Exam 3 review Flashcards
What are the four types of heat loss?
- Radiation
- Conduction
- Convection
- Evaporation
What is radiation heat loss?
Heat loss due to heat transfer to cooler surfaces and objects not directly in contact with the body. Think heat lamp
What is conduction heat loss?
Loss of heat to a cooler surface directly from skin contact.
Baby on moms chest warms; baby on cold table or bed
What is convection heat loss?
Loss of heat from the warm body to the air (think wind/ac)
What is evaporation heat loss?
Loss of heat when water on the skin is converted to a vapor.
Think wet baby
What are the 3 physiologic adaptations of fetal circulation?
- Foramen ovale
- Ductus arteriosus
- Ductus venosus
What is the #1 nursing priority in regards to the infant immediately after birth?
WARM, dry, stimulate; suction airway
A premature infant is classified as an infant born before ___ weeks.
37 weeks
How is circulation assessed in a newborn?
pulse ox/palpate femoral artery
where is the pulse ox placed?
Right upper extremity; palm of hand
What is a complication of supplying oxygen to premature infants?
retinopathy and prematurity of lungs
The umbilical vein carries ______ blood to the baby in utero.
Oxygenated
The umbilical arteries carry _____ blood to the placenta in utero.
Deoxygenated
SGA (small for gestational age) is
An infant that is less than 10% of the birth weight.
Maternal risk factors for SGA (8)
- malnutrition
- HTN
- smoking
- substance abuse
- DM
- cardiac/renal abnormalities
- young maternal age
- hx of small babies
SGA infant complications (4)
- Congenital aspiration syndrome (meconium)
- Hypoxia
- Hypoglycemia
- Polycythemia (too many RBCs increased rx for clots)
LGA (Large for gestational age) is
A baby born above 90th percentile
Maternal Rx factors for LGA (3)
- DM
- Obesity
- hx of big babies
LGA infant complications (6)
- birth trauma from vag: clavicle fracture depressed skull fracture cephalohematoma - fetal distress - hypoglycemia - hypocalcemia - prolonged labor - hyperbillirubemia
IUGR (intrauterine growth restriction) is
Advanced gestation with limited fetal growth.
Maternal Rx factors for IUGR (7)
- multiples
- smoking
- old
- poor nutrition
- substance abuse
- poor prenatal care
- HTN
IUGR infant complications (8)
- meconium aspiration
- hypoxia
- hypoglycemia
- increased rx for infection
- cerebral palsy
- still born
- poor temp control
- motor/neuro disabilities
Contraindications for breastfeeding (4)
- HIV/aids
- illicit drug/alcohol use
- TB
- Galactosemia
How does an infant receive IgG (given)
Passive immunity; passed through fetus via placenta; received last four weeks of pregnancy; premes dont get this and are at increased rx of infection
How does an infant receive IgA (acquired)
Passive immunity; acquired through breastfeeding-colostrum; protects infants intestinal mucosa
How does an infant receive IgM (made by me/fetus)
Active immunity; cant pass through placenta
Produced by fetus during 10-15wks gestation
What is PPH?
The loss of 500ml of blood vaginally or the loss of 1000ml csec
PPH Rx factors (7)
- HTN
- Placenta abruption/previa
- infection
- prolonged labor
- multips (multiple pregnancies=stretched uterus)
- bladder distention
- lrg baby
PPH interventions/tx (8)
- RUB FUNDUS
- remove fragments/clots
- uterine tamponade; balloon
- oxytocin
- hemabate
- lay pt flat
- trendelenburg
- check peripads frequently
What is a cervical laceration?
The tearing of the vagina during delivery/epis.
Cervial lac rx factors (6)
- forceps
- vaccum
- multiparous
- lrg baby
- oxytocin; speeds up labor
- vag delivery
Cervical lac interventions/tx (2)
-surgical repair
-sitz bath/self care
PREVENT INFECTION BIH
What is mastitis
Inflam./infection of breast tissue
MOST COMMONLY CAUSED BY STAPH/STREP; a break in the skin
Mastitis s/s (6)
- pain
- chills
- fever
- malaise
- hard, warm, tender upper quadrant
- tachycardia
Mastitis rx factors (5)
- poor hand washing/hygiene
- unsupportive bra
- milk stasis
- poor latching/positioning
- poor feeding schedule
Mastitis interventions/Tx (6)
“Heat rest, empty breast)
- antibiotics
- good breast support/bra
- local heat
- analgesics
- improved hand washing/hygiene
- breastfeed/nipple care
What is HELLP syndrome?
