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maternity > exam 2 > Flashcards

exam 2 Flashcards

1
Q

purpose and use of fetal monitoring in labor

A
  • ID signs of fetal well-being or compromise
  • assess both FHR and UC’s
  • no method of fetal assessment can ID every compromised fetus
  • poor predictive value
  • low tech approach (intermittent auscultation (doppler)
  • high tech approach continuous monitoring
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2
Q

fetal monitoring as a major role for medical malpractice

A
  • documentation is key (nurse’s must document and prove standard of care was met)
  • nurse should identify abnormal/non-reassuring findings, intervene and report to MD/CNM in timely manner
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3
Q

types of fetal and uterine monitoring

A
  • auscultation and palpation for intermittent auscultation
  • ultrasound and tocodynamometer (TOCO) external EFM
  • internal spiral electrode (FSE) and intrauterine pressure catheter (IUPC) (internal EFM)
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4
Q

fetoscope or doppler

A
  • peform leopold’s manuevers and place doppler over area of maximal intesity of fetal heart tones
  • palpate maternal artery at same time
  • determine relationship of contraction and FHR by palpating for contractions during the FHR auscultation
  • count FHR between cotraction for at least 30-60 seconds to determine baseline
  • determine differences between baseline FHR and response to contraction
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5
Q

external fetal monitor parts

A
  • ultrasound transducer: recevies waveforms from fetal heart interpreted by the computer in the fetal montior to produce sound and visual tracing to reflect FHR
  • toco- strain gauge that detects skin tightness or contour changes resulting from UC’s
  • monitor paper
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6
Q

internal electronic fetal and uterine monitoring

A
  • uses fetal scalp electrode (FSE) or internal scalp electrode applied to fetus presenting part to directly detect FHR
  • internal electronic uterine monitoring involves an IUPC placed in uterine cavity to directly measure contractions
  • membranes must be ruptured
  • needs this when troubleshooting methods that do not alter the quality of tracing, maternal obesity, lack of progress in labor
  • contraindication: infections, placenta previa, undiagnosed vaginal beleding
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7
Q

monitoring fetal paper

A
  • each dark vertical line represents 1 minute and each lighter vertical line represents 10 seconds
  • FHR recorded on top fird in bpm while UC recorded on lower grid in mmHg with IUPC and relative height for TOCO
  • thin vertical lines (or boxes) = 10 seconds apart
  • heavy vertical lines = 1 minute apart
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8
Q

interpretation of FHR baseline

A
  • baseline rate
  • baseline variability
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9
Q

interpreetation of periodic and episodic changes

A
  • accelerations
  • decels
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10
Q

interpretation of uterine activity

A
  • frequency
  • duration
  • intensity
  • resting tone
  • relaxation time between UCs
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11
Q

category I FHR

A
  • normal
  • predictive of well-oxygenated nonacidotic fetus w/ normal fetal acid-base balance
  • routine following and no action needed
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12
Q

category II FHR

A
  • intermediate
  • do not predict abnormal acid-base balance status
  • requires eval, continued surveillance, and reevaluation in context of clinical circumstances
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13
Q

category III FHR

A
  • abnormal
  • predictive of abnormal acid-base balance
  • requires prompt intervention and depending on situation efforts to resolves should be expedited include intrauterine resuscitation or immediate birth
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14
Q

FHR baseline

A
  • mean FHR in 10 minute period rounded to nearest 5pm
  • should be between 110-160
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15
Q

fetal tachycardia

A
  • FHR above 160bpm that lasts for at least 10 minutes and often accompanied by a decreased or absent baseline variability
  • may be a sign of early fetal hypoexmia
  • if persists above 200-220bpm, fetal demise may occur
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16
Q

causes of fetal tachycardia

A
  • maternal: fever, infection, anxiety, dehydration, anemia, meds, ilicit drugs
  • fetal: compensatory effort following acute hypoexmia, infection, activity or stimulation, chronic hypoxia, tachyarrythmia, cardiac abnormalities, anemia
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17
Q

treatment for fetal tachycardia

A
  • treat underlying cause
  • assess variability and consider position change or O2 to promote oxygenation
  • assess maternal VS
  • initiate interventions to decrease maternal temp (meds, ice packs)
  • assess hydration and admin IVF or water
  • reduce anxiety by explaining, reassuring, and encouraging
  • decrease or discontinue o2
  • notify HCP
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18
Q

fetal bradycardia

A
  • baseline FHR <110bpm
  • unresolved may result in fetal hypoxia and needs immediate intervention
  • sudden profound bradycardia (>80bpm) obstetrical emergency
  • with normal variability may be beginning
  • with loss of variability or late decels is associated with current or impending fetal hypoxia
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19
Q

causes of fetal brady cardia

A
  • maternal: supine position, dehdyration, hypotension, acute maternal cardiopulmonary compromise, uterine rupture, placental abruption, medications (anesthetics, adrenergic receptors)
  • fetus: fetal response to hypoxia, umbilical cord compression, acute hypoxemia (late or profound), hypothermia, hypokalemia, chronic fetal head compression, fetal bradyarrythmias
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20
Q

treatment of fetal bradycardia

A
  • medical: cause related, consider delivery
  • confirm FHR vs MHR
  • assess fetal movement
  • assess fetal response to fetal scalp stimulation
  • perform vaginal exam and assess for prolapsed cord
  • assess maternal VS
  • assess hydration and hydrate prn
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21
Q

depending of FHR variability and other characteristics…

A
  • change maternal postion (left or right lateral) to promote fetal oxygenation
  • discontinue oxytocin to reduce UC
  • give oxygen 10L/min via nonrebreather face mask to promote fetal oxygenation
  • modifying pushing to every other contraction or stop pushing until the FHR recovers to promote fetal oxygenation
  • encourage open glottis pushing efforts
  • discourage prolonged or sustained breath holding while pushing
  • provide support
  • notify HCP
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22
Q

assessing baseline variability

A
  • most important characteristic of FHR presence implies that both branches of autonomic nervous system are functioning
  • beat to beat changes/variations/fluctuations in FHR baseline
  • described by undetectable, observed at fewer than 5bpm, 6-25bpm, 25bpm
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23
Q

absent variability

A
  • 0-2bpm
  • looks like flatline
  • non-reassuring
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24
Q

minimal variability

A

3-5bpm

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25
Q

causes of absent or minimal variability

A
  • fetal acidemia secondary to uteroplacental insufficiency
  • cord compression
  • preterm
  • maternal hypotension
  • uterine hyperstimulation
  • abruptio placentae
  • fetal dysrhythmia
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26
Q

interventions for absent or minimal variability

A
  • lateral positioning of mother
  • increase IVF rate
  • administer oxygen at 8-10L/min via mask
  • consider internal F montioring
  • report to HCP and document
  • prep for possible C-section in case no changes occur
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27
Q

moderate variability

A
  • 6-25
  • indicates autonomic and nervous system of fetus are well developed and well oxygenated
  • considered a GOOD sign of fetal well0being and correlates with absence of significant metabolic acidosis
  • this is NORMAL and fetus can utilize o2
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28
Q

marked variability

A

> 25bpm (excessive)

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29
Q

causes of marked variability

A
  • cord prolapse or compression
  • maternal hypotension
  • uterine hyperstimulation
  • abruptio placenta
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30
Q

interventions for marked variability

A
  • determine cause
  • lateral positioning
  • increase IVF rate
  • administer o2 at 8-10L/min by mask
  • discontinue oxytocin
  • observe for changes in tracing
  • consider internal fetal monitoring
  • notify HCP and prep for surgical birth if no change
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31
Q

determining if accel’s are present

A
  • transitory abrupt increases in FHR above baseline that last <30 seconds from onset to peak
  • determine if present or absent
  • always reassuring, occurs with fetal movement or stimualtion
  • if present and 15x15 (abrupt increase by at least 15 beats above baseline for at least 15 seconds) it is reactive
  • this strip has a FHR baseline of 145 and is reactive because FHR baseline has increase to at least 160 for minimally 15 seconds
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32
Q

decelerations

A
  • decrease in FHR caused by stimulation of the parasympathetic nervous system
  • describe by their shape and association to uterine contractions
  • determine if present or absent, if absent GREAT
  • can be early, variable, late, prolonged
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33
Q

early decels

A
  • occur early with onset of the contraction
  • mirrors the shape and timing of contraction (therefore need a ontraction to determine the type of decel)
  • appearance is shallow and cuplike
  • reassuring: caused by vagal stimulation that occurs with pressure on fetus’ head
  • NO intervention needed
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34
Q

variable decels

A
  • can occur or be ID’d with or without contraction
  • often ABRUPT, with a U, V, or W shape, return to baseline is also abrupt
  • non-reassuring especially if deep or prolonged
  • results from compression of umbilical cord!!!!!
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35
Q

interventions for variable decels

A
  • change maternal position
  • perform sterile vaginal exam to eval cord
  • admin oxygen at 10L/min via nonrebreather
  • prep for possible amnioinfusion
  • decrease or discontinue oxytocin
  • consider need for tocolytics to reduce UC
  • consider internal fetal monitoring
  • modify pushing
  • provide support
  • notify HCP
  • plan for delivery and care of neonate
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36
Q

late decels

A
  • occur late or after onset of contraction
  • need contraction to determine kind of decels
  • apperance is shallow and cuplike
  • NON-reassuring especially if seen with absent or minimal variability
  • results of uteroplacental insufficiency (fetus isn’t getting o2)
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37
Q

treatment for late decels

A
  • change the maternal position
  • discontinue oxy and consider terbutaline
  • assess hydration and give IV bolus
  • consider fetal scalp stimulation
  • administer o2 at 10L/min via nonrebreather
  • consider internal fetal monitoring
  • provide support
  • notify HCP
  • plan for delivery and care of baby
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38
Q

prolonged decels

A
  • a “long & late” 15bpm drop below baseline testing >2minutes but <10 minutes
  • non-reassuring
  • result of uteroplacental insufficiency with or without cord compression
  • interventions same as the rest
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39
Q

