Exam 3 - Powerpoints Flashcards
1
Q
What causes babies to breath at delivery
A
mechanical, chemical, thermal, sensory
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
3
Q
chemical causes for breathing
A
increase of CO2 and decrease of O2 –> stims medulla to breath (gasping)
4
Q
thermal causes for breathing
A
from warm 98F to 68F while wet - cold causes contrition and faster breathing
5
Q
sensory causes for breathing
A
touch - such as rough drying of a baby, light and sounds
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
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
8
Q
Ix for excess blood in babies
A
proper feeding for it can poop it out or UV lights to break more down
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)
10
Q
APGAR timings
A
1, 5 and (10) min
11
Q
APGAR general facts
A
- 0-2 per categories
- higher is better
- ones occasional
12
Q
APGAR categories
A
- Activity (muscle tone)
- Pulse
- Grimace (reflex irritability)
- Appearance (skin color)
- Respiration
13
Q
Activity scores
A
(0) absent
(1) sluggish and minimally flexed arms and legs
(2) active and flexed arms and legs
14
Q
Pulse Scores
A
(0) absent
(1) < 100 BPM
(2) > 100 BPM
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
16
Q
Appearance Scores
A
(0) Pale; Blue
(1) Pink body; blue extremities
(2) Pink (light skined), cyanosis absent (dark skinned); mucous membranes
17
Q
Respiration Scores
A
(0) Absent
(1) Slow and irregular or weak cry
(2) Vigorous cry
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
19
Q
Ix for 1s on APGAR
A
Ix depend on 1 but are required
20
Q
can babies be circumcised if parents refuse vitamin k
A
NO
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
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)
23
Q
When are newborn reflexes checked
A
within 30 min
24
Q
Newborn assessments
A
–Match bands, VS, color, skin, cord and circumcision
fontanels, Ears, Mouth, Neck, Chest,
genitals, Urine, Hips, Hair, Sacrum, rectum
25
fontanel assessment
depressed or bulging
26
ear assessment
symmetrical (down syndrome babies’ ears have ears lower than eye level)
27
mouth assessment
feeling for palate – suck and swallow reflex
28
neck assessment
folds, move/assess clavicles (can be broken if the bone moves, xray to confirm, from suprapubic pressure)
29
chest assessment
breathing, barrel-chest,
30
genitals assessment
descended testes, hypospades
minora bigger than major at birth
31
urine assessment
begin blood in early urination
32
hips assessment
hip dysplasia from a macrosomia baby – when baby is prone one cheek is higher than the other
33
hair assessment
preterm babies are hairy, term are not
34
sacrum assessment
for dimple - if open possible spinal bifida
35
rectal assessment
for patent rectum
36
Normal elimination for meconium
Meconium within 24 hrs (if not it is possible obstruction) void
- have parents save all diapers
37
Normal passive immunity adaptations
lasts 4 weeks, PT infants are more susceptible to infection
38
Normal visual and auditory adaptations
Alert, able to follow with eyes and hear,, able to recognize mom's voice
39
Normal Olfactory/taste/tactile adaptations
smell of mom, sensitive to touch, able to interact
- may have sniffles bc of mucus from birth
40
Breastfeeding facts and positioning
- 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
41
Cluster feeding
when baby feeds multiple times in a few hours
42
Mastitis causes
- poor latching or poor breast emptying
43
Mastitis SS
(infected milk gland) hard lump in breast, malaise, flulike symptoms, fever
44
Mastitis Ix
always position correctly and always start with breast you ended with last time
45
Newborn screening
- 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)
46
Bilirubinemia (--\> Jaundice) Causes
increased bilirubin to liver from RBC destruction, traumatic birth, RH incompatibility, poor feedings
47
Bilirubinemia Ix
- feed often
- monitor output
- phototherapy
48
Parent Discharge teaching
- 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
49
Caput succedaneum
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
50
Cephalohematoma
- 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
51
Ortolani test
hip click indicates hip displasia
52
SA of baby compared to adult
baby SA is 4x more
53
how do babies keep warm
they used brown fat that burns glucose, and can cause glucose depletion
54
Babies dont shiver they ....?