H(hemolysis, which is the breaking down of red blood cells)
EL(elevated liver enzymes)
LP(low platelet count)
HELLP s/s (5)
- elevated liver enzymes
- low plt count
- flulike symptoms
- epigastric pain
- hemolysis
HELLP rx factors (2)
- severe preeclampsia
- HTN
HELLP syndrome interventions/tx (3 drugs)
IV dexamethasone/betamethasone/mag sulf.
What is a puerperal infection?
s/s (5)
Infections in the uterus during or after pregnancy; common postpartum affecting vagina or cervix
- foul smell
- abnormal discharge
- epigastric/vaginal pain
- fever
- subinvolution
Puerperal infection rx factors (4)
- DM
- prolonged labor
- PROM
- invasive procedures; fetal scalp electrode, foley, amniocentesis
Puerperal infection inteventions/tx (3)
- antibiotics
- rest
- continue to breastfeed
(nothing in vag)
What is PIH?
pregnancy induced HTN
PIH s/s (6)
- HTN
- proteinuria
- periorbital edema
- decreased urine output
- visual chngs
- HELLP
PIH rx factors (7)
- chronic HTN
- DM
- kidney disease
- hx of preeclampsia
- multiples
- primipara
- obesity
PIH interventions/tx (3)
- Treat HTN
- prenatal care
- seizure precautions
truly fixed w delivery
What is RDS? & two subtypes
Respiratory distress in newborn
TTN: transient tachypnea of newborn (fluid in lungs doesnt go away)
Meconium aspiration syndrome
RDS s/s (4)
- nasal flaring
- SOB
- tachypnea
- grunting
RDS rx factors (2)
- prematurity (surfactant underdeveloped)
- csection
RDS interventions (for baby) (5)
- O2 via nc, oxyhood, cpap
- suction
- surfactant
- betamethasone if still in utero
- ABGs,VBGs,CBGs
PPH s/s (4ts)
Tone: uterine tone
Trauma: lacerations and uterine rupture
Thromboplastin: bleeding disorders
Tissue: retained tissue/placenta
Meds not compatible w breastfeeding
Methotrexate/cancer drugs, antimetabolites
What is pyelonephritis?
untreated UTI that travels up to kidneys
Pyelonephritis s/s (6)
- chills
- high fever
- flank pain
- N/V
- dec. urine output
- dehydration
Pyelonephritis rx factors(4)
- urinary blockage
- catheter
- UTI
- poor hygiene
Pyelonephritis tx (2)
IV antibiotics
fluids
What is thrombophlebitis?
blood clot within the vein usually in legs
thrombophlebitis s/s (4)
- warm skin
- tenderness
- red skin
- calf pain
When does thrombophlebitis most commonly occur?
1st 6 weeks postpartum
thrombophlebitis rx (7)
- obesity
- smoking
- HTN
- varicose veins
- DM
- bedrest
- csec
Thrombophlebitis tx (4)
- heat
- NSAIDS/blood thinners
- exercise
- compression stockings
What are the two types of jaundice/hyperbilirubinemia?
Physiologic & pathologic
when does physiologic jaundice occur?
Occurs AFTER 24hrs of birth; usually ok- infant presents normal
when does pathologic jaundice occur?
Occurs WITHIN 24hrs of birth; could indicate underlying disease
How does pathologic jaundice present>
Newborn looks sick!
flulike symptoms, anemic, yellow skin, dark urine, pale stool
Hyperbillirubinemia/jaundice rx factors (5)
- hematoma
- breastfed baby
- preme
- delayed cord clamping
- incompatible blood typing: Rh - mom Rh + baby, O- mom
Hyperbillirubinemia tx (4)
- phototherapy
- provide adequate nutrition
- increase fluids
- blood transfusion
What is cold stress?
