Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OB > 8.2a Care Management - Birth through First 2 Hours > Flashcards

8.2a Care Management - Birth through First 2 Hours Flashcards

1
Q

Birth Risks that Need Assessment

A
  • Hepatitis B and C
  • HIV through maternal blood (newborn is considered contaminated)
  • Wear gloves when handling newborn until blood and amniotic fluid are removed during the initial bath
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Immediate Care After Birth

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Goals of Term Newborn

A
  • Establish effective respirations

IF NEWBORN HAS GOOD MUSCLE TONE, CRYING
Routine Care includes..

  • Placing newborn on skin to skin contact
  • Dry infant with gentle warming
  • Remove wet linens and cover mom/baby in warm blanket
  • Dry head and apply cap
  • Wipe away nasal/oral secretions (bulb syringe)
  • Assessment of neonatal breathing/color/activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Goals of Preterm Newborn

A
  • Poor muscle tone, not crying,

Interventions

  • Immediately place under radiant warmer
  • Assessments done under warmer until temperature stabilizes for skin to skin contact
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Positive Signs of Good Birth

A
  • Trunk and Lips are pink
  • Blue on hands and feet is normal
  • Put baby under radiant warmer and positive pressure ventilation if baby is apneic or gasping
  • Pulse ox should be used on right hand instead of checking for cyanosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Heart Rate

A
  • Measured by grasping base of umbilical cord or auscultating chest
  • Heartrate should be greater than 100 bpm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Post-birth care

A
  • Place identical bands on newborns wrist, ankle, and mothers wrist and significant other
  • ID bands should be placed before
  • Security tag is given to prevent abduction
  • Infant is “footprinted” with ink/scanning device within 2 hours and photograph is taken for ID
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Preconception Assessments

A
  • Age
  • Pre-existing maternal conditions (obesity, diabetes, hypertension, anemia, renal disease)
  • Genetics and family history
  • OB History (Gravity and Parity, history of stillbirth, miscarriage, In-vitro
  • Blood type and Rh
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Prenatal Assessments

A
  • When prenatal care was started
  • Nutrition (weight gain, diet, obesity, eating disorders)
  • Health factors (smoking, alcohol, drugs)
  • Blood type and Rh
  • Medications used
  • STI, GPS, Hepatitis B,C
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Intrapartum

A
  • Length of gestation (preterm, early term, post term)
  • External fetal monitoring, rupture of membranes, signs of fetal distress in first stage of labor
  • GBS status and treatment
  • Second Stage of Labor - Vagina, C-section, Length, Forceps, Vacuum, Complications (bleeding, shoulder dystocia), cord prolapse, maternal analgesia/anesthesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Initial Physical Assessment

A
  • Done on skin to skin contact or under radiant lamp

- Newborn stays on skin to skin for 1-2 hours and breastfeeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

APGAR Score

A
  1. Heart rate (auscultation or palpation of umbilical cord)
  2. Respiratory effort based on observation of chest wall
  3. Muscle tone based on degree of flexion and movement of extremities
  4. Reflex irritability (grimace, crying, or withdrawal)
  5. General skin color (pallid, cyanotic, pink)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

APGAR Score

A

0-3 means severe distress
4-6 moderate difficulty
7-10 Minimal adaptation to extrauterine life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

APGAR Score

A
  • Checked and 1 and 5 minutes after birth
  • Scores less than 7 at 5 minutes should be repeated every 5 minutes for 20 minutes
  • APGAR score measures newborns transition to extrauterine life (does not predict neurological outcomes)
  • Resuscitation needs should be assessed before 1 minute APGAR score
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

APGAR Score

A

A - Appearance (oxygenation level of blood)
0 - Pale/Cyanotic
1 - Acrocyanotic
2 - No Cyanosis

P - Pulse (Umbilical cord or apical pulse)
0 - Absent
1 - Under 100
2 - 100+

G - Grimace (Response to stimuli)
0 - No response
1 - Minimal response
2 - Cry

A - Activity (Muscle Tone)
0 - Flaccid
1 - Some muscle flexion
2 - Active

R - Respirations (Quality of breathing)
0 - No breathing
1 - Weak cry or slow/irregular breath
2 - Strong cry and normal rate in breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

General Appearance Survey

A
  • Determines maturity status
  • Color
  • Posture
  • Activity
  • Obvious Signs of Anomalies that can cause distress
  • Presence of bruising or other birth trauma
  • State of Alertness
17
Q

Vital Signs

A

Temperature - 36.5 - 37.5 (97.7 - 99.5)

RR - 30-60 breaths a minute (exceeds 60 when crying)
(Shallow and irregular (periodic breathing) NORMAL)
(Respirations should be counted for a full minute)
(Observe symmetrical chest movement)

HR - checked at apical pulse done when baby is asleep or in quiet alert state
Awake (120-160)
Sleep (70-90) - Bradycardia is less than 80
Tachycardia - Greater than 180-200

BP - 4 BP can be assessed or when murmurs are heard
BP is higher in upper extremities
If upper extremities have bp greater than 20 mmHg above lower, than there may be a cardiac defect such as coarctation of the aorta.

