NCMA 219: Midterms

TOPICS: 1. Nursing Care of At-Risk/ High Risk/ Sick Child - NEWBORN 2. Newborn Screening 3. Diseases of the Newborn 4. At-Risk / High Risk / Sick Toddlers, Preschool and School Age 5. Alterations in Oxygenation 6. Alterations in Fluid and Electrolytes and Acid-Base Balance

Less than 2500g (5.5lbs)

Low birth weight

Between 1000-1500g (3.3lbs)

Very Low birth weight

Hormones involved in CAH

Cortisol
Aldosterone
Androgens

Between 500-1000 g (2.2lbs)

Extremely low birth weight

between the 10th percentile and 90th percentile of weight for their age. Between 2500g to 4000g

Appropriate for gestational age

intrauterine growth was slow down during the time that they are inside the womb. Below the 10th percentile in the uterine growth age less than 2.5kg

Small for gestational age

Commonly see on babies who are SGA's. They fail to grow at the expected rate at the utero.

Intrauterine growth restriction

above the 90th percentile on the intrauterine growth chart for gestational age. 4kg and above

Large for gestational age

Born before completion of the 37 weeks gestation

Preterm (premature)

Between the beginning of 38 weeks of gestation and the completion of 42 weeks

full term

born after 42 weeks of gestation

post mature (post term)

born between 34 weeks and 36 weeks of gestation

late preterm

neonate manifests any heartbeat, breaths, displace voluntary movement regardless of their gestational

Live birth

death of the fetus after they have reached their 20 weeks of gestational and before they delivered

fetal death

death that occurs during the first 27 days of life

neonatal death

death that occurs during the first week

early neonatal death

total number of fetal and early neonatal deaths per 1000 live births

perinatal mortality

death that occurs at 28 days to 1 year after birth

postnatal death

Initial assessment for high risk newborn

APGAR

one of the most common anatomical part that is injured at birth. it is also the biggest part of the body

head

newborn stomach capacity day 1

5-7 ml

newborn stomach capacity day 3

22-27 ml

newborn stomach capacity week 1

45-60 ml

newborn stomach capacity 1 mos

80-150 ml

Serious lung disorder cause by immaturity and inability to produce surfactant

Respiratory Distress Syndrome

Respiratory disease syndrome is also known as

Hyaline membrane disease

which of the following is not a major sign of RDS

Tachycardia

normal pulse of newborn

120-160 bpm

normal respiration for newborn

30-69

normal blood pressure for newborn at birth

60-80/40-45 mmhg

normal blood pressure for newborn at day 10

100/50 mmhg

normal temperature for newborn

36.5-37.5c

respiratory severity score that is severe

Grade 2

respiratory severity score that is normal

Grade 0

respiratory severity score that lagging of respiration, lower chest rectractions is visible

Grade 1

The aspiration of amniotic fluid containing meconium into the fetal or newborn trachea in utero or at first breath

Meconium Aspiration Syndrome

Antibiotics prescribed for Meconium Aspiration Syndrome

Ampicillin, Gentamycin, Amikacin

Bacterial infection in the bloodstream

Sepsis or Septicemia

When can you find sepsis in infant?

first month of life

sepsis that develops in the first 2-3 days after birth

early onset sepsis

sepsis that develops within 3-7 days or 1-3 weeks after birth

late onset sepsis

a blood infection occurring in infants younger than 90 days old

Neonatal sepsis

Most common infecting organism in INFANTS

group b streptococcus (GBS)

Most common infecting organism in PRETERM-INFANTS

e.coli

refers to an excessive level of accumulated bilirubin in the blood and categorized by jaundice

Hyperbilirubinemia

breakdown product of the hemoglobin that results from RBC destruction

Bilirubin

normal values of unconjugated bilirubin

0.2-1.4 mg/dl

refers to the noninvasive monitoring of bilirubin through cutaneous reflectance measurements

Transcutaneous bilirubinometry (TcB)

Once phototherapy has been initiated TcB is still useful as screening tool

False

Main form treatment for hyperbilirubinemia

phototherapy

effective in reducing bilirubin levels in infants with RH isoimmunization and ABO incompatibility

Intravenous immunoglobulin (IVIG)

refers to the application of a special source of light to the infants exposed skin

phototherapy

most common heart disease that caused RHD

mitral valve stenosis

proceudre to determine if the newborn infant has a heritable congenital metabolic disorder

newborn screening

when will you do the nbs

24-48 hours after birth

NBS includes screening of 6 disorders:

