Exam 1 & 2 Decks Flashcards
1
Q
Maternal-Newborn Nursing
A
the promotion and maintenance for optimal family health to ensure cycles of optimal child-bearing or child-rearing
family centered
2
Q
The Basic Unit of Society
A
Family
3
Q
Types of Families
A
Binuclear (divorsed), nuclear (married), single parent, same sex
4
Q
Birth Rate
A
number of live births in one year/1000 population
5
Q
Infant Mortality Rate
A
number of deaths of infants younger than 1 year/1000 live births
6
Q
Maternal Mortality Rate
A
number of maternal deaths form births and complications of pregnancy, child birth, and puerperium
1st 42 days after termination of pregnancy/100k births
7
Q
Healthy People 2030
A
- reduce maternal mortality rate
- reduce rate of infant mortality
- reduce rate of preterm births
- increase proportion of women delivering live births and having a healthy weight prior to pregnancy
- increase proportion of women who are screened for postpartum depression ar postpartum checkup
- increase proportion of infants who are breastfed
8
Q
Nurse Practice Act
A
defines the rules and safe parameters
1. scope of practice
2. standards of care
3. standards for educational programs
4. licensure requirements
5. grounds for disciplinary actons
6. enforced by state board
9
Q
Scope of Practice
A
range in services and care provided by nurse via state requirements
ex: RN vs NP
10
Q
Scope of Care
A
promotes consistency and ensures quality nursing care and outcomes
minimum legal acceptance
11
Q
Evidence-Based Practice
A
based on nursing and research to provide quality, safe client care
12
Q
State Board of Nursing
A
hospitals have own set of policies for nurses
can limit scope of practice but never expand
13
Q
Professionsal Negligence/Malpractice
5 Reasons
A
- duty
- breach of duty
- foreseeability
- causation
- injury or harm
14
Q
Informed Consent
A
person’s agreement to allow something to happen based on full disclosure ot risks, benefitsm alternatives, and consequences of refusal
failure to claim - claim of battery
15
Q
HIPAA
A
minimalize exclusion of preexisting conditions, designate rights for those who lose other health coverages, eliminate medical underwriting in group plans including privacy rule
16
Q
Privacy Rule
A
right of patients to keep personal info from being disclosed
17
Q
Cultural Competence
A
acknowledging, respecting, and appreciating ethnic, cultural, an linguistic diversity
18
Q
Encultuation
A
socialization into one’s primary culture as a child
19
Q
Acculturation
A
culture of minority is gradually displaced by culture of dominant cultural group
20
Q
Assimulation
A
process by which a person or group’s language or culture resembles those of another group
21
Q
Ethnocentrism
A
conviction that values and beliefs of ones’ own cultural group are best or only acceptable one
22
Q
Autonomy
A
respect right to self determination, independent decision making
23
Q
Fidelity
A
keep promises
24
Q
Justice
A
fairness
25
Beneficence
positive actions to help
26
Nonmaleficence
avoid causing harm
27
Veracity
truth telling
28
Paternalism
provider makes decisions on diagnosis, therapy, and prognosis
29
Fundal Massages
lower hand underneath in cupped position above pubic synthesis, upper hand at fundus
upper hand rotates while lower hand supports
muscles will contract
30
Breastfeeding
important in 1st hour
removal of colostrum
skin-to-skin and allowing baby to smell milk
31
Attachment
| Breastfeeeding
baby uses jaw and tongue to massagae nipple, goes far back into mouth
one hand on breast, one hand on baby's head
problems with attachement - remove milk early to make supply
32
Breast Milk
| Breastfeeding
hand in "C" shape, press back, compress, relax
33
Calories
| Breastfeeding
frequent, small feedings
bright yellow stools expected at day 5
34
C-Section
| Breastfeeding
placed skin-to-skin in operating room
35
Small/Early Babies
| Breastfeeding
below 6lbs or 37 wks
may be sleepy, still offer milk even if it is through hand expression and with a spoon
36
Shaken Baby Syndrome
shake baby back and forth
cause severe vision, behavioral, or developmental problems
convulsions, seizures, loss of consciousness and vision, not breathing, pale, poor feeding, vomiting
37
Antepartum
pregnant women before onset labor
38
Intrapartum
time of labor and childbirth
39
Postpartum
6-8wk time period after delivery of baby and placenta
reproductive system returns to non-pregnant state
40
Involution
pelvic reproductive organs return to approximate pre-pregnancy size, position, and function
takes about 6wks, fastest on day 3-4
risk of hemorrhage
41
Quick Involution Factors
non-complicated L&D process, breastfeeding, early ambulation, complete expulsion of placenta
42
Slow Involution Factors
multiple gestations, c-section, polyhydraminos, retained placenta, full bladder, multiple pregnancies, prolonged labor
43
Placental Detachment
uterus has rapid contractions to vasoconstrict (pinch off) blood vessels as the site of placental attachment - controls bleeding
44
Protein Catabolism
uterine muscle cells decrease in size (6wks)
45
Exfoliation
placental site healing, sloughing off dead tissue in form of lochia
46
Uterine Atony
boggy uterus 1-2hrs after birth
47
Normal Descent of Uterus
1cm / 1 fingerbreadth per day
nonpalpable by day 10-14
48
Afterpains
| Involution
intermittent uterine contractions, more uncomfotable in multiparous women
happens during breastfeeding with release of oxytocin
49
Lochia
postpartum uterine discharge classified according to appearances and contents
50
Lochia Rubra
day 1-3
red with small clots
pad saturation in 50 minutes or less - excessive
51
Lochia Serosa
day 3-10
pale pink/brown
52
Lochia Alba
day 10-14
yellow to white
53
Cervix
| Postpartum
flabby, thin, protrudes into vagina
closes in 1 wk
54
Vaginal Walls
| Postpartum
smooth and swollen, can be ecchymotic (bruised)
55
Vagina
| Postpartum
returns to pre-pregnant state
may have edema and small lacerations
56
Kegels
strengthen perineal muscles
57
Dyspareunia
vaginal dryness in painful intercourse because of decreased estrogen
58
Menstral Flow Postpartum
70% return in 9-12wks
7wks for non-nursing mothers
1st cycle - non-ovulatory because of elevated prolactin
59
Cardiac Output and Blood Volume
increase - hypervolemia
CO returns after 12wks of delivery
60
Diuresis
urinate a lot because of decrease in aldosterone and Na retention
61
Diaphoresis
sweating a lot
62
Fibrinogen
protein responsible for blood clotting - must monitor for blood clots after birth
63
Walking and Urinating Postpartum
critical, bladder tone diminished
decrease UTI susceptibility
64
Neurological Effects Postpartum
lack of feeling in legs
dizziness and headache
disconfort and fatigue
symptoms of carpal tunnel syndrome
65
Endocine Effects Postpartum
sharp decrease in estrogen and progesterone, lactation begins
estrogen = prolactin inhibiting hormone
66
Musculoskeletal Effects Postpartum
relaxin hormone relaxes pelvic ligaments and joints within pregnancy
joints may feel altered
abdomen wall - weakened and maybe separated (diastasis recti)
67
Gastrointestinal Effects Postpartum
very hungry and thirsty
bowel tone - sluggish
go on high fiber diet or use laxatives
68
Integumentary Effects Postpartum
melanocyte decreases
cholasma and linea nigra gradually fades
striae fades to silvery lines
spider nevi and palmar erythema disappear
69
Immune System Effects Postpartum
Rubella, Rhogam, Coombs test
70
Rh Factors with Rh- mom and Rh+ baby
Coombs test - negative = mom is not sensitized to it
300mcg of RhoGam in first 72 hours after delivery
71
Why it is necessary to give mom RhoGam shot
prevent maternal antibody production from Rh+ antigens
if blood mixes = cause problems in future pregnancies
72
Rubella Vaccine
administer to nonimmune mother
safe for nursing mothers
avoid pregnancy for 1 month
never want to give it to pregnant mom since it is a live vaccine
73
Lactation
synthesis, release, and ejection of milk through ductal system
inhibitory with high levels of progesterone and estrogen
74
Colostrum
rich in nutrients, protein, antibodies, immune cells
75
Traditional Milk
2-5 days after delivery
rich in fat and protein
76
Mature Milk
10-15 days after delivery
77
Let Down Reflex
milk ejected though ductile system through neurohormonal reflexes
infant sucking = stimulates oxytocin from posterior pituitary
milk ejection = stimulates prolactin from anterior pituitary
78
Breastfeeding Benefits for Baby
antibodies, increases intellecual development
79
Breastfeeding for Mom
involution, decrease hemorrhage, increase expenditure of calories, decrease risk of osteoporosis, breast cancer, ovarian cancer, increse attachement
80
Common Breastfeeding Positions
football, lying down, cradling, across lap
81
Rubin's Restorative Phases
Taking in
Taking hold
Letting go
82
Taking In
| Rubin's Restorative Phases
dependent, absorbing experiences of labor, need rest, comfort, and nutrition
83
Taking Hold
| Rubin's Restorative Phases
independent, attend to infant's needs, want to learn about how to care for child
84
Letting Go
| Rubin's Restorative Phases
interdependent, redefine new role
85
Positive Attachement
touching, holding, kissing, cuddling, talking, singing, "en face" position
86
Malattachment
refusing to look at infant, no touch, no holding, no naming, negative comments, refusing to respond to infant cues
87
Malattachment Interventions
rooming in, skin-to-skin in en face position, providing praise and support
88
Baby Blues
3-5 days after delivery
80% of women
changes in hormones can make mom feel sad, irritable, and confused
89
Postpartum Assessment
determine physiological needs: vitals
intrapartum history
need for immunizations
educational/cultural/religious/language/DV
90
Vital Signs
elevated temp (100.4) in first 24 hrs
postpartum shivers common
pulse: 60-100, may see slight bradycardia from the increased CO in preg
if tachycardic: may be infection
BP should be normal
91
Orthostatic Hypotension
BP decreases after lying down for long period and standing rapidly
92
C-Section Assessment
stool softeners, early ambulation, incision: REEDA
93
REEDA
| C-Section Assessment
