OB PEDS EXAM 2

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OB PEDS EXAM 2
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  1. APGAR score
    • Done at one and five minutes
    • done at the warmer
    • score 7-10 is best
    • score 4-6 requires stimulation and possible positive pressure O2
    • score <4 requires resuscitation
  2. Vitamin K (aquamephyton)
    • needed for clotting 
    • 25G 5/8in in Vastus Lateralis
  3. Erythromycin opthalmic
    • Protects against effects of Neisseria gonorrhea and chlamydia 
    • Ribbon of ointment, inner to outer canthus
    • DO NOT TOUCH EYE WITH APPLICATOR
  4. Cord Care
    • Triple dye
    • done in nursery
  5. Initiation of resp in newborns
    • Provide stimulation at birth - rub hard
    • 1st breath is inspiratory gasp - triggered by increased PCO2 and decreased pH and Po2
  6. Thermal Stimuli (Cold)
    • Significant decreased in environmental temp after birth
    • stimulates skin nerve endings
    • newborns responds with rhythmic respirations
  7. Sensory Stimuli (cold, noisy)
    • Intrauterine - dark, sound dampened, fluid filled, weight less, 98.6 degrees
    • newborn experiences - light, sound, gravity, abundance of stimuli
  8. Respiratory Distress
    Clinical Manifestations
    • Tachypnea
    • grunting (keeps alveoli open)
    • retractions
    • flaring
    • GFR = respiratory distress
  9. Foramen Ovali
    Opening from RA to LA
  10. PA and Aorta
    Blood goes to head
  11. Ductus Arterious
    • Is the bridge from PA to aorta
    • already O2 rich
    • some blood can get to the liver by the ductus venousis
  12. Blood Volume
    In infant
    estimated to be 80mL/Kg
  13. Delayed cord clamping
    • BV increases 50% with delayed clamping
    • placental vessels have 75-125mL of blood at term
  14. Non-shivering thermogenesis
    • Occurs when skin receptors perceive a drop in environmental temp
    • * if newborn shivers, metabolic rate doubles and they require more O2
  15. BAT (Brown Adipose Tissue)
    • Primary source of heat in hypothermic newborn
    • appears in fetus 26-30 weeks
    • increases until 2-5 weeks after birth
  16. Molding
    Overriding sutures
  17. Kernicterus
    • Yellow staining and degenerative lesions in basal ganglia associated with high levels of unconjugated bilirubin in infants
    • AKA bilirubin encephalopathy
  18. Breastfeeding
    • Prolactin and oxytocin 
    • 4% fat
    • 20 cals/oz
  19. Voiding
    • 93% void by 24H after birth and 100% void by 48H
    • Initial bladder volume is 6-44mL
    • 6-10 wet diapers after 1st week
  20. 1st period of reactivity
    • Lasts up to 30 mins
    • Awake and active
    • appears hungry and has strong reflexes
    • opportunity to start breastfeeding
    • VS elevated
  21. Inactivity to sleep phase
    • After 30 mins, newborns activity decreases
    • HR and RR decreased
    • difficult to awaken
  22. 2nd period of reactivity
    • 4-6 hours
    • HR and RR increases
    • Be alert for apenic periods (>20 seconds)
    • Pass meconium
    • sucks, roots and swallows
  23. Tracking
    Watching an object
  24. Transposition of the Great Vessels
    Aorta rising from RV, Pulmonary artery rising from LV
  25. Coarctation of the Aorta
    Weak or absent femoral pulses, cool lower extremities
  26. Atrial Septal Defect
    Blood shunts from LA to RA
  27. Patent Ductus Arteriosus
    Blood shunts from aorta through duct into pulmonary artery
  28. Ventricular Septal Defect
    Abnormal Opening between right and left ventricle
  29. Kawasaki Disease
    • Acute systemic vasculitis of unknown cause associated with coronary artery aneurysms
    • leading cause of quiet heart disease in children
    • causes aneurysms
  30. Tetraology of Fallot
