EXAM 3 Flashcards
A low birth weight is considered anything less than…
2500g OR 5lbs, 8oz
Very low birth weight (VLBW) infant—Infant whose birth weight is less than 1500 g (3 lbs 5 oz)
Extremely low birth weight (ELBW) infant—Infant whose birth weight is less than 1000 g (2 lb 3 oz)
What weight percentile is the Appropriate-for-gestational-age (AGA) infant?
weight falls between the 10th and 90th percentiles on intrauterine growth curves
What weight percentile is the Small-for-date (SFD) or small-for-gestational age (SGA)?
An infant whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on intrauterine growth curves
What is the difference between symmetric and asymmetric IUGR
Symmetric vs asymmetric: babies will shunt nutrients to the brain & head to grow first, trunk next, limbs last-both in utero and after delivery
So if have a baby that is asymmetric in growth, then it is a nutrition thing
If they are small symmetrically, look for congenital viral infections or other reasons that are more than just nutrition in utero (both head and body are below the 5th
What weight percentile is the Large-for-gestational-age (LGA) infant?
Infant whose birth weight falls above the 90th percentile on intrauterine growth charts
What weight and gestational age will get a baby automatic NICU admission for observation
34 wk < 1800 almost always
some < 36 wk, < 2000 gm
Preterm (premature) infant
—Infant born before 37 0/7 weeks of gestation
Late-preterm infant
—Infant born between 34 0/7 and 36 6/7 weeks of gestation
Early-term infant
—Infant born between 37 0/7 weeks and 38 6/7 weeks of gestation
Full-term infant
—Infant born between 39 0/7 weeks and 40 6/7 weeks of gestation
Late-term infant:
Infant born between 41 0/7 weeks and 41 6/7 weeks of gestation
Postterm (postmature) infant
—Infant born after 42 0/7 weeks of gestation
What are CHARACTERISTICS OF POSTTERM INFANTS
Dry, loose, peeling skin
Overgrown nails
Large amount of hair on the head
Visible creases on palms and soles of feet
Small amount of fat on the body
Green, brown, or yellow coloring of skin from baby passing meconium before birth
More alert and “wide-eyed”
May be LGA or SGA
Why is asphyxia so common for post-term infants
Asphyxia-placenta doesn’t function as well post term-can’t handle stress of delivery
What steroid do you give to mom to mature a pre-term labor baby’s lungs?
Betamethasone
2 doses 24 hours apart and 24 hours before delivery
At what gestation do fetuses make their own surfactant?
32-36 weeks
At what gestation do fetuses develop alveoli
23-24 weeks
describe apnea of prematurity
This is where they have an immature response to high levels of carbon dioxide and low levels of oxygen, resulting in apneic episodes
apnea episodes should not exceed 20 seconds or becomes an issue.
to fix: Tactile stimulation-holding, suction, along with O2 therapy and ppv
Cns stimulants: caffeine, theophylline and others
What are the 3 things that must matured before discharge from the NICU
Renal and gut function, and the ability to eat by mouth
Kidney don’t reabsorb Na and bicarb as well, renal function immature. Early feeding is good as it promotes gut development-enteral feeding
What pathogen causes the most common infection in neonates
group B strep
How can you tell if a neonate is suffering from an infection
because immune system is underdeveloped, may not be normal response to infection.
Resp status is often an early indicator of problems.
May have a decreased temp instead of a fever as a response to infection
Could have tachy or bradycardia. So want to look for any out-of-range s/s
Use a blood culture to officially Dx
Quick to give prophylactic antibiotics. Ampicillin or gentamycin. Be wary that antibiotics can cause hearing and kidney toxicity.
Describe NECROTIZING ENTEROCOLITIS in a neonate
inflammatory disease of bowel unique to infants, most common in premature
risk factors include, decreased blood flow to gut, pathogenic bacteria, substrate when baby is hypoxic, blood is shunted to brain & other vital organs and can cause ischemia of intestines & damage to mucosal cells of intestine.
cells are more susceptible to anaerobic bacteria and this problem is usually only seen after feeding has begun
Subtle Sx, increased abd girth and poor feeding, decrease in bowel sounds, Hematachezia (bright red blood from anus)
Stop feeds to take away medium for bacterial growth-put on TPN and abx.