jitter
55
Priority assessments and actions for cold or cold-exposed babies
- assess BG (most hospitals have standing orders to poke babies PRN)
- keep baby awake by tapping foot or changing diaper
56
Methods of baby heat loss
Convection, Radiation, Evaporation, Conduction
57
conduction
heat loss via direct contact on a surface
58
convection
heat loss via circulating cooler air
59
radiation
heat transfer not through direct contact (being by cold windows or outside walls)
60
evaporation
air drying of skin that causes cooling (baby being wet)
61
cold pathway in baby
62
Circumcision facts
* 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
63
Non-pharm pain management techniques
swaddleing, skin-skin, breastfeeding, mothers voice, sucrose water
64
Hyperbilirubinemia causes
delayed clamping
tramatic birth
poor feeding
intestinal obstruction
65
Hyperbilirubinemia Dx
Dx by bilirubin nomogram (age in hours, x-axis; serum bilirubin in mg/dl, y-axis)
\> ~5-7 in first 24 hours
66
Kernicterus
Dx and causes
Bilirubin \>25 mg/dl
Acute Bilirubin Encephalopathy
67
Acute Bilirubin Encephalopathy
causes bilirubin deposits in basal ganglia and stem
disrupts neuronal function and metabolism
68
Acute Bilirubin Encephalopathy
Adverse effects
cerebral palsy
epilepsy
mental retardation
death
69
Acute Bilirubin Encephalopathy Ix (missing information)
VS monitored
strict I/O (breastfeeding in mins, there will be supplemental feeding sources)
70
baby RR
30 - 60
71
baby HR
120 - 160
110-160 in utero
72
RF for RDS (Respiratory Distress Syndrome)
Preterm
meconium
DM mother
macrosomia mother
73
what benign causes might cause a baby to show signs of RDS?
transitioning to air so check pulse ox
74
SS of sepsis
inability to maintain temperature (will get cold)
poor feeding, lethargic, irritable, low urine output
difficulty breathing is a late sign
75
maternal signs of fetal sepsis
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
fetal signs of sepsis
TC \> BC (if TC check mothers temp)
decreased fetal movements
absent/min late decels; lack of acels
77
Fetal Sepsis Ix
monitor FHR
mother's temp q1-2Hr after rupture
1-2 hrs after give ATB prophylactically
section meconim if its thick otherwise nothing
78
infant CPR
30 compressions
2 breaths
check brachial pulse which is on the inner side of biceps for no more than 10 sec
79
NICU needs to be
quiet and organized
noise can increase VS in PT or sick infants even cardiac arrest
80
Preterm (PT) - weeks and min viable age
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
PT infant appearance
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
PT infant problems
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
Late preterm infant age
34 weeks - 37 weeks and 6 days
84
Ix for late PT infants
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
Car seat test
infant put into seat while in NICU while VS are monitored closely for 2x drive to see if their VS are stable
86
Post term infant at risk for
RF infection, meconium (passes because in tight quarters and low amniotic fluids make thick meconium), degradation/calcification of placenta thus decreasing perfusion
87
post term infant appearance
thick creases on hands and feet, dry skin, ruddy skin, dark ruggae on skin
88
SGA
small for gestational age
89
LGA
large for gestational age
90
gestational age assessment
measurement of child's weight, hight, and head circumference to see if its appropriate for the child's supposed gestational age
91
if mother was DM and baby is SGA/LGA baby should be checked for ...
Ix ....
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
baby BG must be above ...
40 mg/dl
93
SIDS teaching
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
indications for dx testing
To detect genetic abn and evaluate fetal conditions to monitor and help fetues
95
first trimester purpose and tests
for viability and dates
US
hGC
Progesterone
CVS
96
second trimester tests purpose and tests
Age and growth
US
MSAFP
Amniocentesis
97
third semester tests
fetal movement
NST
Vibroacoustic stimulation
BPP
CST
98
first trimester US and hGC are used to ...
