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4-Fourth Semester > exam 3- complicated mom and baby > Flashcards

exam 3- complicated mom and baby Flashcards

1
Q

what subjective data are you asking mom

then you do what do you get

A

Last mentsutal period
What doing right before dishcagre
How long in care before cramping

Then objective data, list in PRIORITY order: like vs and things

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2
Q

High risk pregnancies

what ages under/over
hx of what
what underlying medical conditions
unexplained what
what weights
are they past how long
hx of what
do they have what

A

Under 16 and over 35

History of preeclampsia

Underlying medical conditions like cardiovascular disease, HTN, diabetes, sickle cell, pulmonary disorders,

Any unexplained miscarriages or stillborn

Are they underweight or overweight

Are they past 42 weeks

Hx of preterm labor

Do they have cervical incompetence

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3
Q

What is the goal? of pregnancy

always what

A

always healthy mom and healthy baby

  • want baby in as long as possible as long as its healthy for mom and baby
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4
Q

Fetal Movement Count (kick counts) non invasive

what counts as a kick
when are babies most active
when do they slow down

A

all fetal momvemnt is counted as a kick

Babies are more active in third trimsester

Does slow down at 36 weeks due to low space

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5
Q

Fetal Movement Count (kick counts) non invasive- When?

around when

mothers feel what

A

Around 18-20 weeks

  • mothers feel quickening/fluttering feeling
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6
Q

Fetal Movement Count (kick counts) non invasive- How?

give what
do it how
count alll for how long

A

Give a chart,

do It at same time every day, in same position,

count all movements for a full hour

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7
Q

Fetal Movement Count (kick counts) non invasive- Mom should become concerned when

how Many in how much time

A

there is less then 10 movements in 3 hours

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8
Q

Fetal Movement Count (kick counts) non invasive
After about 20-30 minutes- if you don’t feel anything-

change
drink what
eat what

then if nothing you do what

A

change position,

drink juice/high sugar,

eat a snack

, and if there is no movement you need to be seen because there could be an issue.

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9
Q

when are babies the most active

A

Babies tend to be the most active when mom sits down

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10
Q

Ultrasonography-noninvaseive
Biparietal diameter-diameter-

measures what

A

measures baby head to foot

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11
Q

Ultrasonography-noninvaseive
Doppler umbilical velocimetry-

for what
and is it what

A

blood flow of umbilical cord,

and Is it properly perfusing to placenta/ baby

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12
Q

Ultrasonography-noninvaseive
Placental grading for maturity-

is placenta what
and is it

A

is placenta old-past 40/41 week,

and is it functioning

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13
Q

Ultrasonography-noninvaseive
Amniotic fluid volume-

tests for what

A

is there proper amount of fluid volume/not enough

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14
Q

Ultrasonography-noninvaseive
Nuchal translucency (NTT)-

checks for what
how

A

checks for downs-

checks space behind baby head

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15
Q

Ultrasonography-noninvaseive

start having them when

A

Should start having them between 18-22 weeks

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16
Q

Ultrasonography-noninvasive
Early on- if mom doesn’t know LMP or if any issue for maturity/knowing how old baby is-

do what
considered what
put where

A

then you will do vaginal ultrasound-

considered nonivnase-

prop into vagina

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17
Q

Baseline fetal heart tones

between what

A

between 110-160

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18
Q

Variability heart tones

what is it
minimal-
moderate-
marked-

What will the nurse do?

A

difference between the highest and lowest hr

Minimal- 5 beats or less

Moderate-6-25 beats

Marked-greater then 25 bpm

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19
Q

Contractions (duration/frequency)

What will the nurse do?- how do you measure

A

measure from the start of the incline to the end of the decline

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20
Q

Is it reactive (accelerations?)

are they a good sign
what are they

What will the nurse do?

A

positive sign

Accelerations are short-term rises in the heart rate of at least 15 beats per minute,

lasting at least 15 seconds

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21
Q

Early decels

what does it mean

What will the nurse do-m

A

head is compressed

monitor-not too signifiant

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22
Q

LAte decels

what does it mean
how do you help mom(change / prepare / give)

What will the nurse do?

A

uterine placental problems

change moms positions
prepare for c section
give oxygen 10-15 liters

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23
Q

Variable decels

what are they

what will nurse do(r/ give/ may need)

A

variable decals are when the decals dip variably- no real structure to them

reposition
give oxygen
may need c section

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24
Q

External FHR monitoring

what look like

measures what

A
  • two bands-top(toco) is on moms zyphoid

Bottom is by baby spine and measures fetal heart rate

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25
Q

When do you only place internal monitors

also place what as well w this

A

only place them if membranes have ruptured

also place internal contraction device as well

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26
Q

downside to internal monitor

moms cant do what
needs to be what

A

moms cannot walk around or bounce on labor ball

needs to stay connected to machine

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27
Q

Non stress test (NST)–noninvasive-used if mom has

any form of what
what bp
decreased what

A

any form of diabetes,

HTN,

decreased kick count,

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28
Q

Nonstress test

nurses will get what

want how many accelerations

want to see what

A

nurse will get a 20 minute strip-

want 2 accelerations for baby-

want to see a reactive stress test

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29
Q

Non stress test (NST)- if Non reactive-(not good)

need what
may need
dont have time for what
baby goes where

A

-need to be admitted to hospital-

may need emergent c section-

may not get spinal-

want baby out asap- then baby may need to go to childrens hosital

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30
Q

-Non stress test (NST)want positive result for fetal movements-

want what
see what number

A

want bump and hill in fetal heart tones-

want 15 accelerations

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31
Q

-Non stress test (NST)-if nonreasctive

change
drink
eat

A

change positions

, drink sugary drinks,

eat snacks

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32
Q

Non stress test (NST)
keep in mind what

also trying to figure out what

A

Keep in mind that baby can hear- try to figure out if they are more active when family or dogs or something is around

What is moms diet- is there a lot of caffeine or smoking- is mom on a stimulant of some sort

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33
Q

Non stress test (NST)

when do babies sleep
when are they awake

A

Babies tend to sleep when mom is around and moving-

and awake when she stands still

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34
Q

nonreactive stress test requires what

A

immediate c section

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35
Q

Ultrasonography: Biophysical Profile

5 variables to assess

B
A
T
M
N

A

B-breathing

A-amniotic fluid

T- tone of infant

M-movement of infant

N-non stress test

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36
Q

Ultrasonography: Biophysical Profile

what number is ideal

what number requires intervention

what number requires emergent intervention

A

8-10 is ideal

Less then 8 requires intervention

Less then 6 requires emergent intervention
Like c section

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37
Q

Ultrasonography: Biophysical Profile

want baby how
dont want them to look how or how

A

want baby in fetal position

Don’t want baby to look flacid
Or with free floating extremities with arms
Legs hyperextended out

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38
Q

Contraction Stress Test (CST)

used to see if what

A

Used to see if the baby is “healthy” enough to go through labor

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39
Q

what does positive contraction test mean

A

not able to go through labor, will need to have c/s

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40
Q

Contraction Stress Test (CST)
when Mom gets admitted-

get what in her
give what
have what at bedside

A

get an iv in her-

give small amounts of iv Pitocin to see how baby handles it

have tocolytic at bedside in the case that baby doesn’t tolerate-

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41
Q

if baby cannot handle Pitocin -contraction stress test

shows what
then you do what
will need what

A

If baby doesn’t handle it and has decels on heart rate-

reverse Pitocin with tocolytic

will need c section

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42
Q

Contraction Stress Test (CST)
Done on
G d
what bp
p
climbing
any what

A

gestational diabetes,

HTN,

preeclamspia,

climbing bp,

any underlying cardiac or vascular disease-

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43
Q

Amniocentesis

how does it work
will do what

Invasive Fetal Testing

A
  • ultrasound guided needle that is placed via ultrasound-

will aspirate some amniotic fluid from the sac-

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44
Q

amniocentesis -Invasive Fetal Testing-

done for what
what time
looks for what

A

Done for genetic testing

at 14-16 weeks

, looks for down syndrome and other genetic disorders

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45
Q

amniocentesis -Invasive Fetal Testing-

ensure what is up to date
when do you not do it

A

Ensure that coag panel is up to date-

do not do if mom is risk for bleed

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46
Q

amniocentesis -Invasive Fetal Testing–Checks for fetal lung development

what is LS ratio
what is diabetic mom goal

what if mom is less then 32 weeks

A
  • LS ratio is 2:1-

diabetic moms goal is 3-1

// if mom is less then 32 weeks then mom may have a reveres ratio where s is greater- not good for feral lung development