redness, edema, ecchymosis, discharge, approximation
94
Pulmonary Infections Postpartum
use of narcotics and immobility
95
Postpartum Focused Assessment (BUBBLE HEB)
breasts, uterus, bladder, bowels, locia/lacerations, episotomy
hemmorhoids, emotions, bonding
96
Intimate Partner Violence
pattern of coercive control, imbalance of power
hostile, demanding, answering for patient
97
Types of Abuse
emotional/psychological, verbal, physical, sexual, financial, spiritual
98
Violence Against Women Statistics
1/4 women in US will be in abusive relationship
battering is the most common form of injury
1/3 attempt suicide
1/3 of ER visits are DV related
99
Cycles of Violence
tension building
explosion
honeymoon
100
Tension Building
| Cycle of Violence
abuser is critical and bully
victim feels some control, but walking on eggshells
101
Explosion
| Cycle of Violence
physical or emotional violence
victim feels helpless
102
Honeymoon
| Cycles of Violence
apologetic abuser, very romantic
103
Batterers
90-95% men
personal entitlement, charming, angry, very attentive to victim in hospital
104
Screening for DV
private space, non-judgemental
direct and indirect questions
105
Newborns' and Mothers' Health Perception Act (NMHPA)
| Preparing for Discharge
minimum federal standards for health plan coverage and minimum stay
48hrs for uncomplicated vaginal birth
96hrs for uncomplicated C-section
106
Criteria for Discharge - Mother
1. stable vitals
2. right lochia
3. firm fundus
4. adequate urine output
5. surgical wounds healing
6. ambulates with minimul discomfort
7. adequate pain control
8. family support
9. Rh status known
107
Criteria for Discharge - Newborn
1. stable vitals for 12 hrs
2. passed urine and stool spontaneously
3. 2 successful feeds
4. no abnormalities upon physical exam
5. no bleeding and circumcision for 2hrs
6. jaundice is managed
7. Hep B administered or appointment made
8. appointment with PCP
9. congenital cardiac heart defect screening
10. hearing screening
108
SIDS
sudden death in 1st year of life
most occur 2-4 months old
109
Triple Risk Model
| SIDS
vulnerable infant, critical development period, stressors
110
Safe to Sleep
firm mattress, no soft objects in crib, no smoking, right temperature, sleeping close but not with, in supine position
111
Ovulation
egg is released from ovary and uterus thickens
112
Ovary
contains oocytes in a folicle
113
GnRh
gonadotropin-releasing hormone
released from hypothalamus to stimulate FSH and LH
114
Anterior Pituirary Hormones
FSH and LH
115
Ovarian Hormones
estrogen and progesterone
116
FSH and LH in Ovary
promote folicle growth and oocyte maturation, estrogen production, primes endothelium to thicken
117
Rise of Estrogen on LH
surge of LH secretion, also surges progesterone to increase
118
Rise of LH Effect
trigger ovulation and a formation of a corpus luteum
119
Corpus Luteum
yellow hormone-secreting body in the female reproductive system
secretes estrogen and progesterone
maintains endothelium if pregnancy occurs
120
Effects of Progesterone and Estrogen on FSH and LH
progesterone and estrogen inhibit FSH and LH
121
Uterine Cycle
menstural phase
proliferate phase
secretory phase
ischemic phase
122
Menstural Phase
| Uterine Cycle
3-6 days, starts on first day of flow
uterus sheds
progesterone and estrogen are low
123
Proliferate Phase
| Uterine Cycle
end of menses to ovulation (day 14)
influenced by outside factors and hypothalamus changes: stress, diet, sleep
high in estrogen, stimulating endometrium to fill with blood
increase in cervical mucus, thin and less acidic
124
Secretory Phase
| Uterine Cycle
after ovulation
progesterone increases, endometrium swells to prepare for a fertilized ovum, estrogen decreases
if fertilization does not occur, estrogen and progesterone decrease, vasoconstriction
125
Ischemic Phase
| Uterine Cycle
blood supply to the endothelium sloughs and blood escapes with tissues and mucus
does not happen if fertilization occurs
estrogen and progesterone decrease
126
Ovarian Phase
follicular phase
luteal phase
127
Follicular Phase
| Ovarian Cycle
with menstrual and proliferate phase
developing viable follicles for ovulation
estrogen is secreted by follicles and surges to the end of this phase - leads to positive feedback on LH leading to luteal phase
128
Luteal Phase
| Ovarian Cycle
with secretory an ischemic phase
ovum released from follicle - follicle turns into corpus luteum
LH and FSH decrease, progesterone and estrogen increase to prepare uterine lining
129
Conception
union of sperm and ovum
sperm: 48-72hrs
ova: 12-24hrs
130
Fertilization
sperm penetrates outer layer of ovum
develops embryo
72hr critical time
occurs in ampulla of fallopian tube
131
3 Factors of Fertilization
ability of egg and sperm to mature
ability of sperm to reach ovum
ability of sperm to penetrate ovum
132
Estrogen and Fallopian Tubes
increases contractility
have peristalis and cilia
133
Capacitation
sperm penetrating ovum
sperm has to stay in genital tract for 4-6 hours to fertilize because of this
134
Ovum Once Penetrated
outer later changes to prevent other sperm from attaching
if more than one do, embryonic death
tail detaches, head largens, 2 nuclei move and fuse
135
Zygote
fertilized ovum with unique genetic material
secretes HCG
136
Zygote and Placenta Secrete
hCG
137
Function of hCG
maintain corpus luteum to secrete progesterone
138
Pre-Embryonic Period
begins with fertilization
rapid cell division
zygote implants in upper posterior part of uterus (lining is thickest and best blood supply)
becomes blastocyst
139
Embryonic Period
rapid organ formation
susceptible to teratogens
3 germ layers
embryonic membranes: chorion and amnion
umbillical cord and placental development
140
Chorion
outermost layer closest to uterine lining
141
Amnion
smooth membraine that lines fluid-filled space
fills with amniotic fluid
prevent umbillical cord compression
142
Amniotic Cavity
cusion, movement, temperature, protection
143
Umbilical Cord
2 arteries with deoxygenated blood from fetus to placenta
1 vein supplying O2 and nutrients
Wharton's Jelly to insulate and protect
144
Placental Functions
transport and exchange: serves as lungs, GI, liver, passive immunity
hormone secretion: hCG, estrogen, progesterone, hPL
145
First Trimester: Fetus
| Conception to 12wks
face more human
reflexes
spontaneous movement
heartbeat
45g, 3 1/2in
susceptible to teratogens
sex distinguished
146
Second Trimester: Fetus
| 13wks-26wks
very active
lanugo present (hair)
vernix caseosa coats skin (white biofilm)
brown fat forms
lungs form with alveoli and surfactant
eyes open and are sensitive to light
700-800g, 10in
147
Third Trimester: Fetus
| 27wks-Birth
increase in subcutaneous fat
bones are soft and flexible
increase in muscles
respiratory and circulatory systems are functioning
lanugo and vernix may disappear
maternal antibodies transferrred
head down position
148
Estrogen
secreted in ovaries then placenta
increases uterine growth
increases support of breast development
increases uterine blood flow
prevents further follicular development during pregnancy
relaxes pelvic ligaments
149
Progesterone
secreted in corpus luteum then placenta
relaxes smooth muscles
reduces gastric motility
relaxes blood vessel walls
supports and maintains uterine lining for implantation of developing embryo
decreases prostaglandin production
150
hCG
secreted from placental cells
prevents involution of corpus luteum
peak at 9-10wks
151
Relaxin
secreted in corpus luteum and small amounts in placenta
decreases uterine contractility
relaxes connective tissues
152
hPL
secretes in placenta
makes glucose available for fetus
growth promoting and lactogenic
153
Prolactin
secreted in the anterior pituitary
promotes development of breasts and supports lactation
lactation inhibits estrogen
154
Melanocyte Stimulating Hormone
secreted in anterior pituitary
produces hyperpigmentation
155
Oxytocin
secreted in posterior pituitarty
stimulates uterine contractions
stimulates milk ejection reflex
156
Aldosterone
secreted in the adrenals
conserves Na and maintains fluid balance
157
Cortisol
secreted in adrenals
active in metabolism of glucose and fats
may help prevent rejection of pregnancy because of anti-inflammatory effect
158
Thyroxine
secreted in thyroid
stimulates basal metabolic rate
159
FSH
secreted in anterior pituitary
initiates maturation of ovum and suppressed during pregnancy
160
LH
secreted in the anterior pituitary
stimulates ovulation of mature ovum in non-pregnant state
161
Prostaglandins
secreted in cell membrane
stimulates smooth muscle contractility
influences onset of normal labor with oxytocin
promotes cervical ripening
162
Fundal Height at the 12th, 20th, and 36th Week
palpated just above the pubic symphysis
level of umbilicus
at xiphoid process
163
McDonald's Rule
fundal height = gestational age between 22wks and 34wks
164
Heger's Sign
| Uterus Changes
softening of lower part of uterus
165
Braxton Hicks Contractions
irregular and intermittent contractions about 4mo into pregnancy
166
Goodell's Sign
softening of the cervix
167
Chadwick's Sign
increased vascularituy to cervix and vagina - turns purple
168
Leukorrhea
vaginal secretions that are white and thick
ph down to 4/5
169
Breasts in Pregnancy
tingling/tenderness
increased vascularity
areola darkens, Montgomery tubercles enlarge
170
Blood Volume in Pregnancy
increases 1500mL
171
RBC in Pregnancy
increase 20-30% for increased iron
172
Coagulation in Pregnancy
increased fibrinogen, clot easier
173
WBC in Pregnancy
increase 45-50%
174
BP in 2nd Trimester
goes down because of systemic vascular resistance
175
Hemorrhoids in Pregnancy
enlargement of uterus puts pressure on pelvic and femoral vessels, interferes with venous blood return
176
Supine Hypotensive Sign
lying supine allows fetus to put pressure on vena cava - reduces blood flow to right atrium
feeling of faintness, BP lowers
177
Respiratory System in Pregnancy
more need for O2, stable rate
estrogen relaxes ligaments for better chest expansion
may see epitaxis (nosebleeds)
178
GI and Pregnancy
N/V from increased hCG
cardiac sphincter tone and gastric motility decreases leading to acid reflux