VEAL CHOP

A
  • Variable decels = Cord compression
  • Early decels = Head compression
  • Accels = Ok
  • Late decels = Placental insufficiency
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40
Q

contractions

A
  • frequency measured in minutes, beginning of one contraction to beginning of next
  • duration measured in seconds beginning to end of each contraction
  • intensity (toco-palpation, mild moderate, strong) (IUPC-subtracting resting tone from strongest (tallest UC) and weakest (shortest UC) for a range in mmHg
  • resting tone, pressure of uterus at rest/between UC (external palpation soft or firm, internal in mmHg (do NOT want >35mmHg)
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41
Q

assessing intensity of contractions

A
  • place fingertips on fundus of uterus to assess degree of tension as the contraction occurs
  • intensity measured at peak of contraction and rated as mild, moderate, or storng
  • resting tone is measured between contraction and listed as soft, firm, uterine tone
  • subjective and can be biased by fat distribution of client’s abdomen
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42
Q

assessing intensity

A
  • resting tone
  • weakest contraction (highest point - resting tone = x)
  • strongest UC (strongest UC - resting=x)
  • UC intensity range from weakest and strongest with resting tone
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43
Q

dystocia

A
  • abnormal progression of labor
  • characterized by a slow and abnormal progression of labor
  • fatiguining for both mother and fetus
  • leading indicator for C-section
  • because cannot be predicted for diagnosed w/ certainty, the term “failure to progress” is often used
  • abnormalities involve the powers, passengers, and psyche
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44
Q

what problem is associated with powers

A
  • hypertonic uterine dysfunction
  • hypotonic uterine dysfunction
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45
Q

hypertonic uterine dysfunction

A
  • uncoordinated uterine activity
  • contractions frequent and painful but ineffective in promoting dilation and effacement
  • risk for maternal exhaustion and fetal intolerance of labor and asphyxia due to decreased placental perfusion
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46
Q

assessment of hypertonic uterine dysfunction

A
  • painful
  • frequent contractions with inadequate relaxation inbetween
  • little cervical changes
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47
Q

medical management of uterine dystocia / hypertonic uterine dysfunction

A
  • evaluate progress
  • determine cause
  • hydrate
  • provide pain management
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48
Q

nursing care for hypertonic uterine dysfunction/uterine dystocia

A
  • promote rest
  • admin pain meds as ordered
  • promote relaxation
  • hydrate with IV or PO fluids
  • assess FHR and UC’s
  • evaluate labor progress via sterile vaginal exam
  • support and explain
  • notify HCP
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49
Q

hypotonic uterine dysfunction

A
  • occurs during active labor (dilation >5-6cm)
  • contractions become poor in quality and lack sufficient intensity to dilate and efface the cervix
  • MAJOR risk for postpartum hemorrhage as the uterus cannot contract effectively to compress blood vessels
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50
Q

clinical manifestations of hypotonic uterine dysfunction

A
  • weak contractions that become milder
  • uterine fundus that can be easily fingertip pressure at peak of each contraction and contractions that become more infrequent and brief
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51
Q

medical management of hypotonic uterine dysfunction

A
  • evaluate labor progression
  • determine cause
  • consider interventions (starting oxy, performing amniotomy, c-section, etc)
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52
Q

nursing interventions for hypertonic uterine dysfunction

A
  • assess uterine activity
  • assess maternal and fetal status
  • ambulate and change position
  • hydrate w IVF or po fluids
  • augment labor with oxy per protocol
  • provide support and keep woman and family informed
  • notify HCP of response and progression
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53
Q

precipitous labor

A

entire labor and birth within 3 hours

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54
Q

risks for precipitous labor

A
  • maternal: cervical laceration, potential for uterine rupture
  • fetal: head trauma (i.e., intracranial hemorrhage, nerve damage), hypoxia due to rapid progression of labor
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55
Q

nursing management for precipitious labor

A
  • promote safety
  • monitor VS and UCs q15 min
  • provide support
  • anticipate complications
  • prep for delivery
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56
Q

problems with passenger

A
  • should dystocia
  • breech/positioning
  • preterm labor
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57
Q

shoulder dystocia

A
  • difficulty during delivery of shoulder after birth of head which often occurs when passage of anterior shoulder is obstructed by symphysis pubis
  • first sign is retraction of fetal head against the maternal perineum after delivery of head, sometimes called turtle sign
  • increased suspicion with prolonged second stage of labor
  • risk factors not clearly ID’d but associated with birth weight >4000g (fetal macrosomia)
  • EMERGENCY!!!
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58
Q

management of shoulder dystocia

A

qplace women’s legs upward and pressing down on abdomen

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59
Q

nursing management for shoulder dystocia

A
  • call for help
  • explain the situation to client and family
  • urge NOT to push
  • help client assume position
  • assist HCP w/ manuevers and techniques during birth
  • document maneuvers including amount of time required to resolve shoulder dystocia
  • provide encouragement and support
  • assess newborn for clavicle or humerus fracture, brachial plexus injury, and asphyxia
  • assess mother for early hemorrhage and trauma to vagina, perineum, and rectum
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60
Q

positoning of fetus

A
  • single footing breech (one foot out)
  • frank breech (buttocks is presenting part)
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61
Q

preterm labor

A
  • occurence of regular contractions accompanied by cervical effacement and dilation before end of 37 weeks gestation
  • if not halted, results in preterm birth
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62
Q

signs of preterm labor

A
  • uterine contraction q10 min or less w/ or w/o pain
  • mild menstrual like cramps felt low in abdomen
  • constant or intermittent feelings of pelvic pressure that may feel like the baby pressing down
  • rupture of membranes
  • low, dull, backache, constant or intermittent
  • change in vaginal discharge
  • urinary frequency, urgency, hesitancy, or hematuria
  • abdominal cramping w/ or w/o diarrhea
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63
Q

primary interventions for preterm labor

A
  • diagnosis and treatment of STIs, UTIs, and bacterial vaginosis
  • admin hydroxyprogesterone 100mg 2x/daily vaginally
  • cervical cerclage
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64
Q

secondary prevention of preterm labor

A
  • administer antibiotics to treat infection if needed
  • placement of emergency or rescue cerclage in early 2nd trimester
  • tocolysis
  • if woman is btwn 24-34wks and candidate for tocolysis, admin corticosteroids (betamethasone or dexamethasone) for benefit of fetal lung maturity
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65
Q

tocolytic medications

A
  • terbutaline
  • magnesium sulfate
  • nifedipine (procardia)
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66
Q

terbutaline

A
  • admin subq (0.25mg normally)
  • use not exceeding 48-72hrs
  • often used for breakthrough contractions in a patient not currently in active labor
  • sometimes used in labor for tachysystole
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67
Q

magnesium sulfate

A
  • tocolytic choice
  • do not admin if on CCB
  • loading dose 4-6g IV 100mL of IVF over 20 minutes (maintenance 2-4g/hr)
  • maintain for 12-24 hrs at lowest rate
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68
Q

nifedipine (procardia)

A
  • calcium channel blocker
  • PO or IV
  • acts by reducing flow of calcium ions into intracellular space of myometrial smooth muscle cells inhibiting contractile activity
  • check BP before
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69
Q

health promotion ot prevent preterm labor

A
  • teach to recognize s/s of preterm labor
  • teach to evaluate contractions
  • ensure pt knows when to report and notify HCP
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70
Q

hospital based nursing care for preterm labor

A
  • promote rest
  • monitor vitals and I&Os
  • continuosuly monitor FHR and UCs
  • admin tocolytics
  • keep informed, provide explanations, allow expression of feelings and concerns
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71
Q

post-term pregnancy

A
  • extends >294 days or 42 completed weeks past the first day of LMP
  • associated with deterioration of placenta and related problems for baby (reduced blood supply, decreased fetal oxygenation, reduced nutritional supply
  • 20% of postterm fetuses experience dysmaturity syndrome (associated with uteroplacental insufficiency resembling IUGR, meconium aspiration, and short term neonatal complications)
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72
Q

maternal risks after post-term pregnancy

A
  • increased discomfort of pregnancy
  • anxiety
  • insomnia
  • C-section
  • operative vaginal birth (forceps, vaccum)
  • perineal trauma or damage
  • maternal hemorrhage
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73
Q

clinical interventions for post-term pregnancy

A
  • HCP will begin specialized monitoring when completing 40th weeks (nonstress and biophysical profile)
  • if problems occur, induction of labor recomended
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74
Q

nursing care for post-term pregnancy

A
  • assess EDOB and criteria to establish date
  • evaluate FHR during NST or during care of laboring patients
  • be preped to intervene for non-reassuring FHR
  • assess fluids for presence of meconium once membranes are ruptured
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75
Q

induction of labor

A
  • deliberate stimulation of UCs before onset of spontaneous labor to facilitate a vaginal delivery
  • induction of labor refers to techniques for stimulation UCs to accomplish delivery before osnet of spontaneous labor
  • maternal indications: preeclampsia, eclampsia, fetal death, chorioamnionitis
  • fetal indications: IUGR, isoimmunizations, premature rupture of membranes with established lung majority)
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76
Q

contraindications of labor induction

A
  • complete placenta previa
  • placental abruption
  • transverse lie
  • floating presenting part
  • fetal distress
  • previous uterine surgery that prohibits trial of labor
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77
Q

management for induction

A
  • u/s to evaluate fetal size, position, and GA along with locating placenta
  • engaged fetal part
  • pelvimetry to rule out fetopelvic disproportion
  • NST to evaluate fetal well being
  • phosphatidyl glycerol levels to assess fetal lung maturity
  • confirmation of category I FHR
  • vaginal exam to eval cervix and inductability
  • labs: CBC, UA
  • methods to induce: mechanical, cervical, pharmacologic
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78
Q

bishop score 0

A
  • closed
  • effaced 0-30%
  • -3 station
  • firm cervix
  • posterior cervical position
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79
Q

bishop score 1

A
  • 1-2 cm dilated
  • 40-50% effaced
  • -2 station
  • medium cervical consistency
  • cervix in midposition
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80
Q

bishop score 2

A
  • 3-4 cm dialted
  • 60-70% effaced
  • -1 fetal station
  • soft cervix
  • anterior positioning
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81
Q

bishop score of 3

A
  • 5-6 cm dilated
  • 80% effaced
  • +1/+2 station
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82
Q

pharmalogical method for induction

A

misoprostol

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83
Q

action of misoprostol

A

ripens cervix making it softer and causing it to begin to dilate and efface, stimulating uterine contractions

