painful intercourse). The treatment is drug therapy and surgical intervention.
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Premenstrual dysphoric disorder (PDD)
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It's a severe variant of PMS. Women with PMDD find that it has a very disruptive effect on their lives.
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What are some bacterial STIs?
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- Chlamydia
- Gonorrhea - Syphilis - Pelvic inflammatory disease (PID) |
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Alterations in cyclic bleeding
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It's dysfunctional uterine bleeding.
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Endometriosis
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The presence and growth of endometrial tissue outside of the uterus. The major symptoms are dysmenorrhea and deep pelvic dyspareunia (painful intercourse). The treatment is drug therapy and surgical intervention.
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What are some bacterial STIs?
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- Chlamydia
- Gonorrhea - Syphilis - Pelvic inflammatory disease (PID) |
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What are the major symptoms of Endometriosis?
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The presence and growth of endometrial tissue outside of the uterus. The major symptoms are dysmenorrhea and deep pelvic dyspareunia (painful intercourse). The treatment is drug therapy and surgical intervention.
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Premenstrual dysphoric disorder (PDD)
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It's a severe variant of PMS. Women with PMDD find that it has a very disruptive effect on their lives.
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What are some treatments for PMS?
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- diet and exercise
- herbal therapies |
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What are some bacterial STIs?
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- Chlamydia
- Gonorrhea - Syphilis - Pelvic inflammatory disease (PID) |
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Alterations in cyclic bleeding
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It's dysfunctional uterine bleeding.
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Endometriosis
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The presence and growth of endometrial tissue outside of the uterus. The major symptoms are dysmenorrhea and deep pelvic dyspareunia (painful intercourse). The treatment is drug therapy and surgical intervention.
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What are some bacterial STIs?
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- Chlamydia
- Gonorrhea - Syphilis - Pelvic inflammatory disease (PID) |
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Chlamydia
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a common sexually transmitted disease (STD) caused by the bacterium, Chlamydia trachomatis, which can damage a woman's reproductive organs. Even though symptoms of chlamydia are usually mild or absent, serious complications that cause irreversible damage, including infertility, can occur "silently" before a woman ever recognizes a problem. Chlamydia also can cause discharge from the penis of an infected man.
Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth. Any sexually active person can be infected with chlamydia. The greater the number of sex partners, the greater the risk of infection. Because the cervix (opening to the uterus) of teenage girls and young women is not fully matured, they are at particularly high risk for infection if sexually active. Since chlamydia can be transmitted by oral or anal sex, men who have sex with men are also at risk for chlamydial infection. |
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Gonorrhea
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a sexually transmitted disease (STD). Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus.
Gonorrhea is spread through contact with the penis, vagina, mouth, or anus. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread from mother to baby during delivery. People who have had gonorrhea and received treatment may get infected again if they have sexual contact with a person infected with gonorrhea. |
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Syphilis
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a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those of other diseases.
Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils. |
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Syphilis manifests in 3 stages.
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Primary, secondary, and tertiary.
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Primary Syphilis
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Primary syphilis begins after infection. Usually, it takes between two and six weeks for symptoms to manifest. During this stage, a painless sore called a chancre will appear somewhere on your body, generally at the point of infection. Typically, these chancres will grow on your genitals, anus, lips, or tongue, but they can appear on other body parts too. Sometimes the chancres grow inside the genitals, making the infection hard to diagnose. The chancre will disappear within a few weeks of their appearance. If left untreated, your syphilis may become chronic.
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Secondary syphilis
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Secondary syphilis begins 3 to 6 weeks after the disappearance of your chancres. The syphilis rash will appear. This is a brown skin rash that will appear on the soles of your feet and the palms of your hands. This rash can spread to cover your whole body or it may be limited to certain areas. This rash can be contagious, so it is important to avoid skin-to-skin contact with an uninfected person. You will experience other mild symptoms, including fever, sore throat, swollen glands, and hair loss. These syphilis symptoms can also disappear without treatment. They may reoccur for up two years before you progress to the next stage of the disease.
