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NUR 209 - Maternaty > Exam 3 - Powerpoints > Flashcards

Exam 3 - Powerpoints Flashcards

1
Q

What causes babies to breath at delivery

A

mechanical, chemical, thermal, sensory

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2
Q

Mechanical causes for breathing

A
  • pressure on chest from birthing - oozing coming from mouth and nose that Dr sucks out - c-s babies requires more suctioning and are kept sideways or upright to get more drainage
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3
Q

chemical causes for breathing

A

increase of CO2 and decrease of O2 –> stims medulla to breath (gasping)

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4
Q

thermal causes for breathing

A

from warm 98F to 68F while wet - cold causes contrition and faster breathing

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5
Q

sensory causes for breathing

A

touch - such as rough drying of a baby, light and sounds

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6
Q

what causes continuation of respiration

A

getting babies to cry causes surfactant circulate into alveoli to progressively open them up making each breath easier

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7
Q

Benefits of delayed cord clamping

A

30-60 sec - increases blood volume by 50% (75 - 125 ml) to the baby - the increases increases RF for jaundice bc babies lack ability to break down excess heme from blood

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8
Q

Ix for excess blood in babies

A

proper feeding for it can poop it out or UV lights to break more down

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9
Q

RN responsibilities at delivery

A

APGAR - resuscitation - VS - meds (vit K in vastus lateralis, erythromycin) - bonding with mom (kangaroo care [skin to skin], breast feed within 1 hr)

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10
Q

APGAR timings

A

1, 5 and (10) min

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11
Q

APGAR general facts

A
  • 0-2 per categories
  • higher is better
  • ones occasional
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12
Q

APGAR categories

A
  • Activity (muscle tone)
  • Pulse
  • Grimace (reflex irritability)
  • Appearance (skin color)
  • Respiration
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13
Q

Activity scores

A

(0) absent
(1) sluggish and minimally flexed arms and legs
(2) active and flexed arms and legs

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14
Q

Pulse Scores

A

(0) absent
(1) < 100 BPM
(2) > 100 BPM

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15
Q

Grimace Scores

A

(0) Floppy (no response to suction or slap on soles)
(1) Minimal Response to stimulation
(2) Prompt response to stimulation with cry

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16
Q

Appearance Scores

A

(0) Pale; Blue
(1) Pink body; blue extremities
(2) Pink (light skined), cyanosis absent (dark skinned); mucous membranes

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17
Q

Respiration Scores

A

(0) Absent
(1) Slow and irregular or weak cry
(2) Vigorous cry

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18
Q

Ix for Appearance score of 1

A

check temp and teach what it means blue should disappear within 1 hour - caused bc babies’ hearts delivering blood to major organs first then peripherally - parents will think that baby is cold

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19
Q

Ix for 1s on APGAR

A

Ix depend on 1 but are required

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20
Q

can babies be circumcised if parents refuse vitamin k

A

NO

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21
Q

Should vitamin K be given when an assisted delivery

A

yes - parents must be edu if they dont want it because of high RF bleeding

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22
Q

Newborn reflexes (7-8)

A
  • Sucking and Rooting (touching cheek and it turning to suck)
  • Swallowing
  • Grasp (Palmar, Plantar)
  • Extrusion (sticking tongue out )
  • Tonic neck or ‘Fencing’ (head turned and arm facing is stretched out, arm behind is bent up)
  • Moro Reflex
  • Babinski’s (big toe bends up and other toes fan out)
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23
Q

When are newborn reflexes checked

A

within 30 min

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24
Q

Newborn assessments

A

–Match bands, VS, color, skin, cord and circumcision

fontanels, Ears, Mouth, Neck, Chest,
genitals, Urine, Hips, Hair, Sacrum, rectum

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25
Q

fontanel assessment

A

depressed or bulging

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26
Q

ear assessment

A

symmetrical (down syndrome babies’ ears have ears lower than eye level)