Sometimes surgery is needed and often have some of bowel removed-can be fatal
Why would a baby have a INTRAVENTRICULAR HEMORRAHGE
Less than 30 weeks gestation and in-utero vasculature isn’t ready to change for outside living.
Assess for:
Full fontanels
Anemia
Acidosis
Apnea
Hypotonia
Prevent by:
Neutral Head for 1st 72 hrs
Gentle Ventilation
Slow IV’s, maintain BP
Describe RETINOPATHY OF PREMATURITY
Maturity of eye vessels is not really complete until about 3 weeks after term, so preterm is even more compromised. These vessels are meant to develop in a low oxygen environment. Increased O2 environment causes vessels to overgrow and these vessels are heavy and put tension on the retina, this can damage the retina and even cause detachment
Prevention-maintain and monitor O2 and keep infant from big changes-swings between hyper and hypoxia helps prevent this so make sure O2 sats are accurate-may need to change frequently and make sure to prevent skin breakdown from probes
How do you treat RETINOPATHY OF PREMATURITY
Avastin is a drug that is injected into the eye to help treat from eye diseases. The drug blocks the growth of abnormal blood vessels in the back of the eye.
Laser treatment of tortuous vessels
Laser reattachment of retina if gets that far
What are the 4 criteria that must be met before discharge from NICU
Thermoregulation
Control of breathing
Respiratory stability
Feeding skills and weight gain
What are the 4 types of hyperbilirubemia
Physiologic: liver can’t keep up
Breastfeeding: those exclusively breastfeeding that are not getting enough volume-dehydration
Breast milk: -not sure of the cause-happens 10-15 days after birth-stopping breastfeeding for 24 hours and restarting usually solves the issue-etiology unknown
Hemolytic: ABO; rH blood incompatibilities
How do you treat Rh incompatibility
Rogam
What is the difference between ABO incompatibility and Rh incompatibility
ABO incompatibility disease affects newborns whose mothers are blood type O, and who have a baby with type A, B, or AB. Baby;s blood from placenta mixed with mom DURING GESTATION and mom forms MORE MILD ATTACK on fetus. Usually successfully treated with phototherapy and sometimes, IVIG, immunoglobulin. Very rarely do we need transfusions.
Rh incompatibility: blood mixes & mom develops antibodies if baby is Rh +
Then SUBSEQUENT PREGNANCIES, mom’s body will attack fetal RBC’s and cause hemolysis & miscarriage is common.
T/F: Red meat can sensitize a O mom to AB blood, causing the mom to attack the AB fetus
True
Explain how phototherapy works
Sends unconjugated bili out of the body and bypasses gut-sends bili directly from liver to kidneys for excretion
What’s different about transfusing blood in a neonate than an adult (in a Rh incompatibility scenario)
You need to take out the volume of blood you’re going to put in if you’re replacing blood affected by Rh incompatibility.
What are the five most common pathogens that cross the placenta and infect fetuses
T–oxoplasmosis
O—Other (e.g., syphilis, HBV, parvovirus, HIV, West Nile virus, Zika virus)
R—Rubella
C—CMV infection
H—Herpes simplex
What maternal infection causes severe hemolysis in fetuses
parvovirus B19
What do you do if you feel like a neonate isn’t acting “right”
sepsis workup
What are early Sx of neonatal sepsis
Tired, difficulty breathing, high/low temps,
What are late Sx of neonatal sepsis
cyanosis, abdominal distention, seizures, hypotonia (very little tone)
What do you need to be worried about for Neonatal Opioids Withdrawal Syndrome (NOWS)
Watch for dehydration b/c don’t feed well & diarrhea.