    Overriding aorta, VSD, Right ventricular hypertrophy, pulmonic stenosis
  31. Aortic Stenosis
    Narrowing or stricture of the aortic valve
  32. Hypoplastic left ventricle
    Small or absent left ventricle
  33. Pulmonic Stenosis
    Obstructed right ventricular outflow tract causing right ventricular hypertrophy
  34. Rheumatic Fever
    • Inflammatory disease that occurs after infection with group A-B hemolytic streptococcal pharyngitis
    • inflammatory connective tissue disorder
    • effects heart valves, joint, brain and skin
  35. PVR
    • Pulmonary vascular resistance
    • The pressure the right heart must eject against in order for blood to flow to lungs
  36. SVR
    • Systemic Vascular Resistance
    • The pressure the left heart must eject against in order for blood to flow to the body
  37. Congenital Heart Disease
    • Defect in the heart and great vessels present at birth
    • #1 common birth defect
    • Heart develops between 4-7th week
  38. CHD - Increased Pulmonary Blood Flow
    • Left to Right shunt
    • Pressure is higher in the left side so more blood goes to the right side...therefore more blood goes to the lungs and increases pulmonary vascular system and develop pulm HTN
  39. Clinical Manifestions
    Increased Pulm Blood Flow CHD
    • Tachypnea
    • Poor wt gain
    • Tachycardia
    • Murmur
    • develop CHF
  40. Increased Pulm Blood Flow - Ventricular Septal Defect (VSD)
    • Hole in ventricle septum
    • most common heart defect
    • blood flow from left to right bc more pressure in left
    • Too much blood in lung can lead to CHF; R heart works harder and eventually fails
    • can close on its own within 6 mths
    • or patch hole with systemic materal
  41. Increased Pulm blood flow 
    Atrial Septal Defect (ASD)
    • Hole in atrial septum
    • blood foes from left to right
    • leads to too much blood in the lung and CHF
    • can be very small when foramen ovale does not close
    • if large hole - patch in OR
  42. Increased Pulm blood Flow
    Patent Ductus Arteriosus (PDA)
    • PDA stay open after birth
    • blood flow will go from aorta to pulm
    • left to right shunt
    • repair by Sx by tying 2 ends of ducts to make it nonfunctional
  43. Congenital Heart Disease
    Obstruction of systemic blood flow
    • Defect that obstructed blood flow, increases pressure on the ventricle and decreases CO
    • Clinical Manifestations:
    • Lower BP in LE
    • Diminished pulses
    • CHF and pulmonary edema
    • delayed capillary refill in legs
  44. Congenital Heart Disease
    Decreased Pulm Blood Flow
    • Less blood gets to the lunch and leads to cyanosis
    • Polycythemia - to many RBC = increased risk of stroke
    • Increased hemoglobin also increased risk of stroke
  45. Decreased Pulm Blood Flow
    Tetraology of Fallot (TOF)
    • VSD, Pulm artery stenosis, overriding aorta, RV hypertrophy
    • Pulm Stenosis decreases amount of blood going to the lungs and makes blood harder to get there
  46. TET Spell
    • When pulm vascular resistance gets higher, i.e when a baby gets angry or upset
    • Can be an emergency
    • Knee to chest
    • O2
    • Morphine
  47. Congenital Heart Failure
    Mixed Blood Flow
    • Mixed flow = cyanosis
    • too much shunting leads to CHF
    • pulmonary congestion leads to arrhythmia
  48. Mixed Blood Flow
    TGA
    • Aorta and Pulmonary connect to wrong ventricle
    • aorta connect to RV , pulm connect to LV
    • Parallel Circulation - blue blood goes out to the body and returns to Right heart; red blood goes back and forth between left heart
    • Prostagladins - keep DA open til Sx
    • Balloon atrial septostomy
    • Sx - Arterial switch at 1 week old
  49. Open Heart Surgery
    • Heart needs to be stopped, no circulation in the heart