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84
Q

indication for misoprostol (cytotec)

A
  • used for preinduction cervical ripening (ripen cervix before oxytocin induction of labor when bishop score is 4 or less)
  • used to induce labor or absortion
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85
Q

misoprostol dosage and admin

A
  • 25mcg as initial dose
  • insert intravaginally into posterior vaginal fornix using tips of index and middle fingers without use of lubricant
  • redosing is permissible if cervix remains unfavorable
  • FHR normal and have at least 3hrs since last dose
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86
Q

nursing management for misoprostol

A
  • explain procedures to client and family
  • assess VS, FHR, and pattern and perform bishop score
  • have woman void before insertion of med
  • admin as ordered
  • monitoring for tachysystole, fever, chills, vomiting, diarrhea
  • prep to admin terbutaline 0.25 mg SQ if adverse effects occurs
  • document all findings and admin procedures
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87
Q

oxytocin indications

A
  • used primarily for labor induction and augmentation
  • can be used to control postpartum bleeding
  • goal: use lowest dose possible to achieve adequate labor evidence by progressive cervical effacement and dilation (0.5-1cm/hr) after active labor has been acheived
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88
Q

dosage and admin of oxytocin

A
  • admin IV through secondary line via infusion pump
  • start at 1-2miliunits/min
  • increase rate by 1-2milliunits/min no more frequently than 30-60 minutes based on response
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89
Q

adverse effects of oxytocin

A
  • maternal: uterine tachysystole, placental abruption, uterine rupture
  • fetal: fetal compromise, progressive decrease in fetal oxygen status, neonatal acidemia
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90
Q

nursing management for oxytocin

A
  • HIGH alert
  • education and support
  • assess uterine activity and FHR continuously using EFM
  • evaluate tracings q15min during first stage and during passive stage
  • evaluation tracing q5min during active pushing
  • contractions shouldn’t occur >q2min
  • titrate to lowest dose that acheieves labor progres
  • document time, each time increased, decreased, or discontinued, assessment and communication w/ HCP
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91
Q

prolpased umblical cord

A
  • precedes fetal presenting part
  • trapped between preenting part and pelvis
  • pressing part not firmly against cervix
  • potential obstruction of blood flow through cord
  • variable or prolonged decels
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92
Q

nursing management of prolpased cord

A
  • MEDICAL EMERGENCY
  • if loop of cord palpated on vaginal exam, push presenting part up off cord and hold
  • call for help
  • notify HCP
  • explain to client what is happening
  • place client in knee chest position or trendelenburg
  • admin O2 at 10L/min via mask
  • admin IVF
  • discontinue oxytocin
  • prep for immediate delivery
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93
Q

forceps assisted birth

A
  • used to apply traction to fetal head or provide method of rotating fetal head during birth
  • are stainless steel instruments, similar to ongs, with rounded edges that fit around fetus’s head
  • applied to side
  • type determined by HCP
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94
Q

vaccum assisted birth

A
  • cup shaped instrument attached to suction pump for extraction
  • suction cup placed against occiput
  • pump used ot create negative pressure
  • HCP applies traciton until fetal head emerges
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95
Q

indicateds for forcep or vaccum

A
  • prolonged 2nd stage
  • distress FHR
  • failure of presenting part to rotate and descend into pevlis
  • limited senstation and inability to push effectively from anesthesia
  • presumed fetal jeporady or distress
  • maternal heart disease, pulmonary edema, intrapartum infeciton, maternal fatigue
  • trend to use vaccum over forceps
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96
Q

nursing interventions for forceps

A
  • assess woman’s anesthesia level and comfort level
  • insert straight cath
  • provide emotional support
  • document type of forceps, # of applications, and time
  • anticipate potential complications
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97
Q

nursing interventions for vaccum extraction

A
  • assess woman’s anesthesia level and comfort
  • educate and reassure
  • anticipate potential complication
  • pump vaccum to appropriate level
  • pressure should be released during contractions
  • document pump was used
  • time how long cup is on fetal head
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98
Q

maternal complications of forceps or vaccum

A
  • lacerations of cervix, vagina, or perineum
  • hematoma
  • extension of episiotomy incision into anus
  • hemorrhage
  • infection
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99
Q

fetal complications of forceps and vaccum assist

A
  • ecchymoses
  • facial and scalp lacerations
  • facial nerve injury
  • cephalohematoma
  • caput succedaneum
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100
Q

cesarean birth

A
  • surgical birth of fetus through incision in abdominal wall
  • most commonly performed surgery in US
  • indicated for abnormal presentation, previous uterine surgery, placenta previa, non-reassuring fetal status, active herpes infection, dystocia
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101
Q

complications of c-section

A
  • infection
  • hemorrhage
  • aspiration
  • PE
  • urinary tract trauma
  • thrombophlebitis
  • paralytic ileus
  • atelectasis
  • fetal injury and transient tachypnea of newborn
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102
Q

spinal anesthesia (block)

A
  • anesthetic solution containing local anesthetic alone or in combo w/ opiod
  • injected into 3rd,4th, or 5th lumbar interspace into subarachnoid space
  • mixes with CSF
  • provides anesthesia from nipples to feet
  • lasts 1-3hrs depending on type and amougn
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103
Q

advantages of spinal block

A
  • immediate onset on anesthesia
  • relative ease of admin
  • smaller drug volume
  • maternal compartmentalization of drug
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104
Q

disadvantages of spinal block

A
  • primary intense blockage of synthetic fibers
  • uterine tone is maintained
  • short acting
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105
Q

complications of spinal block

A
  • hyoptension
  • high level complete spinal or total spinal block
  • spinal headache
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106
Q

nursing care during spinal anesthesia

A
  • assist with positioning
  • provide support and encourage breathing and relaxation
  • provide o2 via nasal cannula or face mask
  • record baseline
  • admin fluid bolus
  • palpate uterus to detect contractions
  • after procedure assist to supine with wedge
  • keep client informed
  • assess fr hypotension and difficulty breathing
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107
Q

lumbar epidural block

A
  • provides adequate pain relief, does not pass placenta
  • allows woman some sensation to feel pressure and push
  • preferred method of pain relief
  • most common technique used in labor is continuous infusion pump (PCEA)
  • side effects: hypotension, pruritus, patchy blocks, shivering
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108
Q

advantages of lumbar epidural block

A
  • produces good analgesia
  • woman fully awake
  • does not enter fetal bloodstream
  • once pump stopped, wears off within 1-2hrs
  • if fails to profress, epidural can be used for c-section
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109
Q

disadvantages of lumbar epidural block

A
  • maternal hypotension secondary to peripheral vasodilation
  • can be prevented by preloading with rapid infusion of IVF (500-1000cc) and then providing IVF continuously until birthq
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110
Q

maternal hypotension

A
  • caused by spinal blockade which lowers peripheral resistance which decreases venous return to heart and lowers cardiac output causing decreased BP
  • will lead to uteroplacental insufficiency in fetus presenting as late decels
  • to minimize: preload with IVF and continue IVF
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111
Q

when complication occurs you want to

A
  1. flip: reposition on side
  2. flush: increase fluids
  3. O: administer 10L o2 via nonrebreather
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112
Q

nursing care for epidurals

A
  • assess maternal VS and FHR
  • ensure O2 and resuscitative equipment ready and function
  • start IVF and admin
  • encourage rest when tired
  • assist with procedure
  • help reposition and monitor BP and FHR
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113
Q

general anesthesia

A
  • achieved throrugh combination of IV analgesics and inhaled agents
  • IV anesthetics used: propofol, ketamine
  • inhaled meds: nitrous oxide and halogenated agents
  • major complications: fetal respiratory depression, uterine relaxation, vomiting, aspiration
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114
Q

nursing care for general anesthesia

A
  • administer antacids prophylactically
  • position with wedge under hip
  • preoxygenate
  • start IVF
  • assist anesthesiologist and other surgical team members
  • provide emotional support
  • encourage breastfeeding when awake
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115
Q

preop teaching for C-section

A
  • provide education, clarification and support (explain why and what for)
  • prepare for postop period (breastfeeding, pain management, ambulation)
  • emergency c-section (support partner)
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116
Q

postop care

A
  • assess dressing, stitches, and staples
  • perineal pad check q15min
  • fundus palpated
  • determine if remaining firm
  • IV oxytocin
  • assist with cough and deep breathing
  • newborn safety
  • promote bonding
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117
Q

propsoed causes of preeclampsia

A
  • placental implantation with abnormal trophoblasts invasion in uterine wall
  • immunological maladaptive tolerance between maternal, paternal (placental), and fetal tissues
  • maternal maladaptation to cardiovascular changes or inflammatory changes of pregnancy
  • genetic factors including inherited predisposing genes and epiegnic influences
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118
Q

preeclampsia signs/symptoms

A
  • sevre headache
  • swollen face
  • visual disturbances
  • epigastric/chest pain
  • high BP
  • swollen hands/fingers
  • swollen legs/feet
  • proteinuria
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119
Q

risks for woman w/ preeclampsia

A
  • cerebral edema, hemorrhage, or stroke
  • disseminated intravascular coagulation (DIC)
  • pulmonary edema
  • congestive HF
  • maternal sequelae resulting from organ damage including RF, HELLP sundrome, thrombocytopenia, disseminated intravascular coagulation, pulmonary edema, eclampsia, (seizures), and hepatic failure
  • placenta abruptio
  • 1.5-2x more likely to develop heart disease
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120
Q

risk for fetus and newborn with preeclampsia

A
  • uteroplacental ischemia including fetal growth restriction, oligohydraminos, placental abruption, and nonreassuring fetal status
  • fetal intolerance to labor due to decreased placental perfusion
  • still birth
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121
Q

medical managemet for preeclampsia

A
  • control of BP and prevention of seizure activity and cerebral hemorrhage
  • induced brith is indicated for women at less than 34weeks gestation with severe features of preeclampsia or unstable maternal or fetal status at any gestation
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122
Q

nursing management of preeclampsia

A
  • accurate assessment and monitoring for labs
  • admin antihypertensives
  • admin mag sulfate
  • assess for CNS changes (headache, visual changes, DTRs, clonus)
  • assess for epigastric pain or RUQ pain showing liver involvement
  • maintain accurate I&Os to eval kidney fxn
  • perform atenatal fetal testing for FHR monitoring
  • provide adequate environment to decrease CNS stimulation
  • maintain bedrest in lateral recumbent position
  • provide information to woman and her family
  • report decline in maternal or fetal status to HCP
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123
Q

magnesium sulfate dosage and admin

A

IV access: load 4-6g 10% mag sulfate in 100mL solution over 20 minutes, maintenance dose 1-2g/hr

no IV access: 10grams of 50% solution IM (5g in each buttock)

