Exam 2

Question 1

Gestational diabetes

Answer 1

Gestational diabetes is a type of diabetes that can develop during pregnancy in women who don’t already have diabetes. During pregnancy, your body makes more hormones and goes through other changes, such as weight gain. These changes cause your body’s cells to use insulin less effectively, a condition called insulin resistance

A diagnosis requires two elevated blood glucose readings

Question 2

Nutrition postpartum

Answer 2

Encourage non lactating clients to consume 1800-2000 kcal/day

Reinforce the lactation client to increase there caloric intake and to include calcium enriched foods

450-500 calories a day should be added for lactating clients

Consume a diet high in protein to help aid tissue repair

continue taking prenatal vitamins until 6 weeks following birth

Question 3

Umbilical cord care after delivery

Answer 3

After birth, the cord is clamped and cut. Eventually between 1 to 3 weeks the cord will become dry and will naturally fall off. During the time the cord is healing it should be kept as clean and as dry as possible. A sponge bath is the best way to clean your baby until the umbilical cord falls off.

Question 4

Neuromuscular assessment of newborn

Answer 4

Muscle tone and reflex reaction

Moro Flex which is allowing the head and trunk of a newborn in a semi-sitting position to fall back to an angle of 30 degrees. The newborn will symmetrically extend their arms and abduct the elbows to form a “C”

Palpation for the presence and size of fontanels for fullness or bulge

Question 5

Infant heat loss post delivery

Answer 5

Thermoregulation- Maintain a babies core temperature

When babies are cold-stressed, they use energy and oxygen to generate warmth. If skin temperatures drop just one degree from the ideal 97.7° F to 99.5° (36.5°C), a baby’s oxygen use can increase by 10 percent.

Hence becoming chilled can cause overuse in their fat reserves

Ineffective thermoregulation can lead to hypoxia, acidosis, and hyperglycemia.

Question 6

Usage of bulb syringe post/necessity of bulb syringe

Answer 6

Used for sucking excess mucus from mouth and nose

Suction mouth first and then nose to prevent aspiration

Suctioning makes it easier for the
baby to breathe and eat

Question 7

Review reflexes for newborns

Answer 7

Rooting:

The rooting reflex is an innate response of the head due to the stimulation of the face, mouth, or cheek by touching/stroking (the head is turned towards the side of the stimulus and starts to suck

Disappears after 3-4 months but could last till 1 year of age

Palmar Grasp: Placing examiner finger in newborns hand. The newborn’s hand should curl around the finger.

Plantar Grasp: Placing examiner finger on newborns toes. The newborn should respond by curling toes down.

Moro Reflex ( see previous note card)

Tonic Neck: When a newborn is supine the examiner turns the head quickly to one side. The arm and leg on that side should extend, opposing the opposite side.

Babinski Reflex: Stroking the outer edge of the foot sole, moving upward towards the toes and then across the ball of the foot.

Stepping: Holding the newborn upright with feet touching a flat surface, The newborn should respond with stepping movements

Question 8

SGA

Answer 8

Small for gestational age (SGA) is defined as a birth weight of less than 10th percentile for gestational age.

Newborns who are SGA are perinatal asphyxia,meconium aspiration,hypoglycemia, and instability of body temperature

Question 9

Possible complications from vacuum/forceps deliveries.

Answer 9

Vacuum complications: Scalp lacerations, subdural hematoma of the neonate, Cephalohematoma,
Maternal lacerations to the cervix, vagina, or perineum

Forcep Complications: Lacerations of cervix, vagina and perineum, injury to the bladder, facial nerve palsy to neonate, facial bruising to neonate and possible subdural hematoma

Question 10

Postpartum assessment of fundus

Answer 10

Fundus ( top portion of the uterus) :

Should be palpable and firm at the midline and 2cm below the umbilicus.

1 hour after delivery the fundus will rise to the umbilicus

After 12 hours the fundus can be palpated 1 cm above the umbilicus

Every 24 hrs it should decend 1-2 cm, halfway between the symphysis pubis and the umblicus by the 6th postpartum day

After 2 weeks the uterus should lie in the true pelvis and should not be palpable.

Question 11

Postpartum assessment of lochia

Answer 11

Lochia is post birth discharge that contains blood,mucus and uterine tissue

Lochia Rubra is Dark red menstrual like, lasts 1-3 days, has a fleshy odor

Lochia Serosa: Pinkish brown color serosanguineous consistency. From day 4 -10.

Lochia Alba: Yellowish creamy color, fleshy odor, lasts from day 10 to 8 weeks postpartum

Post labor checks for Nurse:

Determined by the quantity of saturation on the perineal pad.

Check for normal color, amount, odor and consistency.

Every 15 mins for the first hour then every hour for the next 4, and then 4-8 hours depending on facility regulations.

Question 12

Postpartum breast assessments

Answer 12

A clear yellowish fluid called colostrum secrets for 2-3 days immediately after birth, Milk is produced 72-96 hr. after the delivery.

