N-Trivia |
- Lobectomy
- Ortolani-Barlow Test
- Anomalies of the Placenta
- Theories of Labor Onset
- Neonatal Gastrointestinal Adaptation Processes
- Neonatal Cardiovascular Adaptation Process
| Posted: 11 Nov 2010 11:00 AM PST
Lobectomy is a thoracic procedure, which removes a lobe of the lungs. It is performed when a disease pathology is limited to one area of the lung, bronchogenic carcinoma, giant emphysematous blebs or bullae, benign tumors, metastatic malignant tumors, bronchiectasis, and fungal infections. The surgeon makes a thoracotomy incision: its exact location depends on the lobe to be removed. When the pleuralspace is entered, the involved lung collapses and the lobar vessels and the bronchus are ligated and divided. After the lobe is removed, the remaining lobes of the lung are re-expanded. Usually, two chest catheters are inserted for drainage. The upper tube is for air removal, the lower one is for fluid drainage. Sometimes though, only one catheter is needed. Then, the chest tube is connected to a chest drainage apparatus for several days.
Pre-operative Management:
Post operative Management:
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| Posted: 10 Nov 2010 08:06 PM PST
Ortolani and Barlow Test Congenital hip dysplasia is the improper formation and function of the hip socket. Detecting developmental or congenital hip dysplasia in newborns is essential because the longer the condition goes undetected and untreated, the more difficult it is to correct. Assessment and examination in newborns is vital to detect congenital hip dysplasia. Early detection promotes timely intervention to any abnormality noted in infants. Nurses should have extensive knowledge on these assessment tests to start an early treatment just as early as the condition was suspected. Ortolani Test (steps 1-5) Ortolani test or Ortolani Maneuver is a physical examination for congenital hip dysplasia or developmental hip dysplasia. The test was named after Marino Ortolani, the person who developed it in 1937. The maneuver is performed by abducting the infant's hip an assessing for a clicking sound. This test is used to detect the posterior dislocation of the hip. A positive Ortolani's sign is noted when a clicking or distinctive "clunk" is heard when femoral head re-enters the acetabulum. Ortolani maneuver is performed before 2-3 months of age. The maneuver is done in early infancy because after 2-3 months the development of soft tissue contracture prevents the hip from being relocated, thus, no clicking or clunking sound will be assessed in children with congenital hip dysplasia. Barlow Test (steps 6 and 7) Barlow test is a maneuver performed by bringing the thigh towards the midline of the body. Feeling of femoral head slipping out of the socket postolaterally, is considered as a positive Barlow's sign. The Ortolani test is then used to confirm that the hip is actually dislocated. Procedure
Source: Maternal and Child Health Nursing by Pillitteri, 5th Ed Image from orthopediatrics.com, www2.massgeneral.org Related posts:
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| Posted: 10 Nov 2010 08:05 PM PST
Anomalies of the Placenta The placenta is a thick, disk-shaped organ. This organ approximately weighs 500 g and is 15 to 20 cm in diameter and about 1.5 to 3.0 cm thick. Normally, its weight is approximately one sixth of the fetus. Placenta is a very important structure for the fetus as it is involved in metabolic, circulatory, respiratory and endocrine functions. It has two components, the maternal and fetal side. The maternal side is rough and it attaches to the uterine wall whilst the fetal portion is smooth with branching vessels covering the membrane-covered surface. This fetal structure is always examined for the presence of anomaly. Injury of placental portions can lead to serious fetal demise if left untreated.  (top) placenta succenturiata (middle) battledore placenta (bottom) velamentous insertion of the cord Placenta succenturiata is a condition where one or more accessory lobes are connected to the main placenta by blood vessels. A succenturiate (accessory) lobe is either a second or third lobe that is quite smaller than the main lobe. This smaller succenturiate portion often has areas of disorder or atrophy. Such accessory lobes by themselves are of no major consequence to the fetus. However, they could produce problems on delivery. Membranes in between the lobes of a succenturiate placenta can be torn during delivery resulting to massive blood loss. The small lobes can be retained in