constipation because decreased gastric motility and increased water absorption
gallstones from increased cholesterol in bile
ptyalism and PICA
179
Renals and Pregnancy
ureters: hyperplasia and hypertrophy
urine rate low - leads to UTIs
increased urinary frequency
nocturia
180
Musculoskeletals and Pregnancy
cartilage loosens
lordosis
carpal tunnel syndrome: edema in perpheral nerves
181
Endocrines and Pregnancy
basal metabolic rate increases
thyroid increases
pancreas increases insulin
182
Skin and Pregnancy
warm and flushed from increased circulation
stretch marks: striae gravidarum
hyperpigmentation
melasma/cholasma: on face
183
Hair and Pregnancy
hair is in a resting phase
fewer hairs fall out
184
Hyperemesis Gravidarum
excessive vomiting
risk of dehydration, electrolyte balance
185
Gestational Diabetes
glucose intolerance or not secreting enough insulin
186
Maternal Role Attachment
interaction and development process occurring overtime where mother becomes attached to infant, acquires competence in care-taking tasks in role, express pleasure and gratification in role
187
First Trimester
| Psychologial Adaptation
acceptance of pregnancy
"I am pregnant"
not a good time to teach about L&D
188
Second Trimester
| Psychological Adaptation
differentiation
focus shift on baby, perceived as seperate
"I am going to have a baby"
better to teach now
189
Third Trimester
| Psychological Adaptation
nesting
ambivalence returns, anxious
"I am going to be a mom"
really teach about L&D
190
Presumptive Signs of Pregnancy
subjective
N/V, breast changes, fatigue, amenorrhea (no period)
191
Probable Signs of Pregnancy
objective
serum lab test, positive pregnancy test, Chadwick's Sign, Goodell's Sign, Hegar's Sign, fetal outlline by examiner, ballottment
192
Positive Signs of Pregnancy
diagnostic
fetal heart audible, fetal movement palpable, visualization
193
Determining Due Date
add 280 days to 1st day of last period
194
Nagele's Rule
1st day of last period, subtract 3 months, add 7 days
195
Ultrasound to Determine Due Date
crown rump length
biparietal diameter
femer length
196
Crown Rump Length
7-13wks
length of the embryo or fetus from the top of its head to bottom of torso
little biological variability during this time - most accurate
197
Biparietal Diameter
>13 diameter
measures the head
198
Femer Length
>13wks
199
Gravida
number of times someone has been pregnant
200
Nulligravida
never been pregnant
201
Primigravida
first pregnancy
202
Multigravida
2nd or more pregnancies
203
Para
number of deliveries after 20wks
twins/triplets: 1 para
204
Nullipara
no pregnancies at viable time
205
Primipara
first pregnancy to viable term
206
Multipara
two or more pregnancies to viable term
207
Post-Term Birth
after 42wks
208
Preterm Birth
after 20wks and before 37
209
Term
38-42wks
210
Viability of Fetus
22-24wks
500g
211
1st Prenatal Visit
* medical history of family
* past medical history of mother
* gynecological history
* past OB history
* social history
* exposes to infection/teratogens
* nutritional status
* immunization record
* illnesses
* risk factors
212
1st Prenatal Exam
* full physical and pelvic exam
* auscultation of FHR
* Labs for blood type and Rh status, HIV, rubella, syphilis, CBC, Hep B, pap smear, urinalysis, STIs, TB
213
Return Visits
every 4 weeks until 28wk
every 2 weeks until 36wk
every week until delivery
214
Weight Gain and Energy Needs
extra 300cal every day
need lots of energy
215
Weight Gain Chart
Thin >18.5 – 28 -40 lbs
Avg 18.5 – 24.9 – 25-35lbs
Heavy 25-29.9 – 15-25lbs
Obese >30 – 11-20lbs
216
Nutritional Needs
folic acid, iron, vitamin D for bone growth, avoiding listerosis
217
Listerosis
food-borne illness from bacteria
avoiding raw fish, meat, lunch meats, unpasteurized milks, fewer than 200mg of coffee daily
218
Nurse's Role in Prenatal Check-Ups
* knowledge of tests
* meanings of results of test
* how procedure works
* what to prepare for prior to test
* what to do before and after test
* risks/complications
* when tests are performed
* client education
219
Ultrasound
tissue imaging using high frequency sound waves deflected by organs and return as echos
220
First Trimester and Ultrasounds
* determine viability
* estimate gestational age
* determine cause of vaginal bleeding
* help visualize for CVS
221
Second Trimester and Ultrasounds
detect polyhydramnios/oligo (too much amniotic fluid)
help visualize for amniocentesis
222
Third Trimester and Ultrasounds
* determine placental insufficiencies
* determine intrauterine growth restrictions
* detect congenital abnormalities
* part of biophysical profile
223
CVS
diagnose for fetal chromosomal abnormalities
sampling chorionic villi of the placenta around 10-12wks
224
Alpha Fetal Protein Screen
screening for neural tube defects (spina bifida) around 16-18wks
225
Amniocentesis
screens amniotic fluid from sac for genetic analysis and fetal lung maturity at 15-20wks
meaures lecithin and sphingomyelin: surfactants in proper pulmonary function, ratio 2:1 for proper lung maturity
severe diabetes can skew test
226
Non Stress Test
reactive=good
watching for accelerations in response to fetal movement
shows good and intact CNS and good oxygenation
2 or more accelerations in 20 minutes
15 bpm above baseline lasting 15 seconds
227
Non-Reactive Stress Test
not good
fetus may be asleep - eat glucose or use vibrations
may be from hypoxia, asphyxia, drug use, congenital heart abnormalities
228
Contraction Stress Test
see if fetus can tolerate labor
looking for decelerations in fetal heart rate
no decels = negative test
229
Biophysical Profile
used to evaluate the well being of a fetus
uses ultrasounds and FHR monitoring
2 points given to each component
less points = may need c-section
* fetal breathing movements
* gross body movements
* reactive FHR
* qualitative amniotic fluid
230
Risk Factors in Pregnancy
1. age
2. parity
3. lifestyle
4. low income
5. existing health conditions
6. genetics
7. environment
231
Age and Pregnancy Risk Factors
* being too young or old
* young: high BP, anemia, go into labor earlier, STI's, decreased prenatal care
* old (over 35): higher risk for C-sections, delivery complications, prolonged labor, infants with genetic disorders
232
Parity and Pregnancy Risk Factors
* 5 or more pregnancies
* risk for preterm labor
233
Lifestyle and Pregnancy Risk Factors
* poor nutrition, vegetarian diet
* substance use: alcohol or drugs
234
Low Income and Pregnancy Risk Factors
* no prenatal or inadequate care
* screen for drugs
235
Existing Health Conditions and Pregnancy Risk Factors
* diabetes
* PCOS
* obesity
* zika
* autoimmune diseases: lupus, multiple sclerosis
* cardiac disease
* HIV/AIDS
236
Genetics and Pregnancy Risk Factors
* defective -> chromosomal abnormalities could lead to spontaneous abortion
237
Pregestational Pregnancies at Risk
* substance abuse
* diabetes
* anemia
* HIV/AIDS
* heart disease
238
Gestational Onset Pregnancies at Risk
* hypertensive disorders
* spontaneous abortions
* ectopic pregnancies
* Rh alloimmunization
* herpes
* GBS+
* CMV (herpes)
* hyperemesis gravidarum
* gestational trophoblatic disease (multiple tumors)
239
Substance Abuse During Pregnancy
* 30% of women
* rates higher in 1st and 2nd trimester
* universal screening for everyone
* may be associated with decreased fetal growth restriction, stillbirth, preterm birth, neurological development: hyperactivity, poor cognitive function
* increased use of medically assisted treatment
* most at risk: below poverty level, exposed to violence, DV, depression, less than high school education, unmarried, unemployed
* most common: smoking cannabis in white women
* frequently misdiagnosed
* autonomy vs nurse's obligation
* fear of losing custody: decrease prenatal care
* prenatal use: withdrawl syndrome in newborn
240
Heroin Treatment
behavioral therapy mized with pharmacological therapy (MAT) medical assisted therapy
* methadone
* buprenorphine
* naltrexone
241
Methadone: Heroin Treatment
* most common
* during pregnancy, brings addicted woman into agencies that promote prenatal care
* help with withdrawl symptoms
242
Buprenorphine: Heroin Treatment
* better treatment adherence with fewer side effects and overdoses in comparison to methadone
243
Naltrexone: Heroin Treatment
* opioid antagonist, non-addictive, may improve compliance if an issue
* work through same opioid receptior, but safer
244
Patho of Diabetes
diabetes: metabolic disease with hyperglycemia from insulin secretion defects
* makes blood more viscous and causes high BV, cellular dehydration, polyuria, and polydipsia (excessive thirst)
* starts to burn both proteins and fats = ketones and fatty acids which causes weight loss because of breakdown in tissue
* change in vascular circulation with organs
245
Four Cardinal S/S of Diabetes
1. Polyuria
2. Polydypsia
3. Weight Loss
4. Polyphagia
246
Polyuria in Diabetes
excrete large volumes of urine
* glucose hyperconcentrated = kidney loses ability to pull glucose from water
* osmotic pressure rises, H2O cannot be absorbed back into blood = urination
247
Polydipsia in Diabetes
dehydration in cells, can be from polyuria
248
Weight Loss in Diabetes
breakdown of fats and muscles to make ketones and fatty acids
249
Polyphagia in Diabetes
tissue breakdown = starvation
person may eat excessive amounts of food
250
Classifications of Diabetes Mellitus
1. Type 1 DM: absolute insulin deficiency
2. Type 2DM: insulin resistance
3. Gestational Diabetes: any degree of glucose intolerance
251
White's Classification of Diabetes
in pregnancy
based on age of diabetes, duration of illness, presence of any organ involved
* eyes and kidneys
* classes A-C: positive pregnancy outcome if glucose controlled
* classes D-T: poor outcome, vascular damage
252
Influence of Pregnancy of Diabetes on Physiological Changes in 1st Tri.
alter insulin requirements
* insulin decreases because increased estrogen and progesterone stimulates pancreas to make more insulin
* this increases peripheral use of glucose
* hypoglycemia with N/V
253
Influence of Pregnancy of Diabetes on Physiological Changes in 2nd and 3rd Tri.