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27
Q

mouth assessment

A

feeling for palate – suck and swallow reflex

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28
Q

neck assessment

A

folds, move/assess clavicles (can be broken if the bone moves, xray to confirm, from suprapubic pressure)

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29
Q

chest assessment

A

breathing, barrel-chest,

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30
Q

genitals assessment

A

descended testes, hypospades
minora bigger than major at birth

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31
Q

urine assessment

A

begin blood in early urination

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32
Q

hips assessment

A

hip dysplasia from a macrosomia baby – when baby is prone one cheek is higher than the other

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33
Q

hair assessment

A

preterm babies are hairy, term are not

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34
Q

sacrum assessment

A

for dimple - if open possible spinal bifida

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35
Q

rectal assessment

A

for patent rectum

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36
Q

Normal elimination for meconium

A

Meconium within 24 hrs (if not it is possible obstruction) void
- have parents save all diapers

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37
Q

Normal passive immunity adaptations

A

lasts 4 weeks, PT infants are more susceptible to infection

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38
Q

Normal visual and auditory adaptations

A

Alert, able to follow with eyes and hear,, able to recognize mom’s voice

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39
Q

Normal Olfactory/taste/tactile adaptations

A

smell of mom, sensitive to touch, able to interact
- may have sniffles bc of mucus from birth

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40
Q

Breastfeeding facts and positioning

A
  • positioning most important
  • keep babies head at 90*
  • mouth on whole areola not just end of nipple
  • feeding done on babies’ demand (rooting, open mouth crying)
  • always start with second breast from last feeding
  • feed ~1 hr but at least once every 3 hr
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41
Q

Cluster feeding

A

when baby feeds multiple times in a few hours

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42
Q

Mastitis causes

A
  • poor latching or poor breast emptying
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43
Q

Mastitis SS

A

(infected milk gland) hard lump in breast, malaise, flulike symptoms, fever

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44
Q

Mastitis Ix

A

always position correctly and always start with breast you ended with last time

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45
Q

Newborn screening

A
  • PKU (phenylketonuria)
  • Hearing test
  • Bilirubin test
  • hepatitis vaccine
  • CCHD - congenital cardiac HD (pulse ox on right hand and either foot - pulse ox should be within 3% of each foot)
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46
Q

Bilirubinemia (–> Jaundice) Causes

A

increased bilirubin to liver from RBC destruction, traumatic birth, RH incompatibility, poor feedings

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47
Q

Bilirubinemia Ix

A
  • feed often
  • monitor output
  • phototherapy
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48
Q

Parent Discharge teaching

A
  • Cord, circumcision care
  • void 6-8 diapers a day
  • >3 bowl movements in breastfed babies
  • SS of infection
  • SIDS
  • Car seat test
  • Jaundice
  • feeding well for 24 hrs
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49
Q

Caput succedaneum

A

localized edema from pressure of vaginal vault that is benign and goes away

  • goes past the bones under the skin
  • caused bu swelling
  • Both eventually go away in ~24 hr
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50
Q

Cephalohematoma

A
  • Goes up to the bones (periostium) but not past it
  • higher risk for jaundice
  • Ix is vitamin K
  • caused bleeding
  • Both eventually go away in ~24 hr
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51
Q

Ortolani test

A

hip click indicates hip displasia

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52
Q

SA of baby compared to adult

A

baby SA is 4x more

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53
Q

how do babies keep warm

A

they used brown fat that burns glucose, and can cause glucose depletion

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54
Q

Babies dont shiver they ….?