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47
Q

amniocentesis -Invasive Fetal Testing–This is only done if mom is having problems- like

p l

or really

A

premature labor,

really HTN

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48
Q

amniocentesis -Invasive Fetal Testing- -Only cure for preeclampsia is delivery

why get an amniocentesis if before 32 weeks

A

If c section before 32 week mark

, get amniocentesis to check if lungs are developed

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49
Q

amniocentesis -Invasive Fetal Testing-
-Gestational diabetes may have babies that are large- so may be deceptively healthy-

can have what
why is amniocentesis done

A

big babies that can have respiratory issues-

amniocentiesis then is performed to check lung development

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50
Q

Complications in pregnancy-miscarriage definitions

Threatened

imminent-

A

risk for one/

one is going to happen at some point

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51
Q

Complications in pregnancy- miscarriage definitions

Complete

incomplete-

A

mothers body completely miscarried

retained part of baby

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52
Q

Complications in pregnancy- miscarriage

Missed

and/or recurrent-

A

missed- when you miscarry without bleeding

reccurent- 2 consecutive miscarriages

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53
Q

miscarriage- If mom comes in with bleeding or believes she has a miscarriage-

never do what
just do what

Medically stable mom is needed for stable baby

Complications in pregnancy-

A

NEVER do vaginal exam-

just take note and look at evidence they bring in like bleeding pad and note it

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54
Q
  • miscarriage-If mom is bleeding-

put pt where
put in
get
think of what (what hr/bp)

Complications in pregnancy-

A

lay pateitn down,

put in iv,

get vitals-

think of hemorrhage shock- find map-tachycarida, hypotension

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55
Q

miscarriage

assess what
collect what

Complications in pregnancy-

A

Assess type of blood, if any clotting,

Collect subjective date- like how it felt when it happened and what they were doing before, how much blood, is there any discharge/odor(infection)
Is there pain that radiates to back-hemorrhage internally

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56
Q

Ectopic pregnancy-

is it sustainable with life

what is it

Complications in pregnancy-

A

non sustainable with life-

it is when implantation of fertilized ovum attaches outside of endometrial lining- usually in fallopian tube

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57
Q

Ectopic pregnancy-

who should be suspected to have ectopic pregnancy

Complications in pregnancy-

A

Any fertile female with lower abd. pain

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58
Q

Ectopic pregnancy-
Pt may not even know that they are pregnant

ask what
often when

Complications in pregnancy-

A
  • need to ask when lMP was-

often very early in pregnacny

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59
Q

Ectopic pregnancy-
PROBLEM Recognition

p/f
may have some what

Complications in pregnancy-

A

pain/ fever- might not have any pain,

maybe some bleeding but maybe not

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60
Q

Ectopic pregnancy-
Considered life threatening

why
what can happen
leads to what

Complications in pregnancy-

A

because hypovolemic shock risk is high-

womens fallopian tube can rupture

lead to internal hemorrhage

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61
Q

Ectopic pregnancy
-Risks-

previous e
previous what surgery
p I d
implanted

Complications in pregnancy-

A

previous ectopic,

previous tubal surgery(like endometriosis)

pelvic inflammatory disease

implanted iud

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62
Q

Ectopic pregnancy- Treated w (depending on size/location

small ectopic

give what drug
will cause what
get another dose when

Complications in pregnancy-

A

can give methyltrexate- chemo drug-

will cause patient to miscarry-

pt will get that dose in ER and then another 48-72 hrs after

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63
Q
  • Ectopic pregnancy
    -If its ruptured or larger ectopic-

will need what
how does it work
can they get pregnant still

Complications in pregnancy-

A

will need to go to OR for laparoscopy-

go in through ab wall and potential removal of fallopian tube-

can still get pregnant-

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64
Q

Ectopic pregnancy-Consider

does mom need what
given when
what else

Complications in pregnancy-

A
  • does mother need rogam-figure out blood type-

needs to be given within 72 hrs of miscarriage-

and post op care of abdominal patient

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65
Q

Ectopic pregnancy-
When they come in w large ectopic

get what
prep for what
preventing what

Complications in pregnancy-

A
  • Get 2 ivs

prep for surgery,

want to prevent hypovolemic shock

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66
Q

Ectopic pregnancy
-What does hypovolemic shock look like-

what hr
what bp
adminster what

Complications in pregnancy-

A

high hr,

low bp,

administer bloods/fluids depending on coag panel

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67
Q

Ectopic pregnancy-

try to figure out what
what lab
number 1 reason for what

Complications in pregnancy-

A

try to figure out how early on by LMP or ultrasound

Serum HCG level

numb 1 ER visit for women of childbearing age

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68
Q

Gestational Trophoblastic Disease (Hydatidiform mole)-

was this a pregnancy
what can grow
never was what

Complications in pregnancy-

A

this is not a pregnancy and was never a pregnancy

  • teeth and hair can grow-

never was a fertilized ovum – can grow for years

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69
Q

Gestational Trophoblastic Disease (Hydatidiform mole)-

Partial or complete could lead to->

what is that

Complications in pregnancy-

A

Choriocarcinoma

rapidly metastasizing malignancy( really invasive cancer)

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70
Q

Gestational Trophoblastic Disease (Hydatidiform mole)-

needs what after
dont do what
put pt on what

Complications in pregnancy-

A

Will need surgery and chemo/radiation after-

do not get pregnant for at least a year,

put pt on some form of birth control for a year

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71
Q
  • Gestational Trophoblastic Disease (Hydatidiform mole)-
    What are s/s? –

large what
potential what
what pain

Complications in pregnancy-

A

large uterus,

potential vaginal bleeding,

minimal cramping pain,

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72
Q

Gestational Trophoblastic Disease (Hydatidiform mole)-

what confirms this
never had what

Complications in pregnancy-

A

Need ultrasound to confirm

Never had a HR

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73
Q

Cervical insufficiency (premature cervical dilation)-

when cervix does what

cervix shouldn’t start until when

is baby able to be saved

Complications in pregnancy-

A

when cervic starts to prematurely open early on in pregnancy-

cervix should not start opening until you are close to delivery

A lot of times baby is unable to be saved

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74
Q

Cervical insufficiency (premature cervical dilation)-

If you have had it in past- when you get pregnant again-doctor does what

Complications in pregnancy-

A

early on the doctor will do cervical cerclage and put stitch in to prevent incometent cervix from happening again

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75
Q

Cervical insufficiency (premature cervical dilation)-

what do you do When mom is close to delivery-around 38 weeks-

Complications in pregnancy-

A

will cut stitch and send mom home

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76
Q

Cervical insufficiency (premature cervical dilation)-

educate that what
need what
what restrictions
may need what

Complications in pregnancy-

A

Educate that any s/s of birth they need to come in

Need to stay hydrated during pregnancy

Lifting restrictions

May need bed rest

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77
Q

Cervical insufficiency (premature cervical dilation)-

what is only treatment

Complications in pregnancy-

A

Cervical cerclage (McDonald procedure)-

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78
Q
  • Placenta Previa-

when placenta is where

Complications in pregnancy-

A

when the placenta covers part of cervical os(opening)

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79
Q

Placenta Previa-

s/s

Complications in pregnancy-

A

Painless bleeding- small old blood

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80
Q

Placenta Previa-

unable to do what
placenta shifting means what
possible what treatment

Complications in pregnancy-

A

Unable to have vaginal delivery

Placenta can shift during pregnancy- so may shift out of previa, or may shift into

Possible C/S if the placenta continues to cover the cervical opening

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81
Q

Placenta Previa- if bleeding need to come to hospital-

risk for what
risk for needing what else

Complications in pregnancy-

A

risk for hemrohage-

risk for needing post delivery hysterectomy if bleeding isnt under control

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82
Q

Placenta Previa
-If mom is before 37 weeks and is having bleeding or ruptured membrane

get them where
give what
why does that help

Complications in pregnancy-

A
  • admit to hospital

give steroids

to develop baby lungs before delivery

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83
Q

Placenta Previa- what confirms this

Complications in pregnancy-

A

Ultrasound can confirm this

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84
Q

Placenta Previa-If they come in as a known previa and bleeding

put where
get what
worry about what
put what in
give what
ultimately need what

Complications in pregnancy-

A
  • lay down,

get vials,

worry about shock-

put IV,

give iv fluids, blood producs-

will need c section

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85
Q

Placenta Previa- If early on identiefied-

mom may need what

Complications in pregnancy-

A

bedrest through whole pregnancy

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86
Q

abruption placentae)-

what is it

Complications in pregnancy-

A

Premature separation of the placenta

placenta is being ripped from uterine wall as a complication of trauma or accident