    • VSD,ASD,TOF,TGA will be open heart
    • Median Sternotomy Incision
  50. Closed Heart Surgery
    • Heart can circulate blood
    • Heart does not need to stop
    • Thoractomy incision on left lat thorax
    • PDA and coarctation will be closed heart
  51. Congestive Heart Failure
    • Occurs when the heart does not pump blood well enough to supply the body
    • - Right heart problem - Blood backs up into the body= liver congestion=JVD
    • Obstructive defect - blood backs into lung
  52. Clinical Manifestations
    Congestive Heart Failure
    • Early - poor feed, decreased activity, decreased urine output, poor wt gain, diaphoresis, pallo, exercise intolerance
    • Late - Tachypnea, tachycardia, oliguria, cough, crackles, fluid volume overload, difficulty breathing, edema
  53. Kawasaki Disease
    Stage 1 - Acute febrile stage
    • first 1-2 weeks
    • sudden high fever (>102.2 for >5 days)
    • red eyes
    • red throat
    • red tongue
    • swollen hands and feet
    • rash on trunk and peritoneum
    • enlarged cervical lymph nodes
  54. Kawasaki Disease
    Stage 2 - Subacute Stage
    • 2-4 weeks
    • crack of lips
    • start losing skin on fingers and toes
    • joint pain
  55. Kawasaki Disease
    Stage 3 - Convalescent phase
    • 6-8 weeks
    • normal with signs on inflammation
  56. Kawasaki Disease
    Treatment
    • IV immunoglobulins within 10 days given with D5
    • High dose ASA
  57. Chorea
    • Aimless movement of extremities
    • Tx - abx, asa, anti-inflammatory
  58. Dystocia
    Difficult labor involving uncoordinated uterine contractions; irregular in strength, timing or both and fail to dilate
  59. Hypertonic Labor Pattern
    >5 contractions in a ten min period
  60. Tx for hypertonic labor pattern
    • TURN OFF PIT
    • Bedrest
    • sedation
    • change position
    • patient teaching
  61. Hypotonic labor pattern
    • fewer than 2-3 contractions in 10 mins after active labor has been established
    • risk for hemorrhage
  62. Tx for hypotonic labor pattern
    • Oxytocin
    • rupture membranes
    • Nipple stim (releases oxytocin)
    • C-section
  63. Precipitous Labor
    • Labor < 3 hours and results in rapid birth
    • risk of laverations to cervix, vagina and perineum
    • Fetal Risks - cerebral trauma, brachial plexus 
    • MONITOR FHR
  64. Postterm Pregnancy
    • A pregnancy that extends more than 42 weeks 
    • 4-19%
    • #1 complication for baby is meconium aspiration
    • skin is dry, peeling and cracked
    • olighydramnios
    • decreased perfusion from placenta
    • loss of fat=hypthermia risk
  65. Conditions associated with breech presentation
    • Preterm Birth
    • placenta previa
    • uterine anomalies
    • hydramnios
    • multiple gestation
    • fetal anomalies
    • increased r/o birth trauma
    • increased r/o asphyxia and nonreassuring fetal status
    • cant be vaginally delivered
  66. Brow presentation
    • Longer labor or C/S if brow doesnt convert to face or occipital presentation
    • maternal risks - long labor, slow decent, C/S
    • fetal risks - mortality, facial edema, bruising, exaggerated molding
  67. Face Presentation
    Increased r/o cephalopelvic disproportion (CPD), impacted fetal head, increase r/o infection, C/S, cephalohematoma, facial edema, pronounced molding
  68. Causes of persistent OP positioning
    • Poor quality contractions
    • abnormal head flexion
    • large fetus
  69. Macrosoma and Shoulder Dystocia
    • Fetal wt of more than 4500g (9.9lbs)
    • 2nd shoulder gets hooked on pubic bone
    • shoulder dystocia EMERGENCY
  70. McRoberts Maneuver
    • Get legs all the way up and back
    • hips flexed
    • put continuous or rocking pressure on pubis symp.