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Tertiary syphilis
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80% of those with secondary syphilis will also experience tertiary syphilis. This stage can last for decades and is more difficult to treat. Symptoms become more dangerous to your body and can include damage to the joints, weakening of the bones, gradual blindness, heart disease, and liver disease. Treatment is still an option, even at this stage.
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Pelvic Inflammatory Disease
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Occurs when chlamydia or gonorrhea (or other bacterial infection) migrates from the vagina and endocervix into the uterus and uterine tubes. S/s include dull cramping/pain, discharge, and fever.
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Viral infections
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- Human Papillomavirus (HPV)
- Herpes Simplex Virus (HSV) - Human Immunodeficiency Virus (HIV) |
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Human Papillomavirus (HPV)
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Several different strains of the virus, 16 and 18 have the highest rate for causing cervical cancer.
The types of HPV that infect the genital area are spread primarily through genital contact. Most HPV infections have no signs or symptoms; therefore, most infected persons are unaware they are infected, yet they can transmit the virus to a sex partner. Rarely, a pregnant woman can pass HPV to her baby during vaginal delivery. A baby that is exposed to HPV very rarely develops warts in the throat or voice box. |
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Herpes Simplex Virus (HSV)
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Two types: I and II. There is pain and recurrent genital ulcers. Neonatal herpes is fatal. Risk is highest with a primary infection of HSV-II. There is no cure.
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Vaginal infections
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- Bacterial vaginosis
- Candidiasis (yeast infection) - Trichomoniasis - Group B strep (GBS) |
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Bacterial vaginosis
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Sexually associated, presence of anaerobic bacteria causes a change in vaginal pH. S/s include odor and discharge. Treatment is Metronidazole. This can cause preterm labor.
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Trichomoniasis
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Almost always sexually transmitted. S/s include greenish, frothy, malodorous, purulent discharge, pruritis, "strawberry spots" on vagina, cervix. Both partners are treated with metronidazole.
Trichomoniasis is caused by the single-celled protozoan parasite, Trichomonas vaginalis. The vagina is the most common site of infection in women, and the urethra (urine canal) is the most common site of infection in men. The parasite is sexually transmitted through penis-to-vagina intercourse or vulva-to-vulva (the genital area outside the vagina) contact with an infected partner. Women can acquire the disease from infected men or women, but men usually contract it only from infected women. |
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When does PMS start and end?
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Begins in the luteal phase (after ovulation) of the menstrual cycle and ends with the onset of menses.
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What is endometriosis characterized by?
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Secondary amenorrhea, dyspareunia, abnormal uterine bleeding, and infertility.
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dyspareunia
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is painful sexual intercourse, due to medical or psychological causes. The term is used almost exclusively in women, although the problem may occur in men.
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PDA
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After birth, the ductus arteriosus is supposed to close within a few days as part of the normal changes occurring in the baby's circulation. In some babies, however, the ductus arteriosus remains open (patent). This opening allows blood to flow directly from the aorta into the pulmonary artery, which can put a strain on the heart and increase the blood pressure in the lung arteries.
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Periventricular-Intraventricular Hemorrhage (PVH-IVH)
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One of the most common types of brain injury that occurs in neaonates and most severe.
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Necrotizing Enterocolitis (NEC)
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A gastrointestinal disease that mostly affects premature infants, NEC involves infection and inflammation that causes destruction of the bowel (intestine) or part of the bowel. NEC typically occurs within the first 2 weeks of life, usually after milk feeding has begun. It is thought that the intestinal tissues of premature infants are weakened by too little oxygen or blood flow, and when feedings are started, the added stress of food moving through the intestine allows bacteria that are normally found in the intestine to invade and damage the wall of the intestinal tissues. The damage may affect only a short segment of the intestine, or it may progress quickly to involve a much larger portion.
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What does cold do to a newborn?
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Cold stress increases the need for O2 and may deplete glucose stores.
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When caring for a newborn the nurse must be alert for signs of cold stress which would include what?
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Increased respiratory rate. Additional signs of cold stress, include increased activity level and crying (increase BMR and heat production) and hypoglycemia as glucose stores are depleted. Newborns are unable to shiver as a means to increase heat production; they increase their activity level instead.
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Meconium Aspiration Syndrome (MAS)
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Every expectant parent hopes for an uncomplicated birth and a healthy baby. But some babies do face delivery room complications. One condition that may affect a newborn's health is meconium aspiration, also referred to as meconium aspiration syndrome (MAS). Although it can be serious, most cases of MAS are not.
About Meconium Aspiration MAS can happen before, during, or after labor and delivery when a newborn inhales (or aspirates) a mixture of meconium and amniotic fluid (the fluid in which the baby floats inside the amniotic sac). Meconium is the baby's first feces, or poop, which is sticky, thick, and dark green and is typically passed in the womb during early pregnancy and again in the first few days after birth. The inhaled meconium can partially or completely block the baby's airways. Although air can flow past the meconium trapped in the baby's airways as the baby breathes in, the meconium becomes trapped in the airways when the baby breathes out. And so, the inhaled meconium irritates the baby's airways and makes it difficult to breathe. MAS can affect the baby's breathing in a number of ways, including chemical irritation to the lung tissue, airway obstruction by a meconium plug, infection, and the inactivation of surfactant by the meconium. |
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Persistent Pulmonary Hypertension (PPH)
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In a baby with PPHN, the fetal circulatory system doesn't "switch over." The ductus arteriosus remains open, and the baby's blood flow continues to bypass the lungs. Even though the baby is breathing, oxygen in the breathed air will not reach the bloodstream. Because the blood returning from the body is unable to enter the lungs properly - and instead flows through the still-open ductus arteriosus - it returns to the heart in an oxygen-poor state.
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Erb's Palsy (Brachial Plexus)
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If your newborn can move one arm but not the other, he or she may have a condition called Erb's palsy. The inability to move the arm is a symptom of an injury to the brachial plexus, a network of nerves that provides movement and sensation to the arm, hand and fingers.
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Bell's Palsy (Facial Palsy)
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Bells palsy is a condition that causes the facial muscles to weaken or become paralyzed. It's caused by trauma to the 7th cranial nerve, and is not permanent.
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Treatment for a clavical fracture
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gentle handling, supporting the shoulder when changing moving infant, education.
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Signs of a clavical fracture
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Limited use of the arm, absence of Moro reflex on affected side, crepitus over the bone.
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Signs of Erb's Palsy
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Arm hangs limps at one side, shoulder and arm are adducted and internally rotated, a grasp reflex may be present.
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Treatment for Erb's Palsy
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Immobilize on the upper abdomen, ROM exercises, supportive splints to decrease wrist flexion contractures, undress beginning with the unaffected side and dress beginning with the affected side. Teach parents to use a football hold when holding the infant.
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Subdural hematoma
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It's bleeding into the space between the dura and arachnoid membrane resulting from trauma lacerated small veins in this area.
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Subarachnoid hemorrhage
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Bleeding into the space that lies between the arachnoid membrane and the pia mater and contains cerebrospinal fluid (CSF) Most common ICH.
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When may Subdural hematoma and Subarachnoid hemorrhage occur?
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- to term infants as a result of trauma
- to preterm infants as a result of hypoxia |
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Signs and symptoms of subarachnoid hemorrhage and subdural hematoma
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- asymptomatic
- CNS depression or irritability and/or seizure - poor feeding - apnea - unequal pupils - Infant may appear normal until seizing starts on the 2nd - 3rd day |
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Nursing implications for subarachnoid hemorrhage and subdural hematoma
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- supportive
- monitoring neurological - IV therapy - Observation and management of seizures - prevention of ICP |
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What are some general types of neonatal infections?
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Bacterial, viral, and fungal
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What are the 2 patterns of neonatal bacterial infections?
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Congenital (early onset) and nosocomial infection (late onset)
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congenital bacterial neonatal infections
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- manifests within 24-48 hours
- progresses rapidly - usually caused by microorganism from the normal flora of the maternal vaginal tract. |
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nosocomial bacterial neonatal infections
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- commonly seen after 2 weeks
- slower progression - bacteria responsible for late onset is varied, may be acquired from the birth canal or external environment |
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Neonatal viral infections
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- may cause miscarriage, stilbirth, intrauterine infection, congenital malformations, and acute neonatal disease.