maternal metabolism directed toward supplying adequate nutrition for fetus
* placental hormones: cause insulin resistance
* promote more blood glucose to transfer through placenta
* fetus produces nore glucose when it gets glucose
254
Influence of Pregnancy of Diabetes on Hormones
* hPL
* somatotropin (growth hormone)
* promotes more insulin on bloodstream
* do not produce sufficient amount of insulin to maintain glucose homeostasis
255
Other Influences of Pregnancy in Diabetes
* accelerates progress of vascular disease
* more difficult to control in pregnancy
* fetus will get bigger since insulin turns into fat
256
Maternal Risks with Diabetes
* poor glycemic control = miscarriage and big baby (over 4000g)
* risk for C-section
* hydramnios: fetal urination, uterine dysfunction, infection
* hyperglycemia and ketoacidosis
* high risk for infections
* worsening retinopathy
257
Fetal Neonatal Risks with Diabetes
produce insulin around 14 wks = growth hormone
* macrosomia: could have birth injury delivering vaginally
* congenital abnormalities
* IUGR: interuterine growth retardation = decreased profusion to placenta with decreased vascularity
* respiratory distress syndrome: inhibit enzymes necessary for surfactant production
258
Clinical Therapy for Diabetes
* early detection and diagnosis
* assess risk at 1st visit
* if low risk: screen at 24-28wks
* if high: screen asap
259
Diabetes Levels
>128 mg/dL fasting glucose
>200 mg/dL random glucose
>6.5% ha1c
260
Increased Risk for Diabetes
* over 40
* family history
* obesity
* PCOS
* hypertension
* glucosuria
* prior macrosomic, malformed, stillborn
261
Screening for Gestational Diabetes
at 24-28wks
1hr 50g glucose tolerance test
262
Screening for Diabetes: Negative
lower than 140
routine care
263
Screening for Diabetes: Positive
over 140
3hr 100g GTT test
fasting 95
1hr: 180
2hr: 155
3hr: 140
if 2 values exceed these: positive
negaive = 1 value greater
264
Hemoglobin A1C Control
normal: 4-5.9%
hemoglobin will stick to RBC
* levels between 5-6 = fetal malformation rates comparable to those observed in normal pregnancy (2-3%)
* goal for HA1C = 3 months prior to conception
* HA1C concentration = fetal anomaly rate 20-25%
265
Pregnancy Complications
* Rh factor
* ABO incompatability
* ectopic pregnancy
* HSV
* GBS+
* preeclampsia/eclampsia
* gestational trophoblastic disease
266
Rh Alloimmunization
Rh = inherted protein on surface of RBC (+)
no protein (-)
267
Rh - Mother
Rh + baby
antibody-antigen response
sensitized mother
268
No Treatment to Sensitized Mother
* jaundice
* anemia
* brain damage
* heart failure
* death
269
Maternal Alloimmunization
when woman's immunse system is sensitized to foreighn erythrocyte surface antigen
stimulates the production of IgG antibodies
270
Sensitized Woman
small amounts of fetal blood cross the placenta
maternal IgM antibodies are produced and RhoGam will not help since she is sensitized
271
2nd Pregnancy and Sensitized Woman
Rh+ child - IgG antibodies produced and cross placenta
risk for hemolysis of fetal RBC
272
Indirect Coomb's Test
identifies antigen that could cause problems in newborns or mother
possible need for transfusion
positive test = antibodies present, no RhoGam
negative test = no antibodies present
273
Amniocentesis and Rh Compatability
using amniocentesis to test if fetus is Rh + or -
274
Ultrasound and Hemolytic Anemia
faster blood flowing through ultrasound
275
Other Interventions for Rh Incompatability
* monitoring pregnancy
* intrauterine transfusions of newborn
* exchange transfusion of newborn: erythopoietin and iron
276
Goals of Rh Incompatability
* prevent sensitization
* treat isoimmune disease in newborn
277
RhoGam Shot
when mom is not sensitized with - titer of + fetus
300mcg Rh immune globulin (RhoGam) IM at 28 wks
repeat dose within 72 hrs with + newborn
also given if any mixing of blood occurs
278
ABO Incompatibility
common and mild type of hemolytic diseases in babies
mom type O and infant type A or B
279
Maternal Serum Antibodies Crossing the Placenta
* can cause hemolysis of fetal RBC
* mild anemia
* hyperbilirubinemia
* not treated antepartally
280
Perinatal Infections
* herpes simplex virus
* GBS
281
HSV
1:6 between ages 14-49 are infected
282
Fetal Neonatal Risks with HSV
* spontaneous abortion
* preterm labor
* intrauterine growth resistance
* neonatal infection
* varies with route of birth and presence of lesions
* c-section of outbreak during labor
283
Clinical Therapy of HSV
* antiviral after 36wks gestation
* acyclovir, famciclovir, valacyclovir
* can reduse the need for a c-section
284
GBS
* in lower gastrointestinal tracts, urogenital tracts
* fetal risk: unexpected intrapartum stillbirth
* clinical therapy guidelines
285
Hypertensive Disorders
* chronic hypertension
* chronic hypertension with superimposed preeclampsia
* preeclampsia/ecclampsia
* gestational hypertension
286
Preeclampsia Diagnosis
* BP of over 140/90 with proteinuria
287
Preeclampsia Diagnosis: Before 20 Weeks
* no stable proteinuria and chronic hypertension
* new or increased proteins and preeclampsia superimposed on chronic hypertension
288
Preeclampsia Diagnosis: After 20 Weeks
* proteinuria and preeclampsia
* no proteinuria and gestational hypertension
289
Patho of Preeclampsia
* affects 5-10% of women
* multiorgan disease
* spiral arteries of uterus do not increase in diameter to promote perfusion to placenta
* vascular remodeling does not happen and decrease in placental perfusion and hypoxia occur
* endothelial dysfunction and vasospasm
* imbalance of vasodialating hormones: prostacyclin and vasoconstricting hormones: thromboxane
290
Three Characteristics of Preeclampsia
1. vasospasm and decreased organ perfusion
2. intravascular coagulation
3. increased permeability and capilary leakage
291
Vasospasm and Decreased Organ Perfusion: Preeclampsia
* hypertension
* uteroplacental spasm - intrauterine growth restriction
* glomerular damage - oliguria (small amounts of urine)
* cortical brain spasms - CNS problems
* retinal arteriolar spasms - blurred vision
* hyperlipidema
* liver ischemia
292
Intrautuerine Coagulation: Preeclampsia
* hemolysis of RBC
* platelet adhesion - low platelet count and DIC (affects clotting)
* increased VIII antigen
293
Increased Permeability and Capilary Leakage: Preeclampsia
* decreased serum albumin levels and decreased intravascular volume as fluid with protein
* increase in blood viscosity
* proteinuria
* generalized edema
* pulmonary edema
294
Clinical Manifestations and Diagnosis
don't use mild
proteinuria is not an official criteria
BP over 140/90 on two occassions, 4hrs apart after 20wks
low platelets, renal insufficiency, impaired liver function
295
Risk Factors to Preeclampsia
* first pregnancy
* materal age below 19 and above 30
* african american or hispanic
* low socioeconomic status
* family history
* chronic hypertension
* diabetes
* lupus
* multigestation
* gestational trophoblastic disease
* fetal hydrops
296
Nursing Assessment: Worsening Preeclampsia
* increased edema
* scotomata (vision problems)
* blurred vision
* decreased urinary output
* epigastric pain
* vomiting
* bleeding gums
* persistent/severe headache
* neurological hyperactivity: deep tendon reflex, clonus (involuntary muscle contractions)
* pulmonary edema
* cyanosis
297
Eclampsia
* seizures or coma
* multifocal, focal, generalized
* nursing assessment suring seizure
* treatment: magnesium sulfate, antihypertensive agents
* fetal reaction to survive: should reconsider when mom stabilizes
298
Preeclampsia Treatment
* early detection
* treat symptoms
* early treatment: bedrest, regular diet, monitor BP, proteinuria
* hospitalization if more severe
* therapeutic goal: diastolic BP between 90-100
* meds: hydralazine, labetol, oral nifedipine, magnesium sulfate: CNS depressant, seizure prophylaxis, smooth muscle relaxant, safe for fetus
299
HELLP Syndrome
continuation of preeclampsia
H) hemolysis
E) elevated
L) liver enzymes
L) low P) platelet count
* associated with severe preeclampsia
* symptoms: N/V, malaise, epigastric pain
300
Postpartum and HELLP
* possibility of HELLP
* eclampsia for 48hrs
* increased cardiovascular issues in future
301
Preeclampsia Maternial Consequences
* with eclampsia: 20% maternal mortality rate
* risk of: abrupto placenta, retinal attachment, cardiac failure, cerebral hemorrhage/stroke
302
Preeclampsia Fetal Consequences
* fetal growth retardation
* fetal hypoxia
* fetal death
303
Ectopic Pregnancy
* pregnancy outside of uterine cavity (2% of all preg)
* 95% implant in the fallopian tubes
* normal cell growth and division
* pressure from growth causes symptoms
* will rupture if pressure is too great: maternal death in 1st trimester
304
Risk Factors to Ectopic Pregnancies
* history of STI's or PID
* previous tubal, pelvic, or abdominal surgery
* endometriosis
* IVF or other methods of assisted reproduction
* in utero: Diethylstilbestrol (DES) exposure with abnormalities of reproductive organs
* use of IUD
305
Management of Ectopic Pregnancies
* salpingostomy/salpingectomy (removal of conception product/tube)
* methotrexate
* monitor blood loss
* emotional support
306
Hydatiform Mole (Molar Pregnancy)
* abnormality of placenta from fertilization
* forms grape-like cysts that fill entire uterus instead of normal placental tissue
* vast proliferation of trophoblastic tissue associated with loss of preg and can lead to the development of cancer = choriocarcinoma
* 20% become malignant
307
2 Types of Molar Pregnancies
1. complete molar preg: ovum with no functioning or missing nucleus or empty egg with normal sperm
2. partial: some fetal tissue present with normal ovum but two sperm
308
Increase Incidence of Molar Preg
* women with low protein intake
* >35 years old
* Asian women
* experienced prior miscarriage
* undergone ovulation stimulaiton (clomid)
309
S/S of Molar Preg
* rapid vaginal growth
* vaginal bleeding
* N/V
* hypertension
* abnormally high hCG levels
* no fetal heartbear
* ultrasound: only cysts and no fetus
310
Management of Molar Preg
* D&C
* monitor for malignancy through serial hCG levels
* no preg for 1 year
* emotional support
311
Complications of Labor
1. bleeding disorders (PP and PA)
2. placenta previa
3. placental abruption
4. polyhydramnios
5. oligohydrammios
312
Placenta Previa
* implantation in lower uterine segment, over or near cervical os (the opening in the cervix at each end of the endocervical canal)
* may be multifactional uterine scarring predisposes to lower segment implantation
313
Risk Factors: Placenta Previa