    • 10L O2 for mom
  71. Prolapsed Umbilical Cord
    • Umbilical cord precedes the fetal presenting part
    • pressure on cord prevents flow to fetus; occurs with ruptured membranes
    • **in SROM or AROM, FHR is 1st priority**
  72. If mom has membranes ruptured...
    • LOOK AT FHR
    • Note color, amount, odor
    • Time of rupture (increased r/o infection)
  73. Bleeding in 4th stage of labor
    • Uterine atony - failure to involute - #1 cause of 4th stage bleeding
    • If bleeding always go to fundus first
  74. Vaginal Lacerations
    • 1st degree - perineal skin, vaginal mucous membrane
    • 2nd degree - above plus fascia and muscle of perineal body
    • 3rd degree - extends up anterior wall of rectum
    • 4th degree - extends through lumen of rectum
  75. Amniotic Fluid Embolism
    • Presents like any other embolism
    • sudden onset of resp distress, circulatory distress, dyspnea, cyanosis, HF, hemorrhagic shock and coma
  76. Retained Placenta
    • #1 cause of uterine atony or post partum hemorrhage
    • mom has 30 mins to expel placenta
  77. Placenta Accreta
    • When the chorionic villi attach directly to the myometrium of the uterus
    • maternal hemorrhage 
    • failure of placenta to detach
    • hysterectomy may be necessary
  78. Newborn period
    1st month of life
  79. Factors that put newborns at risk
    • Low SES (socioeconomics)
    • Limited prenatal care
    • maternal age - >35 & <19
    • parity - 1st child
    • medical conditions
    • pregnancy complications
    • drugs and alcohol
    • domestic violence
  80. Dysmaturity
    Size doesnt match gest age
  81. Immaturity
    • Premature baby
    • failure to progress, forceps, etc
  82. Small for gestational Age (SGA)
    • <10%ile 
    • Extreme SGA < 3%ile
    • Causes:
    • #1 cause is smoking
    • multiples
    • genetics
  83. Intrauterine growth retardation 
    IUGR
    • A condition in which a fetus is unable to reach his/her genetically determined potential size
    • may be better out than in (try to wait for 30-32 wks)
    • small and growth stops
    • long and thin wrinkly skin, cord is thin and dull
  84. Causes of IUGR
    • Maternal Disease - DM, malnutrition, HTN, heart disease
    • Environmental factors - drugs, alcohol, meds
    • placental insufficiency
    • congenital issues
  85. SGA/IUGR complications
    • Asphyxia 
    • aspiration
    • hypothermia
    • hypoglycemia
    • polycythemia
    • cognitive difficulties
  86. Large for gestational age (LGA)
    • > 90%ile
    • uncontrolled maternal DM
    • genetic predisposition
    • multiparous woman
  87. S/S hypoglycemia
    • Hypothermia
    • Jittery
    • Bradycardic
  88. Post term newborn
    • Wide-eyed 
    • dry skin
    • long fingernails and hair
    • meconium staining
  89. Premature infants
    • born before 37 weeks
    • extreme - < 26 weeks
    • resuscitate at 24 weeks
  90. Clinical manifestations of Premature infants
    • Color - Pink
    • Skin - Thin and delicate, blood vessels very superficial 
    • Lanugo - abundance
    • vernix - increased with gestational age
    • Ears - lack cartilage, stays folded 
    • Genitals - testes not descended, clitoris very dominate 
    • Cry - very weak d/t resp status
    • reflexes - some may not be developed
    • movements - very jerky d/t lack of muscle tone
  91. Complications of premature infants
    • Apnea
    • PDA
    • IVH
    • NEC
    • RDS
  92. Apnea in premature infants
    • Cessation of breathing for > 20 seconds or < 20 seconds with signs of cyanosis
    • Tx - caffiene, zantac, reglan
  93. IVH in premature infants
    • Intraventricular Hemorrhage
    • anytime blood flow is interrupted they run a risk of blood vessels rupturing 
    • Tx - Grade 1&2 - reabsorbed
    • Grade 4 - r/o seizures, cerebral palsy and hydrocephalus
  94. NEC in premature infants
    • Necrotizing Enterocolitis
    • Alteration in perfusion, premature, formala
    • < 1500 g at risk
    • prime time for NEC - birth to 14 days old
    • Tx - bowel rest, NPO 7-10 days, TPN, broad spectrum abx, bowel removal
  95. RDS in premature infants
    • Respiratory distress syndrome
    • AKA Hyaline membrane disease
    • immature lung development
    • gas exchange ineffective until 36-37 weeks
    • Tx - Surfactant replacement, ventilation
  96. Clinical Manifestations of RDS
    • Pallor/cyanosis
    • labored breathing
    • tachyonea
    • apnea
    • expiratory grunting
  97. ROP