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87
Q

abruption placentae)-

what pain
what bleed

Complications in pregnancy-

A

Sharp, stabbing pain

bright red active bleeding

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88
Q

abruption placentae)-

need what emergency
get what
lay where
v
what products

Complications in pregnancy-

A

Emergency C/S stat!-

get large bore iv,

lay down,

vitals,

0- blood products

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89
Q

abruption placentae)-

baby isn’t getting what

Complications in pregnancy-

A

Baby isn’t getting blood/oxygen

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90
Q

abruption placentae)- If function of placenta is altered- like in previa and abruption-

how does baby look

Complications in pregnancy-

A

baby may be smaller

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91
Q

abruption placentae)-
Complete tear

baby isn’t what
emergent what
dont have time for what
do what to mom instead

Complications in pregnancy-

A

baby isn’t getting any oxygen- and will die soon-

emergency c section

don’t have time for a spinal-

put mom to sleep and intubate and get to nicu

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92
Q

abruption placentae)- In small tear-

admitted where
give what x2
ultrasound how often
constant what
what ivs
worried about what

Complications in pregnancy-

A

admitted to hospital-

give steroids and bedrest-

get ultrasounds every few hrs,

constant vitals

large bore ivs,

worried about hypovolemic shock and DIC

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93
Q

preterm labor

labor when

Complications in pregnancy-

A

Labor occurring between 20-36 weeks

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94
Q

preterm labor
Risks

addicted to what
g d
what diseases
s c

Complications in pregnancy-

A
  • addicted to narcotics,

gestational diabetics

, cardiac, renal liver diseases,

sickle cell

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95
Q

preterm labor

are they in pain
may have what
might have some what

Complications in pregnancy-

A

Sometimes pt not in a lot of pain- like in Braxton hicks that are tolerable but wont go away

Might have some drainage- might not

Might have some dialation/ no dialation

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96
Q

preterm labor

Terbutaline does what

what other drug

Complications in pregnancy-

A

Terbutaline- iv push to stop contractions

Magnesium Sulfate

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97
Q

preterm labor
Corticosteroid – betamethasone

does what
given when

Complications in pregnancy-

A

– develops lungs-

given in 2 doses 48 hrs apart

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98
Q

preterm labor-If terbutaline works- to stop contractions

put where
lay on what side
give what
no what
avoid what
no what
decrease what

Complications in pregnancy-

A

put on bed rest-

lay on left side,

give fluids

, no lifting

, avoid breast and nipple stimulation

, no leg/foot massage,

decrease stress

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99
Q

Preterm rupture of Membranes (PROM)

Rupture of membrane occurs when

Complications in pregnancy-

A

occurring before the end of week 37 gestation

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100
Q

Preterm rupture of Membranes (PROM)
To diagnose:

Complications in pregnancy-

A

Nitrazine paper test-

will turn blue – test anywhere you get disacharge

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101
Q

Preterm rupture of Membranes (PROM)
To diagnose:
Ferning (microscope)-

if NPT is what
what means positive pregnancy

Complications in pregnancy-

A

if NPT is purple-

if present then it is positive for membranes

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102
Q

Preterm rupture of Membranes (PROM)

want to deliver how fast

prevents what

Complications in pregnancy-

A

Want to deliver within 24 hrs

to prevent Chorioamnionitis – infection of the membranes

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103
Q

Preterm rupture of Membranes (PROM)

keep where
give what x2
what team

Complications in pregnancy-

A

Keep in hospital-

give steroids, antibiotics,

nicu team if really early on

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104
Q

Preterm rupture of Membranes (PROM)-If mom comes in-

do what w her words
the earlier what

Complications in pregnancy-

A

believe her until you can prove that it isn’t happening-

the earlier you can intervention the earlier you can save baby

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105
Q

-Hypertensive Disorders in Pregnancy

what is cure
how do babies present

Complications in pregnancy-

A

Only cure is delivery

Babies will be smaller

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106
Q

Hypertensive Disorders in Pregnancy-Preeclampsia

happens from what
affects what

A
  • happens from vasoconstriction from hypertension

that affects placenta and has systemic effects on mom

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107
Q

Hypertensive Disorders in Pregnancy

what’s rising
worry when

A

Bp may be slowly rising-

will worry when bp is around 140/80 or map around 100-110

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108
Q

Hypertensive Disorders in Pregnancy-Risk factors-

what age
underlying

A

increased maternal age,

underlying cardio disorder

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109
Q

Hypertensive Disorders in Pregnancy- perform detailed assessment:

check urine for what
what in eyes
h
what pain

A

check urine for protein,

floaters/spots in eyes,

headaches

, left sided abdominal pain

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110
Q

Pre eclampsia no severe features

what bp
what proteinuria
how much wt gain
mild what

A

140/90-bp

Proteinuria 1+

Wt. gain 2 lb/week

Mild edema

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111
Q

Pre eclampsia w/ severe features

what bp
what Proteinuria
o
what is affected

A

160/110

Proteinuria 3+

Oliguria

Renal function affected
CNS, lungs, liver, heart or thrombocytopenia

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112
Q

Eclampsia-s/s

s
c

A

Seizure /

Coma

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113
Q

Pre eclampsia no severe features

where
what med
what position
monitor how often

A

At home

Low dose ASA

Bedrest, lateral recumbent

Monitor weekly

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114
Q

Pre eclampsia no severe features

diet
watch for what

A

Diet- decrease sodium,

Watch for dvt/stroke

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115
Q

Pre eclampsia w/ severe features

over 37 weeks do what
under 37 weeks do what

A

over 37 weeks = deliver baby

under 37 weeks = hold off and give steroids

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116
Q

Pre eclampsia w/ severe feature

b
restrict who
what precaitions

A

bedrest

restrict visitors-

seizure precautions

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117
Q

Pre eclampsia w/ severe features

needs to be under 0 stress to do what

A

prevent stroke/ heart attack

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118
Q

Pre eclampsia w/ severe features

VS how often
L
daily what
24 hr what

A

VS q 4 h,

Labs,

daily weights,

foley, 24 h urine- w urometer bag

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119
Q

Pre eclampsia w/ severe features

what every4 hr

F
B
N

A

FHT,

BPP- ultrasound

NST

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120
Q

Pre eclampsia w/ severe features
Diet

high
low

A

high protein,

mod. Na

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121
Q

Pre eclampsia w/ severe features
Meds

H
L
M s

A

hydralazine,

labetalol- beta blocker

Mag. sulfate

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122
Q

Eclampsia

montior what
give what for seruizure x2
give what
F

A

Airway!

Mag. Sulfate or diazepam- for seizure

O2

FHT

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123
Q

what is immediate treatment for eclampsia

A

Delivery baby- immediately

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124
Q

Magnesium sulfate

given to who
go back to what state

A

Given to e clampsia-

can go back to pre-eclampsic state(uncontrolled HTN)

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125
Q

Magnesium sulfate-What does the nurse assess?