US: determine gestational age and any abn of the uterus, viability, or tumors
hGC: determine pregnancy
99
second trimester US and amniocentesis can be used to ...
US: determine anomalies in fetus or growth rate
Amnio: confirm MSAFP
100
vibroacoustic test
startles the fetus
101
purpose of the doppler US
determine if there are any blood flow problems; red moves toward transducer and blue away
not done for every pregnant mom
102
indications for dopper US
mother has HT, smokes, DM where the baby would be expected to be SGA
103
MSAFP
what
purpose
when
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
MSAFP problems and caused by
many false positives caused by wrong gestational age, maternal wt, multifetal pregnancies, race, maternal DM
105
Increased MSAFP indicate
Open NTD
threatened abortion
normal fetus + underestinated gestational age
106
low MSFAP indicate
Down syndrome or trisomy 21
normal fetus + overestimated GA
107
Amniocentesis risks
maternal : hemorrhage, infection, labor
fetal: death, hemorrhage, direct injury
risks mixing blood so give RhoGam
108
second trimester amniocentesis would be done to ...
confirm abn MSAFP
109
third trimester amniocentesis would be done to ...
confirm lung development if in PT labor; if in PT labor would give betamethasone and delay for as long as 24 hours
110
Why would a CVS be done?
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
How is CVS done and what are the risks?
Extracts villi. This test can be done vaginally or abdominally guided by ultrasound. High risk to injury of fetus and loss of pregnancy.
112
NST result requirements
\>= 2 acels in 20 min
113
Ix when non-reactive stress test (non-reassuring)
turn pt, give water or food, use a vibroacoustic stimulator
bad if no change
114
BPP categories (5)
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
BBP purpose
used to determine if the baby would need to be delivered or the amount of amnio fluid
116
What is AFV or AFI?
amniotic fluid volume
amniotic fluid index
117
10/10 BBP interpretation and actions
normal
repeat 1-2 weeks
118
8/10 (normal AFI) BBP interpretation and actions
RF asphyxia rare
repeat in 1-2 weeks
119
8/8 (w/o NST)
8/10 (abn AFI)
BBP interpretation and actions
normal: repeat in 1-2 weeks
chronic asphyxiation suspected: induce birth
120
6/10
BBP interpretation and actions
possible asphyxia
AFI --\> Deliver
Normal AFI --\> repeat test
121
4/10
BBP interpretation and actions
probable asphyxia
induce birth
122
2/10
BBP interpretation and actions
Almost certain asphyxia
induce birth
123
0/10
BBP interpretation and actions
certain asphyxia
induce birth
124
CST negative test would have ...
no decels
125
why would a CST be run
a failed BPP; it is run to determine if mom/baby can survive stress using pitocin
126
CST positive test would have ...
late decels
127
what is AFI
Amniotic Fluid Index
128
oligohydramnios
5 cm \> AFI (measured by black space around infant)
increases RF cord compression, pt will be induced
129
causes of oligohydraminos
congenital anomalies
IUGR
fetal distress
kidney problems
130
what is Placenta Previa
when the placenta grows over the cervix, is a problem because placenta gets pulled apart during dilation
131
Placenta Previa RN considerations
NO VAG EXAMS - can worsen bleeding
baby will be delivered by c-s
track blood loss
132
Placenta Previa SS
Sudden onset painless bleeding
133
Abruptio Placentae
types
partial separation (concealed hemorrhage or apparent hemorrhage [obvious bleeding])
complete separation (concealed hemorrhage)
134
Abruptio Placentae SS
(sudden onset) severely painful rigid abd
bleeding
signs of shock (HoT, low urine, TC)
135
partial separation (concealed hemorrhage)
may heal on its own, would calcify, could be painless
136
partial separation (apparent hemorrhage )
Placenta torn away
137
complete separation (concealed hemorrhage)
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
Abruptio Placentae RF
Maternal HT
Cocaine use
blunt external abd trauma
previous abruption
trachysystole
139
What is considered a miscarriage?
