ALL MNEUNOICS FROM EXAM 3

A = appearance (color)
P = pulse (HR)

G = grimace (reflex irritability)

A = activity (muscle tone)

R = respiratry (effort)

APGAR

Red

• NEVUS VASCULOSUS (Strawberry mark/hemangioma)

• NEVUS FLAMMEUS (port-wine stain)

• NEVUS SIMPLEX (STORK BITES/SALMON PATCHES)

• ERYTHEMA TOXICUM

• BRUISING

White

• MILIA

• VERNIX CASEOSA

• EPSTEIN PEARLS

Blue

• ACROCYANOSIS

• CONGENITAL DERMAL MELANOCYTOSIS (mongolian spots)

Brown

• CAFE AU LAIT SPOTS

Half

• MOTTLING

• HARLEQUIN SIGN (clown suit)

Hair

• LANUGO

“Red White Blue, Brown Half Hair”

What are the normal skin variations in a newborn?

• Sucking

• Stepping

• Babinski

• Rooting

• Moro (startle)

• Palmar grasp

• Plantar grasp

• Truncal incurvation reflex (Galant reflex); turn when touched on one side

• Tonic neck (head turn to one side, arm and leg extend on that side, other side stays bent)

What are the newborn reflexes?

• PKU (phenylketonuria)

• Congenital hypothyroidism

• Galactosemia (can’t process galactose)

• Sickle cell anemia

• Cystic fibrosis (thick secretions in airways and ducts)

“Please Check Good Sick Children”

What are the state infant screening, newborn screening, (metabolic) PKU tests?

Jittery

• JITTERY, irritability

Inactive

• Listlessness/lethargy/weak cry

Temperature low

• HYPOTHERMIA

Trouble feeding

• Poor feeding

Ep of apnea

• Apnea, cyanosis

Risk of seiure

Sometimes asymptomatic

What are the S/S hypoglycemia in newborns?

• Temperature instability, Tachycardia

• Respiratory problems

• Irritability or lethargy

• Changes in feeding habits, vomiting, diarrhea (poor feeding)

• Seizures, Sugar changes (Hypoglycemia or Hyperglycemia)

• Hypotension

TRIPS H

What are the s/s newborn sepsis?

• Toxoplasmosis

• Other (gonorrhea, syphillis, HIV, chlamydia)

• Rubella

• CMV

• Herpes simplex virus

TORCH

What are the CONGENITAL INFECTIONS that can lead to newborn sepsis?

CBC w/ differential

CRP

CSF

Chest/Ab x-ray

Blood

Urine culture

CCCCBU

What are the LABS/DX for newborn infections?

• C-SECTION BRITH W/O LABOR (no squeeze)

• Asthma

• PRECIPITOUS DELIVERY

• Male gender

• Perinatal Asphyxia

• Maternal Diabetes (slows fetal lung maturity)

CAP MAD

What are the RISK FACTORS for TTN?

• C-section w/o labor (not enough time to prepare)

• PRETERM

• Perinatal asphyxia

• MATERNAL DM (slows surfactant production)

• Males

What are the RISK FACTORS for RDS?

BIG

• MATERNAL DM (can increase growth, macrosomia)

SMALL

• SGA

STUCK

• Breech presentation

• Forceps or vacuum-assisted births

LONG

• POSTTERM PREGNANCY (>42 weeks, low placental nutrients)

• Prolonged labor

MOM

• Maternal smoking or drug abuse

• Maternal HTN (constrict bv to baby)

“Big Small Stuck Long Mom”

What are the RISK FACTORS for MAS?

Any condition that reduces oxygen delivery to the fetus can result in asphyxia, including:

In utero “CHD”

• CORD COMPRESSION

• Maternal HTN

• Maternal DM

Ex utero “BMASH”

• Birth trauma

• Malformation (congenital anomalies)

• Asphyxia (MAS, RDS, etc.)

• Sepsis

• Hypovolemic shock (abruptio placentae, cord cupture); placental blood loss

What are the RISK FACTORS for HIE?

• Feeding diffcult, Floppy or flexed (abnormal tone)

• Lethargy/decreased LOC

• Low APGAR scores, Apnea

• Coma

• Convulsions (seizures)

• Issues multi-organ

• Difficult breathing, APNEIC episodes

FLACCID

What are the S/S HIE?

• Cerebrral palsy

• Hearing and/or visual impairment

• Mental retardation (Intellectual disability)

• Speech DO (Language DO)

• Learning disabilities

CHILL

What are the COMPLICATIONS of HIE?

• Intellectual impairment

• Learning disabilities

• High activity level

• Short attention span

• Poor short-term memory

LEARN HIGH SHORT

What is the CNS impairment in FAS?

Behavioral: CRIES TITS

• Console difficulty

• Restless, excessive activity

• Irritability

• Exaggerated Moro reflex

• Seizures, TREMORS

• Tone increase (hypertonia)

• Increased muscle rigidity

• Tears (high pitch cry)

• Sleep poorly, yawning increased

Related to feeding: SUCKS

• Sucking excessive

• Uncoordinated sucking and swallowing

• Comes up (vomit and regurgitation)

• Kills weight (loss)

• Stool loose (diarrhea)

Respiratory: RAN

• Retractions

• Apnea, tachypnea

• Nasal stuffy, sneezing

Other: F DEM

• Fever

• Diaphoresis

• Excoriation (picking DO, lesions from shaking)

• Mottling

What are the S/S NAS?

