Exam 3 Flashcards
what can be tested for with an umbilical cord sample
see what drugs and nutrients the mother took in that passed to the baby
what can be checked for with a newborn to see if mom was involved in substance abuse
umbilical cord
babys urine
meconium (baby waste)
how much folic acid is recommended daily prior to conception
0.4 mg (400 micrograms)
what does folic acid play a role in
neural tube defects
what are other sources of folic acid that can be recommended
green leafy veggies
liver
chicken
turkey
what can inadequate weight gain during pregnancy cause
preterm labor
intrauterine growth restriction (IGR)
how much is recommended for the average women to gain
25-35 pounds
what does the weight gain in birth account for
uterus weight
baby weight
amniotic fluid weight
how many calories is recommended to increase during pregnancy from baseline for that woman
300 calories
how much calcium is recommended daily for pregnant women
1,300 mg
which fat soluble vitamins are you supposed to take when pregnant
A, D, K, E
which fat soluble vitamin should you not take too much of and why
Vitamin A
can cause congenital anomalies
what does B12 assist with in pregnancy
helps to form red blood cells
eggs, dairy
how much folic acid is recommended for pregnant women
0.6 mg
600 micrograms
what can Pica be a sign of
anemia
what is nausea and vomiting called in pregnancy
hyperemesis gravidarum
what type of foods can help offset nausea
sweet or salty foods
what medications can be prescirbed for pregnancy N/V
Zofran (cheap, causes headaches and constipation)
Diclegis (very expensive, hard to get)
what can iron supplements cause
constipation
what can iron be taken with to increase absorption
vitamin C (glass of orange juice)
what is Pirosis
heartburn
what should you recommend to pregnant women with heartburn
sit up for 30 min after eating
small frequent meals
what are the two main concerns for adolescent pregnancies
well balanced diet
adequate weight gain
how much protein and water should the pregnant woman ingest per day
70g
3L
are more or less calories needed in lactation vs. pregnancy
more calories in lactation
how many more calories per day should a women ingest during lactation
500 more
how many centimeters should the uterus descend each day post partum
1-2 cm
what is post partum considered
the interval from childbirth to return of the uterus to non-pregnant state (not pre pregnant-never be same)
what is Involution
the shrinking of the uterus
what factors promote involution
early/frequent ambulation uterine contractions (2-3 days post partum) breast feeding (release Oxytocin--cause uterine contractions)
by what time should the uterus be no longer palpable
2 weeks postpartum
what is Subinvolution (Uterine Atony)
failure of the uterus to return to non-pregnant state
what can occur if their is no uterine contraction and why
excessive blood loss and hemorrhage
due to exposed vessels not being constricted
what are the factors that slow involution/cause subinvolution
no uterine contractions
full bladder (uterus deviated to left, no space)
multiparius women (increased risk of hemmorhage/uterus is stretched)
prolonged labor (>18 hours)
anastesia/epidural
infection
retained placenta fragments
what is Colostrum made up of
nutrients
antibodies
protein
decreased fat
how long does mom have to feed baby colostrum
72-96 hours post partum
how long can engourgement last
24-48 hours
what does a fundal rub do
makes the uterus contract and prevents hemmorhage
what should you do before a fundal rub
have mom empty bladder
what is the Estimated Blood Loss (EBL) for a vaginal and C-section birth
500mL vaginal
1,000mL C-section
when does the vagina return to non pregnant size
6-10 weeks post partum
what causes delay in secretion of cervical mucosa due to hormones
lactation
what is lochia and what is it the result of
vaginal discharge
result of involution
how long should lochia rubra be seen and what color is it
bright red
