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MATERNAL/INFANT > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

what can be tested for with an umbilical cord sample

A

see what drugs and nutrients the mother took in that passed to the baby

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2
Q

what can be checked for with a newborn to see if mom was involved in substance abuse

A

umbilical cord
babys urine
meconium (baby waste)

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3
Q

how much folic acid is recommended daily prior to conception

A

0.4 mg (400 micrograms)

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4
Q

what does folic acid play a role in

A

neural tube defects

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5
Q

what are other sources of folic acid that can be recommended

A

green leafy veggies
liver
chicken
turkey

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6
Q

what can inadequate weight gain during pregnancy cause

A

preterm labor

intrauterine growth restriction (IGR)

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7
Q

how much is recommended for the average women to gain

A

25-35 pounds

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8
Q

what does the weight gain in birth account for

A

uterus weight
baby weight
amniotic fluid weight

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9
Q

how many calories is recommended to increase during pregnancy from baseline for that woman

A

300 calories

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10
Q

how much calcium is recommended daily for pregnant women

A

1,300 mg

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11
Q

which fat soluble vitamins are you supposed to take when pregnant

A

A, D, K, E

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12
Q

which fat soluble vitamin should you not take too much of and why

A

Vitamin A

can cause congenital anomalies

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13
Q

what does B12 assist with in pregnancy

A

helps to form red blood cells

eggs, dairy

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14
Q

how much folic acid is recommended for pregnant women

A

0.6 mg

600 micrograms

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15
Q

what can Pica be a sign of

A

anemia

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16
Q

what is nausea and vomiting called in pregnancy

A

hyperemesis gravidarum

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17
Q

what type of foods can help offset nausea

A

sweet or salty foods

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18
Q

what medications can be prescirbed for pregnancy N/V

A

Zofran (cheap, causes headaches and constipation)

Diclegis (very expensive, hard to get)

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19
Q

what can iron supplements cause

A

constipation

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20
Q

what can iron be taken with to increase absorption

A

vitamin C (glass of orange juice)

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21
Q

what is Pirosis

A

heartburn

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22
Q

what should you recommend to pregnant women with heartburn

A

sit up for 30 min after eating

small frequent meals

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23
Q

what are the two main concerns for adolescent pregnancies

A

well balanced diet

adequate weight gain

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24
Q

how much protein and water should the pregnant woman ingest per day

A

70g

3L

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25
Q

are more or less calories needed in lactation vs. pregnancy

A

more calories in lactation

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26
Q

how many more calories per day should a women ingest during lactation

A

500 more

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27
Q

how many centimeters should the uterus descend each day post partum

A

1-2 cm

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28
Q

what is post partum considered

A

the interval from childbirth to return of the uterus to non-pregnant state (not pre pregnant-never be same)

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29
Q

what is Involution

A

the shrinking of the uterus

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30
Q

what factors promote involution

A 
early/frequent ambulation
uterine contractions (2-3 days post partum)
breast feeding (release Oxytocin--cause uterine contractions)
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31
Q

by what time should the uterus be no longer palpable

A

2 weeks postpartum

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32
Q

what is Subinvolution (Uterine Atony)