H
L
F
i

A

Headache,

lethargic,

flushing,

irritable,

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126
Q

Magnesium sulfate- check for toxicity

B
U
R
P

A

B- BP

U-urine output- decreased

R- decreased respirations

P-platella reflexes

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127
Q

Magnesium sulfate

watch how
check bp how often
what checks

A

Wathc pt closely- 1/1 ratio

Check bp every 15

Reflex checks

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128
Q

Magnesium sulfate

want what in
may be on what

A

Want urometer in

May be on capnograpghy

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129
Q

Hellp syndrome

H
E
L
L
P

A

Hemolysis- breakdown of RBC

Elevated
liver enzymes- liver damage

low
platelet count- risk for bleeds

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130
Q

Hellp syndrome

d/t what
is prognosis good
risk for what

A

D/T elevated BP

High maternal and infant mortality rate

risk for stroke/ hemmorrhage

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131
Q

Hellp syndrome

high levels cause what
mom may need what

A

High levels of bilirubin causes liver to fail

Mom may need liver transplant

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132
Q

Hellp syndrome-Pt will be

J
what pain
what bp
risk for what

A

jaundaices,

abdominal pain,

HTN,

risk for clot and bleed

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133
Q

Hellp syndrome

what blood product
iv what
what to infant

A

FFP,

IV dextrose,

infant delivery

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134
Q

Hellp syndrome-Nusring considerations

watching for what-(h)
put in large what

A

Hemorrhage,

Large bore iv

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135
Q

Hellp syndrome
Controlling bp-

m
h
b

A

mag,

hydralazine,

beta blockers,

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136
Q

Hellp syndrome

lots of what

A

Lots of blood products and heparin

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137
Q

Complications in pregnancy-Multiple Pregnancy

what are identical
what are non identical

A

Monozygotic (Identical)

Dizygotic (Non identical)

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138
Q

Complications in pregnancy-Multiple Pregnancy

what is a mono mono twin

will need what

A
  • share a umbilical cord and same amniotic sac-

will need c section

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139
Q

complications in pregnancy-Oligohydramnios

what is it

will require what

A

< 500 ml of amniotic fluid

( will require an Amnioinfusion during labor – will help baby by allowing to slide through canal)

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140
Q

complications in pregnancy-Oligohydramnios
etiology

u o
what issues
what insuffinceny
what type of pregnancies

A

uretheral obstruction

kidney issues

placental insufficiently

late pregnancies

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141
Q

complications in pregnancy-Oligohydramnios
complications

can cause what restriction
what complications

A

cause intrauterine growth restriction,

birth complications

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142
Q

Polyhydramnios

how much amniotic fluid
what is normal amount

A

2000 ml-

normal amount if 700-1000

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143
Q

Polyhydramnios tx

a
treat what

A

amnioreduction

treat underlying cause

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144
Q

Polyhydramnios complications

f m
what prolapse
what birth

A

fetal malposition

umbilical cord prolapse

premature birth

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145
Q

what causes Polyhydramnios

f a
m c
i

A

fetal abnomalties

maternal conditions

idophathic

146
Q

Isoimmunization (Rh Incompatibility)-rhogam

give when what mom

Complications in pregnancy-

A

Rh negative

147
Q

Isoimmunization (Rh Incompatibility)-rhogam

if not given can cause what

Complications in pregnancy-

A

Hemolytic disease of the newborn

(Erythroblastosis fetalis)- fatal for infant

148
Q

Isoimmunization (Rh Incompatibility)-rhogam

first dose when

next one when

Complications in pregnancy-

A

Give first dose around 28 weeks,

next one 72 hrs postpartum

149
Q

Isoimmunization (Rh Incompatibility)-rhogam

If mom has any bleeding issues/ any chance of miscarriage then do you give rhogam

Complications in pregnancy-

A

If mom has any bleeding issues/ any chance of miscarriage then still give rhogam

150
Q

Complications in Pregnancy: pre-existing

A

Cardiac disease

Hypertensive vascular disease

Thromboembolic disease- DVT

Anemia (Sickle-cell anemia)

UTI

Glycosuria

Respiratory disorders

GI disorders

Endocrine disorders- Diabetes

151
Q

: pre-existing- impact of diabetes
uncontrolled diabetes can

lead to
p b
p

Complications in pregnancy-

A

lead to birth defects

preterm birth

preeclampsia

152
Q

pre-existing- impact of hypertension
increases risk of

p
p b
low what

Complications in pregnancy-

A

preeclamspia
premature birth
low birth weight

153
Q

pre-existing- impact of heart disease

h f
what during pregnancy

Complications in pregnancy-

A

heart failure

aarythmias during pregnancy

154
Q

Complications in pregnancy-pre-existing- gestational diabetes

what is goal during pregnancy

A

control blood glucose

155
Q

Complications in Pregnancy: pre-existing-
gestational diabetes

Complications at risk for:
LGA what is it

A

LGA-large gestation age baby-big baby

156
Q

Complications in Pregnancy: pre-existing-
gestational diabetes

Complications at risk for: Hydramnios
what is it

A
  • too much amniotic fluid
157
Q

Complications in Pregnancy: pre-existing-
gestational diabetes

Complications at risk for:CPD / Shoulder dystocia - what happens

A

baby is too big for mom pelvis

158
Q

Complications in Pregnancy: pre-existing-
gestational diabetes

Complications at risk for:

Risk of what after birth

A

Risk of hypoglycemia in infants after birth

159
Q

Complications in Pregnancy: pre-existing- gestational diabetes
What mothers are at risk for developing gestational diabetes- ?

p o s
what diabetes
o

A

polysustic ovarian syndrome

, type 2 diabetes,

obese,

160
Q

Complications in Pregnancy: pre-existing- gestational diabetes

how do you get diagnosed

A

Around 26 weeks-

1 hr glucose test, sit for 1 hr and draw blood- if blood sugar is over 130- failure

then 3 hr glucose test if fail- draw blood

161
Q

Hypotonic contractions-

what is it
cannot do what
what doesn’t work

Complications in Labor: Force

A

not enough contraction-

cannot do vaginal delivery-

cervix will not dilate

162
Q

Hypotonic contractions-

try what med

if that doesn’t work then get what

A
  • may try Pitocin-

if Pitocin doenst work need c section

163
Q

Hypertonic uterine contractions-

how many contractions
not enough what
no what

Complications in Labor: Force

A

too many-

not enough rebound time-

no rest period-

164
Q

what is goal in hypertonic contractions

if cant do that, then do what

A

try to slow labor down

  • if cant –then c section
165
Q

Uncoordinated contractions-

what looks like
cervix doesn’t do what

Complications in Labor: Force

A

all over place-

cervix will not dialate-

166
Q

Uncoordinated contractions-

try what

if that dosnert work then what

A

try Pitocin

  • if baby doesn’t normalize then c section
167
Q

Precipitous Labor:

what is it

A

lasts less than 3 hours & results in a rapid birth

168
Q

Precipitous Labor:
Maternal Risks:

L
p h

A

Lacerations

Postpartum hemorrhage

169
Q

Precipitous Labor: Fetal Effects:

H
c t
P

A

Hypoxia

Cerebral trauma

Pneumothorax

170
Q

Precipitous Labor: Hx of precipitous labor:

what do you do

A

Close monitoring during last few weeks of pregnancy

171
Q

Precipitous Labor:
Assessment

r d
intense what

A

Rapid dilation

Intense uterine contractions

172
Q

induction of high risk pregnancy- why induce

problems w what
what readiness

Complications in pregnancy-

A

problems with fetal maturity

cervical readiness

173
Q

complications in Labor: induction of high risk pregnancy

why give Cervidil, Misoprostol-

A

Will ripen cervix

174
Q

complications in Labor: induction of high risk pregnancy

give Pitocin in what
cant give this until what
does what

A

Pitocin (in LR)

– cant start until cervix is ripened

induces labor

175
Q

Amniotomy

what is it

risk of what
check what after

complications in Labor: induction of high risk pregnancy

A

Artifical rupture of membrane

Risk of cord prolapse

Check FHR right away after!

176
Q

Cesarian-

help what
increase what
restrict
early

complications in Labor: induction of high risk pregnancy

A

help bond succescfully

increase fluids

restrict exercise and activity

early ambulation to avoid complications

177
Q

Why do c section-

if mom not doing what
if what comes back
what placenta
active what
baby measures how

A

if mom not dilating,

diagnostics came back saying its not healthy for mom and baby

, malfunctioning placenta

, active genital herpes,

baby measuring large

178
Q

when do you only do cesarian

A

Benefits of delivery have to outweigh risks of continuing pregnancy

179
Q

Oxytocin (Pitocin)

Risks
h
what bp
what urine output

complications in Labor: induction of high risk pregnancy

A

: hyperstim,

hypotension,

decreased urine output

180
Q

Oxytocin (Pitocin)

Any sign of fetal distress or hyperstim, what should the nurse do?

complications in Labor: induction of high risk pregnancy

A

Ready for c section

181
Q

Oxytocin (Pitocin)

how fast of administration

complications in Labor: induction of high risk pregnancy

A

Titrates medication- start slow

182
Q

Oxytocin (Pitocin)