A

jitter

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55
Q

Priority assessments and actions for cold or cold-exposed babies

A
  • assess BG (most hospitals have standing orders to poke babies PRN)
  • keep baby awake by tapping foot or changing diaper
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56
Q

Methods of baby heat loss

A

Convection, Radiation, Evaporation, Conduction

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57
Q

conduction

A

heat loss via direct contact on a surface

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58
Q

convection

A

heat loss via circulating cooler air

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59
Q

radiation

A

heat transfer not through direct contact (being by cold windows or outside walls)

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60
Q

evaporation

A

air drying of skin that causes cooling (baby being wet)

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61
Q

cold pathway in baby

A
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62
Q

Circumcision facts

A
  • Consent must be signed
  • must have peed first bc dont know if ~ can affect ability to pee
  • post op vaseline on penis and gauze and immob so it doesnt rub against diaper
  • Baby needs to be restrained (swaddle top half?) and monitored for pain (crying and increased VS)
  • dont pick at scab
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63
Q

Non-pharm pain management techniques

A

swaddleing, skin-skin, breastfeeding, mothers voice, sucrose water

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64
Q

Hyperbilirubinemia causes

A

delayed clamping

tramatic birth

poor feeding

intestinal obstruction

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65
Q

Hyperbilirubinemia Dx

A

Dx by bilirubin nomogram (age in hours, x-axis; serum bilirubin in mg/dl, y-axis)

> ~5-7 in first 24 hours

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66
Q

Kernicterus

Dx and causes

A

Bilirubin >25 mg/dl

Acute Bilirubin Encephalopathy

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67
Q

Acute Bilirubin Encephalopathy

A

causes bilirubin deposits in basal ganglia and stem

disrupts neuronal function and metabolism

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68
Q

Acute Bilirubin Encephalopathy

Adverse effects

A

cerebral palsy

epilepsy

mental retardation

death

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69
Q

Acute Bilirubin Encephalopathy Ix (missing information)

A

VS monitored

strict I/O (breastfeeding in mins, there will be supplemental feeding sources)

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70
Q

baby RR

A

30 - 60

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71
Q

baby HR

A

120 - 160

110-160 in utero

72
Q

RF for RDS (Respiratory Distress Syndrome)

A

Preterm

meconium

DM mother

macrosomia mother

73
Q

what benign causes might cause a baby to show signs of RDS?

A

transitioning to air so check pulse ox

74
Q

SS of sepsis

A

inability to maintain temperature (will get cold)

poor feeding, lethargic, irritable, low urine output

difficulty breathing is a late sign

75
Q

maternal signs of fetal sepsis

A

Fever, high WBCs, uterine infection, too many vaginal exams, GBS, meconium, prolonged rupture of membranes, macrosomic babies (ms babies higher RF RDS or pneumothorax)

76
Q

fetal signs of sepsis

A

TC > BC (if TC check mothers temp)

decreased fetal movements

absent/min late decels; lack of acels

77
Q

Fetal Sepsis Ix

A

monitor FHR

mother’s temp q1-2Hr after rupture

1-2 hrs after give ATB prophylactically

section meconim if its thick otherwise nothing

78
Q

infant CPR

A

30 compressions

2 breaths

check brachial pulse which is on the inner side of biceps for no more than 10 sec

79
Q

NICU needs to be

A

quiet and organized

noise can increase VS in PT or sick infants even cardiac arrest

80
Q

Preterm (PT) - weeks and min viable age

A

20 weeks - 37 weeks and 6 days

anything over 23 weeks can be saved but slim

dont wan to deliver until it must be

81
Q

PT infant appearance

A

ruddy (deep red; very vascular high RBCs [high RF jaundice])

transparent thin skin

small and not very flexed

cant really cry (increased VS for pain level)

82
Q

PT infant problems

A

CV, Respiratory (RDS), GI, CNS, F/E imbalance, thermoregulation, immunity, feeding, pain sensation

  • care must be given in small bits, give report away from baby so it doesnt get over stimulated
83
Q

Late preterm infant age

A

34 weeks - 37 weeks and 6 days

84
Q

Ix for late PT infants

A

observe how they are feeding and are they stable?