Illness from the cold; infant cannot maintain body temp
Cold stress s/s (5)
- shivering stops
- hypoglycemia
- vasoconstriction
- limp
- lethargic
Cold stress rx factors (6)
- HTN
- DM
- cold environment
- IUGR
- Preme
- SGA
Cold stress tx (4)
- warm body; blanket, hat, skin to skin
- mo rectal temp
- mo bs
- O2 prn
SLOWLY REWARM
What is neonatal hypoglycemia?
Glucose less than 40
we want 50-150
Neonatal hypoglycemia s/s (7)
- SHAKING
- pale skin
- apnea
- poor feeding
- poor body tone
- seizures
- lethargy
Neonatal hypoglycemia rx factors
- SGA
- IUGR
- Preme
- LGA
Neonatal hypoglycemia tx
- feed regularly
- IM glucagon
- IV dextrose
What is neonatal sepsis?
infection of neonate blood
Neonatal sepsis s/s (8)
- decrease in wbc
- poor temp control; decreased temp
- poor glycemic control
- tachy or brady
- mottled skin
- poor feeding; abdominal distention
- bleeding probs
- inconsolibility
Neonatal sepsis rx factors (2)
- preme
- maternal UTI/STI
Neonatal sepsis tx
IV antibiotics
Ortoloni’s maneuver
tests for congenital hip dysplasia; manual procedure performed to rule out the possibility of developmental dysplastic hip; flex hips and knees 90 degrees
What is a Pavlik harness?
used to fix congenital hip dysplasia; put the infant in this for 23 1/2hrs a day until resolved to align the hips and joints; keeps hip at 90 degrees.
What is Gastrochisis
birth defect of the belly wall. Intestines are found outside the body.
what is a cephalohematoma?
rupture of capillaries during birth causes collection of blood on head; DOES NOT CROSS SUTURE LINES; increased rx for jaundice
what is Caput succadeum?
swelling or edema occurring in or under he fetal scalp during labor; DOES CROSS SUTURE LINES
What is reflex irritability?
This is the grimace response to stimuli
what is the Dubowitz exam?
physical/neuromuscular exam to assess for problems
What is taking in?
Mother is thinking about her needs and being dependent on the help of others
What is taking hold?
Mom is ready to take hold of the situation and care for her baby
What is transient tachypnea of the newborn
respiratory distress seen after delivery caused by fluid due to impaired clearance
3rd degree laceration
laceration extends through perineal skin
4th degree laceration
laceration extends through rectal sphincter
What is subinvolution?
failure of a part to return to its normal size after functional enlargement, such as failure of the uterus to return to normal size after pregnancy
What is endometritis?
infection of the endometrium/inner lining of uterus
what are the 3 newborn screening tests?
- CHD
- Newborn screen (metabolic)
- Hearing
What is the CHD screening for?
screens for congenital heart defects; tetralogy of fallow & coarctation of the aorta
What is the newborn metabolic screening for?
- PKU
- Maple syrup urine disease
- hypothyridism
- CF
- galactosemia
What is a circumcision and why would the parents choose or decline?
Removal of an epithelial layer from the glans penis. May be done for religious reasons, or to be similar to the father; can reduce UTIS
circumcision complications
- infection
- obstruction
- hemorrhage
what are the methods of circumcision
- gomco; cut right off
- mogen; cut right off
- plastibell; tied and falls off due to lack of circulation
Circumcision care (4)
- wipe with wet wash cloth once a day
- keep it clean
- dont pull it off
- keep vaseline on it so the diaper does not rub/irritate
What are the two congenital heart defects?
- Tetralogy of fallow
2. Coarcation of aorta
How long is breastfeeding recommended for
6 months
5 benefits of breastfeeding?
- decreased rx of heart disease, DM, asthma, cancer
- less expensive
- baby gets more nutrients and antibodies
- decreased rx of allergies
- promotes maternal infant attachment
Toxoplasmosis is transmitted via
Raw meat or cat liter; crosses placenta
Toxoplasmosis is a
parasite
How is toxoplasmosis detected?
blood test/serology
elisa
Toxoplasmosis tx
Spiramycin, folinic acid
How is hep b transmitted?
Iv drugs or sexual intercourse, can cross the placenta or transmit during delivery; blood
How is Hep B detected?
