Exam 1 Flashcards
what age is considered an old maternal age?
over age of 35
what does the baby need to become independent in after birth?
- their respiratory system
- their circulatory system
- their ability to thermoregulate
- their ability to produce a source of glucose
how much fluid is in a newborn’s lungs?
about 80-110 mL
why do c-section babies have more fluids in their lungs compared to normal newborns?
because they aren’t being squeezed out and the fluid isn’t being ejected
ductus arteriosus location
between pulmonary artery and aorta
foramen ovale location
between right and left atrium
what is common in a newborn due to their foramen ovale and ductus arteriosus not closing?
they might have murmurs for the first 6 months, then should close
normal newborn heart rate
100-160 beats/min
how is NB circulation changed?
with adequate respiratory function
during sleep, what might be a normal HR?
80-100 beats/min
during crying, what might be a normal HR?
180 beats/min
how long should apical HR be counted?
a full minute
apgar score
initial assessment of vital functions; assess HR, RR, muscle tone, reflex irritability and color
when is an apgar score taken?
at 1 minute after birth and 5 minutes after birth
normal RR for a newborn
30-60 per min
since NB RR are irregular often, what is the best way to check for them?
by watching their abdomen since they are nose breathers
what is important to know about a NB’s temperature immediately after birth?
it drops rapidly
what is the best way to assess for a NB temperature?
axillary; rectal is not advised
normal temp of a NB
97.7-100.0
how long does a NB temp take to stabilize?
24 hours
what is the best way to keep a NB warm besides using a heater?
skin-to-skin (kangaroo care)
what body temperature would be concerning and why?
anything under 97.9; below 97.5 is correlated with poor brain growth and increased mortality
explain brown fat
- metabolized for heat production
- develops at 26-30 weeks
- depletes by 2-5 weeks of age
- more rapidly depleted by cold stress (hypothermia)
what are effects of hypothermia?
- resp. distress
- hypoglycemia
- loss of weight
- jaundice
what can the nurse do to keep the baby warm?
- dry and wrap in warm blanket
- cover head with hat
- place under radiant heat source or on mom’s abdomen
what can hyperthermia cause?
increased metabolic rate and increased need for glucose and oxygen
what is the NB stomach capacity and when do they empty their stomach?
5-10 mL at birth (30-90 when stretched) and empties within 2-4 hours
what occurs in the first period of reactivity?
- it is from birth to 30-60 minutes
- NB is alert, responsive, rapid HR and resp., strong suck
- best time to feed
what occurs in the period of inactivity?
- lasts 60-100 minutes
- NB sleeps, recovers from birth
- bowel sounds audible
what occurs in the 2nd period of reactivity?
- occurs at 4-8 hours of age and lasts 4-6 hours
- awake/alert, rapid color changes
- meconium, void, feed
what is common in a NB since their cardiac sphincter is immature?
regurgitation of food; must burp in between feedings
how much weight is a NB expected to lose?
5-7% of their birth weight
meconium stool
black, tarry, no odor; passed within 12-48 hours after birth
what would it mean if the meconium is passed before birth?
could be a sign of fetal distress
transitional stool
3-4th day; greensih/loose
newborn stool
5-6th day; depends on type of feeding
breastfeeding stools
- occurs on 4th day
- light yellow stools
- sweet smelling
- seedy
- goes 3-4 times a day
bottle-feeding stools
- occurs on 4th day
- pale yellow to light brown stools
- more odor than breastfed: sour milk odor
- 2 stools per day
- firmer consistency
normal WBC count in NB
9,000-30,000/mm (avg. 17,000) ~ higher due to inflammatory process in beginning of life
normal bilirubin count in NB
1-4 mg/100mL
normal blood sugar in NB
50-60 mg/dl x 3 days
60-70 mg/dl after 3 days
*we worry more about hypoglycemia
why do NBs have leukocytosis when first born?
due to stress of labor, not an infectious process
when does urine production begin and what is it used for?
it begins in the 12th week of fetal life and is a component of amniotic fluid
when should a NB’s first void be?
by 24 hours of life, then 6-10 times/day
how is a NB’s urine?
it is very dilute for the first 3 days due to the decreased ability to concentrate urine
what does the NB liver play a role in?