- May cause chronic infection (herpes). - Important to recognize infection in the neonatal period to be able to treat acute infection, prevent nosocomial infections to other newborns, anticipate growth and development problems. |
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Maternal risk factors for neonatal sepsis
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- low socioeconomic status
- poor perineal care - poor nutrition - susbstance abuse |
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Neonatal risk factors for neonatal sepsis
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- Multiple gestation
- male - birth asphyxia - MAS - congenital abnormalities of skin or mucous membranes - Galactosemia - Absence of spleen - LBW - Prematurity/post mature - IUGR - Prolonged hospitalization |
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Galactosemia
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It's a hereditary disease that is caused by the lack of a liver enzyme required to digest galactose. Galactose is a breakdown product of lactose, which is most commonly found in milk products. Since galactose cannot be broken down, it builds up in the cells and becomes toxic. The body then produces abnormal chemicals, which causes the symptoms seen in infants with untreated galactosemia.
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Intrapartum risk factors for neonatal sepsis
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- PROM
- maternal fever - chorioamnionitis prolonged labor - rupture of membranes > 12-18 hours - premature labor - maternal urinary tract infection |
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Septicemia
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generalized infection in the blood
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Signs and symptoms of sepsis
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- apnea, bradycardia, tachypnea
- grunting nasal flaring, retractions, decrease in O2 sat, metabolic acidosis - Feeding intolerance (decreased suck, strength and intake, increase residuals - decreased cardiac output, tachycardia, hypotension, decreased perfusion - temp instability, lethargy, hypotonia, irritability, seizures - jaundice, pallor, petechiae, mottling |
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What are the serious consequences of immobilization?
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- Physical
- Social - Psychologic - Muscular system - Decreased muscle strength and endurance - Atrophy - Loss of joint mobility - Bone demineralization - Negative calcium balance - Decreased metabolic rate - Negative nitrogen balance - Hypercalcemia - Decreased production of stress hormones - Decreased efficiency of orthostatic neurovascular reflexes - Diminished vasopressor mechanism - Altered distribution of blood volume - Venous stasis - Decreased need for oxygen - Diminished vital capacity - Poor abdominal tone and distention - Mechanical or biochemical secretion retention - Loss of respiratory muscle strength - Dependent edema GI system - Distention caused by poor abdominal muscle tone - Difficulty feeding in prone position - Gravitation effect on feces - Anorexia - Decreased circulation and pressure leading to decreased healing capacity - Alteration of gravitational force - Difficulty voiding in supine position - Urinary retention |
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Psychological effects of immobilization
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- Diminished environmental stimuli
- Altered perception of self and environment - Increased feelings of frustration, helplessness, anxiety - Depression, anger, aggressive behavior - Developmental regression |
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What is the most crucial time for Soft Tissue Injuries?
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The first 12 hours are the most crucial.
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What is RICE?
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- Rest
- Ice - Compression - Elevation |
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What is ICES?
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- Ice
- Compression - Elevate - Support No heat before examination |
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What is the most frequently broken bone in childhood?
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clavicle
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Therapeutic Management of Soft Tissue Injuries
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- RICE and ICES
- Rest the injured part - Immediately (max 30 min at a time) - Wet elastic bandage for compression - Elevation of the extremity - Immobilization and support (casts or splints as appropriate to injury) |
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Types of Fractures
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- Compound or open
- Complicated - Comminuted - Greenstick |
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compound or open fracture
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fractured bone protrudes through the skin
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Complicated fracture
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bone fragments have damaged other organs or tissues
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Comminuted fracture
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small fragments of bone are broken from fractured shaft and lie in surrounding tissue
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Greenstick fracture
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compressed side of bone bends, but tension side of bone breaks, causing incomplete fracture
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Epiphyseal Injuries
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- Weakest point of long bones is the cartilage growth plate (epiphyseal plate)
- Frequent site of damage during trauma - May affect future bone growth - Treatment may include open reduction and internal fixation to prevent growth disturbances |
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Clinical Manifestations of Fracture
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- Generalized swelling
- Pain or tenderness - Diminished functional use - May have bruising, severe muscular rigidity, crepitus |
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Assessment of Fractures: The 5 P’s
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- Pain and point of tenderness
- Pulse—distal to the fracture site - Pallor - Paresthesia — sensation distal to the fracture site - Paralysis — movement distal to the fracture site |
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Why is traction used?