May get a consent right away in the case that what

what do you do
needs what

complications in Labor: induction of high risk pregnancy

A

baby/mom doesn’t tolerate

automatically stop pitocin

needs emergency c section

183
Q

Oxytocin (Pitocin) -Hyperstim

what are they

complications in Labor: induction of high risk pregnancy

A
  • frequent contractions that you don’t get rebound off of
184
Q

Oxytocin (Pitocin)

need what
to measure what

complications in Labor: induction of high risk pregnancy

A

Need a urometer or hat in toilet

measure output

185
Q

Oxytocin (Pitocin)

what do With decels-

mom on what side
put on what
give what

complications in Labor: induction of high risk pregnancy

A

put mom on left side,

put on oxygen,

give fluid bolus

186
Q

Failure to progress

when what stop happening
labor how long
maxed out on what

complications in Labor: Force

A
  • when cervix stops dilating,

labor longer then 24 hours,

maxed out on Pitocin

187
Q

Failure to progress

what do you need to do

Complications in Labor: Force-

188
Q

Failure to progress-Prolonged descent or arrest of descent-

baby not doing what

Complications in Labor: Force-

A

baby is no longer coming down pelvis

189
Q

Failure to progress

What is this most often attributed to?
L
C D

Complications in Labor: Force-

A

LGA (big baby),

cephlopelic disproportionate(baby head to big)

190
Q

Umbilical cord prolapse

what happens
what stops happening

Complications in Labor: Passenger-

A

-cord comes around baby head-

baby will stop perfusing

191
Q

Umbilical cord prolapse

how do you help this
do not do what- do what

Complications in Labor: Passenger-

A

Get sterile gloves and lift babies head off of umbilical cord-

do not get off bed - scream to get help

192
Q

Umbilical cord prolapse

needs what

do what to mom

Complications in Labor: Passenger-

A

– needs c section

Intubate mom and get baby out asap

193
Q

Cephalopelvic Disproportion (CPD)-

what happens
what do if you know about it beforehand

Complications in Labor: Fetal position, presentation, size

A

pelvis is too small for baby to fit through-

if know about it beforehand can get c section

194
Q

Complications if didn’t know about CPD beforehand-

s d
what fracture
P

A

shoulder dystocia,

clavical fracture,

pneumothroax

195
Q

-External cephalic version

if baby presents how
will try to do what

Complications in Labor: Fetal position, presentation, size

A

If baby is breached-

will try to feel externally and move baby to correct position

196
Q

External cephalic version

this is done where
needs what
guided
constant what

Complications in Labor: Passage-

A

Done in OR- very painful,

needs iv,

ultrasound guided,

constant fetal heart tones

197
Q

External cephalic version

how long in gestation
monitor what during

Complications in Labor: Passage-

A

34-38 weeks gestation

Monitor FHR during

198
Q

External cephalic version
high risk of complications-

any signs of what
do what

Complications in Labor: Passage-

A

any sings of placenta burst

will do emergent c section

199
Q

Vacuum extraction/ Forceps birth

happens when
or if what
Complications in Labor: Passage -

A

Happens if having hard time pushing,

or if epidural is causing you to not feel anything

200
Q

Vacuum extraction/ Forceps birth
Watch for

v a
h
t d

Complications in Labor: Passage -

A

vaginal aspirations,

hemorrhage,

tissue damage

201
Q

Vacuum extraction/ Forceps birth

mom at risk for what
baby will have some what

Complications in Labor: Passage -

A

Mom risk for bleeding,

baby will have some head deformity(should even out in a few weeks)

202
Q

What is the greatest risk to the mother after giving birth?-

A

bleeding/ hemorrhage

203
Q

Lochia –what look like

rubra- what looks like+ how long
serosa- what looks like+ how long
alba- what looks like+ how long

A

Lochia rubra-redneded pieces-1-3 days

Lochia serosa-pink -7-14 days

Lochia alba-white/gray-10-14 days-up tp 6 weeks

204
Q

what does Abnormal lochia look like

never be what
never have what
means a possible what
no sex how long

A

–never be absence

or never should have foul oder-

possible infection

for 6 weeks-no sex

205
Q

Needs a focused assement, especially on pelvis postpartum

L
what does what
weight what
dont want mom to do what

A

Lochia –what look like

What does discharge look like/how much

Weight the peripads

Don’t want mom to flush after feeling gush of fluid

206
Q

Check uterus every few minutes for first few hours-

measure what

A

measure to make sure it is slowly shrinking down back to 0

207
Q

what are you pushing on after birth

watch for what

A

Push on the softball feeling-

as you push watch for any discharge that may be coming out

208
Q

why do you want mom to move around after postpartum

A

Want mom to move around because you don’t want blood to pool

209
Q

risk factors for uterine atony- uterus doesn’t contract enough after childbirth causing blood loss

what baby
retained what
p
L L

A

LGA baby,

retained placenta,

Pitocin,

long labor

210
Q

complications in postpartum

T- lack of what
B u-

4 t’s

A

lack of tone-

boggy uterus

211
Q

complications in postpartum

T- trauma-any what

4 t’s

A

any lacerations

212
Q

complications in postpartum

T-retained what

4 t’s

A

T- retained tissue

213
Q

complications in postpartum

T- thrombin-what issues

4 t’s

A
  • clotting factor or coagulation issues
214
Q

What are the PRIORITY actions by the nurse? Bleed
Deep fundal massage-

what do you do
assess what

A

will hurt, but will help- be very forceful to try and get uterus to clamp down-

assess what kind of drainage is coming out

215
Q

What are the PRIORITY actions by the nurse? Bleed

Pitocin in iv fluids-how does it work

A

aids in contracting of uterus

216
Q

If mom is stable and just a little bit of drainage-

have mom do what
helps what

What are the PRIORITY actions by the nurse? Bleed

A

can have mom breastfeed because it will

help cause uterus to clamp down

217
Q

Also just normal shock from hypovolemia-

lots of what
what products
what can stop bleeding

What are the PRIORITY actions by the nurse? Bleed

A

Lots of big iv,

blood products,

methergine can stop bleeding.

218
Q

What are the PRIORITY actions by the nurse? Bleed

is you cant reverse shock- can go into what

last chance is what

A

If cant reverse can go into DIC

Last choice is OR and getting hysterectomy

219
Q

Who is at risk? for postpartum infections

D
unstable what
compromise what
what type of birth

A

– diabetics,

unstable blood glucose,

compromised immune system,

traumatic birth

220
Q

Endometritis- uterus/// Perineum infection
s/s

what temp
what from incision
o
what hr
maybe-

Puerperal infections

A

increased body temp,

increased drainage from incision,

odor,

tahycardia,

maybe lethargic-

221
Q

Endometritis- uterus/// Perineum infection

may need what
watch for what

A

Watch for s/s of sepsis

May need PICC line

222
Q

Puerperal infections-Peritonitis- need to return to hospital immediately
signs of this

what abdomen
what pain

A

rigid like abdomen

belly pain

223
Q

Puerperal infections
Mastitis

infection where
s/s-(p/c/t)
can they breastfeed

A
  • breast tissue-

will have pain, chills , temp

yes, can breastfeed

224
Q

Puerperal infections

UTI- why can it happen x2

A

can happen from the birth iteself-

or foley placed-

225
Q

Puerperal infections

Urinary retention-

happens from what

A

retention can happen from the spinal epidural

226
Q

Postpartal depression-Who is at risk?

lack
hx

A

-lack of support,

hx of depression ,

227
Q

Postpartal depression

last longer then what

can moms control this

A

Longer than 1-10 days

Moms cannot control this- cannot just “get over”- need help

228
Q

how may moms look in postpartum depression

when do they come into hospital

A

Moms may be sleeping too much/not enough

need to come in if they have suicidal ideation

229
Q

teach postpartum depression to who

when will ob check

A

teach support person about watching/reporting

ob checks at week 6

230
Q

Postpartal psychosis-medical crisis

overwhelmingly what
non

A

Overwhelmingly sad

Non sleeping

231
Q

Postpartal psychosis-medical crisis

what state
lose what
will have what

A

Heightened manic state

Lost contact w/ reality

Will have hallucinations/ delusions

232
Q

Postpartal psychosis-medical crisis

what is needed

they may do what

A

Crisis intervention needed!-

may harm infant- never leave her alone or alone w baby

233
Q

breastfeeding jaundice

breastmilk jaundice

Pathologic Jaundice

A

Breastfeeding Jaundice- (caused by poor feeding practices)

BreastMIlK Jaundice -caused by milk composition.