- iron storage (from mom) for RBC production
- carbohydrate metabolism
- conjugation of bilirubin
- coagulation
what is given when a NB is born to help with clotting?
vitamin K
where is vitamin K given and what is the maximum a NB can be given?
given in the vastus lateralis and 1 mL is the maximum
why is a prophylactic eye ointment given to a NB?
to prevent ophthalmia neonatorum caused by gonorrhea or chlamydia
IgG
passive immunity from mom
IgM
produced by fetus/NB
IgA
produced by infant 6-12 weeks after birth
when do antibodies get transferred to fetus?
in the 3rd trimester and when breastfeeding
is fever a reliable sign of infection?
NO; low body temperature is more indicative of a bacterial infection
caput succedaneum
edema of scalp caused by pressure from cervix; disappears in 3-4 days
cephalohematoma
blood between skull bone and periosteum; caused by pressure on maternal pelvis or birth trauma; resolves in 3-6 weeks; increases risk of hyperbilirubinemia
signs of neurologic integrity
NB’s ability to console himself, sleep and wake, and respond to voices
what kind of cry is concerning?
high pitched cries and weak cries or no cries
blink reflex
protects eye from an object coming near
rooting reflex
when the cheek is stroked and the NB will turn their head that direction; works with breast feeding too
sucking reflex
when lips are touched, NB sucks; disappears in 3-4 months
if a baby is not taking fluids by mouth due to feeding tube, what should be offered to them to stimulate the sucking reflex?
they should be offered a pacifier
moro (startle) reflex
NB will raise her arms and cry when startled
how does vision work in a NB?
can see best at 8-12 inches (why we do cradle hold); sensitive to light; prefer human face
how does hearing work in a NB?
it is well developed and respond to mother’s voice most often; listen best to a quiet voice
how does smell and taste work in a NB?
well developed in 6 days
how does touch work in a NB?
most sensitive at mouth and hands
preterm babies
born before 37 weeks
term babies
born between 37-40 weeks
post-term babies
born after 40 weeks
what gestation babies tend to be more prone to hypoglycemia?
small and large gestational age babies
macrosomia
when mom has high BG levels the fetus will receive high glucose levels
when does the fetus secrete their own insulin?
10-14 weeks
acrocyanosis
hands and feet are blue; may be due to baby being cold or poor circulation
hypospadias
urethral openeing under penis
epispadias
urethral opening on top of penis
how long do each trimesters last?
1st = from LMP through 13th week
2nd = 14th week - 26th
3rd = 27th week - 40
how do you start counting when a pregnancy began?
start with the first day of missed menstrual period
gravida
any pregnancy, regardless of duration
nulligravida
never been pregnant
primigravida
pregnant for the first time
multigravida
second of subsequent pregnancy
para
counts births after 20 weeks, regardless of outcomes; does not count infants, just births
GTPAL
Gravida
Term deliveries (37 weeks and up)
Preterm births (between 20 and 36 6/7 weeks)
Abortion
Living children
when does ovulation occur?
14 days before the first last day of the cycle
what do the urine tests test for?
human chorionic gonadotropin (hCG) ~ when sperm and egg come together, this is created
what might higher than normal levels of hCG be seen with?