\<20 weeks
\< 500g
usually 50% genetic causes
140
Threatened abortion
possible abortion but can still be rescued
141
inevitable abortion
will happen
142
incomplete abortion
has happened but hasnt cleared out, requires D&C or pitocin
143
complete abortion
everything has passed
144
missed abortion
baby has died but hasnt had time to be cleared
145
septic abortion
infection caused it
146
recurrent abortion
abortions that recurre
147
Reliable indicators of spont abortion
pelvic cramping
backache
148
info needed for D&C
Rh
IV therapy
blood loss
blood type and match
149
In cases of perinatal loss, when you dont know what to say ...
dont say anything at all
150
RF for perinatal loss
AMA
Race or socioeconomic
abn quad screen
obesity DM HT
multiples
smoking
Hx of past losses
151
Ix in spont abortion
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
what is an incompetent cervix-cerclage
tying a suture around the cervix so that it prevents premature dilation of the cervix ;removed at 36 weeks
153
Incompetent Cervix-Cerclage additional care needed
prophylactic ATB
RhoGam
psych needs
154
What is an ectopic pregnancy
when embryo implants itself outside the uterus
155
Ectopic Pregnancy RF
IUD
PID
endometriosis
previous tube surgery or scar tissue
previous Ectopic Pregnancy
156
Ectopic Pregnancy SS
v Syncope
v Lower Abdominal Pain
v Vaginal Bleeding
v Sharp one-sided pain
v Deferred shoulder pain (ruptured)
v Rigid Abdomen
157
Ectopic Pregnancy tx
methotrexate
158
what is methotraxate
folic acid antagonist that interferes with cell division
159
Gestational Trophoblastic Disease (Hydatiform Mole) types
uComplete: no fetus
uPartial: some fetal tissue
160
Hydatiform Mole SS
uHigh hcG levels
uExcess N/V
uLarger uterus
uEarly PIH
uCluster like bleeding discharge
161
Hydatiform Mole Tx
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
Amniotic fluid embolism SS
sudden Respiratory Distress
Cardiac Disfunction
DIC
163
Amniotic Fluid Embolism Ix
CPR -- place woman on hard surface and place a wedge under her back
164
what is Amniotic Fluid Embolism
amniotic fluid into blood stream
165
Premature Rupture of Membranes (PROM) causes
uInfection
uUTI
uAmniocentisis
uPlacenta Previa
uAbruptio Placentae
uTrauma
166
Premature Rupture of Membranes (PROM)
ØRDS
ØSepsis
ØProlapse Cord
ØNon-reassuring Heart Tones
ØOligohydraminos
ØPremature birth
ØIncreased morbidity/mortality
167
Premature Rupture of Membranes (PROM) Ix
prepare for c-s but hold off until the baby can no longer tolerate being inside
168
TACO
Time
Amount
Color
Ø Urine
Ø Amniotic fluid
Odor
Ø Assess for possible infection (temperature)
169
what is PT labor
occurs at 20-36 weeks
170
fetal fibronectin test
at 16-20 weeks
done when trauma
shows whether labor will occur within the next 2 week
171
Ritrodrine
class
action
implication
beta adrenergic
inhibits uterine activity
TC, not used any more
172
Terbutaline
class
action
implication
beta adrenergic
bronchodilator; inhibits uterine activity
TC, dyspnea, tremors, flushing, NV
dont use on asthma pts
173
Procardia
class
action
implication
Ca channel blocker
reduces uterine activity
vasodilator --\> HoT
dont use on people with heart condition
174
Indocin
class
action
implication
prostaglandin inhibitor
blocks prostoglandin that stim ctx
good for \<32 week
use for only 48-72 hr bc it affects fetus
175
MgSO4
class
action
implication
CNS depressant
inhibits uterine activity while protecting neuro development
causes lethergy, sedation
can cause toxicity
176
PT labor SS
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