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- To provide rest for an extremity
- To help prevent or improve contracture deformity - To correct deformity - To treat dislocation - To allow position and alignment - To provide immobilization - To reduce muscle spasms (rare in children) |
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Manual traction
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applied to body part by the hand placed distally to fracture site
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Skin traction
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pulling mechanisms are attached to skin with adhesive material or elastic bandage
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Skeletal traction
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Applied directly to skeletal structure by pin, wire, or tongs inserted into or through diameter of bone distal to fracture
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Cervical Traction
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- Crutchfield or Barton tongs
- Inserted through burr holes in skull with weights attached to the hyperextended head - As neck muscles fatigue, vertebral bodies gradually separate so the spinal cord is no longer pinched between vertebrae - Halo traction can be applied in some cases |
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Nursing Considerations for traction
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- Maintain traction
- Maintain alignment - Skin traction - Skeletal traction - Prevent skin breakdown - Prevent complications |
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Distraction
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- Process of separating opposing bone to encourage regeneration of new bone in created space
- Can be used when limbs are unequal in length and new bone is needed to elongate shorter limb |
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Amelia
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absence of entire extremity
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Mecromelia
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partial absence of extremity
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Phocomelia
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deficiency of long bones with relatively good development of hands and feet attached at or near shoulder or hip (“seal limbs”)
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Osteogenesis Imperfecta (OI)
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- A group of heterogeneous inherited disorders of connective tissue
- Characterized by excessive fragility and bone defects - Defective periosteal bone formation and reduced cortical thickness of bones - Hyperextensibility of ligaments |
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Legg-Calvé-Perthes Disease
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- Self-limited, idiopathic, occurs in juveniles ages 3 to 12, more common in males ages 4 to 8
- Avascular necrosis of femoral head - 10% to 15% cases have bilateral hip involvement - Most have delayed bone age - Pathophysiology: cause is unknown but involves disturbed circulation to the femoral head with ischemic aseptic necrosis - After resolving may have normal femoral head or may have severe alteration |
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Kyphosis
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- Abnormally increased convex angulation in the curvature of the thoracic spine
- Most common form is postural - Can result from TB, arthritis, osteodystrophy, or compression fracture |
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Lordosis
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- Accentuation of the cervical or lumbar curvature beyond physiologic limits
- May be idiopathic or secondary complication of trauma - May occur with flexion contractures of hip, congenital dislocated hip - In obese children, abdominal fat alters center of gravity, causing lordosis |
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Scoliosis
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- Most common spinal deformity
- Complex spinal deformity in three planes - May be congenital or develop during childhood |
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Therapeutic Management of scoliosis
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- Team approach to treatment
- Bracing - Exercise - Surgical intervention for severe curvature (instrumentation and fusion) |
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Osteomyelitis
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- Inflammation and infection of bony tissue
- May be caused by exogenous or hematogenous sources |
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Exogenous
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infectious agent invades bone following penetrating wound, open fracture, contamination in surgery, or secondary extension from abscess or burn.