HbsAg antigen blood test
Hep B tx
Baby will be given immune globulin if mom is a carries after birth then vaccine
Rubella is a
virus
How is rubella transmitted
Mother who isn’t vaccinated; saliva or resp droplets
How is rubella detected?
Blood test; titer test
How is rubella treated
PREVENTION IS KEY
vaccine given 1-3 months after pregnancy
GBS is
bacterial/viral
GBS is transmitted
to baby in birth
How is GBS detected
Vaginal or rectal culture during 35-37 wks; blood test
How is GBS tx
Use antibiotics prophylaxis, autoimmune meds, plasma exchange
What is CMV?
Cytomealovirus
CMV is transmitted via
Body fluids; Saliva, urine, breast milk, sexual intercourse
How is CMV detected
fluorescent antibody,complement fixation test
How is CMV tx
isolate infant, tx symptoms
What is HSV?
herpes simplex virus
How is HSV transmitted
Can be through sex or vaginal birth; BODY FLUIDS
How is HSV detected?
Serology blood test, cultures, pap smear
HSV tx
Viral therapy after 36 wks; acyclovir
What does APGAR assess?
- Appearance; skin color
- Pulse
- Grimace; reflex irritability
- Activity; muscle tone
- Respirations
What is the perfect APGAR score?
10
What is the most common APGAR score and why?
9; acrocyanosis
Normal infant appearance
Pink, crying, fussy
Abnormal infant appearance
blue, silent, limp
When should the infants cord be cut?
cut when done pulsing but mom still contracting; not immediately but not too late
what is the infant at risk for if the cord cutting is delayed?
increased risk of jaundice
how is an infants glucose assessed?
heel stick on side of foot to avoid hitting a nerve
In utero the placenta belongs
partly to mom and partly to baby
what is the purpose of the foramen ovale in utero?
Separates R & L atria; allows blood to go from R atria to L atria due to high pressure and resistance in lungs.
Neonate lungs (in utero)
High pressure; higher on R side
Lungs and liver are not used
Ductus arteriosis in utero
allows blood to travel from pulmonanry artery to aorta and then the rest of the body.
The pulmonary artery has ____ pressure due to _____ resistance in lungs forcing blood into the aorta.
high pressure, high resistance
the umbilical artery brings blood back from the aorta to the _____.
placenta
After birth the placenta is
removed from fetal circ.
What happens to the ductus venosus after birth?
it closes
How does the ductus venosus close?
umbilical cord cut–>whartons jelly contracts around vessels when temp falls–>low resistance to high resistance–>blood in umbilical vein and ductus venosus starts clotting off & blood flow is decreased.
After birth what do the lungs do?
take in air; first breath pushes fluid out of lungs,O2 lvls increase
What happens to the ductus arteriosus after birth?
It closes
Ductus arteriosus closing patho
Muscles constrict during 1st few hrs of life–>body sense increase of O2 in blood–>prostaglandins produced by placenta are no longer present–>DA closes
prostaglandin production keeps the ________ open
ductus arteriosus
why should moms not take NSAIDS during pregnancy
they are prostaglandin inhibitors; can affect fetal circ.
What does oxytocin/pitocin do pp
treats PPH; makes uterus contract
Oxytocin need to know
- administer IV/IM
- H2O intoxication- no IV bolus
What does methylergonovine/methergine do?
Assists in the delivery of the placenta and assists in controlling/preventing PPH.
Methylergonovine/methergine need to know
Contraindicated for HTN/preeclampsia pts.
NEVER ADMIN TO NEWBORN
Monitor BP, fundal height, lochia
Do not smoke during administration
Carboprost, Tromethamine/hemabate is used pp for
Treats/prevents postpartum hemorrhage, reduces blood loss secondary atony
Carboprost, Tromethamine/hemabate need to know
Contraindicated for asthma patients. Max dose 12mg Max duration of use 48hrs Admin in large muscle Mo. Uterine status; bleeding Delay breastfeeding for 24hrs following administration
Misoprostol/cytotec is used pp for
to prevent/control pph
Misoprostol/cytotec need to know
Do not give pitocin less than 4 hrs after administration
Administer only when FHR and uterine activity can be continuously monitored
What is mag sulfate used for pp
pre-eclampsia/eclampsia
Mag sulfate need to know
Administer IM into gluteal site, teach patient about their condition and what the drug is being used for, assess for magnesium toxicity- antidote sodium gluconate.