A

failure of the uterus to return to non-pregnant state

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33
Q

what can occur if their is no uterine contraction and why

A

excessive blood loss and hemorrhage

due to exposed vessels not being constricted

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34
Q

what are the factors that slow involution/cause subinvolution

A

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

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35
Q

what is Colostrum made up of

A

nutrients
antibodies
protein
decreased fat

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36
Q

how long does mom have to feed baby colostrum

A

72-96 hours post partum

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37
Q

how long can engourgement last

A

24-48 hours

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38
Q

what does a fundal rub do

A

makes the uterus contract and prevents hemmorhage

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39
Q

what should you do before a fundal rub

A

have mom empty bladder

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40
Q

what is the Estimated Blood Loss (EBL) for a vaginal and C-section birth

A

500mL vaginal

1,000mL C-section

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41
Q

when does the vagina return to non pregnant size

A

6-10 weeks post partum

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42
Q

what causes delay in secretion of cervical mucosa due to hormones

A

lactation

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43
Q

what is lochia and what is it the result of

A

vaginal discharge

result of involution

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44
Q

how long should lochia rubra be seen and what color is it

A

bright red

seen first, 3-4 days after

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45
Q

what color is lochia serosa and how long can it be seen

A

pink/brown

22-27 days

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46
Q

what color is lochia alba and how long can it be seen

A

white

up to 6 weeks

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47
Q

what should you always assess when it comes to lochia

A

color
odor
amount

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48
Q

when is lochia considered heavy

A

saturated peri pad within 1 hour

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49
Q

what is an episiotomy and when should it heal

A

a purposeful cut of the perineum to allow baby to come through (2-3 weeks for it to heal)

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50
Q

what degree can a perineal laceration go up to

A

4th degree

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51
Q

what is considered a 4th degree laceration of the perineum

A

perineum to the anus is ripped

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52
Q

what are concerns with perineal lacerations

A

infection

comfort

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53
Q

what can be done for perineal lacerations from the nurse

A 
ice to perineum 
high fiber diet
stool softeners
encourage urination
ease the fear of voiding
sitz bath
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54
Q

what are some indications that a c-section is needed

A 
large baby
distressed baby (HR drops)
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55
Q

what does post partum care consist of for a woman with a c-section

A 
bed rest for 12 hours
blood clot/DVT watch
incision site
infection
STILL HAVE TO DO FUNDAL RUBS
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56
Q

what will happen in the respiratory system post partum and when will this occur by

A

diaphragm will move down

6 weeks post partum

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57
Q

when will cardiac volume/output go back to normal after birth

A

2-6 weeks post partum

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58
Q

when will BP go back to baseline

A

~1 week

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59
Q

how long do clotting factors stay elevated and what is the mom at risk for because of it

A

6 weeks

blood clots

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60
Q

what can occur to womens hair post partum

A

become more coarse and fall out due to hormones

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61
Q

is it normal to see elevated WBC count after birth

A

yes

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62
Q

if mom tests Rubella Equivical post partum, what does this mean

A

she needs the MMR vaccine

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63
Q

what should be avoid after the MMR

A

getting pregnant for 28 days

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64
Q

can MMR transfer through breast milk

A

No

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65
Q

when will the mom receive Rogam during pregnancy

A

if mom has Negative blood type

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66
Q

when is Rogam given post partum

A

if baby is a positive blood type

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67
Q

when is rogam not needed

A

if the baby is also negative

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68
Q

diuresis (increased frequency) occurs for how many days post partum

A

2-3 days

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69
Q

what can cause urine retention after birth

A

fear to void

decreased sensation to void (catheter, anasthesia)

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70
Q

if the bladder is full, what happens to the uterus and what can this cause

A

uterus displaced to the left

bleeding (decreased uterine contraction) and increase risk for UTI

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71
Q

what hormones decrease after delivery of the placenta

A

progesterone

estrogen

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72
Q

how early can menstrual cycle w/ ovulation occur

A

28 days post partum

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73
Q

when can menses be delayed in post partum women

A

later in women who breast feed (up to a few years) because of increased progesterone

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74
Q

what is normal for the first 3-4 menses after birth

A

for them to be heavier

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75
Q

what can cause an increase in appetite after birth

A

lactation

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76
Q

what is the headache called due to an epidural

A

Spinal Headache

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77
Q

what causes a spinal headache

A

leakage of spinal fluid from epidural

78
Q

how is a spinal headache diagnosed

A

if woman lays flat, headache disappears

79
Q

what is the biggest piece of education to give parents about neborn

A

how to keep them safe

80
Q

what are the pieces of education to keep a newborn safe

A

VARIFY EVERYONE
SOCIAL MEDIA
SECURITY TAG ON BABY
(abduction)