- molar pregnancy
- ectopic pregnancy
- abnormal gestation (DS)
- multiple gestation
what might a decrease in hCG be seen with?
impending miscarriage
what does hCG do?
preserves function of corpus luteum and ensures a continued supply of estrogen and progesterone
where is the uterus in 12-14 weeks of gestation?
right above the symphysis pubis
where is the uterus 20-24 weeks of gestation?
above level of umbilicus
where is uterus 36 weeks gestation?
touches xyphoid process
lightening
occurs at about 38-40 weeks gestation; when the pressure in the pelvis lightens
operculum
mucus plug ~ protects body from pathogens entering in the vagina
goodell sign
softening of the cervix ~ noticeable during first 3 months
chadwick’s sign
violet or bluish discoloration of the vaginal mucous membrane and cervix
ballottement
between 16-18 weeks, can bounce fetus gently and have it rebound
during the 2nd and 3rd trimesters what will occur with the breasts?
colostrum might be present
what might occur with the respiratory system?
nasal stuffiness or congestion
supine hypotensive syndrome
- enlarged uterus may press on the vena cava and the aorta which reduces blood flow to the right atrium
- this lowers BP and causes dizziness and will also reduce blood flow to the placenta
- AVOID LAYING SUPINE!
recommended weight gain for women of normal pre-pregnancy weight
25-35 pounds
recommended weight gain for overweight women
15-25 pounds
what might occur in a pregnant moms urine?
glucosuria: trace amounts may spill into urine due to kidneys inability to filtrate the glucose
what are the three signs of pregnancy categorized as?
- presumptive = changes felt by woman
- probable = changes observed by an examiner
- positive = those that can be attributed only to the presence of a fetus
oxytocics
uterine stimulants: stimulate uterine contractions to promote labor
tocolytics
uterine relaxants: suppression of preterm labor
what does it mean for the cervix to be “ripe”?
it shortens, softens, and dilates; must be ripe before drugs can be given
what drugs promote cervical ripening?
prepidil, cervidil, cytotec
most widely used agent for cervical ripening and controlling postpartum hemorrhage
misoprostol (cytotec)
what does pitocin (oxytocin) do during labor?
it causes uterine contractions but does NOT ripen the cervix
when would we not be able to administer pitocin?
- fetal lungs are not mature
- cervix is not ripe
- patient had previous c-section or uterine surgery
- patient has genital herpes
- cephalo-pelvic disproportion (CPD)
what drug develops the fetal lungs?
betamethasone
antidote for magnesium sulfate
calcium gluconate
where does fertilization occur?
in the outer third of the fallopian tube
how long is an ovum fertile for after ovulation?
24 hours after
how long can sperm survive?
48-72 hours but most are only fertile for 24 hours
zygote
when sperm and ovum unite: 23 chromosomes from each zygote so the zygote has 46 chromosomes
functions of amniotic fluid
- cushions and protects
- controls embyro temp.
- allows freedom of movement for the fetus
what does the umbilical cord consist of?
one large vein that carries oxygenated blood to the baby and two small arteries that carry unoxygenated blood from the baby to the mom
explain both sides of the placenta
- maternal side - “A” = “dirty duncan”
- fetal side - “B” = “shiny shultz”
what time during a pregnancy would be most susceptible to teratogens?
the embryonic stage (week 3-8)
when is the most crucial time period for developmental disorders?
during the first 3 months
when can mom begin to feel fetal movement?
20th week
when do fetal lungs mature?
usually by the 36th week
main advantage of a male condom
protects from pregnancy and STI’s
what is the permanent way to avoid contraception?
tubal ligation or vasectomy
disadvantages of oral contraceptives
- need to take pill daily at same time
- can be cosly
- not an option for smokers > 35 years
- not an option for h/o thromboembolic disease
- does not offer STI protection
infertility
inability of a couple to achieve conception after a year of unprotected sex (6 months if the woman is over age 35) or the inability to carry a pregnancy to a live birth
subfertility
reduced fertility in both partners
secondary infertility
couples have one successful pregnancy and are unable to conceive or sustain a second pregnancy
what is the usually the first approach when trying to diagnose infertility?
- semen analysis
- extensive interview
- physical exams of both
- lab tests for both
hysterosalpingogram (HSG)
shows if tubes are blocked; can cause uterine clamping after since uterus is trying to get dye out