How do you treat NOWS
Start with non-pharm like limit stimulation, swaddle, etc
Morphine solution to start, then methadone but that is harder to wean off b/c longer half-life
How can you tell the difference between Caput & cephalon and subgalea
Caput & cephalon will stay put when palpated but subgalea
shifting of ear position, fluctuant scalp mass, irritability
Symptoms of EXTRACRANIAL BLEEDING
symptoms generally are neurological and occur shortly after birth (6-12 hours) apnea is often the first, also seizure activity
How does IPV impact the neonate
Low birth weight
Pre-term birth
Decreased blood flow to uterus
What are the three things a nurse considers when dealing with an IPV patient
COMPREHENSIVE ASSESSMENT: ASSESS ALL WOMEN FOR SIGNS OF VARIOUS PHASES OF POSTTRAUMATIC EXPERIENCES, AS IPV VICTIMS MAY PRESENT WITH ACUTE INJURIES, BUT OTHER PHASES OF TRAUMA CAN COEXIST.
EMERGENCY DEPARTMENT (ED) PROTOCOLS: IMPLEMENT ED PROTOCOLS SPECIFICALLY DESIGNED FOR VICTIMS OF PHYSICAL ASSAULT TO ENSURE APPROPRIATE MEDICAL CARE AND EVIDENCE COLLECTION.
CRITICAL INITIAL RESPONSE: RECOGNIZE THAT THE INITIAL RESPONSE FROM HEALTHCARE SETTINGS AND OTHER PROFESSIONALS IS CRUCIAL TO THE HEALING PROCESS AND THE VICTIM’S OVERALL WELL-BEING.
At what age do women need to start getting annual mammograms
45 to 54
Most common benign breast change
Fibrocystic changes: More common in 20-30’s
Most significant contributing factor: Normal hormonal variation during monthly cycle
Estrogen/progesterone cause cells to proliferate
Clinical manifestations
Breast lumpiness, with or without tenderness
Symptoms usually develop week before menstruation begins and subside about week after
Treatment
Diet, vit E & B6 supplements, NSAIDS, reduce smoking & alcohol
Name of a common benign solid mass of the breast in younger women
Fibroadenoma
Exact cause is unknown
Influenced by estrogen
Clinical Manifestation
Discrete , solitary lumps <3 cm in diameter, firm, round, smooth
Woman may experience tenderness during menstrual cycle
Treatment
Cryoablation
Surgical excision
How do you officially label someone “menopausal”
Complete cessation of menses for one year
Average age 51.5 (45-55)
What are the clinical manifestations of estrogen deficiency
Dyspareunia
Increased vaginal ph
Urinary frequency
Increase in LDL cholesterol
Increase CVD risk
Osteoporosis
Redistribution of fat
Insomnia-common in menopause
Fatigue
Depression, anxiety, emotional labile, nervous
Difficulty concentrating
Hot flashes
Night sweats
How do you treat estrogen deficiency
Low dose vaginal estrogen
Antidepressants - primary pharmacologic treatment for menopause-associated depression
Other drugs for vasomotor symptoms
Clonidine (Catapres) – antihypertensive drug
Gabapentin (Neurontin) – an antiseizure drug
What does taking estrogen do to a woman’s body
Restores bacterial flora and pH
Improves thickness and elasticity of tissue
Risks and Side effects
Increased risk for breast and endometrial cancer, blood clots
Associated with estrogen use: Headaches, nausea, vomiting, bloating
Treatment guidelines
What is the most effective Non-Pharmacologic method of managing adequate estrogen levels
Exercise and healthy eating
(Adequate intake of calcium and vitamin D)
When do women reach peak bone mass
25-50 years old
What drugs can women take to improve osteoporosis
Calcium supplements
Bisphosphonates
Inhibits resorption of bone
Estrogen-receptor modulators
Binds with estrogen receptors, producing estrogen-like effects on bone, and reduces resorption of bone
Denosumab (Prolia, Xgeva)
Targeted treatment Human monoclonal antibody
Works by preventing the development of osteoclasts which are cells that break down bone (bone reabsorption)
Name the 3 major BACTERIAL STIs
Chlamydia
Gonorrhea
Syphilis
How do you treat chlamydia
Doxycycline 100 mg po twice daily for 7 days
DOXYCYCLINE IS CONTRAINDICATED IN PREGNANCY. TREATMENT DURING PREGNANCY IS AZITHROMYCIN 1 G PO IN A SINGLE DOSE
What is the difference in Sx between chlamydia/gonorrhea
Gonorrhea: cervix with Copious amount of discharge
Chlamydia: bleeding between periods
T/F: Prior infection of chlamydia/gonorrhea provides immunity from future infections
FALSE
How do you treat Gonorrhea
Ceftriaxone 500 mg im in a single dose
Difference in Sx between SYPHILIS and HSV
Ulcer can look like HSV but is painless where HSV lesions are painful
Can SYPHILIS infect your baby if pregnant? If so, how?