VS q 4 Hr

moniter for sepsis, and BG until 3 normal in a row (must eat at least every 3 hours)

85
Q

Car seat test

A

infant put into seat while in NICU while VS are monitored closely for 2x drive to see if their VS are stable

86
Q

Post term infant at risk for

A

RF infection, meconium (passes because in tight quarters and low amniotic fluids make thick meconium), degradation/calcification of placenta thus decreasing perfusion

87
Q

post term infant appearance

A

thick creases on hands and feet, dry skin, ruddy skin, dark ruggae on skin

88
Q

SGA

A

small for gestational age

89
Q

LGA

A

large for gestational age

90
Q

gestational age assessment

A

measurement of child’s weight, hight, and head circumference to see if its appropriate for the child’s supposed gestational age

91
Q

if mother was DM and baby is SGA/LGA baby should be checked for …

Ix ….

A

hypoglycemia (SGA: reduced nutrition to baby, mom could be preeclamptic from low perfusion; LGA: baby exposed to high BG from mothers DM)

Ix - tight feeding schedule

92
Q

baby BG must be above …

A

40 mg/dl

93
Q

SIDS teaching

A

Have baby alone (nothing else in crib such as blankets?), on their back, pacifier to keep baby alert (not recommended bc baby can confuse for nipple)

supervised tummy time (starting from day 1 to prevent flat head)

Avoiding smoking in house

keep baby form getting too hot

never leave baby alone

94
Q

indications for dx testing

A

To detect genetic abn and evaluate fetal conditions to monitor and help fetues

95
Q

first trimester purpose and tests

A

for viability and dates

US

hGC

Progesterone

CVS

96
Q

second trimester tests purpose and tests

A

Age and growth

US

MSAFP

Amniocentesis

97
Q

third semester tests

A

fetal movement

NST

Vibroacoustic stimulation

BPP

CST

98
Q

first trimester US and hGC are used to …

A

US: determine gestational age and any abn of the uterus, viability, or tumors

hGC: determine pregnancy

99
Q

second trimester US and amniocentesis can be used to …

A

US: determine anomalies in fetus or growth rate

Amnio: confirm MSAFP

100
Q

vibroacoustic test

A

startles the fetus

101
Q

purpose of the doppler US

A

determine if there are any blood flow problems; red moves toward transducer and blue away

not done for every pregnant mom

102
Q

indications for dopper US

A

mother has HT, smokes, DM where the baby would be expected to be SGA

103
Q

MSAFP

what

purpose

when

A

Maternal Serum Alpha-fetoprotein

used to test for NTD defects and Down Syndrome

can only be accurately done at 16-18 weeks so a US is crucial before testing

104
Q

MSAFP problems and caused by

A

many false positives caused by wrong gestational age, maternal wt, multifetal pregnancies, race, maternal DM

105
Q

Increased MSAFP indicate

A

Open NTD

threatened abortion

normal fetus + underestinated gestational age

106
Q

low MSFAP indicate

A

Down syndrome or trisomy 21

normal fetus + overestimated GA

107
Q

Amniocentesis risks

A

maternal : hemorrhage, infection, labor

fetal: death, hemorrhage, direct injury

risks mixing blood so give RhoGam

108
Q

second trimester amniocentesis would be done to …

A

confirm abn MSAFP

109
Q

third trimester amniocentesis would be done to …

A

confirm lung development if in PT labor; if in PT labor would give betamethasone and delay for as long as 24 hours

110
Q

Why would a CVS be done?

A

This test is done if a patient has experienced many spont. abortions. This test will confirm any genetic anomalies. The purpose of this test is for the patient to decide if they want to abort the baby at an early trimester.

111
Q

How is CVS done and what are the risks?

A

Extracts villi. This test can be done vaginally or abdominally guided by ultrasound. High risk to injury of fetus and loss of pregnancy.

112
Q

NST result requirements

A

>= 2 acels in 20 min

113
Q

Ix when non-reactive stress test (non-reassuring)

A

turn pt, give water or food, use a vibroacoustic stimulator

bad if no change

114
Q

BPP categories (5)

A

all or nothing; 2 or 0 points each

NST/ Reactive FHR

US: fetal breathing movements

US: fetal activity

US: fetal muscle tone

US: qualitative AFV/AFI

115
Q

BBP purpose

A

used to determine if the baby would need to be delivered or the amount of amnio fluid

116
Q

What is AFV or AFI?

A

amniotic fluid volume

amniotic fluid index

117
Q

10/10 BBP interpretation and actions

A

normal

repeat 1-2 weeks

118
Q

8/10 (normal AFI) BBP interpretation and actions

A

RF asphyxia rare

repeat in 1-2 weeks

119
Q

8/8 (w/o NST)

8/10 (abn AFI)

BBP interpretation and actions

A

normal: repeat in 1-2 weeks

chronic asphyxiation suspected: induce birth

120
Q

6/10

BBP interpretation and actions

A

possible asphyxia

AFI –> Deliver

Normal AFI –> repeat test

121
Q

4/10

BBP interpretation and actions

A

probable asphyxia

induce birth

122
Q

2/10

BBP interpretation and actions

A

Almost certain asphyxia

induce birth

123
Q

0/10

BBP interpretation and actions

A

certain asphyxia

induce birth

124
Q

CST negative test would have …

A

no decels

125
Q

why would a CST be run

A

a failed BPP; it is run to determine if mom/baby can survive stress using pitocin

126
Q

CST positive test would have …

A

late decels

127
Q

what is AFI

A

Amniotic Fluid Index

128
Q

oligohydramnios

A

5 cm > AFI (measured by black space around infant)

increases RF cord compression, pt will be induced

129
Q

causes of oligohydraminos

A

congenital anomalies

IUGR

fetal distress

kidney problems

130
Q

what is Placenta Previa

A

when the placenta grows over the cervix, is a problem because placenta gets pulled apart during dilation

131
Q

Placenta Previa RN considerations

A

NO VAG EXAMS - can worsen bleeding

baby will be delivered by c-s

track blood loss

132
Q

Placenta Previa SS

A

Sudden onset painless bleeding

133
Q

Abruptio Placentae
types

A

partial separation (concealed hemorrhage or apparent hemorrhage [obvious bleeding])

complete separation (concealed hemorrhage)

134
Q

Abruptio Placentae SS

A

(sudden onset) severely painful rigid abd

bleeding

signs of shock (HoT, low urine, TC)

135
Q

partial separation (concealed hemorrhage)

A

may heal on its own, would calcify, could be painless

136
Q

partial separation (apparent hemorrhage )

A

Placenta torn away

137
Q

complete separation (concealed hemorrhage)

A

Placenta torn away but hard to see, compare to baseline VS, prevent shock by IV bolus, lay on supine with wedge

late decels

contraction baseline would increase as the uterus becomes more rigid

can happen in any trimester

138
Q

Abruptio Placentae RF

A

Maternal HT

Cocaine use

blunt external abd trauma

previous abruption

trachysystole

139
Q

What is considered a miscarriage?

A

<20 weeks

< 500g

usually 50% genetic causes

140
Q

Threatened abortion

A

possible abortion but can still be rescued

141
Q

inevitable abortion

A

will happen

142
Q

incomplete abortion

A

has happened but hasnt cleared out, requires D&C or pitocin

143
Q

complete abortion

A

everything has passed

144
Q

missed abortion

A

baby has died but hasnt had time to be cleared

145
Q

septic abortion

A

infection caused it

146
Q

recurrent abortion

A

abortions that recurre

147
Q

Reliable indicators of spont abortion

A

pelvic cramping

backache

148
Q

info needed for D&C

A

Rh

IV therapy

blood loss

blood type and match

149
Q

In cases of perinatal loss, when you dont know what to say …

A

dont say anything at all

150
Q

RF for perinatal loss

A

AMA

Race or socioeconomic

abn quad screen

obesity DM HT

multiples

smoking

Hx of past losses

151
Q

Ix in spont abortion

A

preparation when possible or counseling

support system; grief assessment and counselling

use name of infant if known

photographs

mementos

prepare siblings

move mother from unit to antenatal and let her stay with baby as long as needed

152
Q

what is an incompetent cervix-cerclage

A

tying a suture around the cervix so that it prevents premature dilation of the cervix ;removed at 36 weeks

153
Q

Incompetent Cervix-Cerclage additional care needed

A

prophylactic ATB

RhoGam

psych needs

154
Q

What is an ectopic pregnancy

A

when embryo implants itself outside the uterus

155
Q

Ectopic Pregnancy RF

A

IUD

PID

endometriosis

previous tube surgery or scar tissue

previous Ectopic Pregnancy

156
Q

Ectopic Pregnancy SS

A

v Syncope

v Lower Abdominal Pain

v Vaginal Bleeding

v Sharp one-sided pain

v Deferred shoulder pain (ruptured)

v Rigid Abdomen

157
Q

Ectopic Pregnancy tx

A

methotrexate

158
Q

what is methotraxate

A

folic acid antagonist that interferes with cell division

159
Q

Gestational Trophoblastic Disease (Hydatiform Mole) types

A

uComplete: no fetus

uPartial: some fetal tissue

160
Q

Hydatiform Mole SS

A

uHigh hcG levels

uExcess N/V

uLarger uterus

uEarly PIH

uCluster like bleeding discharge

161
Q

Hydatiform Mole Tx

A

D&C

Emotional care

Serum BhCG levels - to make sure all cells removed

Chest X-Ray - make sure it hasnt spread

Avoid pregnancy for 1 y

162
Q

Amniotic fluid embolism SS

A

sudden Respiratory Distress

Cardiac Disfunction

DIC

163
Q

Amniotic Fluid Embolism Ix

A

CPR – place woman on hard surface and place a wedge under her back

164
Q

what is Amniotic Fluid Embolism

A

amniotic fluid into blood stream

165
Q

Premature Rupture of Membranes (PROM) causes

A

uInfection

uUTI

uAmniocentisis

uPlacenta Previa

uAbruptio Placentae

uTrauma

166
Q

Premature Rupture of Membranes (PROM)

A

ØRDS

ØSepsis

ØProlapse Cord

ØNon-reassuring Heart Tones

ØOligohydraminos

ØPremature birth

ØIncreased morbidity/mortality

167
Q

Premature Rupture of Membranes (PROM) Ix

A

prepare for c-s but hold off until the baby can no longer tolerate being inside

168
Q

TACO

A

Time

Amount

Color

Ø Urine

Ø Amniotic fluid

Odor

Ø Assess for possible infection (temperature)

169
Q

what is PT labor

A

occurs at 20-36 weeks

170
Q

fetal fibronectin test

A

at 16-20 weeks

done when trauma

shows whether labor will occur within the next 2 week

171
Q

Ritrodrine

class

action

implication

A

beta adrenergic

inhibits uterine activity

TC, not used any more

172
Q

Terbutaline

class

action

implication

A

beta adrenergic

bronchodilator; inhibits uterine activity

TC, dyspnea, tremors, flushing, NV

dont use on asthma pts

173
Q

Procardia

class

action

implication

A

Ca channel blocker

reduces uterine activity

vasodilator –> HoT

dont use on people with heart condition

174
Q

Indocin

class

action

implication

A

prostaglandin inhibitor

blocks prostoglandin that stim ctx

good for <32 week

use for only 48-72 hr bc it affects fetus

175
Q

MgSO4

class

action

implication

A

CNS depressant

inhibits uterine activity while protecting neuro development

causes lethergy, sedation

can cause toxicity

176
Q

PT labor SS

A

uWhen uterine contractions occur every 10 minutes or less

uMild menstrual like cramps

uPelvic Pressure

uRupture of membranes

uDull backache

uChange in vaginal discharge-increased amount

uAbdominal cramping

NUR 209 - Maternaty (7 decks)

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