What is rhogam used for pp
This drug is administered postpartum if mom and baby have different blood types, more specifically if baby is positive for Rh cells. This drug prevents the body from attacking the Rh positive fetus or antigens in the body when pregnant, a final dose is given postpartum.
What is erythromycin opthalmic ointment used for?
To prevent any infections being transmitted to the newborn following delivery.
Erythromycin ophthalmic ointment need to know
STATE MANDATED
Coat each eye in a thin line of ointment, assess for diarrhea and ensure adequate fluid intake if diarrhea occurs. Know s/s of possible infection.
Wash hands immediately after
Do not irrigate eyes
Vitamin K Phytonadione pp is used for
Newborns are commonly born vitamin K deficient; vitamin K is important as it plays the role of a major clotting factor. Since newborns don’t have this on their own it is important to give them this vaccine to enhance clotting and decrease any risks of bleeding.
Vitamin K need to know
Given IM vastus lateralis; one time dose one hr after birth, monitor for bleeding and bruising.
If mom was on coags during pregnancy an additional dose should be given
Administer before circumcision
Hep B vaccine pp is used to
To prevent the newborn from contracting hep B from birth or others.
Hep B vaccine need to know
Administer within 24hrs but no later than 7 days old. Drug should be clear and slightly amber. IM injection.
Delay administration if pt has active infection
How should the fundus decrease following delivery?
1 centimeter per day; after delivery, should be under umbilicus
if the fundus is left or right what does it indicate?
full bladder
If the fundus is boggy the nurse should
massage it until it is firm
When using phototherapy on an infant what should the infant be wearing?
eye goggles and genital covering; mo hydration
Breastmilk comes in ____ colostrum comes in _____
2-5 days, right away
If the mom is not planning to breastfeed the mom can prevent by
- wear a well fitted bra; binder
- cold compress
- dont stimulate nipples; no shower water
the more preterm an infant is the more ___ they have
lanugo
in a preterm male the ___ have not descended
testes
if the fundus is firm but the patient is still bleeding this can indicate
retained fragments
baby blues are ___ and last about ____ weeks
normal, first 1 to 2 weeks
due to fluctuating hormones
postpatum depression is ____ and occurs ____ weeks
abnormal, 3 to 4 weeks
postpartum psychosis
voices telling u to kill baby
How do you know baby is latching well?
baby has more areola, audible swallowing
mom will express ___ if latching is wrong
pain
breast care
clean after breastfeeding no soap; just water and dry
Do not warm formula in the ____
Microwave
bottle fed feces
sticky; strong odor
breast fed feces
liquidy yellow green; smells sweet
Increased sweating after delivery is ___
normal; body trying to get rid of extra fluid
what birth control delays breastmilk production
depo
breastfeeding babies should be fed every
2-3hrs
Pill is
estrogen/progesterone
mini pill is
progesterone
depo is
progesterone
nuvaring is
estrogen/progesterone
red brick dust is caused by
uric acid crystals in the urine
normal newborn resp
30-60
normal newborn hr
120-160
normal newborn temp
97.8-99
what is the blink reflex
newborn reflex stimulated by flash of light- response is blinking
pupillary reflex
pupils should constrict
moro/startle reflex
response to sudden movement/loud noise should have symmetric extension of extremities
rooting reflex
stroke infants cheek should attempt to feed
palmar/plantar grasp
fingers and toes grasp
stepping reflex
when baby is held upright one foot should step
babinski reflex
fanning and extension of all toes when heel is stroked upward
babys head should be 1-2cm greater than
chest circumfrence
pp moms can have a temp of ___ and be okay, ___is concerning
100.4, 100.6
BUBBLEHE
Breasts; size, shape, engorgement Uterus; firm or boggy? Bladder; tender or distended? Bowel movement? Lochia; amount, odor, color, clots Episiotomy; location, stiches, edema, redness Homans sign; positive? Emotional status; bonding?
What does a positive homans sign mean?
DVT
newborn weight loss in the first 3-4 days
5-10%= normal