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124
Q

antihypertensive meds dosage and admin

A
  • for SBP >160 or DBP >110
  • labetalol: 10-20mg for more than 2min, 40mg, 80 IV over 2minutes
  • hydralazine (5-10mg IV over 2 min, repeat q20min until BP is reached
  • nifedipine: 10-20mg capsules prn may repeat in 20 minutes
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125
Q

anticonvulsants admin and dosage

A
  • for recurrent seiures
  • lorazepam (ativan): 2-4mg IV, may repeat 10-15min
  • diazepam (valium): 5-10mg IV q5-10min
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126
Q

contraindications for mag sulfate

A
  • pulmonary edema
  • renal failure
  • myasthenia gravis
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127
Q

labetalol contraindications

A
  • avoid in asthma or HF
  • can cause neonatal bradycardia
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128
Q

hydralazine contraindications

A
  • mitral valve disease
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129
Q

DTR scale

A

0 = no response
+1 = sluggish or diminished
+2 = active or expect
+3 = more brisk than expect, slightly hyperactive
4+ = brisk, hyperactive, with intermittent or transient clonus (spasms)

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130
Q

eclampsia

A
  • may be triggered by cerebral vasospasm, cerebral hemorrhage, cerebral ischemia, or cerebral edema
  • often preceded by premonitory signs of cerebral irritation like severe headaches, blurred vision, photophobia, and altered LOC
  • during eclamptic seizures, prolonged FHR decels, even fetal bradycardia, and increase in uterine contractility may occur
  • after a seizure due to maternal hypoxia and hypercarbia, FHR tracing may show recurrent decels, tachycardia, and reduced variability
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131
Q

care during seizures

A
  • remaining with pt
  • call for help
  • providing pt safety and assessing airway and breathing
  • prevent maternal injury
  • record time, lengthm and type of seizure activity
  • notify HCP
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132
Q

after seizure care

A
  • rapidly assess maternal and fetal status
  • assess airway, suction if needed
  • admin O2 (10L via mask)
  • ensure IV access
  • admin mag sulfate
  • provide quiet environment
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133
Q

HELLP syndrome

A
  • variant of preeclamspai (sevre form) involving hemolysis, thrombocytopenia, liver dissunfction
  • life threatening
134
Q

HELLP

A

Hemolysis: causes anemia and jaundice
Elevated Lfts: ALT and AST increase, epigastric pain, n/v
Low Platelets: thrombocytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae, and possibly disseminated intravascular coagulopathy

135
Q

nursing care for HELLP

A
  • perform thorough assessment
  • evaluate lab tests
  • notfiy HCP if HELLP syndrome suspected
  • admin platelets as per orders
  • note assessment and management are sam efro women diagnosed with HELLP
  • provide woman and family info
  • provide emotional supprot
136
Q

gestational diabetes

A
  • group of metabolic disease showing hyperglycemia resulting from effects insulin secretion, action, or both
  • caused by impaired insulin secretion or inadequate insulin action
  • most common endocrine disorder of pregnancy
  • can be successfully managed with multidisciplinary approach
  • goal to maintain glucose levels
137
Q

target blood sugar

A

fasting: <95
premeal: <100
1hr after meals: <140
2hrs after meals <120
A1C: <6

138
Q

nursing managment of GD

A
  • maintain glucose levels throughout pregnancy
  • teach how to test levels using 3 checks/day
  • educate importance of maintenance
  • teach signs of hypoglycemia, hyperglycemia, and DKA
  • reinforce diet and exercise
  • assess behavior and mental health
  • reinforce plan of care related to self management and fetal surveillance (daily kick counts)
139
Q

intrapartum care for GD

A
  • glucose monitoring hourly (80-110 is desired)
  • insulin infusion may be needed to maintain levels
  • avoid dextrose
140
Q

after birth/postpartum care of GD

A
  • most return to normal
  • high risk for future GDM
  • increase risk of type II
  • reassess at 6-12 weeks PP
  • contraceptives
141
Q

postpartum assessment of mother

A
  • based on thorough assessment
  • designed to meet needs of woman and new family as well as dtect and treat complications
  • nurse uses knowledge to guide assessment
  • also assessment time is an excellent opportunity for pt education
142
Q

postpartum assessment principles

A
  • select time
  • consider needs
  • provide explanations
  • ensure relaxation
  • perform procedures gently
  • document and report results
  • take appropriate precautions
143
Q

typical assessments in postpartum period

A
  • 1hr: q15 min
  • 2nd hour: q30min
  • first 24hrs: q4hrs
  • after 24hrs: q8hrs
144
Q

vitals PP

A
  • temp: slightly elevated during first 24hrs, normal afterward
  • pulse: 60-80 bom, pulse >100 needs further investigation
  • respirations: 12-20 and clear
  • BP: WNL, no higher than 140/90 or lower than 85/60
  • pain: goal btwn 0-2
145
Q

BUBBLELE

A
  • breasts
  • uterus
  • bladder
  • bowels
  • lochia
  • episiostomy/lacerations
  • lower extremities
  • emotional status
146
Q

breasts

A
  • assess fit and support of bra
  • provide information on selecting bra
  • examine shape, size, abnormalities, reddened areas or enorgement, check for cracked blistered or bleeding nipples, erect, flat or inverted
  • note dischage and doument
  • palpate breast lightly for softness, slight firmness associated with filling or tightness of engorgement, warmth or tenderness
147
Q

breast teaching

A
  • characteristics
  • breast feeding: use supportive bra, keep nipples dry and watch for fissures or cracks, watch for reddened or tender spots, additional teaching while breastfeeding prn
  • nonbreastfeeding: use supportive bra, avoid breast stimulation, apply cold, raw cold cabbage leaves, allow water in shower to flow over back not breasts
148
Q

uterus

A
  • have her void before exam
  • palpate position of fundus in relation to umbilicus
  • note for boggy, firm, or midline
  • inspect abdominal incision of c-section for REEDA
  • excessive pain may indicate infection
149
Q

bladder

A
  • monitor during hours after birth
  • 1st few voids need to be measured and documented (should be between 150-200mL)
  • assess frequently for distention, frequency, burning, or urgency
  • catheterization may be needed
  • encourage frequent voiding, increase amount of water drinks
150
Q

bowel

A
  • assess bowel sounds and abdomen
  • movements return within 2-3days
  • constipation can increase pressure on perineal sutures and increase discomfort
  • educate on how to return to normal BMs, use of stool softners, not to be scared to have one, dangers of constipation
151
Q

lochia

A
  • assess character, amount, odor, and presence of clots
  • assess for rubra, serosa, and alba
152
Q

lochia education

A
  • normal changes in color and characteristics
  • effect of position changes
  • hygienic measures: use of peribottle, hand hygiene with changing pad, wiping front to back
153
Q

episiotomy/perineum

A
  • inspected in Sim’s position
  • lift buttocks to expose perineum and anuse
  • inspect episiotomy site and for presence of hemorrhoids
  • usually edematous and slightly bruised
  • can take up to 4-6months to heal
  • alsp inspect for hemorrhoids
154
Q

lacerations

A
  • classified based on severity and tissue involement
  • 1st degree: involves only skin and superficial structures above muscle
  • 2nd degree: extends through perineal msucules
  • 3rd degree: extends through anal sphincter muscle
  • 4th degree: continues through anterior rectal wall
155
Q

care of lacerations and episiotomies

A
  • assess q8hrs
  • large areas of swollen bluish skin with sevre pain indicate hematomas
  • redness, swelling, increased discomfort or purulent drainage indicates infection
  • white line running down length of episiotomy is sign of infeciton as well as swelling or discharge
156
Q

inspecting epidural

A
  • visually inspect
  • perform I&Os
  • assess for side effects of injected medications (i.e., itching, n/v, or urinary retention)
157
Q

episiotomy and perineum teaching

A
  • discuss type
  • care of sutures
  • cleansing perineum
  • comfort measures
  • kegels
158
Q

lower extremities

A
  • assess for redness, swelling, heat, tenderness or pain in legs
  • determine degree of sensory and motor fxn by asking if they can feel sensation and ambulate
159
Q

emotional status

A
  • observe interactions, independence, energy levels, eye contact, posture, etc/
  • be alert for mood swings, irritability, or crying episodes
160
Q

emotional education

A
  • rest
  • gradually return to normal activity
  • proper nutrition
  • ask for help
  • infant safety
161
Q

nursing interventions in postpartum period

A
  • provide optimal cultural care
  • determine client’s preferences before intervention
  • may include dietary restrictions, certain clothes, taboos, activites for mental health, use of silence, prayer or meditation
  • restoring health may involve folk medicine or conferring with tribal healer
162
Q

nursing interventions to promote comfort

A
  • ice packs within first 24hrs to reduce perineal edema and prevent hematoma formation
  • peribottle filled with warm water prayed over perineal area after voiding
  • sitz bath after first 24hrs using room temp water to reduce swelling and promote comfort
  • topical prep: benzocaine spray, witch hazel spray and dibucaine or hydrocortiisone for hemorrhoids
  • analgesics: acetaminophen, iburopen, naproxen,
163
Q

nursing interventions continued

A
  • assess voids
  • admin stool softners as ordered
  • encourage to ambulate
  • encourage increase in fluids and fiber
  • encourage adequate rest periods
  • encourage exercise
164
Q

immunizations given postpartum

A
  • tdap (tetanus, diptheria, pertussis)
  • MMR II (measles, mumps, rubella)
  • flu vaccine
  • Rhogam
165
Q

points to remeber about PP care

A
  • best postpartum care is individualized, family0centered, and disrupts family as little as possible
  • knowledge of normal and abnormal helps recognize problems and begin interventions
  • communicating information helps family adjust
  • pt education is vital to prevent further complications
166
Q

postpartum complications info

A
  • can be life thretening and require collab management
  • somtimes requires readmission
  • need to be aware of physical or emotinal complications during birth
  • need to teach s/s of PP complication, when to notify HCP, and how to prevent complicatiosn
167
Q

most common PP complications

A
  • hemorrhage
  • infections
  • thromboembolic disease (clots)
  • postpartum psychiatric disorders
168
Q

postpartum hemorrhage

A
  • > 500mL following vaginal birth
  • > 1000mL following C-section
  • any amount of bleeding that places mother in hemodynamic jeporady
  • primary hemorrhage occurs within first 24hrs
  • late hemorrhage ocurs 24hrs to 12weeks after birth
169
Q

causes of hemorrhage

A
  • uterine atony (failure to contract)
  • lacerations of genital tract
  • episiotomy
  • retained placental fragments
  • uterine inversion
  • coagulation disorders
  • hematoma of vulva, vagina, or subperitoneal areas
170
Q

pathophysiology of PPH (4 Ts)