Pathologic Jaundice- signs WITHIN 24hrs of life.-normal

234
Q

treating jaunduice

what therapy
how much skin
want a lot

A

light therapy with eye protection

as much skin exposed as possible

want baby to eat and have as much bowel movements as possible-gets rid of bilirubin

235
Q

How do you know a fetus is a risk?

prenatal hx->

what status
exposure to what
what conditions
is mom considered what
what of pregnancies

A

lower socialeconomical status may put baby at risk because they may not have access to healthy foods/ not get prenatal care/

exposure to toxic chemicals or any sorts of drugs,

preexisting conditions,

is mom considered a geriatric pregnancy,

amount and number of pregnancies

236
Q

what is Apgar

A

activity

pulse

grimace

appearance

respiration

237
Q

what Apgar score do you want

what if less then that

A

want 7-10

if less then 7 then you need interventions

238
Q

when’s Apgar done

x2

A

at 1 minute

at 5 minutes

239
Q

Lower the weight and degree of prematurity =

A

increased incidence of mortality and morbidity

240
Q

If baby is born to mother who has overdoses-

cant do what
who can you give It to

A

cannot give noloxone

  • can give to mom if she is overdose.
241
Q

what happens if you give naloxone to baby
end up w

p e
c a
s

A

pulmonary edema,

cardiac arrest,

seizures-

242
Q

babies born to narcotic addicted mothers look how

what apgar score
what appearance

A

have low apgar scores

flacid appearcne–

243
Q

If baby starts to aspirate-

do what first
why

A

assess and see how they do before putting down a tube or deep suctioning them-

this is because if they have mecomium in the lungs, we may make it worse, as opposed to if we just allowed it to happen

244
Q

Risk factors for mecomium-

mom has what tones
p labor
d labor
p labor
any what
I I
t
uses what

A

if mom has nonreasoning fetal heart tones,

premature labor,

difficult labor,

prolonged labor,

any intrapartum bleeding

, intrauterine infections ,

twins,

actively using narcotics

245
Q

Care of the newborn at risk for Asphyxia-Red Flags:

nonressuring
diffucult
fetal scalp what
significant what

A

Nonreassuring fetal heart pattern

Difficult birth, prolonged labor

Fetal scalp acidosis (pH < 7.2)

Significant intrapartum bleeding

246
Q

Care of the newborn at risk for Asphyxia-Red Flags:

maternal what
pre
c h d

A

Maternal infection/sepsis

Prematurity, SGA

Congenital heart disease

247
Q

Care of the newborn at risk for Asphyxia-Red Flags:

what abnormality
infant of what
what use in pregnancy

A

Structural abnormality

Infant of multiple pregnancy

Narcotic use in pregnancy

248
Q

Resuscitation of baby- how do you stimulate baby

A

Stimulation by rubbing newborns back w/ dry, warm, sterile towel

249
Q

Resuscitation of baby

infants head where
no what

A

Infant’s head in sniffing position;

no hyperextension

250
Q

Resuscitation of baby- suction only where

A

Suction (mucus, blood, meconium) only in mouth

251
Q

Resuscitation of baby- use of what inflates lungs

A

Use of positive pressure to inflate lungs

252
Q

Resuscitation of baby- what helps to not overinflate lungs

A

Use bag and mask w/ manometer

253
Q

Resuscitation of baby

how fast chest compressions
do you give supplemental 02

A

Chest compressions 100 per minute

Supplemental 02 not utilized right away unless central cyanosis & Sp02 low (Too much 02 can cause long-term adverse effects)

254
Q

Resuscitation of baby

may need what
if you do that- then also give them what

helps w what

A

Endotracheal intubation

If you need to intubate the baby- give surfactant through ET tube

to develop lungs

255
Q

Resuscitation of baby Medications

256
Q

Resuscitation of baby

always check what
for what
give what

A

Also check glucose-

hypoglycemia can also show up as unrepsosive baby-

give dextrose

257
Q

Resuscitation of baby- when do it

what Apgar score
what appearance
not doing what
not doing what

A

Apgar less then 7,

flaccid appearance,

not crying,

not breathing,

258
Q

Fluid & Electrolyte balance

what can develop after resuscitation

consider what then after

A

Hypoglycemia can develop in all infants after resuscitation!

Consideration for D10 Solution IV

259
Q

Fluid & Electrolyte balance

what urine output
how weigh output

A

Urine output should be equal to or higher 2 ml/kg/hr

Measure diapers to weigh output

260
Q

Fluid & Electrolyte balance

closely monitor what
consider what x2

A

Fluids = monitor closely to avoid overload

Consider isotonic fluids, dopamine

261
Q

Radiation

what is it
examples

Regulating Temperature- prevent cold stress=prevent cardiac arrest

A

transfer of body heat to a cooler solid object NOT in contact with baby

heat from baby moving to an open window

262
Q

Convection

Regulating Temperature- prevent cold stress=prevent cardiac arrest

A

-flow of heat from body surface to cooler surrounding air-

air conditioner /open window

263
Q

Conduction

Regulating Temperature- prevent cold stress=prevent cardiac arrest

A

-transfer of heat to solid object in contact with baby-

cold stethoscope on skin

264
Q

Evaporation

Regulating Temperature- prevent cold stress=prevent cardiac arrest

A

loss of heat through conversion of a liquid to a vapor

amniotic fluid evaporation when born

265
Q

what happens when babies shiver

need to give what

A

shiver- use up more energy and become hypoglycemic-

give dextrose

266
Q

how to keep babies warm

warm b
dont do what right away
warm r
what on them
watch what

A

warm blankets

, don’t bathe right away

, warm room

, hat on them,

watch temp

267
Q

why are premature babies at risk for cold stress

what age is that developed

also does what

A

they dont have brown fat

developed at 36 weeks

helps store glucose

268
Q

Nutritional Intake

ensure what before feedings

why

A

Ensure the newborn is stable before attempting feedings

Sucking is hard work for a preterm!

269
Q

Nutritional Intake-May need what if possible

what feeding
via what

A

gavage or gastric feedings w/ breast milk

via NG or gastric tube

270
Q

Nutritional Intake-may need

what regulation
what iv
what type of feedings

A

Glucose regulation,

dextrose IV

,ng tube synringe feedings

271
Q

Nutritional Intake- why might it be hard for babies- dont have enough what

A

May not have enough surfacnat in lungs to do adequate breathing while they are trying to eat.

272
Q

s/s of distress while feeding

c
struggling to do what

A

cyanosis,

struggling to breathe while eating,

273
Q

Preterm Infant

preterm = how early
what is late preterm
what is early preterm

A

Born before the end of 37 weeks gestation

Late preterm = 34 – 37 weeks

Early preterm = 24 – 34 weeks

274
Q

preterm infant- Health problems are associated with immaturity of body systems-

what is number 1 priority
give what pre birth

A

number 1 priority is immature lung development

  • give some steroids pre birth to help develop some lung development
275
Q

Preterm Infant Assessment

head appears how
what skin
what present
L
no what on hands/feet
what eyes
what ears
immature what

A

Head appears larger

Rudy skin w/ no subcutaneous fat

Acrocyanosis present

Lanugo- body hair

No sole creases on hands/feet

Small eyes

Larger ears, cartilage is not formed

Immature CNS

276
Q

SGA (Small for gestational age) Infant Risks:

mom has what
what BP
s
I
T
O

Birth weight is 10th percentile on the intrauterine growth curve

A
  • mom has preeclampsia,

HTN,

smoker

IUGR (Intrauterine growth restriction)