the uterus after delivery that could lead to severe maternal hemorrhage. This can be detected on inspection of the placenta at birth, where it appears torn at the edge. The remaining lobes must be removed from the uterus manually to prevent bleeding. Placenta Circumvallata Normally, the chorionic membranes are not covering the fetal side of the placenta. With placenta circumvallata, the fetal side (smooth portion) is covered to some extent with chorion. The placenta has a central depression on its fetal surface to the edge where fetal membranes are attached. The umbilical cord enters the placenta at the normal site, however, the blood vessels end abruptly at the point where the chorion folds back to the surface. No fetal abnormalities are associated with this type of placenta but it is necessary to note its presence. Battledore Placenta Naturally, the umbilical cord is inserted at the central portion of the placenta. Battledore placenta presents with a marginal cord insertion.  velamentous insertion of the cord In this anomaly, the umbilical cord is inserted directly to the fetal membranes instead of inserting to the middle of the placenta. The cord then travels to the membranes of the placenta where the exposed vessels are not protected by Wharton's jelly which poses a high risk of rupture. This condition may be associated with fetal anomalies. Vasa Previa If the umbilical vessels of a velamentous cord insertion cross the cervical os that causes it to be delivered first before the fetus is a condition called vasa previa. Cervical dilatation may tear the blood vessels that would result to fetal blood loss. If vasa previa is identified a cesarean section is done to deliver the fetus. image from imaging.consult.com, library.med.utah.edu Related posts: | ||||||||||||||||||||
| Posted: 10 Nov 2010 07:57 PM PST
Theories of Labor Onset Labor is a coordinated sequence of involuntary, intermittent uterine contractions. It is the series of events that expels the fetus and placenta out of the mother's body. This is made possible by the presence of uterine contractions and abdominal pressure that push the fetus out during the expulsion period of delivery. Regular contractions result to gradual cervical effacement and dilatation. Adequate pressure from abdominal muscles allows the baby to be pushed outside the mother's womb. Labor and delivery require a woman to utilize her coping methods psychologically and physiologically. Normally, labor begins when the fetus reaches a mature age (38-42 weeks age of gestation). This is to ensure survival of the fetus with the extrauterine life. The mechanism that converts Braxton Hicks Contractions (painless contractions) to strong and coordinated uterine contractions is unknown. In some cases, labor occurs before the fetus reaches the mature age (preterm birth) while in others it is delayed (postterm birth). Although the exact mechanism that initiates labor is unknown. Theories have been proposed to explain how and why labor occurs.
The idea is based on the concept that any hollow body organ when stretched to its capacity will inevitably contract to expel its contents. The uterus, which is a hollow muscular organ, becomes stretched due to the growing fetal structures. In return, the pressure increases causing physiologic changes (uterine contractions) that initiate labor.
Pressure on the cervix stimulates the hypophysis to release oxytocin from the maternal posterior pituitary gland. As pregnancy advances, the uterus becomes more sensitive to oxytocin. Presence of this hormone causes the initiation of contraction of the smooth muscles of the body (uterus is composed of smooth muscles).
Progesterone is the hormone designed to promote pregnancy. It is believed that presence of this hormone inhibits uterine motility. As pregnancy advances, changes in the relative effects estrogen and progesterone encourage the onset of labor. A marked increase in estrogen level is noted in relation to progesterone, making the latter hormone less effective in controlling rhythmic uterine contractions. Also, in later pregnancy, rising fetal cortisol levels inhibit progesterone production from the placenta. Reduce progesterone formation initiates labor.
In the latter part of pregnancy, fetal membranes and uterine decidua increase prostaglandin levels. This hormone is secreted from the lower area of the fetal membrane (forebag). A decrease in progesterone amount also elevates the prostaglandin level. Synthesis of prostaglandin, in return, causes uterine contraction thus, labor is initiated.