A
  1. tone: uterine atony, distended bladder
  2. tissue: retained placenta and clots
  3. Trauma: vaginal, cervical, or uterine injury
  4. Thrombin: coagulopathy (preexisting or acquired)
171
Q

nursing interventions for hemorrhage

A
  • review maternal hx to ID risk factors
  • regular and frequent assessment of fundal position and tone or contractility, if boggy MASSAGE
  • monitor bladder for distension, immediately inttervene if present
  • assess for bleeding
  • examine perineal area for hematomas
  • monitor VS, LOC, I&Os, and O2 sats
  • if suspected PPH, cal for help and notify HCP STAT
172
Q

oxytocin

A
  • given to stimulate contraction of uterus
  • 20-40units in liter IV or 10 units IM
  • monitor fundus for contraction
  • monitor for bleeding q15min
  • monitor vitals q15
  • monitor uterine tone, assure client, offer explanation, provide nonpharmacologic comfort measires, set up IV infusion
173
Q

misoprostol

A
  • stimulates uterus to contract reducing bleeding
  • 800 mcg PR
  • contraindications: undilued as bolus injection IV
  • don’t give with allergy, active CVD, hepatic disease, or asthma
174
Q

dinoprostone

A
  • helps contract uterus to stop bleeding
  • 20mg vaginal or rectal
  • monitor BP (hypotension common), vomiting, diarrhea, nausea, and temp elevation
175
Q

methylergonovine maleate

A
  • stimulates uterus to prevent and treat postpartum hemorrhage due to atony
  • assess baseline bleeding
  • offer explanation
  • monitor for adverse effects of HTN, seizures, uterine cramping, n/v, and plapitations
  • report chest pain
  • don’t give if HTN
176
Q

prostaglandin or carboprost

A
  • stimulates uterine contractions to treat PPH when uncontrolled by other methods
  • 0.25 mg IM
  • monitor vitals, contractions, comfort, and bleeding
  • monitor for adverse effects like fever, chills, headache, n/v, diarrhea, flushing, and bronchospams
  • don’t give w/ asthma or active CVD, renal or hepatic disease
177
Q

don’t give oxytocin or ptiocin as

A

undiluted bolus injection IV

178
Q

don’t give cytotec with

A
  • allergy
  • active CVD
  • pulmonary disease
  • hepatic disease
179
Q

dont give prostin E2

A
  • active cardiac, pulmonary or renal disease
180
Q

don’t give methergine if

A

woman is hypertensive

181
Q

don’t give hemabate if

A

asthmatic

182
Q

nursing care after PPH

A
  • monitor vitals
  • evaluate for s/s of anemia (fatigue, headache, thirst, orthostatic hypotension)
  • evaluate effectives of treatment
  • monitor I&Os
  • notfy HCP of UO <30mL/hr
183
Q

venous thromboebolic conditions

A
  • potentially serious complication of PP
  • one of the leading causes of maternal mortality and morbidity
  • inflammation of blood vessel lining
184
Q

most common types of thromboembolic conditions

A
  • superficial thrombosis: confined to lower leg
  • deep vein thrombosis: LE, varies from foot to iliofemoral region
  • pulmonary embolism: complications of DVT in blood
185
Q

PE s/s

A
  • dyspnea
  • pleuritic chest pain
  • cough w/ or w/o blood
  • cyanosis
  • tachypena
  • tachycardia
  • panic
  • sudden hypotension
  • diaphoresis
  • wheezing, rales, friction rub
186
Q

nursing care for SVT

A
  • admin NSAIDs for analgesia
  • facilitate rest
  • elevate affect leg
  • apply warm compress to promote healing
  • use antiembolic stockings to promote circulation
187
Q

nursing care for DVT

A
  • bed rest or limited ambulation
  • elevate affected leg
  • apply antiembolic stockings or SCDs
  • admin LMWH
  • monitor aPTT, PTT, and platelets
  • apply warm compresses
  • administer analgesics
  • expect to admin oral analgesics for several days
188
Q

nursing care of PE

A
  • institute emergency measrues immediately
  • admin O2
  • initiate LMWH IV
  • maintain bed rest
  • admin analgesics
  • be preped to admin thrombolytics
189
Q

postpartum infection

A
  • any clinical infection of gential tract within 28days after miscarriage, abortion, or birth
  • defined as fever >100.4 after 1st 24hrs
  • organsisms usually those of normal flora
  • most common, endometritis, surgical site infections, UTIs, and mastitis
190
Q

endometritis

A
  • uterine infection typically developing within 2-4 days to as late as 6wks PP
  • involves endometrium, decidua, and adjacent myometrium of uterus
  • broad spectrum antibiotics, measures to restore and promote fluid and electrolytes and analgesic pain relief
191
Q

surgical site infection

A
  • may not show until 24-48hrs
  • s/s: weeping or purulent drainage, separation, edema, erythema, tenderness, discomfort, fever, elevated WBCs
  • therapuetic management: opening of wound to allow drainage, aseptic wound management, hydration, frequent perineal pad changes, ambulation, antibiotics, analgesics
192
Q

urinary tract infections

A
  • urinary frequency, urgency, dysuria, lower abdominal pain, cloudy urine w/ strong odor
  • can be prevented by timely removal of catheters
  • therapuetic management: fluids to prevent dehydration, antibiotics
193
Q

mastitis

A
  • inflammation of mammory gland
  • occurs within 2days to 2wks PP
  • s/s: flu like symptoms, tender, hot painful areas of one breast, inflammation of breast, tenderness, cracking of skin around nipple or areola, breast distention w/ milk
  • management: increase frequency of breastfeeding, antibiotics, ice or warm packs, analgesics
194
Q

nursing assessment and management

A
  • play role in ID s/s of infection
  • assess risk factors by reviewing hx
  • ID early subtle s/s
  • BUBBLEEE
  • REEDA
  • inspect wounds
  • maintain aeseptic technique while performing invasive procedures
  • monitor labs and VS
  • monitor frequency of vaginal exams and length of labor
  • encourage rest, adequate hydration, and healthy eating habits
  • provide education on preventative measures
195
Q

PP psych disorders

A
  • baby blues
  • postpartum depression
  • postpartum psychosis
  • posttraumatic stress disorder
196
Q

baby blues

A
  • mild
  • occurs in 50-70% of mothers
  • typically occurs within 2-4 days
  • lasts about 2weeks
  • assure mother it is normal
197
Q

postpartum depression

A
  • similar to baby blues but includes feelings of worthlessness, lack of concern of overall apperance, irritability or hostility toward baby and suicidial ideation
198
Q

PP depression management

A
  • individaul group therapy
  • antidepressants
  • continue to breastfeed
199
Q

postpartum psychosis

A
  • sleep disturbances
  • depersonalization
  • confused, irrational, or disorganized thinking
  • bizarre behavior
  • psychomotor disturbances (stupor, agitation, rapid and incoherrant speech)
200
Q

nursing management for PP psych issues

A
  • review hx and ID risks
  • be alert for physical findings through activity level, fatigue, sleeping habits
  • observe anxiety and ability to conentrate
  • assess nutritional intake
  • educate about enormous changes that occur during PP period and provide material about PP emotional disorders
  • assist in learning how to ask for help
  • have resources
201
Q

transition to extrauterine life

A
  • neonatal period: first 28 days of life
  • transition begins when umbilical cord is cut and neonates take first breath
  • nruses role is to assess, moitor, and support neonates as they go through changes
202
Q

respiratory system fetus vs newborn

A

fetus: fluid filled, high pressure system causing blood to be shunted from lungs through ductus arteriosus to rest of body

newborn: air-filled, low pressure system encouraging blood flow through lungs for gas exchange, increased o2 content in blood of lungs contributing to closing of ductus arteriosis

203
Q

gas exchange fetus vs newborn

A

fetus - placenta
newborn - lungs

204
Q

circulation throuhg heart fetus vs newborn

A

Fetus:
- pressures in RA > LA
- encourages blood flow through foramen ovale

Newborn:
- pressures in LA > RA causing foramen ovale to close

205
Q

hepatic portal circualtion fetus vs newbron

A

Fetus:
- ductus venosus bypassess; maternal liver performs filtering functions

Newborn:
- ductus venosus closes (becomes a ligament)
- hepatic portal circualtion begins

206
Q

thermoregulation fetus vs newborn

A

fetus:
- body temp maintained by maternal body temp and warmth of intrauterine environment

newborn: body temp maintained through flexed posture and brown fat

207
Q

thermoregulation

A
  • process maintaining balance between heat loss and heart production in order to maitnain body’s core internal temperature
  • neutral thermal environment needed to support neonate during transition
  • newborns dependent on environment for maintenance of body temp immediately after birth
  • maintaining stable temp is critcial to survival
208
Q

characteritiscs predisposing newborns to heat loss

A
  • thin skin; blood vessels close to surface
  • lack of shivering ability
  • limited use of volutnary muscles
  • large body surface area relative to weight
  • lack of subq fat
  • no ability to adjust own clothing or blankets to acheive warmth
  • infants cannot communicate they are too cold or too warm
209
Q

heart production

A

primarily through non-shivering thermogenesis which is metabolism of brown adipose tissue
- located in neck, thorax, axillary area, intrascapular aras and sround adrenal glands
- metabolism of borwn tissue promotes heat production through lipid breakdown and transfers heat to peripheral system
- limited amount in premature infants