Twins,

Oligohydramnios- low amniotic fluid

277
Q

SGA (Small for gestational age) Infant

look how- but what
what eyes

A

Normal but small organs / appearance

Wide eyed

278
Q

SGA (Small for gestational age) Infant

risk for what x2

A

hypoglycemia

infections

279
Q

IUGR (Intrauterine growth restriction)

failed to do what

caused by what

A

Failed to grow at the expected rate,

Caused by stress on the infant in utero

280
Q

IUGR (Intrauterine growth restriction)

muscles look how
what respirations
what eyes
s

A

Muscles appear wasted away

Gasping respirations,

wide eyed,

spastic

281
Q

IUGR (Intrauterine growth restriction)

deliver when
why

A

Can deliver at 31-32 weeks,

will grow better outside of mom-

no more room inside of mom

282
Q

LGA (Large for gestational age) Infant

baby is what
but also what

A

baby is huge

but also deceptively healthy

283
Q

LGA (Large for gestational age) Infant

Monitor for:
h
p
what difficulties

A

Hypoglycemia- drops quickly after birth

Polycythemia

Breathing difficulties

284
Q

LGA (Large for gestational age) Infant-Priority

what fracture
what difficulty

A
  • clavicle/humorous fracture,

breathing difficulties d/t not enough surfactant,

285
Q

LGA (Large for gestational age) Infant

born to who

may have what

A

Born to diabetic mothers

May have congenial abnormalities

286
Q

LGA (Large for gestational age) Infant-Polycythemia-

appear how
needs what
this can cause what
then appear how

A

inc red blood cells, so will appear pink and healthy-

need to be able to break these down

, this can then cause anemia,

and can appear jaundiced

287
Q

LGA (Large for gestational age) Infant

can alter what
may not get what

A

Can alter pulse ox readings-

may not be able to find 02 dropping right away

288
Q

LGA (Large for gestational age) Infant-Signs that they are struggling with breathing-

g
c
n f
what in chest

A

grunting,

cyanosis,

nasal flaring,

retractions in chest,

289
Q

Post Term Infant-

extends past how long

how do they present

A

extends past 42 weeks

could present as either SGA, AGA, or LGA depending on placenta

290
Q

Characteristics of post maturity syndrome-High risk for morbidity & mortality due to poor placental function ->

h
a
h
m a

A

hypoxia

Asphyxia

Hypoglycemia

Meconium aspiration

291
Q

Characteristics of post maturity syndrome-High risk for morbidity & mortality due to poor placental function ->

p
what abnormalties
s
what stress

A

Polycythemia

Congenital anomalies

Seizures

Cold stress

292
Q

Respiratory Distress Syndrome (RDS) in newborn-Assessment

c
what rr
what respirations
n f
significant what
a

A

: cyanosis,

tachypnea,

grunting respirations,

nasal flaring,

significant retractions,

apnea

293
Q

Respiratory Distress Syndrome (RDS) in newborn-Causes:

most common cause->
m a s
s
what transition
p

A

Preterm (most often) from not enough surfactant

Meconium aspiration syndrome

Sepsis

Slow to transition to mom

Pneumonia

294
Q

Respiratory Distress Syndrome (RDS) in newborn

notice when
what type of breathers

A

Can notice during eating.

Obligate nose breathers.

295
Q

Respiratory Distress Syndrome (RDS)–Will require treatemnt

immediate what
possible what
maybe needs what
what med

A
  • immediate assessment,

possible surfactant,

maybe needs intubation,

needs antibiotics

296
Q

Transient Tachypnea of the Newborn

due to what

occurs more in what

why not in vaginal

Illnesses that occur in newborns at risk:

A

Due to inability to clear airway of secretions

Occurs more often in cesarean born infants

In vaginal birth, the contractions will squeeze out secretions, don’t get that in c section

297
Q

Transient Tachypnea of the Newborn

S/Sx of what after birth

Illnesses that occur in newborns at risk:

A

respiratory distress shortly after birth

298
Q

Transient Tachypnea of the Newborn

how treated x2

happens how quick post delivery

Illnesses that occur in newborns at risk:

A

Can be treated quickly by suctioning, possible oxygen

48-72 hours post delivery

299
Q

Transient Tachypnea of the Newborn
What is the difference between RDS and this?

RDS why
transient why

Illnesses that occur in newborns at risk

A

RDS happens as a lack of surfactant,

transient can happen in near term from stress of not being able to clear secretions

300
Q

Meconium Aspiration Syndrome

how does it happen

what does it lead to

Illnesses that occur in newborns at risk:

A

Due to relaxation of anal sphincter usually secondary to asphyxia  expelling meconium stool  meconium-stained amniotic fluid which is then inhaled by fetus

respiratory problems including pneumonia

301
Q

Meconium Aspiration Syndrome

may require what
what is red flag

Illnesses that occur in newborns at risk:

A

May require mechanical ventilation

Red flag is if meconium is present at birth

302
Q

Meconium Aspiration Syndrome

Treatment:
what to baby
do you suction/what kind
possible what

Illnesses that occur in newborns at risk:

A

: assess baby,

hold off on suctioning if possible, can do bulb suction.

Possible antibiotocs for aspitration pnemononia

303
Q

Hemolytic Disease of the Newborn (Hyperbilirubinemia)

what is it

Illnesses that occur in newborns at risk:

A

Early jaundice (within first 24 hours) is most often caused by ABO incompatibility or Rh Incompatibility (rare now because of rhogam)

304
Q

Hemolytic Disease of the Newborn (Hyperbilirubinemia)

Treatment

Illnesses that occur in newborns at risk:

A

Dependent on blood levels not cause

305
Q

Hemolytic Disease of the Newborn (Hyperbilirubinemia)-

What can happen if not treated?

Illnesses that occur in newborns at risk:

A

Kernicterus (permanent brain damage) and severe anemia which can

erythroblastosis fetalis

hydrops fetalis (fluid on the heart or other organs)

death

306
Q

Hemolytic Disease of the Newborn (Hyperbilirubinemia)

watch for what as well

Illnesses that occur in newborns at risk:

A

Also, watch for hypoglycemia in these infants!

307
Q

Hemolytic Disease of the Newborn (Hyperbilirubinemia)

when is jaundice a concern

Illnesses that occur in newborns at risk:

A

Jaundice is a concern when it extends past nipple line, starts from head and goes down

308
Q

Hemolytic Disease of the Newborn (Hyperbilirubinemia)

when is late jaundice
Is this a bad thing

Illnesses that occur in newborns at risk:

A

Late jaundice (24-72 hrs after)

may be normal from RBC being destroyed

309
Q

Hemolytic Disease of the Newborn (Hyperbilirubinemia)
Labs-Total serum bilirubin level

what is normal
what is dangerous in term infant
what is dangerous in preterm

Illnesses that occur in newborns at risk:

A

normal is 0-3 mg/100ml

Term infant w/ bilirubin above 20 mg/dL is dangerous!

Preterm infant w/ bilirubin above 12 mg/dL is dangerous!

310
Q

how do you check labs in newborn

A

Check w a heel stick poke

311
Q

Hemolytic Disease of the Newborn (Hyperbilirubinemia)- Treatment-

what is initial treatment
p
what transfusion

Illnesses that occur in newborns at risk:

A

Early feeding is initial treatment

Phototherapy

Exchange transfusion

312
Q

Hemolytic Disease of the Newborn (Hyperbilirubinemia)- Treatment:

what med
also want to prevent what

Illnesses that occur in newborns at risk:

A

Medications  erythropoietin

Prevent dehydration

313
Q

what is greatest risk factor in Hyperbilirubinemia

what happens if they are hydrated

A

Dehydration is greatest risk factor-

increased probability that it will become worse-

if pt is hydrated, it will flush bilirubin out of body

314
Q

-Hemolytic Disease of the Newborn (Hyperbilirubinemia)-
Billi blanket-

-how long leave the baby under there for
-can become what
-how do you dress them

Illnesses that occur in newborns at risk:

A

do not leave under blanket for longer then they need to be,

can become hyperthermic

Do not put them under w anything more then a diaper

315
Q

Hemolytic Disease of the Newborn (Hyperbilirubinemia)

always have what on them in photo therapy

Illnesses that occur in newborns at risk:

A

Always have a pulse ox and a temp sticker on them

316
Q

Hemolytic Disease of the Newborn (Hyperbilirubinemia)

what does mild jaundice get

what does severe jaundice get

Illnesses that occur in newborns at risk:

A

Mild jaundice goes home w billiblanket

Severe jaundice gets photo therapy light box and that’s done in hospital

317
Q

Hemolytic Disease of the Newborn (Hyperbilirubinemia)

severe jaundice can also get what

waste goes through where

Illnesses that occur in newborns at risk:

A

Severe can also get donor blood

waste goes through umbilical vein

318
Q

Illnesses that occur in newborns at risk:
Anemia

normal to have for how long

A

Normal to have physiologic anemia for 6-12 weeks

319
Q

Illnesses that occur in newborns at risk: - polycythemia

increased what
hyper what
what blood flow to tissues

A

Increased blood volume and hematocrit

hyper viscosity (thickness) of the blood

↓ blood to tissues

320
Q

Illnesses that occur in newborns at risk: - polycythemia

what h/h

A

Hct over 65-70% (normal 49-61%)