seen first, 3-4 days after
what color is lochia serosa and how long can it be seen
pink/brown
22-27 days
what color is lochia alba and how long can it be seen
white
up to 6 weeks
what should you always assess when it comes to lochia
color
odor
amount
when is lochia considered heavy
saturated peri pad within 1 hour
what is an episiotomy and when should it heal
a purposeful cut of the perineum to allow baby to come through (2-3 weeks for it to heal)
what degree can a perineal laceration go up to
4th degree
what is considered a 4th degree laceration of the perineum
perineum to the anus is ripped
what are concerns with perineal lacerations
infection
comfort
what can be done for perineal lacerations from the nurse
ice to perineum high fiber diet stool softeners encourage urination ease the fear of voiding sitz bath
what are some indications that a c-section is needed
large baby distressed baby (HR drops)
what does post partum care consist of for a woman with a c-section
bed rest for 12 hours blood clot/DVT watch incision site infection STILL HAVE TO DO FUNDAL RUBS
what will happen in the respiratory system post partum and when will this occur by
diaphragm will move down
6 weeks post partum
when will cardiac volume/output go back to normal after birth
2-6 weeks post partum
when will BP go back to baseline
~1 week
how long do clotting factors stay elevated and what is the mom at risk for because of it
6 weeks
blood clots
what can occur to womens hair post partum
become more coarse and fall out due to hormones
is it normal to see elevated WBC count after birth
yes
if mom tests Rubella Equivical post partum, what does this mean
she needs the MMR vaccine
what should be avoid after the MMR
getting pregnant for 28 days
can MMR transfer through breast milk
No
when will the mom receive Rogam during pregnancy
if mom has Negative blood type
when is Rogam given post partum
if baby is a positive blood type
when is rogam not needed
if the baby is also negative
diuresis (increased frequency) occurs for how many days post partum
2-3 days
what can cause urine retention after birth
fear to void
decreased sensation to void (catheter, anasthesia)
if the bladder is full, what happens to the uterus and what can this cause
uterus displaced to the left
bleeding (decreased uterine contraction) and increase risk for UTI
what hormones decrease after delivery of the placenta
progesterone
estrogen
how early can menstrual cycle w/ ovulation occur
28 days post partum
when can menses be delayed in post partum women
later in women who breast feed (up to a few years) because of increased progesterone
what is normal for the first 3-4 menses after birth
for them to be heavier
what can cause an increase in appetite after birth
lactation
what is the headache called due to an epidural
Spinal Headache
what causes a spinal headache
leakage of spinal fluid from epidural
how is a spinal headache diagnosed
if woman lays flat, headache disappears
what is the biggest piece of education to give parents about neborn
how to keep them safe
what are the pieces of education to keep a newborn safe
VARIFY EVERYONE
SOCIAL MEDIA
SECURITY TAG ON BABY
(abduction)
how long is post partum considered to last
6 weeks
what can a uterus displaced to the right mean
placenta fragments
holding onto a clot
how far above the umbilicus should the uterus be 2-3 hours post birth
about 1 cm or less
does a gush of blood after a woman stands mean a hemmorhage
no
blood just pooled in uterus and is exiting
what can be done to encourage attatchment
Rooming In
keeping the baby in close proximity to parents
how is bonding encouraged
skin-to-skin
what does skin-to-skin help the baby maintain
temperature
respirations
what is mutuality
newborn does something, causes parent to react
baby cries, mom picks it up
what is aquaintance developed through
eye contact
touching
talking to the baby
what is claiming
identifying with the newborn
“baby has my eyes, my nose, etc.”