81
Q

how long is post partum considered to last

A

6 weeks

82
Q

what can a uterus displaced to the right mean

A

placenta fragments

holding onto a clot

83
Q

how far above the umbilicus should the uterus be 2-3 hours post birth

A

about 1 cm or less

84
Q

does a gush of blood after a woman stands mean a hemmorhage

A

no

blood just pooled in uterus and is exiting

85
Q

what can be done to encourage attatchment

A

Rooming In

keeping the baby in close proximity to parents

86
Q

how is bonding encouraged

A

skin-to-skin

87
Q

what does skin-to-skin help the baby maintain

A

temperature

respirations

88
Q

what is mutuality

A

newborn does something, causes parent to react

baby cries, mom picks it up

89
Q

what is aquaintance developed through

A

eye contact
touching
talking to the baby

90
Q

what is claiming

A

identifying with the newborn

“baby has my eyes, my nose, etc.”

91
Q

what can help with early contact from the nurse

A

promoting skin-to-skin contact
dimming the lights
post pone babys eye cream so baby can see mom

92
Q

what is Biorhythmicity

A

baby is in tune with moms natural rhythm

*promotes bonding

93
Q

what is entrainment

A

baby responds to speech, turns head to look

94
Q

how longs is the process of transitioning to parenthood

A

about 3 weeks

95
Q

what occurs in the Taking In phase and how long is it

A

first 24 hours

mom is excited, wants to talk about her experience

96
Q

what occurs in the Taking Hold phase and how long is it

A

mom is focused on ONLY babies needs

2-3 days (can last up to 3 weeks)

97
Q

what occurs in the Letting Go phase

A

move forward as a unit

mom is learning how to balance her needs, babies needs, rest of family needs

98
Q

how long is the First Period of Reactivity

A

30 minutes

99
Q

what occurs in the First Period of Reactivity

A

HR: 160-180
Grunting/Nasal Flaring
Spontaneous Cry/Startle Response

100
Q

what can grunting and nasal flaring mean in other situtations

A

respiratory distress

101
Q

how long is the Second Period of Reactivity

A

2-8 hours

102
Q

what occurs in the Second Period of Reactivity

A

meconium is passed

103
Q

how long does a baby have to pass meconium before it is of concern

A

24 hours

104
Q

how long is the Neonatal Period

A

birth-28 days

105
Q

what are 6 important things that the babies does in the Neonatal Period

A 
Establishing/Maintaining Respirations
Experiencing circulatory changes
Ingesting and digesting nutrients 
Eliminating and regulating weight
Learning to regulate temperature 
Establishing relationships
106
Q

how long is passive immunity sufficient for the newborn

A

3 months

107
Q

why do babies often experience GERD and vomiting

A

immature/sterile GI system at birth

108
Q

how much weight do babies typically lose in first 24 hours and what is this mostly due to

A

10%

loss of extracellular fluid

109
Q

if a parent voices concern over babies urine being pink, what should you say

A

this is normal

Brick Dust Urine

110
Q

when should first void occur

A

within 24 hours

111
Q

what is normal for female babies to experience with their reproductive system

A

vaginal discharge
blood/spotting
edema to labia
vernix on genitalia (cheese-like)

112
Q

what is normal for male babies to experience with their reproductive system

A

two testes palpable

Hydrocele

113
Q

what is Hydrocele

A

accumulation of fluid in scrotum, resolves itself

114
Q

what should you check the penis for

A

Hydrocele
Epispasdias
Hypospadias

115
Q

what is Epispasdias

A

urethra on dorsal side of penis

116
Q

what is Hypospadias

A

when urethra is found on ventrical space of the penis

117
Q

what are signs that a babies hips are dislocated

A

uneven leg lengths
uneven butt folds
uneven thigh creases
uneven knee placement

118
Q

Ortolani’s Manuver (Test) is when

A

femoral head moves in and out of the asitablum

119
Q

how can hip dysplasia (dislocated) be helped

A

double diaper
pelvic harness
surgery

120
Q

how does jaundice occur

A

RBC’s are broken down—>hemoglobin is released—>hemoglobin further broken down—->Billirubin builds (lab for jaundice)