* scarring from previos previa, prior C/S, abortion, multiparity
* large placenta, multigestation
* infertility, non-white, low SES, short interpregnancy interval
* impeded endometrial vascularistriction: >35 years old, diabetes, smoking, cocaine
* hemorrhage for mom
* prematurity, malpresentation, IUGR/fetal anemia for fetus
314
S/S of Placenta Previa
* painless, intermittent bleeding
* confirmed by ultrasound
* lower uterine segment not as responsive to oxytocin - use methergine
315
Nursing Assessment: Placenta Previa
* avoid vaginal exams
* monitor vitals and SpO2
* continuous EFM (electronic fetal monitoring)
* assess for preterm labor, non-stress test
* BPP (biophysical profile), amniocentesis for lung maturity studies
316
Active Bleeding in Placenta Previa
* large bore IV access
* meaure I and O
* weigh pads
* CBC, coagulation studies, T and X
* O2 at 95%
* anticipate possible c-section birth
317
Placental Abruption
* premature separation of a normally implanted placenta
* bleeding may be external or concealed
* severity depends on degree or separation
* types: partial or complete
318
Risk Factors of Placental Abruption
* hypertension
* seizures
* blunt trauma to maternal abdomen
* short umbilical cord
* previous history of abruption
* smoking or cocaine use
319
S/S of Placental Abruption
* sudden onset of intense, sharp abdoment pain
* uterine irritabilitym tachysystole, increased resting tone
* vaginal bleeding may or may not be present
* dark "port wine" stained amniotic fluid
* fetal heart rate patterns indicative of compromise
* maternal tachycardia
320
Management of Placental Abruption
* assess fundal height
* consider abdominal girth measurements
* assess for increased pain or tenderness
* assess for S/S of shick
* I and O
* weigh pads
* provide continuous EFM
* provide O2 to maintain above 95%
* anticipate and prepare for emergency delivery
* observe for DIC, administer blood products
321
Polyhydraminos
* excessive amniotic fluid, over 2000mL
* associated with fetal GI abnormalities and maternal diabetes
* treatment: shortness of breath and pain - amniocentesis
322
Oligohydramnios
* scanty amniotic fluid, less than 500mL
* etiology - unknown
* risks: detal adhesions and malformation
* treatment: amnioinfusion
323
Assessment Prenatally
* anticipate what may have compromised fetus in utero
* maternal and prenatal history: blood type, lab values, GBS/HIV/HepB, diabetes, preeclampsia, smoking/substance abuse, trauma and disorta wiht high glucose levels
324
Assessment Intrapartum
anticipate what will occur in labor
* analgesia/anesthesia, prolonged rupture of membranes, meconium stained amniotic fluid, nuchal cord, use of forceps/vacuun, evidence of fetal distress, precipitous birth
325
Timing/Frequency of Assessments
* 1st assessment right at 30sec
* about 85-90% do not need any assistance to life
* placed skin-to-skin
* ABC immediately at birth
* thermoregulation
* APGAR scoring
* physical exam of newborn
* considerations of newborn's classification
326
Timing of Newborn Assessment
* admission assessment: 2nd assessment
* physical exam
* general measurements
* gestational age assessment
* attachment
327
Ongoing Assessments
* process of adaptation to extrauterine life
* nutritional status: ability to feed
* behavioral state/organizational abilities
328
General Measurements
* weight: avg 2500-400g, 70-75% of body is water weight
* head circumference: avg 33-35cm, 2cm greater than chest circ
* chest circ: nipple line
* abdominal circ
* length: range of 18-22in (48-52cm)
329
Birth Weight and Gestational Age Classes
1. LGA (large)
2. AGA (appropriate)
3. SGA (small)
330
Gestational Assessment: New Ballard Scale
* neuromuscular activity
* physical maturity
* maturity rating table
331
Estimating GA
first 4hrs after birth
* can preduct at-risk infants and keep alert of problems
* Ballard Tool
332
Ballard Tool
* each finding given point value: -5 to +5
* maternal conditions may affect certain components: stress and diabetes
333
Physical Maturity Characteristics Assessment
* skin
* lanugo
* sole (plantar) creases
* areola and breast bud tissues
* ear/eye formation
* genitalia
334
Skin
7 sub-classifications from transparent skin to peeling
335
Lanugo
thin, soft hair usually arounf 24-25wks
336
Sole Creases
full term: deep sole creases down to and including heel as skin loses fluid and dries after birth
337
Ear Forming and Cartilage
more premature: not as thick of cartilage
338
Eyes
fused eyelids premature
see how tight or loose
339
Male Genitals
should have 5-10mL breast buds
term infant: fully descended testes and entire surface of scrotum is covered by rugae
340
Female Genitals
prominent clitoris, labia majora widely separated, labia minora protudes beyond labia majora
LM can be dark in some ethnic groups
341
Neuromuscularity in Newborn
* posture in supine position
* square window
* arm recoil
* popliteal angle
* scarf sign
* heel to ear
342
Preterm Resting Posture
supine, undisturbed, should be more flexed with increased tone but is more flaccid
343
Full Term Resting Posture
increased tone and more flexed
344
Square Window Sign
bending wrist
full term infant will be able to touch hand to wrist
345
Arm Recoil
* lying in supine: flex both elbows, hold for 5sec, extend arms at baby's side, and release
* angle of recoil to which forearm springs back into flexion is noted
* preterm will not have any arm recoil
346
Popliteal Angle
* bend knee and push foot towards head
* mature: little flex and cannot bend over 90 degrees
* preterm: straight leg and lots of flex
347
Scarf Sign
* extend infant arm across body
* mature: bend elbow, not very flexible
* preterm: straight arm, lots of flexibility
348
Scarf Sign
* extend infant arm across body
* mature: bend elbow, not very flexible
* preterm: straight arm, lots of flexibility
349
Heel to Ear
* extend foot to ear
* mature: unable to do this
* premature: touch foot to ear
350
General Appearance of Newborn
head large for body
tend to stay in flexed position, can hold head up
351
Pulse Rates
* 110-160
* sleep can go down to 70
* crying can go up to 180
* check apical pulse for 1min
352
Respiratory Rates
* 30-60 resp/min
* diaphragmatic but synchronus with abdominal movement
* count for 1 full minute
353
BP Rates
* 70/50 and 45/30 at birth
* 90/60 at day 10
354
Temperature
* normal range: 97.7-99.4
* axillary: 97.7-99
* skin 96.8-97.7
* rectal 97.8-99
355
Anterior Fontanelle
* diamond shaped
* closes in 18mo
* palpable with 2nd and 3rd finger
356
Posterior Fontanelle
* triangle shaped, no buldging
* closes 8-12 wks
* depression: dehydrated or decreased intracranial pressure
* bulging: increased intracranial pressure or trauma
357
Molding
baby in vertex positions for vaginal delivery
* pressure on head against cervix
* flat forehead and rises to point at posterior of skull "cone head"
358
Cephalohematoma
* collection of blood from broken blood vessels that build up under scalp
* does not cross suture line
359
Craniosynostasis
* premature fusion of cranial sutures
* results in growth restriction perpendicular to affected sutures and compensatory overgrowth in unrestricted regions
* will need surgery
360
Plagiocephaly
* rapidly growing head attempts to expand and meets type of resistance such as flat surface like crib
* helmets used to fix aesthetically
361
Eyes: Physical Assessment
* tearless crying: immature lacrimal ducts
* peripheral vision: like close up objects
* can fixate on near objects
* can perceive faces, shapes, colors
* blink in response to bright light
* pupillary reflex present
362
Ears: Physical Assessment
* soft and plaiable
* ready recoil
* pinna parallel with inner and outer canthus
363
Eye and Ear Variations
* low set ears: chromosomal abnormalities or renal problems
* abnormal malformations: absent pinna, abnormal folds
* edema in eyelids from delivery or subconjunctival hemorrhage
* transient strabismus: cross-eyed
364
Nose
* small and narrow
* must breath through nose
* may sneeze a lot
* assess for choanal atresia: abstract one nare at a time
* could have obstruction of posterior nasal passage
365
Mouth
* pink lips, small amounts of saliva
* intact pallate when placing finger on roof of mouth
* ankyloglossa (tongue tied) because short frenulum - hard to breastfeed
* flat phitrum - chromosomal abnormality
* epstein pearls: keratin containing cysts
366
Chest
* size, shape, symmetry, movement
* chest: cylindrical measuring around the nipple line
* breasts: engorged, whitish secretion (witch's milk)
* respirations: diaphragmatic, 30-60
* HR: heard at left nipple, may have murmur in 1st 24 hrs
367
Signs of Distress
* nasal flaring
* sucking in for air: intercostal, substernal
* expiratory grunting or sighing
* seesaw up and down
* tachypnea: greater than 60
* central cyanosis
368
Cardiac Variations
* low pitched murmur: blood moving through turbulent part of heart
* decreased strength or absence of femoral pulses: narrowing aorta can affect it
* CHD: O2 sat monitors
* BP assessment if lost lots of volume, pale, no femoral pulse
369
Abdomen
* cylindrical and soft, no distention
* bowel sounds present by 1hr after birth
* umbilical cord should be white and gelatinous: 2 arteries and 1 vein
* 1 artery can lead to renal problems
370
Extremities
* short, flexible, move symmetrically
* legs: equal in length and symmetrical creases
371
Musculoskeletal Variations
* xiphoid cartilage
* fractured clavicle: palpate each to see intactness
* no splinting, heals quickly
372
Variations in Extremities
* gross deformities
* extra digits or webbing
* clubfoot
* hip dislocation
373
Hip Assessment
baby in Frank Breech position
374
Barlow Test
* grasp and adduct infant thigh and apply gentle downward pressure
375
Ortolani Test
* finger over greater trochanter and lift thigh to bring femoral head from posterior position toward acetabulum
376
Female Genitalia Variations
* pseudomenstration vs uric acid crystals
* labia swollen and darker
* vaginal tags will resolve
377
Hypospadias
* meatus located on ventral surface of glands
* groove that extends from usual area of meatus internally
378
Epispadias
urethral meatus occurs on dorsal surface of penis, undescended testes
379
Cryptorchidism
* if testes cannot be pushed into scrotum manually
380
Phimosis
* uncircumsized
* foreskin unable to be retracted
381
Hydrocele
collection of fluid around testes and scrotum
382
Acrocyanosis
bluish discolorization from poor peripheral circulation
* basal motor instability and capilary stasis
* exposed to cold
383
Mottling