Assess for:

Signs of engorgement, including fullness, around postpartum days 3 and 4

Hot, red, painful, and edematous areas, which could indicate mastitis

Nipple condition and latch-on technique of mothers who are breastfeeding

Question 13

Other complications of postpartum can include

Answer 13

Depression

Bowel complications

UTI’s

Question 14

Breast feeding positions and proper technique to successfully breast feed

Answer 14

Cradle position.

The cradle hold is the most common breastfeeding position.

Cross-cradle position.

Clutch position.

Side-lying position.

Bad latching signs include:

Your child is sucking in their cheeks as they try to breastfeed. Your baby does not have their lips out like a fish. You can see that they have their lips tucked in and under, instead. You can hear a clicking or smacking noises as your little one tries to suck.

Successful: A baby who breastfeeds effectively shows readiness for feedings, is in a good feeding position, latches-on deeply at the breast and moves milk forward from the breast and into his or her mouth.

Question 15

Meds given to newborns after delivery

Answer 15

Hepatitis B vaccination. Hepatitis B is a serious disease that infects and damages the liver

Vitamin K Injection. Vitamin K is needed to make blood clot.

Erythromycin Eye Ointment to prevent infections

Question 16

What to do to prevent thrombophlebitis after delivery

Answer 16

Apply support stockings as prescribed.

If bed rest is longer than 8 hours use active ROM exercises.

Initiate early and frequent ambulation

Elevate legs when sitting

Tell the client to maintain fluid intake of 2-3 L each day.

Discontinue smoking

Question 17

APGAR score

Answer 17

Apgar is a quick test performed on a baby at 1 and 5 minutes after birth. The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score tells the health care provider how well the baby is doing outside the mother’s womb.

The Apgar test is done by a doctor, midwife, or nurse. The provider examines the baby’s:

Breathing effort
Heart rate
Muscle tone
Reflexes
Skin color

Each category is scored with 0, 1, or 2, depending on the observed condition.

For example if baby is not breathing the score would be a 0

Question 18

Signs of TE Fistula in newborn

Answer 18

When a baby with a TE fistula swallows, the liquid can pass through the abnormal connection between the esophagus and the trachea. When this happens, liquid gets into the baby’s lungs.

Signs include :

Coughing or choking while nursing or taking a bottle.

Frothing or drooling from the mouth.
Vomiting.

Difficulty breathing while feeding.

Blue-tinged skin while feeding.

An unusually rounded abdomen.

Failure to gain weight.

Question 19

postpartum jaundice in newborn

Answer 19

Can be physiological:Can appear on day 3 of a newborn but should subside thereafter.

Or Pathological: Jaundice is considered pathologic if it presents within the first 24 hours after birth, the total serum bilirubin level rises by more than 5 mg per dL (86 mol per L) per day, or is higher than 17 mg per dL (290 mol per L), or an infant has signs and symptoms suggestive of serious illness

Phototherapy is a treatment that can be done to help with the appearance of the baby’s skin with a special light

Question 20

Spina Bifida/ myelomeningocele

Answer 20

Infants with spina bifida should be placed in a prone position to prevent pressure on the lumbar sac.

Question 21

infant born with trisomy 21

Answer 21

A medical term for having an extra copy of a chromosome is ‘trisomy.’ Down syndrome is also referred to as Trisomy 21. This extra copy changes how the baby’s body and brain develop, which can cause both mental and physical challenges for the baby including visual, and hearing impairments.

Question 22

important data collected from infant born from diabetic mother- what to monitor

Answer 22

All infants who are born to mothers with diabetes should be tested for low blood sugar, even if they have no symptoms. (Neonatal Hypoglycemia)

Infants of diabetic mothers are prone to neurologic impairments.

Normal glucose levels should be between 40-60 post birth

Question 23

Signs of post partum depression

Answer 23

Postpartum depression symptoms may include:

Depressed mood or severe mood swings
Crying too much
Difficulty bonding with your baby
Withdrawing from family and friends
Loss of appetite or eating much more than usual
Inability to sleep, called insomnia, or sleeping too much
Overwhelming tiredness or loss of energy
Less interest and pleasure in activities you used to enjoy
Intense irritability and anger
Fear that you’re not a good mother
Hopelessness
Feelings of worthlessness, shame, guilt or inadequacy
Reduced ability to think clearly, concentrate or make decisions
Restlessness
Severe anxiety and panic attacks
Thoughts of harming yourself or your baby
Recurring thoughts of death or suicide

Question 24

Findings from hydrocephalus in infant

Answer 24

The most obvious sign of hydrocephalus in infants is a rapid increase in head circumference or an unusually large head size. Other symptoms may include seizures, vomiting, sleepiness, irritability, or eyes that constantly gaze downward.

Question 25

postpartum meds used to firm up uterus to prevent hemorrhaging

Answer 25

Oxytocin (Pitocin) is the first choice for the prevention of postpartum hemorrhage because it is as effective or more effective than ergot alkaloids or prostaglandins and has fewer side effects.