210
Q

convection heat loss

A
  • involves flow of heat from body surface to cooler surrounding air to air circulating over body surface
  • ex. cool breeze, room, outside air
211
Q

strategies to prevent convenction

A
  • increase temp in delivery room
  • move away from air conditioning
  • use radiant warmer
  • monitor temp frequently until neutral thermal conditions are established
212
Q

conduction heat loss

A
  • involves transfer of heat loss from one object o another when two objects are in direct contact
  • refers to heat fluctuation between newborn’s body surface while in contact with other solid surfaces
213
Q

prevention of conduction

A
  • prewarm bed or cover with several layers of warm blankets
  • cover scale with a prewarmed blanket
  • position nebworn in flexed position
  • place blanket over chemical mattress
  • limit use of hot water bottles
  • educate parents
  • NEVER RAPIDLY WARM INFANT
214
Q

radiation heat loss

A
  • involves loss of body heat to cooler, solid surfaces that are not in direct contact but within proximity
  • placed next to cold window, using cold equpment
215
Q

prevention of radiation heat loss

A
  • prewarm incubator
  • move away from windows
  • use radiant warmer with servo control
  • use heat lamps as last resort
216
Q

evaporation heat loss

A
  • involves heat loss when liquid is converted to vapor
  • ex. baby covered in amniotic fluid, bathing
217
Q

prevention of evaporation

A
  • place newborn skin to skin
  • dry with warm blankets
  • warm room
  • bathe quickly and dry and dress
  • avoid overheating adn rapid rewarming which can cause vasodialtion
  • avoid situations contibuting to cold stress which can cause vasoconstriction
218
Q

cold stress

A
  • excessive heat loss resulting in utilization of compensatory mechanisms
  • occurs when there is a decreased environmental temp causing decrease in neonates body temp causing respiratory distress and other serious outcomes
  • consequences of cold stress: hypoglycemia, hypoxia, metabolic acidosis, decreased surfactant, respiratory distress, increased bilirubin and jaundice, poor feeds and weight loss, apnea, death
219
Q

s/s of cold stress

A
  • temp <97.7
  • cool skin
  • restlessness
  • crying
  • pale ro mottled
  • acrocyansosis
  • tachypnea
  • grunting
  • hypoglycemia
  • hypotonia
  • lethargy
  • jittery
  • weak suck
220
Q

prevative measures for cold stress

A
  • dry neonate thoroughly after birth
  • place cap on head
  • provide skin to skin
  • use prewarmed blankets
  • prewarmed equipment
  • delay bath until temp is stable
  • bathe infant under radiant warmer
  • place infant away from air vents
  • open windows
  • place infant away from outside walls and windows
  • educate parents on keeping newborn warm
221
Q

if cold stress is suspected

A
  • monitor temo
  • place cap on head and place in skin to skin
  • assess and correct environmental conditions
  • reassess temp in 30 min
  • obtain heel stick to asses for hypoglycemia
  • place under warmer if temp doesn’t regulate within 30in
222
Q

hepatic system of newborn

A
  • slowly assumes function after birth (iron storage, carb metabolism, conjugation of bilrubin)
223
Q

GI system of newborn

A
  • not fully mature at birth but can rapidly adapt to demands
  • bowel sounds heard within 1st hour of life
  • gastric size 6mL/g 15-24 mL for most infants
  • intake of colostrum is 2-10mL/feed for first 24hrs
  • after first 24hrs, 30-60mL/feed by day 4
  • stomach emptying is 2-4hrs
  • cardiac sphincter and nervous system control of stomach immature leading to regurgitation and uncoordingated peristaltic activity
  • breast milk digested faster than formula
  • breastfed infants feed q2-3hrs
  • formula infants feed q3-4hrs
224
Q

newborn stool

A
  • meconium, then transitional stool, than milk stool
  • breast-fed newborns: yellow gold, losse, stringy, pasty, sour-smelling
  • formula: yellow, yellow-green, loose, pasty, or formed, unpleasant odor
225
Q

renal system in newborns

A
  • control fluid and electrolyte balance and excretion of waste
  • kidneys are initally immature which puts neonate at risk for overhydration, dehydration, electrolytes, or drugs
  • full term excrete 15-60mL/kg of urine/day
  • all newborns need to void within first 24hrs
  • usually lose 5-10% of birth weight during first week
226
Q

meconium is expected days

A

1-2

227
Q

transitional stool expected days

A

3-4

228
Q

breast fed stool or formula fed stool expected days

A

3-4

229
Q

immune system of infants

A
  • essential to newborn’s survival and ability to respond to hostile environment
  • immune system begins workin in early gestation peaking at 32-33wks relying on passive immunity from mom
  • risk for acquiring infection
  • being to produce own antibodies at 2-3months of life
  • immune system response: natural immunity (physical barriers, chemical barriers, resident nonpathological organisms), acquried immunity (development of circulating immunoglobulins, formation of activated lymphocytes and absent until after first invasion)
230
Q

skin of newborn

A
  • protective barrier
  • limtis water loss
  • prevents absorption of harmful agents
  • protects thermoregulation
  • fat sotrage
  • protects against physical trauma
  • accelerated epidermal development with expoure to air for newborns
  • improper handling can cause damage, prevention of healing, and interance with normal maturation process
231
Q

neurological adaptations

A
  • development follows cephalocaudal and proximal distal patterns
  • acute senses of hearing smell tase tocuh and vision
  • adaptations of respiratory circulatory thermoregulatory and MSK systems indirectly indicating CNS transition
  • reflexes are indication of neuro function
232
Q

behavioral patterns

A
  • 1st period of reactivity birth to 30 minuts to 2hrs after birth, alert, moving, appears hungry
  • period of decreased responsiveness: 30-120min old, period of sleep or decreased activity
  • 2nd period of reactivity: 2-8 hours, newborn awakens and show interest in stimuli
233
Q

care of vigorous newborn

A
  • skin to skin with warm blankets
  • APGAR done at 1-5 minutes
  • VS
  • mother and baby give 1-1.5hrs of uniteruptred bonding
  • breastfeeding
  • delayed cord clamping for 30-60seconds
  • lightweight clamp placed after 1/2-1inch from newborn skin
  • do not suction unless absolutely necessary
234
Q

signs indicating problem in newborn

A
  • nasal flaring, chest retractions
  • grunting on exhalation, labored breathing
  • generalized cyanosis, flaccid body posture
  • abnormal breath sounds
  • abnormal RR
  • abnormal HR
  • abnormal size of newborn
235
Q

APGAR scores rated on

A
  • HR
  • RR and effort
  • muscle tone
  • reflex irritability
  • skin color
236
Q

complete newborn assessment

A
  • review prenatal hx
  • done after intial bonding period
  • requries head to toe along with length, weight, gestational age assessment
  • length is 44-55cm normally and weight is 2500-4000g (5lb 8oz-8lb 8oz) full term
  • low birth weight <2,500g (<5.5lb)
  • very low birth weight <1,500g (<3.5lb)
  • extremely low <1,000g (<2.5lbs)
237
Q

gestational age assessment

A
  • established from mothers LMP, ultrasound, and neonatal age assessment
  • use of ballard scale helps estimate gestational age
  • calculated using 6 physical and 6 neuromuscular characterstics
  • examination determines weeks of gestation
  • score uses gestation age based on weight length head circumfrence to determine if AGA, SGA, LGA
238
Q

phytonadione

A
  • privdese newborn with vitamin K for clotting facors
  • prevents vitamin K deficiency bleeding
  • give 1-2hrs after birth
  • give IM injection (90) to outer middle third of vastus lateralis muscle
  • use 25 gauge 5/8in needle
  • hold leg firmly and inject meds slowly
  • adhere to precautions
  • monitor for bleeding
239
Q

erythromycin

A
  • prevents against bacterial eye infections
  • be alert for s/s of conjunctivits
  • wear glovesand open eyes by placing thumb and finger above and below eye
  • gently squeeze tube or ampoule to apply meds to eye from inner to outer eye
  • don’t touch tip of med to eye
  • close eye to make sure med permeates
  • wipe off excess after 1 min
240
Q

physical exam

A
  • done within first 24hrs
  • should not be initiated if crying
  • begin w/ least invasive first
  • early recognition is key
  • ensures proper evaluation and care
  • each clinician has own approach
  • want to look for normal vs abnormal findigns
241
Q

normal skin findings

A
  • pink, warm, acrocyanosis present
  • milia present on bridge of nose and chin
  • lanugo present on back, shoulder, and forehead
  • peeling or crackin often noted >40wks gestation
  • slate gray patches (mongolian spots)
  • hemangiomas (stork bites), nevus flammeus (port-wine stain), strawberry hemangiomas
  • stork bites often at nape of neck
242
Q

abnormal skin findings

A
  • central cyanosis after 10minutes of life
  • jaundice within 24hrs
  • pallor occuring w/ anemia, hypothermia, shock, or sepsis
  • greenish or yellowish vernix indicating passage of meconium
  • persistant ecchymosis or petechiae occuring with thrombocytopenai, sepsis, or congenital infection
  • abundant lanugo in preterms
  • thin and translucent skin
  • nails >40week
  • pilonidal dimple
243
Q

nevus flammeus

A

portwine stain

244
Q

nevus vasculosus

A

strawberry hemagliomas

245
Q

head

A

should be symmetric and round
- inspect and palpate fontanells (should be soft, flat, and open
- palpate skull (should be smooth and fused except for fontanelles and sutures
- assess size of head
- measure head circumference