Yes, can become infected through the placenta and cause SKIN RASHES, BONE DAMAGE, SEVERE ANEMIA, ENLARGED LIVER AND SPLEEN, JAUNDICE, NEURO ISSUES: BLINDNESS, DEAFNESS, MENINGITIS
Hoe do you treat SYPHILIS
BENZATHINE PENICILLIN G (2.4 MILLION UNITS ADMINISTERED INTRAMUSCULARLY) WILL CURE A PERSON WHO HAS PRIMARY, SECONDARY OR EARLY LATENT SYPHILIS.
PENICILLIN G IS THE ONLY KNOWN EFFECTIVE ANTIMICROBIAL FOR PREVENTING MATERNAL TRANSMISSION TO THE FETUS AND TREATING FETAL INFECTION
T/F: you can cure HERPES SIMPLEX VIRUS (HSV)
False: Life-long, incurable infection
What STI causes liver issues in neonates
Hep B
How do you treat a mom with HIV
Zidovudine (ZVD) is the most common medication used to reduce viral load
HAART does not show any negative effects on pregnancy and must be started as soon as possible to reduce the risk of transmission to less than 2%
What are the TORCH infections
Toxoplasma Gondi
Other agents
Rubella
Cytomegalovirus
Herpes simplex
How does a mom get Toxoplasmosis
From raw or undercooked meat, or through exposure to cat feces
Body aches, headache, fatigue, sore throat
Infants may develop chorioretinitis, the inflammation of the choroid and retina of the eye that can lead to blindness; obstructive hydrocephalus; mental retardation; seizures, motor delays; developmental delays
What is bacterial vaginosis
Not an STI: condition where normal vaginal flora are replaced by high concentrations of anerobic bacteria
S/S: thin white/gray vaginal discharge with a “fishy” odor, pruritis (itching)
Treatment
Metronidazole (pills or vaginal gel)
If need flagyl, wait till 2nd trimester to give that
What is Salpingitis:
inflammation of the fallopian tubes
What is Oophritis:
inflammation of ovaries
What is Parametritis:
Inflammation of the parametrium, the connective tissue of the pelvic floor, extending from the subserous coat of the uterus laterally between the layers of the broad ligament
What is Peritonitis:
inflammation of the lining of the abdome
What is involution
The return of the uterus to a nonpregnant state after birth is called involution. This process begins immediately after expulsion of the placenta with contraction of the uterine smooth muscle.
Describe the timeline for the fundus returning to it’s normal size postpartum
The fundus descends 1 to 2 cm every 24 hours. The uterus should not be palpable abdominally after 2 weeks and should have returned to its nonpregnant location by 6 weeks after birth
What is Subinvolution
the failure of the uterus to return to a nonpregnant state due to ineffective uterine contractions. The most common causes of subinvolution are retained placental fragments and infection
When do you give pitocin postpartum
Because it is vital that the uterus remain firm and well contracted, exogenous oxytocin (Pitocin) is usually administered intravenously or intramuscularly immediately after expulsion of the placenta
When do women resume ovulating after having a baby
About 70% of nonlactating women resume menstruating by 12 weeks after birth. The mean time to ovulation in women who breastfeed is about 6 months (Isley, 2021).
The persistence of elevated serum prolactin levels in lactating women appears to be responsible for suppressing ovulation
How do you reverse the diabetogenic effects of pregnancy
Natural decreases in human placental lactogen, estrogens, cortisol, and the placental enzyme insulinase reverse the diabetogenic effects of pregnancy, resulting in significantly lower blood glucose levels in the immediate postpartum period.
Mothers with diabetes will likely require much less insulin for several days after birth, especially if they are breastfeeding.
What is dyspareunia
Localized dryness and coital discomfort (dyspareunia) can persist until ovarian function returns and menstruation resumes.