Advance placental age decreases blood supply to the uterus. This event triggers uterine contractions, thereby, starting the labor. image from mommylife.net Related posts: | ||||||||||||||||||||
| Neonatal Gastrointestinal Adaptation Processes Posted: 10 Nov 2010 06:47 PM PST
Neonatal Gastrointestinal Adaptation Processes In fetal life the placenta is performing the function of the gastrointestinal system. After delivery, newborns must take in, digest and absorb food as placenta no longer performs these functions. Stomach Gastric emptying may be delayed at first in neonates. A neonate's gastric capacity is about 6 ml/kg at birth. However, it may expand to approximately 90 ml in the first week. Gastric emptying in breastfed newborns is more rapid than the formula fed babies. When milk hits the stomach and fills it, gastrocolic reflex is triggered. The gastrocolic reflex or gastrocolic response is a physiological reflex that contributes in controlling gastrointestinal motility and peristalsis. This is the one that signals the colon to empty when food hits the stomach. The reason why infants usually pass a stool after feeding is because of the said mechanism. Intestines The newborn's intestines are quite long in relation to the infant's size. This length allows for extra surface area of absorption. However, the longer intestines make infants more prone to water loss. That's why diarrhea is usually observed in infants. At birth the intestines are sterile. When a neonate is exposed to the extrauterine environment and starts taking in fluids (feeding), entry of bacteria to the intestinal tract occurs. Normal intestinal flora is established within the first few days of life. Bowel sounds, on the other hand, are present within the first few hours. Digestive Enzymes Pancreatic amylase, the enzyme responsible for digesting complex carbohydrates, has inadequate levels for the first 4 to 6 months of life. This enzyme can also be produced in the salivary glands but only in low amounts until the third month. Thus, an infant can start taking in complex carbohydrates (such as cereals) by about 4 to 6 months of age due to the said reason. Amylase is also found in breast milk. Pancreatic lipase is also deficient in newborns. This enzyme is responsible for fat digestion and absorption. Lipase is also found in breast milk making it more digestible than the formula milk. Stools Meconium – the first stool excreted by the neonate. It consists of particles from the fetal structure such as vernix, skin cells, cells shed from the fetal intestinal tract, bile and other intestinal secretions. The color of this defecated material is greenish black with a thick, tarlike and sticky consistency. This stool accumulates into the fetal GI tract throughout gestation. Neonates usually pass meconium within the first 12 to 48 hours. Transitional Stool – mixture of meconium and milk stools. Color is greenish-brown and consistency is looser than the meconium. This is the second stool that is excreted by the neonates. Milk Stools – stools of infants that vary with the type of milk ingested:
Breast milk stools are seedy with the color and consistency resembling to that of mustard with a sweet-sour smell. Babies who are breast-fed pass stools more frequently than formula-fed. Normal breastfed newborn passes at least three stools daily.
A formula-fed infant has a pale yellow to light brown stools. The consistency is firmer than the breastfed infants and has a characteristic odor of feces. The infant may excrete only one or two stools daily. Related posts: | ||||||||||||||||||||
| Neonatal Cardiovascular Adaptation Process Posted: 10 Nov 2010 06:23 PM PST
Neonatal Cardiovascular Adaptation Process During fetal life three accessories – ductus venosus, foramen ovale, ductus arteriosus – are playing a major role in circulation (see section on fetal circulation). After delivery, changes in the circulatory pattern are occurring in a neonate's body. Alterations in the blood oxygen level, shifting of pressure in the left side of the heart and clamping of the cord all contributes to the cardiovascular adaptation of a neonate. These events occur within few minutes after birth. Ductus Venosus Ductus venosus (DV) is an opening between the umbilical vein and the liver shunting blood directly to the inferior vena cava. At birth, when the umbilical cord is clamped blood supply in DV is halted thus, closing the structure. Fibrosis of ductus venosus forms ligamentum venosum. Foramen Ovale Foramen Ovale (FO) is a flap in the septum between the right and the left atrium. This fetal accessory opens only from the right side to the left side of the heart. It remains to be open in the intrauterine life because of the difference of the pressure in the left and the right side of the heart (right side has higher pressure in fetus). Thus, increased left side of the heart pressure at birth contributes to the closure of the foramen ovale. Once it is permanently close, it is called fossa ovale. Ductus Arteriosus The dilated portion in the pulmonary artery and aorta in fetal life is called a ductus arteriosus (DA). Blood no longer needs to enter the immature fetal lungs for oxygenation since exchange of gases already occurred in the placenta. Increase prostaglandin also contributes to the opening of this structure. Hence, decrease prostaglandin levels once the neonate is no longer influenced by the maternal hormones can contribute to its closure. Elevated oxygen levels also after the initiation of respiration constrict the ductus arteriosus. Once closed, it is then called ligamentum arteriosum. Summary of fetal structures and mechanisms of its changes at birth
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