Hgb over 22 g/dl (normal 14-20g/dl)

321
Q

Illnesses that occur in newborns at risk: - polycythemia

most common in :

I
full term infants w what
what transfusion
chronic what
what abnormalities

A

IUGR,

full-term infants with delayed cord clamping,

maternal-fetal & twin-to-twin transfusions,

chronic intrauterine hypoxia

, chromosomal anomalies

322
Q

polycythemia

increased risk for what
decreased what

Illnesses that occur in newborns at risk: -

A

Increased risk for DVT/ Pe

decreased blood to tissues

323
Q

Etiology->

Illnesses that occur in newborns at risk: Necrotizing Enterocolitis (NEC)

A

: Unknown but can result from poor perfusion in the gut

324
Q

Necrotizing Enterocolitis (NEC)- whose at risk

what infants
f f
s

Illnesses that occur in newborns at risk:

A

Preterm infants /

formula feed /

SGA

325
Q

Necrotizing Enterocolitis (NEC)-Manifestations

what intolerance
what diarrhea
L
A
what hr
what abdomen

Illnesses that occur in newborns at risk:

A

Feeding intolerance-spit up

Bloody diarrhea (occult blood)

Lethargy

Apnea

bradycardia

Super distended abdomen

326
Q

Necrotizing Enterocolitis (NEC)Interventions

frequent what
asucaltae what
may need what

Illnesses that occur in newborns at risk:

A

Frequent vitals including temp

Auscultate bowel sounds

May need gastric tube

327
Q

Necrotizing Enterocolitis (NEC) Interventions

stop what
strict what
watch what
what med

Illnesses that occur in newborns at risk:

A

Stop oral feeds

Strict NPO

Watch skin integrity

Antibiotics right away

328
Q

what is only chance of survival in necrotizing enterocolitis

A

OR is the only chance of survival

329
Q

Group B strep infection-
can cause what:

N b
I
s

Newborn at risk from maternal infections

A

can cause newborn blindness,

infection,

sepsis,

330
Q

Newborn at risk from maternal infections-
Ophthalmia Neonatorum-

blindness from what

A

blindness from chlamydia ghonneora

331
Q

Newborn at risk from maternal infections-
Hepatitis B virus –

when does this happen
how prevent this

A

post delivery-

vaccine for this

332
Q

Newborn at risk from maternal infections-
Herpes infection –

what do you get if active herpes

A

if active herpes mom needs c section

333
Q

HIV infection
-moms get what

what special c section

Newborn at risk from maternal infections

A

moms receive screening for HIV to test, and work to prevent infection-

bloodless c sections- cauterize every bleed with every cut

334
Q

Newborns wont always show an elevated temp as a sign of infection->

L
won’t do what
wont what as much
will be Q/L

Newborn at risk from maternal infections

A

may be lethargic

, wont eat,

wont cry as much,

will be quiet and limp

335
Q

Diabetes mellitus

Large infant- pathophyscioology

increased what

Newborn at risk from maternal illnesses:

A

: ↑ glucose to infant =

↑ production of insulin

=↑ utilization of glucose (↑ storage of glucose)=

fat baby\

336
Q

Diabetes mellitus

what helps to manage risks in newborn

Newborn at risk from maternal illnesses:

A

Prenatal management helps decrease risks to newborn

337
Q

Diabetes mellitus
After delivery:

monitoring what
risk for what
early what

Newborn at risk from maternal illnesses:

A

Monitoring blood glucose levels:

at risk for hypoglycemia

early feedings

338
Q

Diabetes mellitus-Assess for complications (LGA)-

what fracture
risk for what

Newborn at risk from maternal illnesses:

A

humerus/clavical fracture,

risk for pneumpthorax

339
Q

Diabetes mellitus

what blood glucose number

Newborn at risk from maternal illnesses:

A

Want a blood glucose of at least 60 on a stick

340
Q

Diabetes mellitus- s/s of hypoglycemia- If babies are

t
j
p
what cry

need to get what

Newborn at risk from maternal illnesses:

A

tired,

jittery,

pale

weak cry,

first thing is get a blood glucose

341
Q

Diabetes mellitus

If you cant control their glucose with feeding- do what

Newborn at risk from maternal illnesses:

A

transfer and get d10 infusion

342
Q

Newborn at risk from maternal illnesses: Drug-dependent mother
s/s

extremely what
not what
t
y
s
what cry

A

Extremely irritable,

not sleeping,

tremors

, yawning,

sneezing,

high pitched cry

343
Q

Newborn at risk from maternal illnesses: Drug-dependent mother

want to do what
what type of room
give what

A

Want to Swaddle,

low stimulation in room,

pacifier

344
Q

Medications to control withdrawal symptoms-

give them what
monitor w what

Newborn at risk from maternal illnesses: Drug-dependent mother

A

give them morphine as well

ciwa-

345
Q

Nutritional support in this
can you give them narcan

Newborn at risk from maternal illnesses: Drug-dependent mother

A

may not want to eat/eat all time

no narcan

346
Q

Fetal alcohol spectrum disorder (FASD): how present

I
m
c p
what lip
failure
what iq
what damage

Newborn at risk from maternal illnesses: Fetal Alcohol Exposure

A

IUGR,

microcephaly,

cerebral palsy,

short palpebral fissure and thin upper lip,

failure to thrive,

impact on IQ,

CNS damage as evidenced by impulsivity, cognitive impairments, speech & language abnormalities

347
Q

Cleft lip/palate

risk x2

Newborn care of child w/ physical or developmental challenge: GI complications

A

Malnutrition risk

Aspiration/pneumonia Risk

348
Q

Cleft lip

D isues
s c issues

A

Dental issues

Speech clarity issues

349
Q

cleft lip may have

complications from what
may need what d/t what

A

Surgical complications

Emotional support/facial deformity

350
Q

Cleft lip

what can help decrease aspiration

may need what

may wait for what

A

There is some direct fit bottles that help decrease risk of aspiration

May need g tube

May wait for sugery

351
Q

Omphalocele

Gastroschisis

what is difference

A

Internal organs are born externally but in a sac

Gastroschisis- not in a sac

352
Q

what do you do in omphalocele/ gastroschsis

what right away

A

Want to cover these right away with sterile dressing/bag

Surgery right away

353
Q

high risk for infection in omphalcole/ gastroschisis

place what
give them what

A

place ng tube in kids

give them antibiotics

354
Q

Tracheoesophageal Fistula (Esophageal Atresia)

milk can go where
resulting in what

Newborn care of child w/ physical or developmental challenge: GI complications

A

During feedings milk can fill the blind pouch of the upper esophagus and then overflow into the trachea, or fistula can allow milk enter the trachea resulting in aspiration

355
Q

Tracheoesophageal Fistula (Esophageal Atresia)

what happens in this

Newborn care of child w/ physical or developmental challenge: GI complications

A

Upper and lower part of esophagus don’t meet up properly

356
Q

Tracheoesophageal Fistula (Esophageal Atresia)

always watching for what
if they have this-> need what right away

Newborn care of child w/ physical or developmental challenge: GI complications

A

Always watch first feeds to make sure they can tolerate-

if they have any assessment findings that they have this then they need surgery right away

357
Q

Spina Bifida

what happens in this

Newborn care of child w/ physical or developmental challenge: Neuro tube defects

A

Congenital condition in which the spinal cord does not develop properly due to incomplete closure of the neural tube

358
Q

Spina Bifida

will be born how
lay them how after birth

Newborn care of child w/ physical or developmental challenge: Neuro tube defects

A

Born via c section-

lay them prone w butt in the air

359
Q

Spina Bifida

risk factors

how prevent this

Newborn care of child w/ physical or developmental challenge: Neuro tube defects

A

Risk factors is lack of folic acid

want prenatal vitamins

360
Q

Spina Bifida

how repair this

Newborn care of child w/ physical or developmental challenge: Neuro tube defects

A

Surgical repair

361
Q

risk for what x3 in spina bifida

I
M
altered what

A

Infection Risk

Malnutrition

Altered Cerebral Perfusion

362
Q

Care of the Family with birth of a high risk newborn

GREIF

A

Anticipatory grief

Acknowledgement of maternal failure

Resumption of process of relating to infant

Understanding special needs and growth patterns

4-Fourth Semester (3 decks)

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