• Poor cognitive, perceptual, and memory skills

• Hyperactivity and impulsivity

• Short attention span

• Poor verbal and peformance skills

• Vision and hearing problems

• At higher risk for CHILD ABUSE and NEGLECT

• Risk for future SUBSTANCE ABUSE

• SLEEP disturbances

LEARN HIGH SHORT, VERBAL, VISION, HEAR, ABUSE, SLEEP

What are the COMPLICATIONS for NAS?

MATERNAL “SIP”

• Smoking/substance abuse

• Infections or malnutrition

• Chronic HTN or Preeclampsia

PLACENTAL

• PLACENTAL INSUFFICIENCY

• Abnormal cord insertion

• Placenta previa

FETAL

• Genetic abnormalities

• Chronic fetal infections

• Congenital malformations

What are the RISK FACTORS for SGA?

• MATERNAL DM

• Maternal obesity

• Multiparity

• Male

• Previous LGA baby

• Genetics

MMMMPG

What are the RISK FACTORS for LGA?

• SWEATING (diaphoresis)

• BLUE color around mouth and eyes

• BREATHING problems

• FAST heart beat (tachycardia)

• LAGGING weight gain (poor growth)

• OVERLOAD, swelling especially around eyes, hands, feet

• POOR FEEDING, takes longer to feed

SBB FLOP

What are the S/S HF in a child?

• Heart murmur

• Tachypnea

• Poor growth

• Respiratory infections

HEART BREATH GROW INFECT

What are the S/S CONGESTIVE HF (ASD, VSD, PDA)?

• Meds

  • IBUPROFEN LYSINE (NEOPROFEN)

  • ACETAMINOPHEN

  • INDOMETHACIN (INDOCIN); INHIBITS effects of PROTAGLANDIN, which acts as a vasodilator to keep duct open (vasoconstricts)

• INTERVENTIONAL CATH: COIL EMBOLIZATION DEVICE (coil into duct)

• SURGICAL LIGATION (binding together)

IAICL

What are the TX for PDA?

Tetraology of fallot (TOF): 4 DEFECTS

• PULMONARY STENOSIS (not enough blood flow to lungs)

• Ventricular septal defect (VSD but with different s/s)

• Overriding aorta (misaligned over a ventricle)

• Right ventricular hypertrophy (works harder)

POVR

What are the DO with DECREASED pulmonary blood flow?

JONES CRITERIA: either 2 MAJOR OR 1 MAJOR and 2 MINOR criteria

• Major: JONES

  • J: joints (polyarthritis)

  • ♥: carditis (pancarditis)

  • N: nodules

  • E: erythema marginatum (non-itchy rash with pink or red circular lesions with flat centers and slightly raised borders)

  • S: Sydenham’s chorea (uncoordinated, involuntary movements)

• Minor: LEAF

  • Long PR interval

  • ESR (sed rate)

  • Arthralgia (joint pain)

  • Fever

What are the S/S for rheumatic fever?

FEVER OF AT LEAST 5 DAYS DURATION AND the presence of AT LEAST 4 OF THE FOLLOWING 5 conditions:

1. Bilateral nonpurulent conjunctivitis (watery, pink eye with no pus)

2. Polymorphous rash (sun allergy, react to UV)

3. Cervical lymphadenopathy (swollen lymph)

4. Changes of lips/oral mucosa (dry, red fissured lips, STRAWBERRY TONGUE, or oropharyngeal erythema (inflammation back of throat)

5. Changes in peripheral extremities (redness and swelling of hands/feet, with subsequent peeling/desquamation (shedding))

CRASH + BURN

What are the S/S Kawasaki disease?

• Barium studies; swallow, UGI, enema

• Endoscopy; UGI, colonscopy w/biopsy

• Esophageal pH probe

• Stool studies; culture and sensitivity; occult blood

• Ab X-ray, US, CT

What is the dx testing of a GI patient?

C: calming techniques
L: lip suture line care (AB ointment, keep clean)

E: evaulate plan

F: feeding techniques

T: teaching

L: lip protection (Logan bow)
I: infection (suture line)
P: protective devices (no-nos on arm and face 24/7)

What is the post op nuring care for CLEFT LIP?

P: pain management

A: airway management (assess swelling, HOB up)

L: liquid diet (3 weeks for sutures to heal)

A: avoid hard foods and objects in mouth (no straws, sippy cups, pacifiers)

T: too hot, spicy, citrisy fluids and foods should be avoided

E: educate parents on signs of infection (foul odor, oozing, bleeding), use of air restraints (no-nos), and advancing diet

What is the post op nursing care for CLEFT PALATE?

• Bladder reflux (VUR)

• Little infant boys uncircumcised

• Obstuction of urinary tract (bottom of bladder)

• Constipation (stool push on bladder, not emptying or drinking enough, concentrated urine)

• Kids of certain ages and gender

  • toddler/preschool

  • adolescent girls (sexual identity(

• Poor toileting hygiene

• Empty incomplete (URINARY STATSIS; increased bacterial growth)

• Easier bacterial growth (susceptibility to infection)

What are the RISK FACTORS of UTI?

• Cotton underwear/ constipation and voiding management

• Liberal fluid intake, Laxatives

• Evaluate scratching

• AVOID BUBBLE BATH, TIGHT JEANS/PANTS, CRANBERRY JUICE

• No holding urine (voiding schedule) (for infrequent voiding, incomplete emptying)

• Proper hygiene (front to back)

• Urine TWICE (DOUBLE VOID; stay on potty a little longer)

• Poop regularly (prevent constipation)

CLEAN PUP

What is the PREVENTION for UTI?

• Sudden onset of severe, progressive scrotal pain (extreme pain)

• Erythema

• Edema

EEE

What are the S/S testicular torsion?