246
Q

molding

A

change in head shape as a result of birth

247
Q

caput succedaneum

A

build up of fluid that crosses suture lines

248
Q

cephalematoma

A

bleeding under head causing hematoma of head that crosses suture line

249
Q

face and nose

A
  • observe for fullnes and symmetry
  • should have full cheeks and be symmetric
  • inspect nose for size, symmetry, position, and lesions
  • nose should be midline with patent and equal size nares and intact spetum
  • are preferential nose breathers and sneeze to clear if needed
250
Q

mouth

A
  • inspect
  • lips should be pink, intact, positioned midline with no lesions
  • inside of mouth should show alignment of mandible, intact soft and hard palate, sucking pads inside cheecks, midline uvula, free mvoing tongue, working gag, swallow and sucking reflex
  • mucous memranes should be pink and most with minimal saliva present
  • normal variation: epsetin pearls
251
Q

normal eyes

A
  • position should be midline with ears
  • open, symmetrical, can follow objects
  • edema may be present
  • iris is blue gray or brown
  • sclear is white or bluidh
  • subconjunctival hemorrhage may be rpesent from birth
  • pupil PERRLA
    • red light reflex and blink reflex
  • no tear production
  • transient strabismus and nystagmus related to immature muscular control
252
Q

abnormal eye findings

A
  • absent red light reflex indicating cataracts
  • unequal pupil reactions (neuro trauma)
  • blue sclera (linked with osteogenesis imperfecta)
253
Q

normal ears

A
  • top of pinna aligned with external canthus of eye
  • pinna without derformities
  • neonate responds to noises and startles
  • hearing becomes more acute as eustachian tubes clear
  • neonates respond to high pitched vocal sounds
254
Q

abnormal ear findings

A
  • low set ears (linked with down syndrome)
  • absent startle reflex
  • skin tags, dimpling, other lesions can be associated with kidney abnormalities
255
Q

neck

A
  • inspect for head movement and ability to support head
  • neck creasing is normal
  • should move freely in all directoins
  • can hold head midline
  • inspect clavicle, should be straight and intact
  • abnormal: webbing
256
Q

chet and lungs normal findings

A
  • barrel shaped
  • symmetrical
  • breast engorgment normal
  • clear or milky fluid from nipples ormal
  • lung sounds are clear and equal
  • scattered crackles normal first few hours after birth
257
Q

abnormal chest and lung findings

A
  • pectus excavatum (funnel chest)
  • pectus carinatum (pigeon chest)
  • chest retractions
  • persistent crackles, wheezes, stridor, grunting, paradoixal breathing, decresed breath shounds, apnea (>15-20 seconds)
  • decreased or absent breath sounds (often related to meconium aspiration or pneumothorax)
258
Q

normal abdominal findings

A
  • soft, round, protuberant, symmetrical
  • bowel sounds present, may be hypoactive
  • passage of meconium stool within 48hrs
  • cord is opaque or whitish blue with 2 arteries and one vein covered in wharton’s kelly
  • skin around imbilical cord should be assess for infection and have no redness, swelling, drianage, or foul smell
  • cord becomes dry and darker in color within 24hrs and falls off within 2wks
259
Q

abnormal abdominal findings

A
  • assymetric
  • hernias
  • one umbilical artery and vein (common with heart or kidney malformations)
  • failure to pass meconium stool (common w/ perforated anus or meconium ileus)
260
Q

female GU normal

A
  • anus is patent
  • passage of stool within 24hrs
  • labia majora covers minora and clitoris
  • may be swollen
  • blood tinged vaginal discharge related to abrupt decrease in hormones
  • whitish vaginal discharge observe in response to hormones
  • urine may be dark with red color crystals (normal in first few days) called brick dust
261
Q

abnormal female GU

A
  • imperforated anus
  • anal fissures or fistulas
  • prominent clitoris and small ,visibile minora
  • ambiguous genitalia
  • no urination after 24hrs (can indicate urinary tract obstruction, polycystic disease, or renal failure)
262
Q

male GU normal

A
  • urinary meatus at tip of penis
  • scrotum large, pendulous, and edematous with rugae
  • both testes are palpateed
  • neonates urine within 24hrs
  • brick dust may be present
263
Q

abnormal male GU

A
  • hypospadis (urethra on ventral surface)
  • epispadias (urethral opening on dorsal surface)
  • undescended testes (cryptorchidism)
  • hydrcele (enlarged scrotum
  • no urination after 24hrs (can indicate urinary tract obstruction, polycystic disease, or renal failure)
  • ambiguous genitalia
  • inguinal hernia
264
Q

MSK normal

A
  • arms and legs symmetrical
  • 10 fingers and toes
  • full ROM in all extermities
  • no clicks at joints
  • equal fluteral folds
  • C-shaped spine with no openings or dimpling
265
Q

MSK abnormal

A
  • polydactyl (extra digits)
  • syndactyly (webbed digits)
  • unequal gluteal folds (+ barlow sign and ortolani manuevers signaling congential hip dysplasia)
  • decreased ROM or muscle tone: birth injury, neuro disorder, preamturity
  • swelling, crepitus, or neck tenderness = possible broken clavicle
  • simian creases, short fingers, wide space between big toe and second are common with down syndrome
  • vertebrae openings may indicate spin bifida
  • dimpling of sinuses may indicate pilonidal cyst or more serious neuro disorder
266
Q

neuro normal

A
  • flexed position
  • rapid recoil of extremities
    • reflexes
267
Q

abnormal neuro

A
  • hypotonia: floppy, limp, related to possible nerve injury related to birth, CNS depression related ot maternal meds, fetal hypoxia, prematurity, or spinal cord injury
  • hypertonia: tightly flexed arms and stiffly extended legs with quviering indicate drug withdrawl
  • paralysis indicating birth trauma or spinal injury
  • tremors due to hypoglycemia, drug withdrawl, or cold stress
268
Q

blinking reflex disappears

A

NEVER
stays into adulthood

269
Q

moro reflex reflex disappears

A
  • 3-6months
  • startle reflex
270
Q

grasp reflex disappears

A
  • 3-4 months
  • grasp onto hand or figer
271
Q

stepping reflex

A
  • disappears 1-2 months
  • steps down when placed upward
272
Q

tonic neck

A
  • fencing position
  • disappears 3-4 months
273
Q

sneeze reflex

A
  • persists
274
Q

rooting reflex

A
  • leaves 4-6 months
  • baby turns toward stimulation near mouth
275
Q

gag reflex

A
  • persists
276
Q

cough reflex

A

persists

277
Q

babinski sign

A
  • leaves around 12 months
  • curling of toes when palpated
278
Q

nursing interventions for newborns

A
  • montior VS
  • monitor I&Os
  • perform newborn screenings
  • educate parents on care
279
Q

circumcision care

A
  • assist w/ circ
  • assess after for bleeding
  • for gumco, change vaseline gauze with each void
  • note first void
  • educate parents on care
280
Q

hearing screening

A
  • screened before discharge
  • must be conducted in quiet room
  • those who fail need follow up at 1 month
281
Q

congenital heart disease screening

A

if fail the first one, perform second after 1hr, if failed 2nd perform another after 1hr, if failed again contact cardio

282
Q

hyperbilirubenemia

A
  • extreme levels can be toxic causing kernicterus (acute bilirubin encephalopathy) causing sever and permanent neurological daamge
  • levels interpreted according to infants age in hours
283
Q

hyperbilrubienmia information

A
  • results from overproduction of bilirubin which is end product of hemoglobin breakdown
  • newborn is at risk for higher RBC mass to bodyweight, shorter RBC lifespan, higher bilrubin production, lack of intestinal bacteria, decreased GI motility, and increased beta-flucuroidase, decreased hepatic uptake of plasma, diminished conjugation of bilrubin in liver to decreased glucuronyl transferase activity
284
Q

bilirubin levels showing jaundice

A

> 5mg/dL

285
Q

clinical significance of bilirubin levels is based off

A
  • gestational age
  • hours of llife
  • and TSB levels
286
Q

complications of hyperbilirubenemia

A
  • acute bilrubin ecephalopathy
  • kernicterus
287
Q

physiological jaundice

A
  • appears AFTER 24 hours of life
  • typically due to newborn’s increased RBC and shorter RBC lifespan, slower uptake of bilirubin by liver, lack of intestinal bacteria ad hydration
  • peaks at around 3-5days of life
288
Q

pathological jaundice

A
  • occurs BEFORE 24 hrs of life
  • result of hemolytic disease or liver’s inability to conjuagte and excrete excess bilirubin from hemolysis
  • peak is variable
289
Q

common reason for hemolytic disease of newborn

A

ABO incompatiability
Rh incompatiabiltiy

290
Q

Rh incompatibility

A
  • Rh+ newborn with + Coombs test
  • increase erythropoeisis with many immature RBCs
  • anemia
  • eleavted levels of bilrubin in cord blood
  • reduction in albumin binding capacity
291
Q

ABO incompatiability

A
  • increase in reticulocytes
  • direct coombs negative
  • indirect coombs positive
292
Q

coombs test

A

tests antibodies or complement proteins

293
Q

caring for infant under phototherapy

A
  • position phototherapy lights 12-16 inches away
  • measure irradiance 1x a shifrt
  • protect eyes and gonads
  • change position frequently
  • monitor vitals
  • maintain adequate hydration
  • monitor I&Os
  • weight infant daily
  • discontinue eye patches for feeding and parent visits
  • assess for side effects (loos stools, dehydration, skin rashes, hyperthermia, lethargy, dehydration)
294
Q

hypoglycemia

A
  • blood glucose levels <40-45
  • common during transition, especially in neonates with complications
  • s/s: jitteriness, tremors, irritability, tachypnea, grunting, seizures, apnea, hypotonia, lethargy, hypothermia, cyanosis, poor feeds
  • nurses responsibility to check
295
Q

assessment findings of IDM

A
  • macrosomia
  • fractured clavicle or brachial nerve injury
  • hypoglycemia, calcemia, and magnesemia
  • polycythemia (increase RBC)
  • hyperbilirubinemia
  • low muscle tone, lethargy
  • poor feeds
  • RDS
295
Q

nursing interventions

A
  • early feeds within 1hr of life, recheck after 30minutes
  • may need bolus of D10W and admission to NICU if symptomatic
  • may need continuous IVF
  • feed q2-3hrs and check glucose before each feeds for 12hrs
  • new research recomending dextrose gel for asymptomatic infants with levels 20-40
296
Q

infant of diabetic mother

A
  • macrosomia occurs in 40-50% of diabetic pregnancies due to high levels of glucose crossing the placenta in response, fetal pancreas produces insulin resulting in increased production and growth
  • large body and normal head circumference because insulin does not cross blood brain barrier
296
Q

nursing management of IDM

A
  • assess for s/s of respiratory distress, birth trauma, congenital abnormalities, hypoglycemia, hypocalcemia, polycythemia, hyperbilrubemia
  • provide early and frequent feedings
  • obtain labs
  • maintain NTE to reduce energy levels
296
Q

large for gestational age

A
  • weight >90th percentile
  • macrosomic >4000g
  • leading cause is diabetic mother
296
Q