121
Q

what are the two types of Bilirubin

A

Unconjugated/Indirect

Conjugated/Direct

122
Q

unconjugated/indirect (fat soluble) can what in the body

A

can cross the blood brain barrier and cause neurotoxicity (Kernicterus)

123
Q

conjugated/direct (water soluble) is excreted through

A

excrete waste

feed baby, poops/pees it out

124
Q

when is the peak of Physiologic Jaundice

A

2-4 days

125
Q

what is pathologic jaundice caused by

A

maternal newborn blood type incompatibility

126
Q

what are signs and symptoms of jaundice to teach parents

A

starts in sclera
works it’s way down body
lethargy, not wanting to eat

127
Q

what are some treatments for jaundice

A

keep baby near window
feed plenty
Phototherapy

128
Q

what should you monitor during Phototherapy

A 
hydration status
monitor temperature
I's and O's
protective goggles
diaper
129
Q

normal HR for baby

A

120-160
low as 80 at rest
little irregularity is normal

130
Q

what are s/s of cardiac issues in baby

A 
persistent tachycardia (>160 bpm)
persistent bradycardia (<100)
131
Q

what are some causes of persistent tachycardia

A

anemia
hypovolemia
sepsis
hyperthermia

132
Q

what are some causes of persistent bradycardia

A

heart block

hypovolemia

133
Q

what CBC values are typically elevated at birth

A 
RBC's= due to fetal circulation/oxygen exchange
WBC's= 24,000 on first day, 12,000 by day two
134
Q

why is there a decrease in clotting factors in baby

A

immature live/GI system

not able to synthesize Vitamin K

135
Q

what are the things that initiate breathing in a newborn

A

uterine contractions
passage through alveoli
cutting of the cord

136
Q

how does passing through the birth canal initiate breathing

A

sqeezed through=baby cries and expands alveoli

137
Q

how do uterine contractions initiate breathing

A

decrease in uterine/placenta flow activates receptors in newborn aorta/carotid

138
Q

what is cold stress

A

baby gets cold, oxygen drops

139
Q

what is the process of cold stress

A

baby gets cold—> increased O2 consumption —> increased RR —> vasoconstriction —> decreased O2 uptake —> decreased O2 to tissues

140
Q

transition to breathing starts as soon as

A

umbilical cord is clamped

141
Q

what are s/s of respiratory distress

A

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)

142
Q

caput succedaneum

A

edema on the head, not controlled to one half

143
Q

cephalhematoma

A

blood between skull and skin
does not cross suture line (well defined)
*risk of Jaundice when it reabsorbs

144
Q

mongolian spots

A

look like bruises

145
Q

Nevi (stork bites)

A

flat and pinkish red in color

146
Q

Erythema Toxicum is also known as

A

newborn rash
no lotion
can get it up to month after birth

147
Q

Rooting/Sucking

A

poke cheek, turn and suck on whatever it is

148
Q

Babinski’s

A

done on the foot, stroke heel lateral aspex
big toe flex, others fan out
disappear 1-2 years
lasts longer can mean neurologic damage

149
Q

Palmer’s Grasp

A

grasp object

150
Q

Plantar Grasp

A

curl toes around object

151
Q

Moro’s Reflex (startle)

A

baby has sensation of falling, brings arms in, spreads out
disappears around 4 months
*lasts longer can mean neurologic damage