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Hematogenous
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pre-existing infection spreads to bone, any organism can cause osteo
Infective emboli travels to arteries in bone metaphsis, causing abcess formation and bone destruction |
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Osteomyelitis
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- Signs/symptoms begin abruptly, resemble symptoms of arthritis and leukemia
- Marked leukocytosis - Bone cultures obtained from biopsy or aspirate - Early x-rays may appear normal - Bone scans for diagnosis |
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Therapeutic Management of Osteomyelitis
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- May have subacute presentation with walled-off abscess rather than spreading infection
- Prompt, vigorous IV antibiotics for extended period (3-4 weeks or up to several months) - Monitor hematologic, renal, hepatic responses to treatment |
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Nursing Considerations for Osteomyelitis
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- Complete bed rest and immobility of limb
- Pain management concerns - Long-term IV access (for antibiotic administration) - Nutritional considerations - Long-term hospitalization/therapy - Psychosocial needs |
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Systemic Lupus Erythematosus (SLE)
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- Chronic, multisystem, autoimmune disease of connective tissues and blood vessels
- Characterized by inflammation - Symptoms variable and unpredictable - Symptoms mild to life threatening |
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Incidence of SLE
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- More common in females ages 10 to 19 years
- More common in African-American, Asian, and Hispanic children - Familiar tendency - Cause unknown - Possible triggers: hormonal imbalance, immune disorders, environmental exposure to drugs, infection, stress, chemical agents |
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Incidence of SLE (systemic lupus erythematosus)
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- More common in females ages 10 to 19 years
- More common in African-American, Asian, and Hispanic children - Familiar tendency - Cause unknown - Possible triggers: hormonal imbalance, immune disorders, environmental exposure to drugs, infection, stress, chemical agents |
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Clinical Manifestations of SLE
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- Cutaneous lesions, lymphadenopathy
- Nausea, vomiting, diarrhea, and pain - Generalized weakness, arthritis, joint pain and stiffness without deformity - Forgetfulness, seizures, paralysis - Pleurisy, pericarditis Proteinuria and renal failure |
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TORCH
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Stands for toxoplasmosis, Other agents, especially syphilis, but also hepatitis B, coxsackie virus, Epstein-Barr virus, varicella-zoster virus, and human parvovirus, Rubella, Cytomegalovirus, Herpes Simplex
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Cytomegalovirus
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Cytomegalovirus (CMV) is a type of herpes virus that often causes asymptomatic infection in otherwise healthy persons.
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Group B strep
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It's a bacterium that causes life-threatening infections in newborns. Many people carry group B strep bacteria in their bodies without developing infection or illness. However, the bacteria can become deadly to people with weakened immune systems. Pregnant women can transmit group B strep to their newborns at birth. It's the most common cause of blood infections and meningitis in newborns.
Most cases of group B strep disease in newborns can be prevented by giving certain pregnant women antibiotics during labor. In newborns, group B strep is the most common cause of sepsis (infection of the bloodstream) and meningitis (infection of the lining and fluid surrounding the brain) and a common cause of pneumonia. Group B strep disease in newborns usually occurs in the first week of life ("early- onset"). Babies can also get a slightly less serious "late-onset" form of group B strep disease that develops a week to a few months after birth. |
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E Coli
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A bacteria that causes severe cramps and diarrhea. It's a leading cause of bloody diarrhea.
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Thrush
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Oral thrush is a disorder caused by infection of the mouth with the fungus (yeast) Candida albicans.
May be caused by factors that reduce the natural resistance, such as illness, stress, long-term use of corticosteroids or medications that suppress the immune system, commonly associated with use of antibiotics, but it may also occur with uncontrolled diabetes mellitus and with the hormonal changes associated with pregnancy or the use of birth control pills. |
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Fetal Alcohol Syndrome
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FAS is one of the leading known preventable causes of mental retardation and birth defects. If a woman drinks alcohol during her pregnancy, her baby can be born with FAS, a lifelong condition that causes physical and mental disabilities. FAS is characterized by abnormal facial features, growth deficiencies, and central nervous system (CNS) problems. People with FAS might have problems with learning, memory, attention span, communication, vision, hearing, or a combination of these. These problems often lead to difficulties in school and problems getting along with others. FAS is a permanent condition. It affects every aspect of an individual’s life and the lives of his or her family. Causes Small size for gestational age or small stature in relation to peers and Sleep and sucking disturbances in infancy.