lacey pattern of dilated blood vessels under leg
* general circulation fluctuations
* can also be from apnea, sepsis, hydrothyroidism
384
Jaundice
yellowish skin and mucous membranes
head to toe direction
385
Erythema Toxicum
rash 24-48hrs long, normal finding
386
Facial Milia
raised white spots on sebaceous glands
387
Vernix Caeosa
whote substance protecting baby's skin and lubricated it
* reabsorbed and may peel
388
Forcept Marks
disappear after 1-2 days
389
Telangiectatic Nevi
stork bites
pink/red spots on eyelids, nose, and nape of neck
390
Nevus Flammeus
port-wine stain
capiliary angioma
391
Mongolian Spots
bluish/black, grey/blue
on dorsal area in different darkened skin races
fade gradually and can be mistaken for bruises
392
Moro Reflex
arms flare out and fingers form C shape
393
Stepping Reflex
able to "walk"
disappears at 2mo
394
Palmar Reflex
fingers will grasp your finger
395
Plantar Reflex
toes will wrap around your finger
396
Rooting Reflex
stroke cheek, will turn head towards
397
Babinski Reflex
stroke foot, foot and toes flare out
398
Trunk Incurvation
prone position, stroke vertebral column, move buttox in curving motion towards side being stroked
399
Protective Reflexes
blink, yawn (overstim), cough/gag, extrusion (tongue pushes out foreign object), sneeze
400
Sleep-Wake States
1. deep sleep
2. light sleep
3. drowsiness
4. quiet alert
5. active alert
6. crying
401
Behavioral Response
influenced by state of newborn, temperment, and self-regulation
402
Engagement Cues
behavior that signals ready to interact with caregiver
403
Disengagement Cues
reduction in stimulus
404
Dr. T. Berry Brazelton: Neonatal Behavioral Assessment
1. habituation
2. orienting response
3. motor organization
4. consolability
5. cuddliness
405
Habituation
ability of infant to lessen their response to repeated stimulus
406
Orienting Response
respond virtually and auditorally to both animate and inanimate objects
follow with eyes and head, react to voices that are high-pitched
407
Motor Organization
spontaneous body activity in response to internal stimulus (hunger, temp, noisy env)
move arms like a bike, jerky movements
408
Consolability
how well they can console themselves or be consoled by others
409
Cuddliness
how baby molds into contours of caregiver's body
410
Daily Newborn Care
1. thermoregulation: cold depletes O2 and glucose
2. feeding practices: feeding in 1st hr of life
3. skin/cord care: clean w water and mild soap
4. prevention of infection: around cord and eye to prevent opthalmia neonatorum
5. security: ankle bracelets
411
Opthalmic Ointment
erythromycin, single dose, 1/4 on lower conjunctival surface
412
Daily Assessments
1. vitals
2. weight: compare against birth weight, lose 7% if breastfed, 3.5% bottle
3. overall color
4. intake and output
5. umbilical cord
6. newborn feeding
7. attachment
413
Preparation for Discharge
* hep b vaccine
* metabolic screening / PKU
* hearing screening
* CHD screening
414
Parental Education
* how to pick up newborn
* holding and feeding infant
* changing diaper
* interpreting newborn cues
* bathing newborn
* cord and circumcisions
* newborn and hearing screening
* void and stool pattern
* safety: car seat and shaken baby
* sleeping positions: sids
415
Circumcision Care
* keeping area clean
* check for bleeding
* apply petroleum ointment
416
Signs of Illness
* temp above 100.4 or below 97.7
* forceful or frequent vomiting
* difference in awaking baby
* cyanosis with or without feeding
* increasing jaundice
* breathing differently, absense of breathing longer than 20 sec
* inconsolable infant / high-pitched cry
* discharge / bleeding from cord, circumcision, any opening
* no wet diapers for 18-24 hrs
* develop eye drainage
417
Care of Newborn at Delivery
85-90% do not need assistance
others: need NRP - neonatal resuscitation program
418
N) Neonatal
provide warmth, clear airway, dry, stimulate
rapid assessment: breathing, muscle tone, color
wet when born, put on mom with blankets, keep warm
419
R) Resuscitation
assess breathing
provide effective ventilations
420
P) Program
assess heart rate
provide effective ventilations or chest compressions
421
Targeted Pre-Ductal SpO2 After Birth
1. 1 minute: 60-65%
2. 2 min: 65-70%
3. 3 min: 70-75%
4. 4 min: 75-80%
5. 5 min: 80-85%
6. 10 min: 85-90%
422
Thermoregulation
balance of heat loss and heat protection
* hypothermia: common because of decrease subcutaneous fat, blood vessels close to surface of skin
423
4 Types of Heat Loss Mechanisms
1. evaporation
2. convection
3. conduction
4. radiation
424
Convection
air flowing by skin and carrying away body heat with it
* air currents
425
Radiation
transfer of heat between 2 objects that are not in contact with each other
* indirect source, cool window warm baby
426
Evaporation
moisture on body lost to the environment
* H2O/vapor, baby born wet and needs to be dried
427
Conduction
loss of hear from body surface to cool surface and in contact
* cold scale and warm baby
428
Neutral Thermal Environment
maintenance of thermal balance
* babies maintain this through non-shivering thermogenesis by using the metabolism of brown fat instead of shivering
429
Temperature Regulation
increased muscle activity, acrocyanosis, increased cellular metabilic activity, increased O2
* can create respiratory distress because temperature is dropping and less adipose tissue
* large body surface in relation to mass
430
Transition of Respiratory System into Extrauterine Life
* 6-12 hours after birth
* exchange of O2 and CO2
* maintenance of acid/base balance
* in utero: received O2 via placenta thru cord and 10% of CO is profusing
431
3 Needs of Respiratory System Once Born
1. air replacing fluid
2. onset of breathing
3. increasesd pulmonary blood flow
432
Inflation of Breathing Mechanisms
* systemic vascular resistance increases
* pulmonary vascular resistance decreases
* all increases profusion of lungs
433
Air Replaces Fluid: Absorption
rest of fluid absorbed by blood vessels in lymphatics
434
Initial Inflation of Lungs
mechanical stimulation in utero: breathing amniotic fluid to promote growth and differentiation of lungs
* first breath: decrease in secretion into pulmonary fluid and reabsorb
435
Surfactant and Alveolar Stability
surfactant needed
* 6th-7th month: cells develop lecithin so thin walls of alveoli do not collapse after each breath
* surface tension pulls on film of fluid in alveoli and lecithin is a surface acting agent that reduces surface tension of fluid by reducing muscular effor needed to draw air into lungs
* increases compliance
436
The First Breath
hardest thing for neonate to do
* requires pressure 10-15x that of later breaths
* inflating all alveoli
* 40% of air remains as residual because of surfactant
437
4 Initiations of Breathing
occur in respitory center in medulla
1. mechanical
2. sensory
3. thermal
4. chemical
438
Mechanical Initiation of Breathing
compression of fetal chest as it moves through birth canal
* chest recoild and creates negative intrathoracic pressure
* passive inspiration of air = replacement of fluid with air
439
Sensory Initiation of Breathing
tactile, visual, auditory
440
Thermal Initiation of Breathing
change in temperature signals respiratory system
441
Chemical Initiation of Breathing
* mild hypercapnia: increasing CO2 levels
* hypoxia: low O2 levels
* acidosis: low pH
* all stimulate respiratory system via peripheral chemoreceptors
* prostaglandins suppress respirations and drop with clamping cord
442
Increase in Pulmonary Blood
blood flow increases to lungs
* 10% of cardiac output perfuses pulmonary vasculature with replacement of fluid by air in lungs
* pressure shift: increased vascular resistance now decreases and leads to increased perfusion
* gas exchange can now occur at the level of capilaries
443
Characteristics of Newborn Respiration
* normal rate: 30-60 breaths/min
* shallow and diaphragmatic with brief pauses (5-15sec)
* apnea: over 20sec and may have skin or HR changes
* nose breathers since reflex to open mouth not there
* use of intercostal muscles, grunting, flaring indicates distress
444
Neonatal Circulatory System
1 cord vein: O2 and blood
2 cord arteries: deox blood
* systemic vascular resistance increases, pulmonary artery pressure decreases and when cord is clamped: placental circulation lost
* closure of fetal shunts: foramen ovale, ductus arteriosus, ductus venosus
445
Characteristics of Cardiac Function
right ventricle stronger in cardiac workload (2/3 of work)
* 4pt BP pressure different in arms and legs
446
APGAR Scores
assessed at 1 and 5 minutes, indicates extrauterine transition
* 7-10 = minimal no difference
* 4-6 = moderate difference
* 0-3 severe distress
447
APGAR: 0 Points
Activity: absent muscle tone
Pulse: absent
Grimace: flaccid reflexes
Appearance: blue, pale
Respiration: absent
448
APGAR: 1 Point
Activity: arms and legs flexed
Pulse: below 100 bpm
Grimace: some flex
Appearance: body pink, extremities blue
Respiration: slow and irregular
449
APGAR: 2 Points
Activity: active
Pulse: over 100 bpm
Grimace: active - sneezing, coughing, pulling away
Appearance: pink
Respiration: crying
450
Phase 1 Transition Phase
period of reactivity: 1-2 hrs
* bonding, head to toe assessments, breastfeeding, increased motor activity, minimal bowel sounds, saliva
451
Phase 2 Transition Phase
sleep period: 1-4 hrs
* deep sleep to stabilize HR and RR
452
Phase 3 Transition Phase
second period of reactivity: 2-8 hrs
* breastfeeding, lots of mucus, meconium
453
Nursing Care During Transition
* review of prenatal birth info
* initial rapid assessment
* newborns' adaptation to extrauterine life
* vital signs per protocol
* assessment of blood glucose if needed
* weight and measurement
454
Difficult Transitions: Maternal Conditions
* increased age
* diabetes
* hypertension
* substance use
* prior history of stillborn
* fetal demise
455
Difficult Transitions: Fetal Conditions
* prematurity/postmaturity
* congenital abnormailities of cardiac system
456
Difficult Transitions: Antepartum Conditions
* placental abnormalities (previa, poly/oligohydraminos)
* breech
* infections
* asphyxia in utero
* narcotics close to delivery time (decrease RR of fetus)
457
Difficult Transitions: Delivery Complications
* assistive devices
* C-section
458
Difficult Transitions: Neonatal Difficulties
* lack of respiratory effors: neurologically depressed, impaired muscle function
* mucus blockages
* respiratory distress from impaired cardiac/lung functioning
459
Blood Volume of Newborn
80-90mL/kg of body weight
* dependent on cord clamping, could be 100