what can help with early contact from the nurse
promoting skin-to-skin contact
dimming the lights
post pone babys eye cream so baby can see mom
what is Biorhythmicity
baby is in tune with moms natural rhythm
*promotes bonding
what is entrainment
baby responds to speech, turns head to look
how longs is the process of transitioning to parenthood
about 3 weeks
what occurs in the Taking In phase and how long is it
first 24 hours
mom is excited, wants to talk about her experience
what occurs in the Taking Hold phase and how long is it
mom is focused on ONLY babies needs
2-3 days (can last up to 3 weeks)
what occurs in the Letting Go phase
move forward as a unit
mom is learning how to balance her needs, babies needs, rest of family needs
how long is the First Period of Reactivity
30 minutes
what occurs in the First Period of Reactivity
HR: 160-180
Grunting/Nasal Flaring
Spontaneous Cry/Startle Response
what can grunting and nasal flaring mean in other situtations
respiratory distress
how long is the Second Period of Reactivity
2-8 hours
what occurs in the Second Period of Reactivity
meconium is passed
how long does a baby have to pass meconium before it is of concern
24 hours
how long is the Neonatal Period
birth-28 days
what are 6 important things that the babies does in the Neonatal Period
Establishing/Maintaining Respirations Experiencing circulatory changes Ingesting and digesting nutrients Eliminating and regulating weight Learning to regulate temperature Establishing relationships
how long is passive immunity sufficient for the newborn
3 months
why do babies often experience GERD and vomiting
immature/sterile GI system at birth
how much weight do babies typically lose in first 24 hours and what is this mostly due to
10%
loss of extracellular fluid
if a parent voices concern over babies urine being pink, what should you say
this is normal
Brick Dust Urine
when should first void occur
within 24 hours
what is normal for female babies to experience with their reproductive system
vaginal discharge
blood/spotting
edema to labia
vernix on genitalia (cheese-like)
what is normal for male babies to experience with their reproductive system
two testes palpable
Hydrocele
what is Hydrocele
accumulation of fluid in scrotum, resolves itself
what should you check the penis for
Hydrocele
Epispasdias
Hypospadias
what is Epispasdias
urethra on dorsal side of penis
what is Hypospadias
when urethra is found on ventrical space of the penis
what are signs that a babies hips are dislocated
uneven leg lengths
uneven butt folds
uneven thigh creases
uneven knee placement
Ortolani’s Manuver (Test) is when
femoral head moves in and out of the asitablum
how can hip dysplasia (dislocated) be helped
double diaper
pelvic harness
surgery
how does jaundice occur
RBC’s are broken down—>hemoglobin is released—>hemoglobin further broken down—->Billirubin builds (lab for jaundice)
what are the two types of Bilirubin
Unconjugated/Indirect
Conjugated/Direct
unconjugated/indirect (fat soluble) can what in the body
can cross the blood brain barrier and cause neurotoxicity (Kernicterus)
conjugated/direct (water soluble) is excreted through
excrete waste
feed baby, poops/pees it out
when is the peak of Physiologic Jaundice
2-4 days
what is pathologic jaundice caused by
maternal newborn blood type incompatibility
what are signs and symptoms of jaundice to teach parents
starts in sclera
works it’s way down body
lethargy, not wanting to eat
what are some treatments for jaundice
keep baby near window
feed plenty
Phototherapy
what should you monitor during Phototherapy
hydration status monitor temperature I's and O's protective goggles diaper
normal HR for baby
120-160
low as 80 at rest
little irregularity is normal
what are s/s of cardiac issues in baby
persistent tachycardia (>160 bpm) persistent bradycardia (<100)
what are some causes of persistent tachycardia
anemia
hypovolemia
sepsis
hyperthermia
what are some causes of persistent bradycardia
heart block
hypovolemia
what CBC values are typically elevated at birth
RBC's= due to fetal circulation/oxygen exchange WBC's= 24,000 on first day, 12,000 by day two
why is there a decrease in clotting factors in baby
immature live/GI system
not able to synthesize Vitamin K
what are the things that initiate breathing in a newborn
uterine contractions
passage through alveoli
cutting of the cord
how does passing through the birth canal initiate breathing
sqeezed through=baby cries and expands alveoli
how do uterine contractions initiate breathing
decrease in uterine/placenta flow activates receptors in newborn aorta/carotid
what is cold stress
baby gets cold, oxygen drops