Describe the nursing interventions for postpartum hemorrhage
massage of the uterine fundus. Express any clots in the uterus.
elimination of bladder distention
continuous IV infusion of 10 to 40 units of oxytocin added to 1000 mL of lactated Ringers or normal saline solution also are primary interventions.
T/F: Blood pressure is the best indication of hypovolemic shock
False: Respirations, pulse, skin condition, urinary output, and level of consciousness are more sensitive indicators of hypovolemic shock
When would you suspect sepsis related to labor in a postpartum woman
A diagnosis of puerperal sepsis is suggested if an increase in maternal temperature to 38 ° C (100.4 ° F) or higher is noted after the first 24 h after birth and recurs or persists for 2 days.
What is the most accurate way to objectively determine blood loss.
weighing clots and items saturated with blood (1 mL equals 1 g)
The nurse always checks for blood under the mother’s buttocks, as well as on the perineal pad
What is the normal respirations range for a postpartum woman
Lower than 16 breath per minute, higher than 20 breaths per minute
Describe the correlation of breast changes and the establishment of milk postpartum
Should be soft for the first two days PP.
2-3 days = filling with milk
day 3-5 = hard breasts when full, will soften with feeding. R/o engorgement (firmness, heat, and pain)
Where should you feel the fundus immediately postpartum
SHOULD BE FIRM/MIDLINE AT UMBILICUS 1ST 24HRS AND DECREASE BY 1 FINGER WIDTH A DAY
If the uterus is soft “boggy”, higher than expected = uterine atony (muscles too weak to clamp down on uterus), lateral deviation of uterus (uterus felt on either side of pt d/t full bladder)
Describe the normal progression of lochia changes postpartum
Days 1– 3: rubra (dark red)
Days 4– 10: serosa (brownish-red or pink)
After 10 days: alba (yellowish white)
Amount overall: scant to moderate Few clots Fleshy odor
ABNORMAL: Large amount of lochia, large clots: uterine atony, vaginal or cervical laceration Foul odor: infection
How much output of fluid is expected the first 24hours postpartum
Diuresis (peeing out excess fluid of pregnancy) starts 12hrs after birth (can void 3k ml of fluid/day)
A new mom hasn’t pooped since before her labor. It’s been two days. What do you say to her?
Bowel movements usually don’t come until 2-3 days after birth. ABNORMAL if BM doesn’t come after 3 days OR is constipated/loose stool
Also: educate the woman about measures to prevent constipation, such as ambulation and increasing the intake of fluids and fiber. Alert the woman to the side effects of medications. Encourage her to implement measures to reduce the risk for constipation. Stool softeners or laxatives may be necessary during the early postpartum period.
The mother can avoid foods (e.g., legumes, beans, broccoli) that tend to produce gas.
When can new moms start having sex again
Unless your health care provider indicates otherwise, you can safely resume sexual activity (intercourse) by the second to fourth week after birth, when bleeding has stopped.
F/U w/ maternal doc w/ in 2 weeks of discharge
T/F: Acrocyanosis, the bluish discoloration of hands and feet, is a normal finding in the first 24 hours after birth.
True: Its central cyanosis that is abnormal and signifies hypoxemia.
What are 6 things that need to happen in order for a baby to take it’s first breath
Decreased levels of oxygen and increased levels of carbon dioxide as a result of contractions during labor seem to have a cumulative effect that is involved in initiating neonatal breathing by stimulating the respiratory center in the medulla.
As a result of clamping the cord, there is a drop in levels of a prostaglandin that can inhibit respirations.
As the infant passes through the birth canal, the chest is compressed. With birth this pressure on the chest is released, and the negative intrathoracic pressure helps to draw air into the lungs
Crying increases the distribution of air in the lungs and promotes expansion of the alveoli. The positive pressure created by crying helps to keep the alveoli open.
The profound change in environmental temperature stimulates receptors in the skin, resulting in stimulation of the respiratory center in the medulla.
Shortly before the onset of labor, there is a catecholamine surge that seems to promote fluid clearance from the lungs, which continues during labor. The movement of lung fluid from the air spaces occurs through active transport into the interstitium, with drainage occurring through the pulmonary circulation and lymphatic system.