If heart murmur is heard palpate peripheral pulses and check oxygen saturation

18
Q

Weight

A

Average is 6-9 pounds

19
Q

Head Circumference and Body Length

A
  • Head is measured with occipitofrontal diameter (widest area)
  • Tape measure placed above eyebrows
  • Average circumference 32.5 - 37.5 cm
  • Head to heel length typically 48-53 cm
20
Q

Gestational Age Assessment

A
  • Perinatal mortality and morbidity relate to gestational age and birth weight
  • New Ballard Score is typically used (as young as 20 weeks)
  • Assess 6 physical and 6 neuromuscular signs
21
Q

Birth Weight with Gestational Age

A
  • Provides an accurate measure of infant mortality/morbidity
  • AGA (appropriate for gestational age) means birthweight is between 10-90th percentile
    (Normal growth rate)
  • LGA (Large gestational age) - above 90th percentile presumed to have grown at an accelerated rate in intrauterine life
  • SGA (Small gestational age) - Below 10th percentile grown at a restricted rate during intrauterine life
  • Gestational age is an important predictor of survival
22
Q

Gestational Age

A

Late preterm - 34 0/7 through 36 6/7 weeks
Preterm - Before 37 0/7 weeks of gestation
Early Term - 37 0/7 to 38 6/7
Full Term - 39 0/7 to 40 6/7
Late Term - 41 0/7 to 41 6/7
Post Term - 42 0/7+

23
Q

Early-Term Infant

A
  • 37 0/7 to 38 6/7
  • Increased risk of morbidity and mortality
    HIGHER RISK OF
  • Hypoglycemia
  • Respiratory Distress Syndrome
  • Transient Tachypnea (TTN)
  • Greater likelihood of NICU admission
24
Q

Late Preterm Infant

A
  • Majority of preterm is between 34 0/7 - 36 6/7
  • “Great Imposters” Often treated as normal infants because they are normal size and weight
    INCREASED RISK OF
  • Respiratory distress
  • Temperature instability
  • Hypoglycemia
  • Apnea
  • Difficulty feeding
  • Hyperbilirubinemia
25
Q

Post Term

A
  • 42 0/7 weeks or above
  • AGA but some show characteristics of placental insufficiency
  • Little vernix caseosa, absence of lanugo, abundant scalp hair, long fingernails
  • Skin is cracked and parchment like (peeling)
  • Wasted physical appearance that reflects placental insufficiency
  • Depletion of subq fat gives them elongated look
  • Stained deep yellow or green skinfolds (because of meconium in amniotic fluid)
  • Increase in risk of fetal mortality
  • Very prone to fetal distress, placental insufficiency, macrosomia, meconium aspiration syndrome
26
Q

Airway Maintenance

A
  • Most secretions move by gravity and coughed up (then drained)
  • Bulb syringe used to suction obstructions
  • Auscultate lung sounds for stridor
  • Crackles common in c-section babies several hours after birth
27
Q

How to use Bulb Syringe

A
  • Keep bulb easily accessible
  • Suction mouth first then nose (to prevent aspiration)
  • When suctioning, avoid center of mouth to avoid gag reflex (use 1 side of mouth)
  • Nasal passages suctioned one at a time
  • Clean bulb with soap and water after each use
28
Q

Conditions of Meeting Adequate Oxygen

A
  • Clear airway
  • Effective establishment of respirations
  • Adequate circulation, perfusion, cardiac function
  • Adequate thermoregulation
29
Q

Maintaining Body Temperature

A
  • Skin to skin contact in first hour is the best to increase baby glucose, temperature stability, and improve breast feeding
  • Dry and wrap baby in warm blankets immediately after birth
  • Keep head covered
  • Keep nursery temperature at 22-26 (72-78)
30
Q

Radiant Heater

A
  • Placed under radiant warmer if skin to skin contact not available
  • Set radiant heater to 36-37 (96.8-98.6) to maintain adequate temp 36.5-37 (97.7-98.6)
  • Thermistor Probe - Placed on upper abdomen to detect temperature change in skin
  • Servo controller - Adjusts temperature on warmer
  • Axillary temperature measured every hour
31
Q

Baths

A
  • Postponed for 6 hours or until temperature stabilizes (above 36.8 (98.2))
  • Bath should be limited to 5 minutes
32
Q

Eye Prophylaxis

A
  • Used on the eyes to prevent ophthalmia neonatorum or neonatal conjunctivitis (inflammation caused by sexually transmitted bacteria through vaginal birth)
  • Recommended for all newborns (including c-section)
  • Erythromycin 0.5% Ointment
  • Without prompt treatment can lead to blindness
  • Administered within 1st hour of birth or delayed 2 hours for breastfeeding and eye contact with baby
33
Q

Vitamin K Prophylaxis

A
  • Lack of intestinal bacteria causes lack of vitamin K
  • Flora appears at 7 days of age
  • Phytonadione is given to prevent vitamin K hemorrhage
  • Delay injection for skin to skin contact
34
Q

Parent-Infant Interaction

A
  • SSC (skin to skin contact) promotes physiologic stability of infant
  • Oxytocin and Lactose rise with SSC
  • Rooming in after birth promotes parent-infant interactions

OB (96 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions