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ob / peds lecture notes (nurse / nursing)

ob / peds lecture notes (nurse / nursing)



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Published by: run.rebel.run on Nov 18, 2008
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- A blue or purple mottled discoloration of the extremities, esp. the fingers, toesand/or nose. This physical finding is associated with many diseases and conditions, such asanorexia nervosa, autoimmune diseases, cold agglutinins, or Raynaud’s disease or phenomenon.Cyanosis of the extremities may be commonly observed in newborns and in others after exposureto cold temperatures, and in those patients with reduced cardiac output. In patients with suspectedhypoxemia, it is an unreliable sign of diminished oxygenation.
- or startle reflex- a reflex seen in infants in response to stimuli, such as that produced bysuddenly striking the surface on which the infant rests. The infant responds by rapid abduction andextension of the arms followed by an embracing motion of the arms.
- a mass composed of clotted blood, located between the periosteum and theskull of a newborn. It is confined between suture lines and usually is unilateral. The cause isrupture of periosteal bridging veins due to pressure and friction during labor and delivery. The blood reabsorbs gradually within a few weeks of birth.
caput succedaneum
- diffuse edema of the fetal scalp that crosses the suture lines. Headcompression against the cervix impedes venous return, forcing serum into the interstitial tissues.The swelling reabsorbs within 1 to 3 days.
ductus arteriosis
- a channel of communication between the main pulmonary artery and the aortaof the fetus.
ductus venosus
- the smaller, shorter, and posterior of two branches into which the umbilical veindivides after entering the abdomen of the fetus. It empties into the inferior vena cava.
-anterior and posterior-where located?-why?-shape?- an unossified membrane or soft spotlying between the cranial bones of the skull of a fetus or infant.Anterior- the diamond-shaped junction of the coronal, frontal, and sagittal sutures; it becomesossified within 18 to 24 months.Posterior- the triangular fontanel at the junction of the sagittal and lambdoid sutures; ossified bythe end of the first year.
foramen ovale
- The opening between the two atria of the fetal heart. It usually closes shortly after  birth as a result of hemodynamic changes related to respiration.
shaping of the fetal head to adapt itself to the dimensions of the birth canal during itsdescent through the pelvis.
erythema toxicum-
(papules, 24-28 hr.-newborn rash) a benign, self-limited rash marked by firm,yellow-white papules or pustules from 1 to 2 mm in size present in about 50% of full-term infants.The cause is unknown, and the lesions disappear without need for treatment.
chemical conjunctivitis-
most common eye infection- of the conjunctiva usually caused bychemical burns.
vernix caseosa
- a protective sebaceous deposit covering the fetus during intrauterine life,consisting of exfoliations of the outer skin layer, lanugo, and secretions of the sebaceous glands. It
is most abundant in the creases and flexor surfaces. It is not necessary to remove this after thefetus is delivered.
- fine downy hairs that cover the body of the fetus, esp. when premature. The presence andamount of lanugo aids in estimating the gestational age of preterm infants. The fetus first exhibitslanugo between weeks 13 and 16. By gestational week 20, it covers the face and body. The amountof lanugo is greatest between weeks 28 and 30. As the third trimester progresses, lanugodisappears from the face, trunk, and extremities.
- white pinhead-size, keratin-filled cyst. In the newborn, milia occur on the face and, lessfrequently, on the trunk, and usually disappear without treatment within several weeks.
telangiectatic nevi or hemangioma
- (stork bite) a benign tumor of dilated blood vessels.
Mongolian spots
- bluish-black areas of pigmentation may appear over any part of the exterior surface of the body. Commonly noted whose ethnic origins are in the Mediterranean area, LatinAmerica, Asia, or Africa
Apgar (know scoring)