What is a normal heart rate range for a newborn
The heart rate for a term newborn ranges from 120 to 160 beats/ min, with brief fluctuations greater and less than these values usually noted during sleeping and waking states.
Irregular heart rate or sinus dysrhythmia is common in the first few hours of life but thereafter may need to be evaluated.
Describe the changes in “normal” blood pressure in a neonate after birth
At birth: 75– 95/ 37– 55 mm Hg
At 12 hours: 50– 70/ 25– 45 mm Hg
At 96 hours: 60– 90/ 20– 60 mm Hg
What causes the functional closure of the foramen ovale
The infant’s first breaths, combined with increased alveolar capillary distention, inflate the lungs and reduce pulmonary vascular resistance to pulmonary blood flow from the pulmonary arteries. Pulmonary artery pressure drops, and pressure in the right atrium declines. Increased pulmonary blood flow from the left side of the heart increases pressure in the left atrium, which causes a functional closure of the foramen ovale
Why does a neonate have excess RBCs at birth
Because fetal circulation is less efficient at oxygen exchange than the lungs, the fetus needs additional RBCs for transport of oxygen in utero.
How do protect a neonate from convection Convection
Convection is the flow of heat from the body surface to cooler ambient air.
Newborns in open bassinets are wrapped to protect them from the cold. A cap may be worn to decrease heat loss from the infant’s head.
How do protect a neonate from Radiation
Radiation is the loss of heat from the body surface to a cooler solid surface not in direct contact but in relative proximity.
Baby is placed away from outside windows, and care is taken to avoid direct air drafts.
How do protect a neonate from Evaporation
Evaporation is the loss of heat that occurs when a liquid is converted to a vapor.
This heat loss is intensified by failing to completely dry the newborn after birth or with bathing.
How do protect a neonate from Conduction
Conduction is the loss of heat from the body surface to cooler surfaces in direct contact.
During the initial assessment, the newborn is placed on a prewarmed bed under a radiant warmer to minimize heat loss. The scales used for weighing the newborn should have a protective cover to minimize conductive heat loss.
If babies can’t shiver, how do they stay warm?
BABIES USE NONSHIVERING THERMOGENESIS BY USING BROWN FAT TO PRODUCE HEAT, THEY ENTER POSITION OF FLEXION, AND MAY CRY/BE RESTLESS
How much should a neonate urinate
During the first few days, term infants generally excrete 15 to 60 mL/ kg/ day of urine; The frequency of voiding varies from 2 to 6 times per day
output gradually increases over the first month
An infant who has not voided by 24 hours should be assessed for adequacy of fluid intake, bladder distention, restlessness, and signs of discomfort.
What is one of the only enzymes not present in a neonate that is present in colustrum
pancreatic amylase
when is the mucosal barrier in the intestines fully mature
4 to 6 months
what synthesizea vitamin K, folate, and biotin
Intestinal flora, or gut microbiota, are established within the first week after birth
Describe the capacity of the newborn stomach
less than 10 mL on day 1
30 mL on day 3
60 mL on day 7
What is REEDA
redness (erythema), edema, ecchymosis (bruising), drainage, and approximation
Adjustment phase Taking in:
First 24 hours focus on self care and Basic needs
Adjustment phase Taking hold:
2nd to 3rd day, focus on care of the baby
Adjustment phase Letting go:
several weeks after birth, moving forward as a family
Difference between early and late PPH
Early: less than 24 hours after birth
Late: more than 24 hours/less than 6 weeks
4 T’s of pph
tone. trauma, tissue, thrombin
Leading cause of PPH
Uterine atony
what is Puerperal sepsis:
any infection within 42 days after abortion or birth
Most common-numerous streptococcal and anaerobic organisms
Predisposing factors: prolonged rupture, C/S, invasive interventions, retained placenta, pre-existing infection
Assessment findings: temp, abnormal lochia, poor involution, tachy, pain
Labs: WBC increase greater than 30% in 6 hours indicates pathology (increased neutrophils & immature bands)
When do you use Cystocele and rectocele
Uterine displacement and prolapse
What is N-PASS
N-PASS: Neonatal Pain, Agitation and Sedation Scale
What is a Ballard score
It assesses six external physical and six neuromuscular signs. Each sign has a numeric score, and the cumulative score correlates with a maturity rating (gestational age).