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cocaine
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When taken early in pregnancy there's an increased risk of miscarriage, while later on it may trigger premature labour. Cocaine doubles the risk of a premature baby. As well as being born early, the baby may be 'small for dates' and with a smaller head (suggesting a smaller brain) because the drug restricts the blood supply (and so nutrition) to the baby. Small babies like this are much more vulnerable, especially in the first few weeks of life, and are at greatly increased risk of cerebral palsy, developmental problems, visual and hearing disabilities. Cocaine can also cause death of the baby in the womb, or a stroke so that the baby is born with brain damage. It also increases the risk of placental abruption and ante-partum hemorrhage, where the placenta comes away from the inside of the womb leading to potentially fatal bleeding.
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Heroin
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Heroin can cross the placenta and an unborn baby can become dependent on the drug. Babies of heroin-dependent mothers can suffer withdrawal symptoms after they are born. They often need special care in hospital. These babies are often born underdeveloped. They suffer from breathing problems and infections in the first few weeks of life. Heroin can cause premature labor. Babies may be born so early that they need intensive care. The baby's poor health can also be associated with the poor health and nutrition of their mothers.
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Methadone
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Methadone maintenance in the setting of comprehensive service provision during pregnancy reduces maternal morbidity and mortality and promotes fetal stability and growth. With an accumulated experience of over 25 years, methadone maintenance has been shown to be an invaluable and often an essential ingredient in bettering the health of women during pregnancy, in improving the outcomes of those pregnancies, and in offering opiate-addicted women a chance to improve both their lives and the lives of their families.
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What is NAS?
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Neonatal abstinence syndrome
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What may occur with methadone users?
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Seizures are more likely in babies born to methadone users.
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What can prenatal cocaine use cause?
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A mother's prenatal cocaine use may be related to an increased risk of sudden infant death syndrome (SIDS).
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What are the symptoms of neonatal abstinence syndrome?
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The following are the most common symptoms of neonatal abstinence syndrome. However, each baby may experience symptoms differently. Symptoms of withdrawal in full-term babies may include:
- tremors (trembling) - irritability (excessive crying) - sleep problems - high-pitched crying - tight muscle tone - hyperactive reflexes - seizures - yawning, stuffy nose, and sneezing - poor feeding and suck - vomiting - diarrhea - dehydration - sweating - fever or unstable temperature |
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ABO test
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The ABO test classifies people's blood into one of four types: A, B, AB, or O.
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Rh test
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Rh blood type checks for the presence (+) or absence (–) of the Rh antigen (also called the Rh factor).
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Why is Rh blood type especially important for pregnant women?
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A potential problem arises when a woman who has Rh-negative blood becomes pregnant with a baby (fetus) that has Rh-positive blood. This is called Rh incompatibility. If the blood of an Rh-positive baby mixes with the blood of an Rh-negative woman during pregnancy or delivery, the mother's immune system produces antibodies. This antibody response is called Rh sensitization and, depending on when it occurs, can destroy the baby's red blood cells.
Rh sensitization does not usually affect the health of the baby during the pregnancy in which the sensitization occurs. However, the baby of a future pregnancy is more likely to be affected if the baby's blood type is Rh-positive. Once sensitization has occurred, the baby can develop mild to severe problems (called Rh disease, hemolytic disease of the newborn, or erythroblastosis fetalis). If untreated, complications from sensitization can, in rare cases, lead to the death of an Rh-positive baby. |
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PKU
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Phenylketonuria is a type of birth defect a child inherits from both parents, who pass along the abnormal gene. A person who has phenylketonuria is missing or deficient in a specific enzyme needed to process an essential amino acid called phenylalanine. Amino acids are the building blocks for protein. For babies or adults with phenylketonuria, too much of this amino acid can be dangerous. An affected newborn needs special low-phenylalanine formula to meet its nutritional needs. Older children and adults must continue to follow a strict diet low in this amino acid.
a disease of metabolism inherited as an autosomal recessive trait. Test is not reliable until the newborn has ingested amino acid phenylalanine found in human and breast milk. Undiagnosed and untreated can cause intellectual impairment. |
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5 P’s of Labor
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- Passenger (fetus and placenta)
- Passageway (birth canal) - Powers (contractions) - Position (mother) - Psychologic response |