    • Retinopathy of prematurity
    • complication of RDS
    • Can lead to blindness
  98. Coanal Atresia
    • occulsion of posterior nares
    • can be bilateral or unilateral
    • bilateral is EMERGENCY d/t nose breathing
    • Sx to treat
  99. Prune Belly Syndrome
    • Absence of one or more layers of abd muscles
    • wrinkled, shapeless abd
    • palpate an enlarged bladder
    • decreased urinary output
    • Tx - abd wall resonctruction, abx, improve urinary drainage
  100. Transient tachypnea of the newborn (TTN)
    • Full-term
    • progressive, short-term resp distress
    • newborn fails to clear the airway of lung fluid, mucus and other debris 
    • RDS at 6 hours and recovery in 24-72 hours
    • tachypnea, GFR, cyanosis, increased AP diameter, flat diaphragm
  101. Hpyoglycemia
    • < 40 mg/dl in NB period
    • Most common metabolic disorder in NB
    • males, epidural, preeclampsia, infection
  102. NB Tx for hypoglycemia
    • NO GLUCOSE WATER
    • early feeding
    • may require D5 bolus
    • supplement feeds with IVF
  103. Hyperbilirubinemia
    Livers inability to properly process or eliminate bilirubin
  104. Bilirubin
    • Byproduct of RBCs
    • 2 forms
  105. Unconjugated Bili
    • Indirect
    • cant be secreted
    • causes jaundice
    • binds with albumin
  106. Conjugated Bili
    • Direct
    • has been processed by liver
    • binds with glucuronic acid
    • becomes water soluble
    • travels thru ducts to duodenum and excreted in urine or stool
  107. Pathologic Jaundice
    • Seen within first 24 hours
    • hemolysis
    • liver dysfunction
  108. Physiologic Jaundice
    • Appears after 24 hours
    • increased bruising, increased RBC, decreased caloric intake
    • liver cant keep up
  109. Breastfeeding jaundice
    • Appears in first couple days of life
    • not compromised, just appear jaundice
    • ineffective feed, not enough milk
  110. Breastmilk jaundice
    • Bilirubin rises after one week of life after mature breastmilk has come in
    • milk can look orange
    • free fatty acid in milk competes with bili to bind with albumin
    • peaks 2-3 weeks old
    • stop breastfeeding until liver can catch up
  111. Dx of Jaundice
    • TcB - biliconcentration in skin, best place is on sternum, 24H its performed
    • Serum bili level - most diagnostic
    • Coombs test - confirm ABO or rH compatibility. tests for moms antibodies.  If positive, baby is at risk for hemolysis
  112. Exchange transfusion
    CC for CC removal and infusion of donor blood
  113. Group B Strep
    • Sepsis in infant
    • Early - PNA
    • Late - 1 week, meningitis, bulging fontanele
    • Tx - Broad spectrum abx - amp and gent
  114. Toxoplasmosis
    • Retinochoroiditis - inflammation of retina and choroid
    • Tx - Sperimycin - doesnt cross placenta
    •        > 18 weeks = broad spectrum abx
  115. Opthalmia Neonatorum
    • Newborn pink eye
    • PNA if baby is not treated
    • exposure to vaginal secretions
    • this is why erythromycin is given
    • if mom is positive for gonorrhea or chlamydia - baby is given arhythromycin for 14 days
  116. HIV/AIDS
    • Must be compliant with meds during pregnancy
    • if compliant  -  1.5% chance of transmission
    • cant breastfeed
    • babys drug regiment will begin 6-12H of delivery
  117. Cytomegatovirus (CMV)
    • 1/2 of adult population is +
    • unaware of having it
    • belongs to herpes simplex virus
    • no treatment exists
  118. Clinical Manifestations of CMV
    • Unexplained hypothermia
    • poor feeding
    • petecchiae or purpura (blueberry type spots)
    • long term sequelae - hearing loss, vision loss, learning disabilities
  119. Herpes Simplex Virus
    • Genital herpes
    • primary infection most concerning for neonate
    • skin lesions
    • C/S
    • Acyclovir IV
  120. Strabismus
    • Abnormal alignment of eyes d/t weakened eye muscles
    • Dx - corneal light reflex, cover-uncover test
    • Tx - patch good eye to make weaker eye stronger 1-2 hours daily
  121. esotropia
    inward deviation
  122. exotropia
    • outward deviation
    • squinting, lop sided head, rubbing eyes, sitting close to the TV
  123. Conjunctivitis
    Opthalmia Neonatorum
    • From moms having chlamydia 
    • can cause blindness
  124. Chemical Conjunctivitis
    Reaction from ointment given at birth
  125. Plugged lacrimal duct
    • Blocked tear duct
    • push on it
    • warm compress
  126. Bacterial Conjunctivitis
    • Pink Eye