LGA at risk for

A
  • c-section or operative birth
  • shoulder dystocia
  • birth trauma
  • hypoglycemia
  • polycythemia and hyperbilirubinemia
  • perinatal asphyxia
  • respiratory distress
  • meconium aspiration
296
Q

risk factors for LGA

A
  • maternal diabetes
  • multiparity
  • previous macrosomic baby
  • prolonged pregnancy
  • increased maternal weight gain in pregnancy ad maternal obesity
297
Q

nursing management of LGA

A
  • review risk factors and hx
  • assess respiratroy status
  • assess for birth trauma
  • obtain and monitor glucose
  • provide early and frequent feeds
  • monitor labs
  • assess skin color for signs of polycythemia
  • perfom gestational age assesment
  • observe for jaundice
298
Q

small for gestation age

A
  • weighs <10th perctile
  • can be preterm, term, or post-term
  • commonly seen with mothers who smoke or HTN
299
Q

IUGR vs SGA

A
  • all IUGR babies are small for gestational age
  • NOT all small for gestational age babies are IUGR
  • IUGR occurs in utero and is a result of uterine insult
300
Q

symmetric IUGR

A
  • refers to fetuses with equally poor growth rates of brain, abdomen, long bones, and thought to be from global insult
  • all parameters of growth affected
  • all body parts are symmetric in proprotion
  • head does not appear overly large or length excessive in relation to body
  • below normal size
  • generally vigorous
301
Q

asymmetric IUGR

A
  • refers to infants who brain growth is spared in comparison to abdomen and internal organs
  • results from maternal or placental conditions that occur later in pregnancy and impeded placental bloodflow
  • appears long, thin, emaciated with loss of subq fat tissue and muscle
  • may have loose skin folds and dry skin and thin meconium stained cord
  • vigorous cry and appear alert and wide-eyed
302
Q

SGA at risk for

A
  • labor intoelrance
  • meconium aspiration
  • hypoglycemia
  • hypocalcemia
303
Q

nursing managemet for SGA

A
  • review risks and hx
  • perform gestational age assessment
  • assess for respiratory distress
  • maintain NTE
  • monitor for hypoglycemia
  • early and frequent feeds
  • monitor labs
  • daily weights
  • monitor VS
304
Q

premature infant facts

A
  • 1/10 infants born premature
  • any infant born before 37wks is considered premature
  • premature infant is NOT SGA
  • preamature infants are categorized by gestation age and weight
305
Q

hx and assessment to ID premie

A
  • mother: LMP, OB hx, med hx
  • newborn: ballard or dubowitz
306
Q

nursing management of premie

A
  • maintain NTE
  • provide respiratory support
  • monitor vitals
  • strict I&Os
  • monitor labs and fluids and electrolytes as ordered
  • admin IVF as rodered
  • administer feedings
  • admin meds as ordered
  • encourage kangarro care and support parents
307
Q

respiratory distress syndrome

A
  • results from small underdeveloped alveoli and insufficient levels of pulmonary surfactant
  • causes an alteration in alveoli surface ension that eventually results in atelectasis
  • S/S: tachypnea, grunting, retractions, nasal flaring, lethargic, hypotonic, decreased breath sounds turning into crackles, increasing o2 demand, tachycardia
  • medical management: surfactant, ABGs, repsiratory support, blood cultures, antibiotics
308
Q

surfactant

A
  • natural or syntehtic
  • administered via ET
  • can be administered iva thin catheter or laryngeal mask
  • reduces surface tesnion of alveoli preventing collapse
  • enhances lung complicance to allow easier breathing
  • improves oxygenation
  • adminsitered prophylactically within 15 minutes of birth or rescue therapy within 6hrs of birth
309
Q

nursing management for RDS

A
  • provide respiratory support as ordred
  • monitor VS
  • monitor labs and ABGs
  • maintain neutral thermal environment
  • monitor I&Os
  • cluster care
  • assist with admin of surfactant
  • support parents
310
Q

postterm infant

A
  • inability of placenta to provide adequate o2 and nutrients to fetus after 42 weeks
  • infant shows dry, cracked, wrinkled skin, possibly meconium stained
  • has long thin extremities; long nails, creases cover entire soles of feet
  • wide eyed and alert
  • abundant hair on scalp
  • thin umbilical cord
  • limited vernix and lanugo
311
Q

nursing management of postterm infants

A
  • monitor for complications
  • monitor for blood glucose
  • initate early and frequent feedings
  • monitor vitals
  • maintain NTE
  • monitor labs
  • monitor I&Os
  • support parents
312
Q

transient tachypnea of newborn

A
  • inadequate or delayed clearance of lung fluid leading to pulmonary edema
  • experience a mild degree of respiratory distress requiring minimal intervention
  • liquid removed slowly or incompletetly
  • resolved by 72hrs of age
  • CXR, mild symmetric lung hyperaeration, prominent erpihilar institial marks and streaks
313
Q

s/s of transietn tachypnea of newborn

A
  • maternal sedation or bith by cesaerean
  • tachypnea
  • expiratory grunting
  • retractions
  • labored breathing
  • nasal flaring
  • mild cyanosis
  • tachypnea
  • barrel shaped chest
  • slightly lower breath sounds
314
Q

nuring management of TTn

A
  • supportive
  • provide adequate oxygenation via oxygood or nasal cannula
  • admin IVF
  • admin gavage feedings
  • maintain NTE
  • monitor vitals
  • support parents
315
Q

meconium aspiration syndrome

A
  • occurs when newborn inhales particulate meconium mixed with amniotic fluid into lungs while inutero or taking first breath after birth
  • can result in obstruction of upper airways, if progresses to lower airways, air trapping and hyperinfalation of alveoli distant to obstruction increases risk of air leaks into surroundin tissue
  • can also cause chemical pneumonitis and inhibit surfactant action
316
Q

s/s MAS

A
  • meconium stained amniotic fluid
  • greenish or yellowish discoloration of skin, nailbeds, and umbilical cord
  • respiratory distress at birth (requiring resuscitation) or within a few hours
  • low APGAR
  • barrel-shaped and overdistended chest
  • extended expiratory phase of breathing
  • diminished airmovement, presence of rales and rhonchi
  • CXR: atelectasis and hyperinflated lungs
  • ABGs: low PaO2 despite 100% O2 and possible respiratory and metabolic acidosis
317
Q

nursing management of MAS

A
  • maintain NTE
  • cluster care
  • administer o2 as ordered
  • monitor vitals
  • monitor labs and ABGs
  • admin vasopressors and antibiotics as ordered
  • provide support to parents
318
Q

infection

A
  • clinical syndrome of bactermia within first month of life
  • neonatal sepsis: bacterial, fungal, or viral microorganisms of toxins in blood and other tisses
  • congenital, early onset, or late onset
319
Q

nursing assessment for infant infection

A
  • early symptoms vague
  • poor feeding
  • breathing difficulty
  • apnea
  • bradycardia
  • GI problems
  • increased o2 requirement
  • lethargy
  • hypotension
  • temp instability
  • unusual skin rash or color changes
  • persistent crying/irritability
  • labs: elevated CRP, abnormal CBC, CXR, blood cx, urine cx, CSF
  • initial treatment: ampicillin, gentamycin
320
Q

nursing management of infant infection

A
  • asses maternal and neonatal risk factors
  • monitor vitals, I&Os, labs,
  • daily weights
  • monitor for s/s of infection
  • assess with diagnostics
  • admin antibiotics, IVF, and feedings
  • support parents
321
Q

hx of newborns exposed to illicit substances

A
  • maternal hx of known drug abuse
  • no prenatal care
  • obtain meconium and urine
  • physical assessment
322
Q

abusing mothers

A
  • most common: tobacco, alcohol, marijuana
  • fetal alcohol syndrome: physical, mental disroder apperaing at birth and remaining problematic
  • fetal alcohol sepctrum disorders
  • alcohol related birth defects
  • neonatal abstinence syndrome: drug dependency acquired in utero manifested by nero and physical behaviors
323
Q

fetal alcohol spectrum signs

A
  • small eyes
  • thin upper lip
  • short palpebral fissues
  • flat midface
  • short noise
  • low nasal bridge
  • ear abnormalities
  • micrognathia
324
Q

nursing management of FAS

A
  • quiet, dim environment
  • consistent caregivers
  • provide adequate nutrition
  • support parents and provide positive reinforcement
325
Q

s/s of infant substance disorders

A
  • tremors and irritability
  • generalized seizures
  • hyperactive reflexes
  • restlessness
  • exagerrated moro reflex
  • hypertonic muscle tone
  • shrill high pitched excessive cry
  • disturbed sleep patterns
  • fever
  • yawning
  • mottling of skin
  • sweating
  • frequent sneezing
  • nasal flaring
  • tachypnea >60breathpm
  • apnea
  • poor feedings
  • franctic sucking or rooting
  • loose or watery stools
  • regurgitation or projectile vomiting
326
Q

nursing management of NAS/NOWS

A
  • provide quiet, dimly lit area
  • perform neonatal abstinence scoring
  • provide small ,frequent feedings
  • admin meds as ordered
  • swadlle with hands near mouth and provide pacifier
  • gently, rocking infant if crying
  • protect from excoriation using clothing with built in mittens
  • apply protective barrier to groin area every diaper change
327
Q
A

maternity (2 decks)

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