- a system for evaluating an infant’s physical condition at birth. Theinfant’s heart rate, respiration, muscle tone, response to stimuli, and color are rated at 1 min, andagain at 5 min after birth. Each factor is scored 0,1, or 2; the maximum total score is 10.Interpretation of scores: 7 to 10, good to excellent; 4-6, fair; less than 4, poor condition. A lowscore at 1 min is a sign of perinatal asphyxia and the need for immediate assisted ventilation.Infants with scores below 7 at 5 min should be assessed again in 5 more min; scores less than 6 atany time may indicate need for resuscitation. In depressed infants, a more accurate determinationof the degree of fetal hypoxia may be obtained by direct measures of umbilical cord oxygen,carbon dioxide partial pressure, and pH.
Silverman (respiratory function test)
- 5 evaluations – what are they? – (handout)1. Upper chest. 2. Lower chest. 3. Xiphoid retractions. 4. Nares dilation.5. Expiratory grunt. Graded 0, 1, 2
- withdrawal bleeding after birth, a scant vaginal discharge that reflects the physiological response of some female infants to an exposure to high levels of maternal hormonesin utero.
tonic neck reflex
- (“fencing”) –with infant facing left side, arm and leg on that side extend;opposite arm and leg flex (turn head to right, and extremities assume opposite postures).
- high in?-breast fluid that may be secreted from the second trimester of pregnancyonward but that is most evident in the first 2 to 3 days after birth and before the onset of truelactation. This thin yellowish fluid contains a great number of proteins and calories in addition toimmune globulins.
- from birth through 28h day of life.
 – normal? Why higher in neonate?- normal <5 mg.dl. (usually drop to 1 mg/dl). Neonatal jaundice occurs because the newborn has a higher rate of bilirubin production and thereabsorption of bilirubin from the neonatal small intestine is considerable.
physiologic jaundice
 – when?- 50-80% of all full-term newborns are visibly jaundiced during thefirst 3 days of life.Term: appears after 24 hours and disappears by the end of the 7
day.Preterm: evident after 48 hours and disappears by the 9
or 10
- a congenital, autosomal recessive disease marked by failure to metabolize theamino acid phenylalanine to tyrosine. It results in severe neurological deficits in infancy if it isunrecognized or left untreated. PKU is present in about 1 in 12,000 newborns in the US. In thisdisease, phenylalanine and its byproducts accumulate in the body, esp. in the nervous system,where they cause severe mental retardation, seizure disorders, tremors, gait disturbances,coordination deficits, and psychotic or autistic behaviors. Eczema and an abnormal skin odor alsoare characteristic. The consequences of PKU can e prevented if it is recognized in the first weeksof life and a phenylalanine restricted (very low protein) diet is maintained throughout infancy,childhood, and young adulthood.
- (pinpoint rash) small, purplish, hemorrhagic spots on the skin that appear in patientswith platelet deficiencies (thrombocytopenias) and in many febrile illnesses.
- a form of jaundice occurring in newborns during the second to eighth day after birth.The basal ganglia and other areas of the brain and spinal cord are infiltrated with bilirubin, ayellow substance produced by the breakdown of hemoglobin. The disorder is treated aggressively by phototherapy and exchange transfusion to limit neurological damage. The prognosis is quite poor if the condition is left untreated.
nevus flammeus
- (port-wine stain) – a large reddish-purple discoloration of the face or neck,usually not elevated above the skin. It is considered a serious deformity due to its large size andcolor. In children, these have been treated with the flashlamp-pulsed tunable dye laser.
Epstein’s pearls
 – in infants, benign retention cysts resembling small pearls, which are sometimes present in the palate. They disappear in 1 to 2 months.
umbilical arteries
- (2) carry blood from the fetus to the placenta, where nutrients are obtainedand carbon dioxide and oxygen are exchanged.
umbilical vein
- (1) oxygenated blood returns to the fetus through the umbilical vein.ALTERNATE VOCAB LIST
 NEWBORN VOCABULARY LISTAbdominal Circumference: measured by placing the tape around the newborn’s abdomenat the level of the umbilicus with the bottom edge of the tape measure at the top edge of the umbilicus.Acrocyanosis: Cyanosis of the extremities. May be present in the first 2 to 6 hours after  birth. Condition is due to poor peripheral circulation which results in vasomotor instability and capillary stasis, especially when the baby is exposed to cold. If the central

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