    • crusty, goupy discharge, red eyes
  127. Viral Conjunctivitis
    • Usually associated with a cold
    • clearish drainage
    • herpes in eye can cause vision loss
  128. Eustachian Tubes
    • Protects middle ear from nasopharyngeal secretions
    • drains secretions produced in middle ear to nasopharynx
    • ventilation of middle ear to equalize air pressure
  129. Otitus Media (ear infection)
    • Inflammation of the middle ear
    • peak is 0-2 years old
    • pain, tugging on ear, fussy,fever, not eating, upper resp infection
  130. Otitus Media with Effusion (OME)
    • increased risk of hearing loss with chronic OME
    • treat with amoxicillin
    • Tylenol for pain
    • speech delays with chronic infection
  131. Qualifications to T&A Sx
    • Recurrent tonsillitis
    • history of peritonsiller abscess
    • hypertrophy
    • sleep apnea with adenoids
    • usually min of 3 years old
  132. Signs of Bleeding
    PO T&A
    • Excessive swallowing
    • clearing throat
    • tachypnea
    • tachycardic
    • NOTIFY MD IMMEDIATELY
  133. Normal Urine output in kids
    1-2mL/Kg/Hr
  134. Urinary Tract Infection (UTI)
    • More common in girls
    • in 1st 1-3 months, more common in boys
    • E-coli infection commonly
  135. Clinical Manifestations of UTI
    • Newborn - non-specific - lethargic, febrile, r/o renal scarring
    • Younger Child (1-2) - febrile, lethargic, foul urine
    • Older child - burning, frequency, febrile
  136. Vesicoureteral Reflux
    • Retrograde flow of urine from bladder into the ureters
    • junction isnt completely closed
    • reflux can cause renal scaring
    • causes incomplete emptying which increases r/o UTI
    • Tx - Abx, sx to reimplant ureter, hopefully grow out of it
  137. Acute Postinfectious Glomerulonephritis
    • Usually 2-6 years old
    • strep throat heals and then this presents 10-21 days later
    • tea colored urine
  138. Clinical Manifestations
    Acute Postinfectious Glomerulonephritis
    • Abrupt flank/mid abd pain
    • microscopic/gross hematuria 
    • periorbital edema
    • oliguria
    • HTN
  139. Characteristics of Nephrotic Syndrome
    • Edema
    • massive proteinuria
    • hypoalbumenia
    • hypoproteinemia
    • hyperlipidemia
    • altered immunity
  140. Nephrotic Syndrome Treatment
    • Prednisone - reverses increased permeability 
    • 90% will respond to steroids
    • 50% will relapse
    • regular protein diet, low sodium, restrict fluids
  141. Wilms Tumor
    Nephroblastoma
    • 4th most common CA
    • unknown cause
    • Kidney Tumor
    • grows very quickly - 2x size in 11-13 days
    • good survival rate, can mets, not painful
    • affected kidney usually taken with tumor
    • DO NOT PALPATE FURTHER ONCE TUMOR IS FOUND
  142. Gastroenteritis 
    Acute Diarrhea
    • Inflammation of GI tract leads to decreased absorption = watery stool
    • causes : acute - viral - rotavirus most common
    • chronic - crohns, IBS, allergy (milk)
  143. Clinical Manifestations
    Gastroenteritis
    • Mild - Frequent loose stools
    • Moderate - Watery Stool
    • Severe - fluid & electrolyte imbalance
  144. Esophageal Atresia & Tracheoesphageal Fistulas
    • defect occurs between 4-5th week gestation 
    • esophagus fails to form as a single tube
    • opening from trach to esophagus exists
    • 90% have both disorders
    • Increased risk of aspiration
  145. Classic signs of esophageal atresia & tracheoesphageal fistula
    • 1. cyanosis
    • 2. coughing
    • 3. choking
  146. Pyloric Stenosis
    • 2-8 weeks after birth this presents
    • unknown cause
    • more common in males
    • hypertrophy of pyloric muscle at bottom of stomach
    • muscle becomes enlarged and prevents passage of food into the intestines
  147. Clinical Manifestations 
    Pyloric Stenosis
    • Projectile vomiting
    • weight loss
    • irritable 
    • dehydration
    • metabolic alkalosis
  148. Qualifications for GERD
    • Weight loss
    • refusal to feed
    • aspiration/infection
    • anemia
  149. Clinical Manifestations
    Gastroesophageal Reflux
    • Regurgitation
    • hungry
    • irritable
    • frequent respiratory infection
  150. Nissen fundoplication
    • Sx for Pyloric stenosis
    • wrap stomach around esophagus and stomach contracts and closes esophagus and child cant reflux
  151. Omphalocele
    • Abdomen contents herniate through umbilical cord
    • 50% also have cardiac defect
    • 30% have chromosomal abnormalities