what is the process of cold stress
baby gets cold—> increased O2 consumption —> increased RR —> vasoconstriction —> decreased O2 uptake —> decreased O2 to tissues
transition to breathing starts as soon as
umbilical cord is clamped
what are s/s of respiratory distress
retractions (sucking in at rib cage)
stridor
episodes of apnea
acrocyanosis (blueish/purple discoloration of feet and hands)
central cyanosis (bluesih/purple discoloration around the mouth and chest)
caput succedaneum
edema on the head, not controlled to one half
cephalhematoma
blood between skull and skin
does not cross suture line (well defined)
*risk of Jaundice when it reabsorbs
mongolian spots
look like bruises
Nevi (stork bites)
flat and pinkish red in color
Erythema Toxicum is also known as
newborn rash
no lotion
can get it up to month after birth
Rooting/Sucking
poke cheek, turn and suck on whatever it is
Babinski’s
done on the foot, stroke heel lateral aspex
big toe flex, others fan out
disappear 1-2 years
lasts longer can mean neurologic damage
Palmer’s Grasp
grasp object
Plantar Grasp
curl toes around object
Moro’s Reflex (startle)
baby has sensation of falling, brings arms in, spreads out
disappears around 4 months
*lasts longer can mean neurologic damage
what is Non-Shivering Thermogenesis
baby trying to keep warm, metabolism of brown fat
why is newborn at risk for heat loss
thin skin
vessels close to the surface
what does an APGAR score tell us
how the baby is transitioning to extrauterine life
when is the APGAR test performed
1 minute and 5 minutes
if APGAR is under 7, what do we do
reassess every 5 minutes until above 7
APGAR for HR
>100 = +2 <100 = +1 absent = 0
APGAR for RR
strong cry = +2
weak cry = +1
absent = 0
APGAR for Muscle Tone
well flexed = +2
some flexion = +1
flacid/floppy = 0
APGAR for Irritability
crying/whaling = +2
small grimace = +1
absent = 0
APGAR for color
all pink = +2
pink core/pale extremities = +1
pale/blue = 0
APGAR scores meaning
0-3 = SEVERE 4-6 = MODERATE 7-10 = MINIMAL
what is the first priority when baby comes out
establish RR
what can you do to induce respirations/increase APGAR score
dry the baby tactile stimulation skin to skin cap on the head bulb suction from MOUTH THEN NOSE (aspiration risk)
vital signs of newborn how to
check axillary temp
HR (1 minute)
RR (1 minute)
O2 Sat (not super reliable at first)
where should O2 Sat be taken on newborn always
Preductal (right hand/wrist)
within 10 minutes what is normal O2 Sat for newborn
85-95
when does the anterior fontanel (soft) close
18 months
when the umbilical cord is cut, what should you look for
how many vessels in it (should be 3)
what are the three standard meds newborns get at birth
Erythromyocin (eye cream)
Vitamin K
Hepatitis B (must have consent)
what is needed if parents refuse Hep B Vaccine for baby
declination form
what is needed if parents refuse Erythromyocin or Vitamin K
Against Medical Advice Form
what can be assessed for s/s of pain in newborn
change in HR, BP, RR, O2 Sat
crying
not eating/sleeping
what is considered Hypoglycemia in a baby
<45
when is hypoglycemia common in babies
big/small babies
maternal diabetes
cold stress/RR distress
where to take newborn BGL
heel stick
lateral aspect (spongey)
warm up heel first
when is a metabolic screen performed on newborns
25 hours and 10-14 days old
assess for genetic diseases
CCHD (Critical Congenital Heart Defect) Test looks at what
O2 Saturation
CCHD is done as long as
baby is on room air
before discharge
what is done in CCHD
Preductal Saturation (right hand) Postductal Saturation (either foot) done at same time
what is criteria for newborn to pass CCHD
> 95%
both within 3% of each other
education for circumcision
keep gauze pad and ointment over it
must void before discharge
what causes lactogenesis
decrease in progesterone, prolactin prepares breasts for milk
what hormone is essential for lactation
Oxytocin
what does Oxytocin cause in lactation
Milk Ejection
Let Down
Benefits of breast feeding immune support
IGA IGD IGE IGG IGM
other benefits of breast feeding
reduce respiratory/GI infections
decrease chance of breast/ovarian cancer
beneficial to environment (no bottles)
what are the contraindications of breast feeding
baby has Galactosemia (Cant process protein in milk)
Mom has active TB or HIV
what is recommended for breast feeding
exclusively breast milk for 6 months
breast feed until 2 years
whats the education for formula feeding
prep formula
don’t prop bottle
burp baby after 15mL (if spitting up during, burp more)
when should complementary feeding begin
6 months
*wait 3-5 days before introducing new foods