1. Congenital Hypothyroidism
2. Congenital Adrenal Hyperplasia
3. Phenylketonuria
4. Glucose 6 Phosphate dehydrogenase deficiency
5. Galactosemia
6. Maple Syrup Urine Disease

Newborn screening act of 2004

RA 9288

endocrine disorder also referred to as cretinism

Congenital hypothyroidism

congenital hypothyroidism, mababa ang thyroid -?

t4

DOC for congenital hypothyroidism

Synthetic Levothyroxine

DOC for congenital hypothyroidism can be crushed and mixed

true

An endocrine disorder that is caused by an inborn defect in the biosynthesis of adrenal cortisol that causes severe salt or sodium losses, dehydration and abnormally high levels of male sex hormones in both b and g

Congenital Adrenal Hyperplasia

responsible for sugar balance

cortisol

Types of CAH

Classical and Non-Classical CAH

most common and severe form of CAH

Salt-wasting CAH

how many months a child must see his or her endocrinologist?

3-4 months

Inborn error of metabolism characterized by lack of enzyme phenylalanine hydroxylase

Phenylketonuria

enzyme that is need to convert phenylalanine to tyrosine

phenylalanine hydroxylase

responsible in the metabolism or reproduction in the epinephrine and norepinephrine

tyrosine

a diagnostic tool to test infants for phenylketonuria

Guthrie blood test

rare autosomal recessive disorder that results from various gene mutations leading to three distinct enzymatic deficiencies . It is also a rare metabolic disorder that affects how the body processes a simple sugar called galactose

Galactosemia

Galactosemia results from the absence if hepatic enzyme -?

Glucose 1 phosphate uridyltransferase (GALT)

Most common enzyme deficiency

glucose-6-phosphate dehydrogenase deficiency (G6PD)

an inherited disorder in which the body is unable to process certain protein building blocks properly

Maple syrup urine syndrome

ingestion of non-nutritive materials or substances

poisoning

leading drug that causes poisoning in children.
Acid base poisoning and this is non corrosive

Aspirin or Salicylate Poisoning (ASA Poisoning)

Which among the following is not a sign of major ASA poisoning

Nausea, Vomiting, Diarrhea

First sign of severe ASA poisoning

Hyperventilation

What will you give to induce vomiting when a child accidentally ingested ASA poison?

Ipecac syrup

ASA poisoning treatment wherein it absorbs the remaining poison in the stomach

Activated Charcoal

Ingestion of Lead containing substance

Lead Poisoning

Another term for Lead poisoning

Plumbism

what are the sources of lead poisoning?

Paint, Crayons, pencil

3 organ system that Lead can damage

Hematologic System
Renal System
Neurologic System

what do you call the removal of the lead from the body

Chelation Therapy

Common health problems on toddler

Poisoning

Common health problems on school age children

enuresis

Involuntary passage of urine past the age when a child should be expected to have attained bladder control

enuresis

Medications for enuresis

Tofranil

fecal incontinence or soiling. repeated voluntary or involuntary passage of stool of normal or near-normal consistency in places not appropriate for that purpose according to the individual own sociocultural setting

Encopresis

identified by age 4 years when a child has not achieved fecal continence

Primary Encopresis

fecal incontinence occuring in a child older than 4 years of age after a period established fecal continence

Secondary Encopresis

What causes encopresis?

constipation

Soiling is produced by emotional problems caused by encopresis whuch sets up a fear-pain cycle and results in learned abnormal defecation patterns

Involuntary retention

Soiling is caused by emotional problems. it is often related to a disturbed mother-child relationship

Psychogenic encopresis

refers to developmentally inappropriate degree of inattention, impulsiveness, and hyperactivity. It is also a condition that makes it difficult for children to pay attention and or control their behavior

Attention deficit hyperactivity disorder

Major behaviors of ADHD

Impulsiveness
Hyperactivity
Inattention

The subtype of ADHD that is hyperactive but has a narrow attention span

Predominantly inattentive type

The subtype of ADHD that is hyperactive and they act before they think

Predominantly hyperactive and impulsive type

The subtype of ADHD that has a combination of inattention, hyperactivity and impulsivity

Combined type