152
Q

what is Non-Shivering Thermogenesis

A

baby trying to keep warm, metabolism of brown fat

153
Q

why is newborn at risk for heat loss

A

thin skin

vessels close to the surface

154
Q

what does an APGAR score tell us

A

how the baby is transitioning to extrauterine life

155
Q

when is the APGAR test performed

A

1 minute and 5 minutes

156
Q

if APGAR is under 7, what do we do

A

reassess every 5 minutes until above 7

157
Q

APGAR for HR

A 
>100 = +2
<100 = +1
absent = 0
158
Q

APGAR for RR

A

strong cry = +2
weak cry = +1
absent = 0

159
Q

APGAR for Muscle Tone

A

well flexed = +2
some flexion = +1
flacid/floppy = 0

160
Q

APGAR for Irritability

A

crying/whaling = +2
small grimace = +1
absent = 0

161
Q

APGAR for color

A

all pink = +2
pink core/pale extremities = +1
pale/blue = 0

162
Q

APGAR scores meaning

A 
0-3 = SEVERE
4-6 = MODERATE
7-10 = MINIMAL
163
Q

what is the first priority when baby comes out

A

establish RR

164
Q

what can you do to induce respirations/increase APGAR score

A 
dry the baby
tactile stimulation
skin to skin
cap on the head
bulb suction from MOUTH THEN NOSE (aspiration risk)
165
Q

vital signs of newborn how to

A

check axillary temp
HR (1 minute)
RR (1 minute)
O2 Sat (not super reliable at first)

166
Q

where should O2 Sat be taken on newborn always

A

Preductal (right hand/wrist)

167
Q

within 10 minutes what is normal O2 Sat for newborn

A

85-95

168
Q

when does the anterior fontanel (soft) close

A

18 months

169
Q

when the umbilical cord is cut, what should you look for

A

how many vessels in it (should be 3)

170
Q

what are the three standard meds newborns get at birth

A

Erythromyocin (eye cream)
Vitamin K
Hepatitis B (must have consent)

171
Q

what is needed if parents refuse Hep B Vaccine for baby

A

declination form

172
Q

what is needed if parents refuse Erythromyocin or Vitamin K

A

Against Medical Advice Form

173
Q

what can be assessed for s/s of pain in newborn

A

change in HR, BP, RR, O2 Sat
crying
not eating/sleeping

174
Q

what is considered Hypoglycemia in a baby

A

<45

175
Q

when is hypoglycemia common in babies

A

big/small babies
maternal diabetes
cold stress/RR distress

176
Q

where to take newborn BGL

A

heel stick
lateral aspect (spongey)
warm up heel first

177
Q

when is a metabolic screen performed on newborns

A

25 hours and 10-14 days old

assess for genetic diseases

178
Q

CCHD (Critical Congenital Heart Defect) Test looks at what

A

O2 Saturation

179
Q

CCHD is done as long as

A

baby is on room air

before discharge

180
Q

what is done in CCHD

A 
Preductal Saturation (right hand)
Postductal Saturation (either foot)
done at same time
181
Q

what is criteria for newborn to pass CCHD

A

> 95%

both within 3% of each other

182
Q

education for circumcision

A

keep gauze pad and ointment over it

must void before discharge

183
Q

what causes lactogenesis

A

decrease in progesterone, prolactin prepares breasts for milk

184
Q

what hormone is essential for lactation

A

Oxytocin

185
Q

what does Oxytocin cause in lactation

A

Milk Ejection

Let Down

186
Q

Benefits of breast feeding immune support

A 
IGA
IGD
IGE
IGG
IGM
187
Q

other benefits of breast feeding

A

reduce respiratory/GI infections
decrease chance of breast/ovarian cancer
beneficial to environment (no bottles)

188
Q

what are the contraindications of breast feeding

A

baby has Galactosemia (Cant process protein in milk)

Mom has active TB or HIV

189
Q

what is recommended for breast feeding

A

exclusively breast milk for 6 months

breast feed until 2 years

190
Q

whats the education for formula feeding

A

prep formula
don’t prop bottle
burp baby after 15mL (if spitting up during, burp more)

191
Q

when should complementary feeding begin

A

6 months

*wait 3-5 days before introducing new foods

MATERNAL/INFANT (3 decks)

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