Postpartum Depression with psychotic features
syndrome characterized by depression, delusions, and thoughts of harming either the infant or herself
Psychiatric emergency; may require hospitalization
Describe the brachial plexus injury during birth
head is pulled too hard while shoulder is stuck and C8-T1 in spine and shoulder is dislocated
What is the difference between cephalohematoma and caput succedaneum?
Cephalohematoma is a buildup of blood (hemorrhage) underneath a newborn’s scalp. It appears soon after birth. The bulge is discrete, does not cross the suture lines of the bones on their head, and is located at the back of the head. It may take months to go away.
Caput succedaneum causes swelling (edema) on the top of the scalp that is usually noticeable at birth. This swelling causes the scalp to feel spongy, does cross suture lines, and starts to go down soon after birth.
How does a newborn get RDs (respiratory distress syndrome)
diabetes slows lung maturity b/c surfactant production is delayed, 4-6 times more likely to develop RDS. Increased glucose also interferes with surfactant production
How do you test a newborn for hip dysplasia
a positive Ortolani test, and a positive Barlow test.
how are the 6 sleep/wake states divided
2 sleep states, 4 awake states
What are warning signs that a newborn is in respiratory distress?
RR of < 30 or > 60 breaths per minute. Tachypnea can be first sign of distress
What are the three shunts that close in the intrapartum/postpartum period?
Foramen ovale
Ductus arteriosus
Ductus venosus
First period of reactivity: up to 30 minutes after birth
HR increases to 160-180 bpm, gradually falls to 100-120 bpm after 30 min
Irregular respirations; 60-80 breaths per minute
Fine crackles on auscultation
Audible grunting, nasal flaring, and retractions of the chest (cease w/in first hour of birth)
Alert; spontaneous startles, tremors, crying, and head movement side to side
Bowel sounds audible; meconium may be passed
Period of decreased responsiveness: 60-100 minutes
Infant is pink
Rapid respirations; up to 60 breaths per minute, shallow but unlabored
Bowel sounds audible, peristaltic waves noted over rounded abdomen
Second period of reactivity: 2-8 hrs after birth and lasts 10 mins to several hours
Brief periods of tachycardia and tachypnea
Ass. w/ increased muscle tone, change in skin color, and mucus production
Meconium commonly passed
Describe the anatomy of the umbilical cord
contains two arteries (the umbilical arteries) and one vein (the umbilical vein ), buried within Wharton’s jelly.
when do you asses Apgar
1 and 5 minutes after birth. 1 minute tells you how newborn tolerated birth, 5 min tells you how newborn is tolerated being outside the womb
what are the 2 results possible from Congenital heart disease screening
Pre-ductal – Part of the aorta proximal to the aortic opening of the ductus arteriosus. Right Hand (RH)
Post-Ductal – Part of the aorta distal to the aortic opening of the ductus arteriosus. Left/right foot (FT)
When would you do car seat testing for a neonate
less than 37 weeks gestation, at risk for airway issues with positioning, or weigh less than 2500 grams at birth. The infant is placed in the seat for 90-120 minutes or however far away they live on cardiac and pulse Ox monitor
How do you fail the car seat test
Apnea that lasts 20 seconds or more
Heart rate of < 80 beats/minute for > 10 seconds
Oxygen saturation level of < 90% for > 10 seconds
What is kernicterus
Aka bilirubin encephalopathy: bilirubin-induced neurological damage
How often should a baby eat?
15-30 ml q feed max
Need 6-8 feeds in 24 hours for newborn
What are general breastmilk storage guidelines?
Fresh donor: room temperature 2hrs, fridge 24hrs, freezer 6mo
Fresh from mom: room temperature 4hrs, fridge 96hrs, freezer 6mo
What are pessaries used for?
A pessary is a prosthetic device inserted into the vagina to support its internal structure. It’s often used in cases of urinary incontinence or vaginal prolapse.