460
Delaying Cord Clamping
enhances pulmonary profusion
* increases iron stores
* risk of jaundice due to high number of RBC and organ damage from the viscosity of blood
461
Erythropoietin Saturation in Fetus
increases due to 50% saturation of fetal blood
* decreases production after birth
* resumes response to low hemoglobin = jaundice
* RBC lifespan 33% less than adult
* leukocytosis = normal and increase in WBC
462
Gastrointestinal Adaptations
* stomach: size of marble
* 36-38 wks: adequate intestinal and pancreatic enzymes
* proteins require more digestion but absorn and digest fats less efficiently
463
Colostrum and the Stomach
correlate with the maturity of enzymes - amylase and lipase lacking of ar birth
* decreased fat, increased antibody and protein in colostrum
464
Swallowing
experience it in utero
* gastric emptying in utero: swallow vernix
465
Air and the Stomach
enters immediately after birth
* hits small intestine 2-12 hrs
* hear bowel sounds hr after birth
* meconium 8-24 hrs
466
Weight Loss
1st 3-4 days
* colostrum acts as a laxative
* 3.5% formula fed
* 7% breastfed
* regained by day 10
467
Urinary Adaptations
* at risk for fluid shifts because kidneys are immature
* glomerular filtration rate low
* limited capacity to concentate urine
* void in the 1st 24 hrs - uric acid crystals
468
Water and Newborns
cannot reabsorb water to maintain vital organ functioning
* risk for over and dehydration
469
Hepatic Adaptations
liver takes up 40% of abdominal cavity
iron storage, bilirubin conjucation, coagulation of blood
470
Iron Storage: Hepatic Adaptations
mom's iron intake lasts for 5-6 months
471
Glucose: Hepatic Adaptations
diffuses across the placenta, not insulin, fetus makes own
* cuts off at birth, rapidly utilize from stress of delivery
* goes to glycogen if depleted - liver needs to be able to do this
* no greater than 40 mg/dL
472
Jaundice
normal biological response
refers ot the increased yellow pigment in tissues from high levels of bilirubin
473
Bilirubin
product of fetal RBC destruction
* heme: iron
* globin: protein
474
Unconjucated Bilirubin
indirect bilirubin from the heme
* fat soluble and unable to be excreted
* crosses the placenta
475
Conjucated Bilirubin
direct bilirubin
476
Total Bilirubin
total of unconjugated and conjugated
* 2-3 mL/dL then 5-6mL/dL in 3-5 days
477
RBC in Newborn
hemolysis occurs as lungs oxygenate newborn
478
Hyperbilirubinemia: A Breakdown
* bili enzymatically converted in liver, water soluble bili excreted in the urine
* glucantranferase: responsible for urine/stool color
* enzyme is lacking since liver immature, this impairs liver's ability to conjugate bili and excrete it
* creates excessive amounts of bili in the blood, risk to cross the blood-brain barrier
479
Normal Intestinal Flora and Bili
reduces conjugated bili to urobilinogen
* excreted in the kidneys and stercobilinogen and excreted in the feces
* requires adequate calories and hydration
* delay in feeds causes reabsorption
480
Transcutaneous Bilirubin
* done prior to discharge
* non-invasive measurement using light to measure bili in blood
* if suspicious: draw blood
481
Bilirubin Levels
high-risk
high-intermediate
low-intermediate
low-risk
482
Why Newborns are Prone to Bili
* accerated destruction of RBC
* blood type or Rh incompatibility
* bruising from instruments, cephalohematoma
* decreased hepatic function
* decreased albumin levels
* drugs that interfere with conjugated bili: indomethacin, sulfa drugs, salicylates
* maternal enzymes in breastmilk inhibit conjugation
483
BF and Jaundice
* early onset, decreased intake of BM
* BF infants have more bili
* peaks 2-4 days
* associated with poor feeding
484
Meconium and Jaundice
leads to dehydration and delay in passing this
* mec has conjugated bili and if not passed in a timely manner, reabsorbs and transported to liver
* enterohepatic circulation
485
BM and Jaundice
* related to milk composition, rare
* late onset = 2-3 wks
* newborns are healthy
* treatment: monitor serum bili levels
* may stop BF for 12-24 hrs and if bili levels drop = BMJ
* genetic component
486
Passive Immunologic Adaptations: IgG
IgG crosses placenta
* 3rd trimester
* begin immunizations at 2 months because of low levels of antibodies and immature WBC
* more vulnerable infections
* Hep B: given at birth
487
Passive Immunologic Adaptations: IgA
in colostrum
* protects against GI and respiratory infections
488
Neurologic Functioning
* lots of neuro development in postpartum period
* time of high risk to intellectual development
* brain: one quarter size of adult brain
* myelination of nerve fibers incomplete
489
Nutrition Across Lifespan
* need lots of nutrients
* most vulnerable to poor nutrition during periods of rapid growth - unborn and 1st yr of life
490
Healthy People 2020
BF = unequalled way of providing ideal food for healthy growth and devlopment of infants
* 81.9% of mom's initiate BF in early postpartum period
* 25.5% exclusively BF at 6 months
* 34% continue at 1 year
* 25.4% of BF infants receive formula before 2 day and want to go down to 14.2%
* 2.9% birth in places with recommended BF care and want to go down to 8.1%
491
Breastfeeding and Other Foods
* 1 mil infants die because given food too early and not breast fed
* rooming in with unrestricted BF
* no food or drink than BM unless medically necessary
492
Contraindications to BF
1. HIV
2. Active Untreated TB
3. Human T-cell leukemia virus type 1
4. exposure to toxic chemicals
5. use of illegal drugs
6. children with metabolic disorders / allergies (galactosemia)
7. some meds given to mom = antimetabolites and therapeutic radiopharmaceuticalas
493
Growth in Neonatal Period
most rapid
* rate tapers off at 2nd half of 1st year
494
Birth Weight Trends
* doubles by 4-6 months and triples by one year
* 4-6 oz per week for first 5-6 months
* meet inital birth weight at day 10-14
495
Nutritional Requirements
calories: 100-120 calories
* proteins for cell growth: whey and casein
* carbs for energy
* fat for brain and CNS
* fluids 100-150 mL/kg/day
* iron: reserves depleted 5-6 months
* vitamin D and K
496
Metabolic Screening
PKU test
* newborn genetic screening aimed at early detection of genetic diseases that can result in severe health problems not symptomatic at birth
* blood sample heel stick and administer on paper
497
Preterm Infant Characteristics
* larger proportion of warer
* little subcu fat
* poorly calcified bones
* incomplete nerve and muscle development
* suck reflex week (usually present at 32-34 weeks)
* limited ability for digestion, absorption, and renal function
* immature liver lacking development in metabolic enzyme system or adequate iron stores
* feeding tubes and supplements for calories
498
Colostrum
* comes in 16 weeks gestation
* high density, thick, gel-like
* yellow in color from high beta keratin
* high in proteins, fat soluble vitamins a and e, minerals than mature milk
* coats gut to prevent adherence of pathogens and promote gut closure
* easy to digest, maternal antibodies
499
BM Transition
* decrease in immunoglobulins and protein
* high in lactose and fat
* longer you breastfeed, higher the fat concentration
500
BF Assessment
* alignment, areolar grasp, compression, audible swallowing
* let down reflex
* nipple condition
* maternal comfort during feeding
* infant's weight and output
501
Infant Stomach
* day 1: 5-7mL
* day 3: 0.75-1oz
* day 7: 1.5-2oz
502
Signd of Effective BF
* nursing 8 times or more in 24 hrs
* mom hears infant swallowing
* number of wet diapers increases
* infant's stools lighten
503
Formula Fed Infants
* can cause harm to GI tracts
* gut is sterile and immature with tight junctions of GI mucosa not mature
* pathogens enter with open junctions
* necrotizing endocolitis
* interfere with flora and pH of gut
504
Formula Prep
* powder or liquid concentrate, ready to feed
* discard if offered to infant or unfridgerated after 1 hr
* water can make intoxication and decreased electrolyte status
505
Baby Bottle Syndrome
* hold them during feeding and rotate sides
* do not prop bottle - risk for aspiration and formation of dental problems over time
506
Newborn at Risk
greater than average chance of morbidity (illness) or mortality because of conditions present at birth or stress of birth
507
High Risk Period
encompasses human growth and development from age of viability up to 28 days after birth
508
Common Problems that Appear with NB
* gestational age and birth weight problems
* drug exposure
* congenital abnormalities
* hypothermia
* hypoglycemia
* TTN
* MAS
* PPHN
* sepsis
* hyperbili
509
Anticipation of NB
* what may have compromised fetus in utero maternal medical and prenatal history
* what occurred in labor
510
Conditions Present at Birth
* IUGR
* SGA
* LGA
* diabetic mother
* preterm baby
* CHD
* inborn error of metabolism
* substance abuse
511
Classification According to Size
* preterm
* full term
* late preterm
* postterm
512
IUGR
* deveiation and restriction in expected fetal growth pattern
* multiple adverse conditions may cause cong. abnormalities
* pathologic: do not get enough nutrients and O2
513
SGA
below 10th precentile
* physically and neurologically mature but smaller
* may be premature, full term, post term
* fetal growth problems
514
IUGR Fetal Factors
* affect genetic growth potential
* chromosomal abnormalities
* heart disease/hemolytic
* IU infection
* TORCH
* malformations
* multiple gestations
515
TORCH
toxoplasomosis
rubella
cytomegalovirus
herpes
516
IUGR Maternal Factors
* hypertension
* age
* drugs/smoking
* anemia/sickle cell
* cardiac/renal/vasc disese
* asthma
* multiple gestations
* no prenatal care/low SES
* grand multiparity
517
IUGR Placental Factors
inadequate delivery of nutrients
* previa
* abruption
* abnormal venous connection
* drugs that decrease blood flow
* diabetes
* chorioamnionitis
* small placenta
518
IUGR Environmental Factors
* high altitude
* X-ray exposure
519
Patterns of IUGR
depends on timing
* symmetrical and asymmetrical
520
Symmetrical IUGR
weight, length, head circ. plot similarly on growth curve and all organ systems small, normally happens in 1st trimester
* poor long term prognosis
* chromosomal abnormailties
* teratogenic effects / TORCH
* may not grow as big as their counterparts
521
Asymmetrical IUGR
disproportion reduction in size of all structures and organs, happens later in preg 2nd/3rd
* from either maternal or placental conditions that occur later in pregnancy and impede on placental blood flow
* preeclampsia, placental infarcts, maternal malnut.