    • huge risk if umbilical cord ruptures
  152. Gastroschisis
    • Abdominal organs rupture thru wall thru hole next to umbilical cord
    • organs are fully exposed
    • increased risk in mothers who smoke
  153. Gastroschisis
    Treatments
    • Bowel Bag - Protects organs and maintains min fluid loss
    • Shilow Bag - slowly allows gravity to pull organs in
  154. Intussusception
    • One portion of the bowel telescopes into another 
    • usually kids under 2 
    • tissue ischemia from rubbing together
    • obstruction
    • cause is unknown but poss link with viral infection
  155. Clinical Manifestations
    Intussusception
    • Abrupt signs and symptoms
    • abdominal pain
    • currant jelly like stool
    • vomiting
  156. Hirschsprung Disease
    • Part of the bowel is missing ganglion cells needed for peristalsis 
    • usually sigmoid colon
    • area missing cells, cant move stool
  157. Hirschsprung Disease
    Clinical Manifestations
    • Newborn - failure to pass meconium, abdominal distention, bilious vomiting
    • Infant/child - failure to gain weight, chronic constipation, recurrent fecal impactions
    • pencil thin stool
  158. Stoma Complications
    • Bleeding
    • Turning blue
    • Output
    • Prolapse bowel
    • Retraction
  159. Imperforate Anus
    • Absence of anal opening
    • frequent association with chromosomal abnormalities like trisome 13
    • could possibly just be a stenosis
  160. Clinical Manifestations
    Imperforate Anus
    • Abdominal Distension
    • failure to pass meconium
    • vomiting - if severe, vomit fecal matter
    • fistula - passing stool in urine
  161. Hernias
    • Diaphragm doesnt fully close
    • organs herniate into thoracic cavity
    • impedes respiration
    • Can shift other organs
  162. Signs and Symptoms
    Hernias
    • Resp Distress
    • bowel sounds in chest
    • heart can be heard on right side
    • absense of lung sounds
    • cyanotic
    • nasal flaring
    • rounded chest with sunken abd
  163. Umbilical Hernia
    • Common in premature infants
    • weakness in umbilical muscle ring
    • organs protrude into umbilicus
    • should be retractable - if not, can be strangulated and cause obstruction and necrosis
    • usually seen before 6 months and resolved by 1 without intervention
  164. External Cephalic Version (ECV)
    • When a fetus is turned from a breech position to a cephalic presentation through manipulation on the maternal abdomen 
    • cant be turned if baby is already engaged
    • this maneuver can cause labor
  165. Amniotomy
    • "breaking the bag"
    • Artificial rupture of the amniotic sac with an amnihook
    • at least 2cm of dilation must have occured
    • **IMMEDIATELY ASSESS FHR**
  166. Stripping membranes
    • Can be performed in the office
    • separates amniotic membrane from lower uterine segment 
    • thought to release prostaglandins
  167. Induction of Labor
    Stimulation of uterine contractions before the spontaneous on set of labor, with or without ruptured membranes
  168. Cervical Ripening
    • Softening and effacement of the cervix for induction of labor
    • sent home and wait for labor
    • protaglandin agent - vaginally or in the cervix
  169. Bishop's Score**
    • Prelabor scoring system
    • 8 or 9 is best for successful induction
    • the higher the score the most success for induction and labor to occur
  170. Oxytocin (pitocin)
    • Pit is always ordered in mU
    • Biggest risk: hyperstim contractions
    • always piggybacked into main IV clsoe to catheter site
    • goal is stable contractions Q2-3 minutes, lasting 40-60 seconds with relaxation between contractions
  171. Safety measures for oxytocin
    Immediate actions include:
    • Turning Pt to L side
    • O2 7-10L, re-breather or face mask only
    • Motify MD

    **IN THIS ORDER**
  172. Forceps
    • Instrumental delivery or operative vaginal delivery - traction to rotate the fetal head
    • there are three types
    • No cephalopelvic disproportion
  173. Outlet Forceps
    Fetal skull has reached perineum
  174. Low forceps
    Presenting part of the fetal head is at +2 station
  175. Midforceps
    When the head is engaged
  176. Vacuum-assisted birth
    • Obstetrical procedure used to facilitate the birth of a fetus by applying suction to the fetal head
    • traction is only applied during a contraction
    • serial head measurements done Q4H

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