* head size spaired but overall weight and organ sizes decrease
* better prognosis
522
IUGR Risks
* labor intolerance related to placental insufficiency and inadequate nutritional O2 reserves
* mec aspiration from asphyxia
* hypoglycemia: heat loss
* hypocalcemia down 7.5mg/dL
* jittery, tetany, seizures
523
Assessment Findings: IUGR
* large head
* long nails
* large anterior font
* decreased wharton's kelly
* thin extremities and trunk
* loose skin and decreased subq fat
* dry, flaky/mec stained skin
* hypothermia, polycythemia
524
SGA Risk Factors
* maternal diabetes
* multiparity
* previoud macrosomic baby
* prolonged preg
* hypertension
* cardiac disease
* renal disease
525
LGA Outcomes
* C-section
* operative vag delivery
* shoulder dystocia
* breech
* birth trauma
* cephalopelvic disproportion
* hypoglycemia
* hyperbili
526
LGA Assessment
* fractured clavicles
* brachial nerve damage
* facial nerve damage
* fepressed skull fractures
* cephalohematoma
* intracranial hemorr
* asphyxia
527
SGA Assessments
* head large for body
* wasted apperance of extremities
* deceased subq fat
* decreased amount of breast tissue
* scaphoid abdomen
* wide skull sutures
* poor muscle tone
* loose and dry skin
* thin umb cord
528
SGA Complications
* hypoxia
* little room to tolerate L and D
* organ dysfunction
* hypoglycemia
* hypothermia
* polycythmia: response to chronic hypoxia, bone marrow stimulation to increase production of RBC
529
SGA Complication Factors
* congenital malormations
* IU infection - TORCH
* hypoxia: cog diff, learning dis.
530
SGA Interventions
* monitor O2, color, RR
* monitor temp over 97.6, hold bath
* free from hypoglycemia
* monitor hypocalcemia
* weigh daily - maybe need to increase caloric intake
* monitor feeding intolerance - may have had placental insuf.
531
LGA
bw over 90%
birth trauma: cephalopelvic disproportion
macrosomia
C-sections
hypoglycemia
polycythemia
532
Infant of Diabetic Mother
* hypoglycemia/calcemia/mag
* hyperbili
* birth trauma
* polycythemia
* RDS
* congen malfor
* low musc tone
* hypoxic: ischemic encephalopathy
* periventricular leukomalacia
* poor feeding
533
Post Term Newborn
* after 42 wks
* post maturity syndrome
* risk for asphyxia and mec passage
* polycythemia/hypoglycemia/hypothermia
* decreased amn fluid
* risk for cord compression and thicker mec stained amn fluid
* risk for morb/mort
* decreased placental fxn from altered O2 and nutrient transport
* increase hypoxia and hypoglycemia
534
PTN Risk Factors
* ancephaly
* 1st preg
* history of postterm preg
* grand multipar
535
PTN Complications
* mec aspiration
* fetal hypoxia: cord comp
* neuro conditions: seizures from fetal asphyxia in labor
* birth trauma
536
PTN Findings
* dry, cracked, peeling skin
* lack of vernix
* profuse hair
* long fingernails
* thin wasted appearance
* mec staining (green/yellow)
* hypogly
* poor feeding
537
Preterm Newborn Class
* Very: less than 32 wks
* Premat: 32-34 wks
* Late: 34-37 wks
538
Preterm Newborn Weights
* LBW: < 2500
* VLBW < 1500
* ELBW < 1000
539
Preterm Findings
* decreased tone and posture
* skin transparent and red
* decreased subq
* lanugo
* creases not on foot or limited
* eyelids fused and open 26-30 wks
* overriding sutures
* pinna: soft and folded
* weak cry
* testes not desc
* immature suck
* apnea and bradycardia
* anemia
540
Preterm Risk Factors
nonmodifiable and modifiable
541
CHD
* screening
* pulse ox to detect diminished O2 delivery
* find mitrial stenosis, hypoplastic left heart, coarctation of aorta, patent dictus arteriosus, transposition of great vessels
542
Inborn Errors of Metabolism
* hereditary disorders, enzyme defects, block met pathway and toxins can accumulate
* afefct organ and energy fxn and production
543
Sub. Abusing Mother
* tobacco
* alcohol
* drugs
544
FAS
* phenotypic features: growth restriction, CNS abnormalities, facial dysmorphology
* long term behavioral and cognitive disab
* reduce environmental stim
* extra time to feed
* reinforce parenting
545
Newborn Withdrawl Syndrome
* hyperactivity
* increased musc tone/exaggerateed reflexes
* tremors
* sneezing, hiccuping, yawning, short unquiet sleep
* fever
* tachyplea, excessive secretions
* vigorous suck
* vom, drooling, dia
* sensitive gag reflex
* poor feeding
* stuffy nose, yawning, flushing, sweatung
* sudden pallor
* excoriated buttocks, knees, elbows
* facial structures
* pressure-point abrasions
546
Nursing Interventions: Sub Abuse Infants
* reduce withdrawl symp
* monitor pulse, resp, temp, small freq feedings
* admin meds as ordered
* swaddling
547
Eat Sleep Console
Finnegan Symptom Prioritization
* newborn inability to take in age-appropriate vol of food, sleep more than one hour after feeding, or be consoled within ten mins
548
Birth Related Stress
* cold
* hypogly
* hyperbili
* infection
* RDS
* TTN
* MAS
* PPHN
549
Cold Stress
* heat loss that newborn compensates for
* increased met rate
* decreased surfactant production and hypoxemia
* increased consumption of glucose and hypogly
* met acid increases risk for jaundice
550
Cold Clinical Intervention
* rewarm w skin to skin, heat lamos, swaddling
* monitor gluc levels
* monitor O2
551
Newborn With Hypoglycemia
want glucose over 40 mg/dL
* jittery
* tachypnea
* diaphoresis
* hypotonia
* lethargy
* apnea
* temp instability
552
Physiological Jaundice
* common after first 24 hours
* increased bili from polycythemia and short life span of FRBC
* decreased uptake of bili by liver
* decreased enzyme activity and ability conjugate bili
* decreased ability to excrete bili
* increased enterohepatic circ
* breastfeeding
553
Pathological Jaundice
* in 1st 24 hrs of life
* total serum level above 12 in term
* total 15 in preterm
* serum bili increase more than 5 mg per day
* conj bili: more than 2
* jaundice lasting 1 wk term
554
Bili Encephalopathy
unconj bili in excess that binds to albumin and crosses BBB
* cause neurotoxicity
* lethargy, irritability
* arching of neck and trunk (retrocollis and opisthonos)
* kernicterus: movement disorfer, athetoid form of CP, deafness, seizure, coma, limited upward gaze
555
Interventions with High Bili
* phototherapy
* exchange transfusion if newborn has active hemolysis, unconj bili level of 14, weighs less than 2500 and less tha. 24 hrs old
556
Phototherapy Nursing Care
* assessments: feedings, BM status
* warmth
* eyepatches, cover genitals
* positioning q2h
557
Newborns with Infection
* anticipate sepsis neonatorum
* immature immune system
* vertical transmission: transplacental, ascending (prolonged ROM), intrapartal
* horizontal: nosocomial infec, transmitted from hospital equiptment or staff
558
Risk Factors for Neonatal Inf: Maternal
* poor prenatal nut
* low SES
* Hx STI
* prolonged ROM: 12 hrs
* GBS
* chorioamnionitis
* maternal temp in labor
* premature labor
* diff labor
* fetal scalp electrode use
* invasive procedures
* UTI
559
Risk Factors for Neonatal Inf: Neonate
* prematurity
* LBW
* diff delivery
* birth asphyxia
* mec staining
* cong abnor
* male
* multi gest
* invasive procedure
* length of stay
* humidifcaion in incubator or vent
* broad spectrum antibiotics
560
Assess for Sepsis
* resp
* temp
* cardovasc
* neuro
* gastro
* skin
* metabolic
* immature total neutrophil ratio >0.2 suggests infection
561
Nursing Interventions for Reducing Sepsis
* hand hygene
* blood cultures, CBCD, urine culture
* supportive care: reso, cardio, fluid/electrolytes, hypogly, acidosis
562
RDS Summary
* hyaline mem disease
* primary absence/def of pul surfantant
* indicated failure to synth adequate surfactant
* lec/spin ratio 2:1
563
RDS Assessment
* grunting, flaring, retracting, tachypnea, skin color gray or dusky
* hypoxemia
* acidosis from sustained hypoxemia
564
RDS Management
* pulse ox
* cardiac monitoring
* exogenous surfactant replacement
* O2 therapy by mask, hoord, cannula
* CPAP
* mech vent
* extracorporeal mem ox therapy (ECMO) if vent not working
565
Transient Tachypnea of Newborn (TTN)
* failure to clear lung fluid, mucus, debris
* exhibit signs of distress shortly after birth
* expiratory grunting and nasal flaring
* subcostal retractions
* slight cyanosis
* maintain adequate resp, nut, hydration
566
Meconium Aspiration Syndrome (MAS)
* mechanical obstruction of airways
* chem pneum
* vasocon of pul vessels
* inactivation of natural surfactant
* assess for complications related to MAS
* mantain adequate resp, nut, hydration
