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Maternal Health > EXAM #4 > Flashcards

EXAM #4 Flashcards

1
Q

What four factors influence the initiation of the first breath?

A

-Chemical
-Sensory
-Thermal
-Mechanical

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2
Q

What chemical factors help with the first breath?

A

-Hypercarbia (too much CO2 in the blood)
-Acidosis (O2 is low)
-Hypoxia (baby has to be when born)
-Increased CO2 prompts medulla to initate breathing

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3
Q

What can prolonged asphyxia cause in newborn?

A

CNS mediated respiratory depression

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4
Q

How do healthcare workers know what the pH of the newborn’s blood?

A

ABG drawn from the umbilical cord immediately after birth

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5
Q

What are signs of respiratory disress in a newborn?

A

-Grunting
-Nasal flaring
-Sternal retractions

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6
Q

Normal newborns will have periods of apnea lasting…

A

10 to 20 seconds

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7
Q

What sensory factors help with the first breath?

A

-Visual and auditory stimulation also help initiate cry
-Increased stimulation of the neonate during the birthing and drying process helps to initate a cry

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8
Q

What Thermal factors help with the first breath?

A

-Drastic change in temperature from 98 to 70-75 degrees prompts the newborn to cry
-Sensors in the skin respond to the drastic temp change, sending signals to the brain to initate respirations

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9
Q

How can cold stress be prevented?

A

Dry newborn and place baby in a radiant warmer or skin-to-skin

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10
Q

What Mechanical factors help with the first breath?

A

-Removing fluid from the lungs and replacing it with air on the first breath
-Fetal chest compression/ thoracic squeeze from the vaginal birth increased intrathoracic pressure helps push fluids out of the lungs
-Recoil of the chest wall after delivery of the trunk creates negative intrathoracic pressure

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11
Q

What 5 changes occur to the cardiovascular system after placental expulsion?

A

-Increased aortic pressure & decreased venous pressure
-Increased systemtic pressure and decreased pulmonary pressure
-Closure of the foramn ovale, ductus arteriosus, and venosus

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12
Q

What is the neutral thermal environment?

A

The range of temperature in which the newborn’s body temp can be maintained with minimal metabolic demands and oxygen consumption

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13
Q

What happens to the newborn when they experience cold stress?

A

Anerobic glycolysis
-Transforms glucose to lactate
-Will turn to lactic acid leading to a state of metabolic acidosis
-Only effective for 10 seconds to 2 min
-Breaksdown brown fat

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14
Q

Evaporation heat loss: Def & intervention

A

-Loss of heat when fluids cover the body are air-dried and converted into vapor
-Dry baby & keep them warm and covered

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15
Q

Conduction heat loss: Def & interventions

A

-Loss of heat to a cooler surface via direct skin contact
-Minimize, radiant warmer, blankets, covering scales, skin-to skin

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16
Q

Convection heat loss: Def & interventions

A

-Loss of heat from the warm body surface to the cooler air currants
-Avoid fans and drafts

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17
Q

Radiation heat loss: def & interventions

A

-Heat loss occurs when there is a transfer of heat between objects that are not in direct contact with each other.
-Prewarmed radiant warmer, avoid placement of cribs near walls or cold windows

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18
Q

What hematopoietic adaptations occur?

A

-Volume is determined by the timing of the cord clamping
-Helps enhance pulmonary perfusion
-Extra blood Increases risk for jaundice due to breakdown of the RBC leads to increase in bilirubin. Babies cannot easiy rid of bili quickly

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19
Q

What hepatic adaptations occur?

A

-Liver stores glucose for the use after birth
-Glucose provides ready energy source for brain and other vital organs
-1st 3 hours
-Can be depleated after a stressful event

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20
Q

What is acrocyanosis?

A

An expected finding at birth that shows oxygenated blood is shunted to the central area of the body and vital organs
-Only extremities are blue/purple or pale which is not true cyanosis

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21
Q

What are factors that affect the blood glucose of a newborn?

A

-Small or large for gestational age
-Mothers with DM
-Post-term or intra uterine growth restricted (insufficient placental nourishment

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22
Q

What are signs of hypoglycemia in a newborn?

A

-Irrtability/fussy
-Jittteriness/tremors
-Lethargy
-Cold

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23
Q

When is the best time to feed and bond with an infant during the behavioral states?

A

Quiet alert

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24
Q

What are GI/GU adaptations for a newborn?

A

-Size of neonate’s
stomach
* 6 ml at birth to 90 ml by end
of first week
* First meconium stool within 8-24 hours after birth
* Can pass 1-10 meconium stools within 24 hours
* No stool within first 72 hours may indicate bowel obstruction
* Initial bladder capacity
between 6ml-44ml
* Normally void between 2 and 6 times in a 24-hour period
* May pass glucose and protein in urine as kidneys learn to
concentrate urine
* Urate crystals (pink or red in color) may pass in urine causing urine to look pink (ends after 24 hours)

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25
Where is passive immunity acquired?
From mother to baby through IgG from placenta IgA from milk
26
What does apgar stand for?
Appearance, Pulse, Grimace, activity, respiration
27
What is a normal apgar score?
> or equal to 7
28
When is apgar conducted?
1 min & 5 min
29
What medications are given at birth?
-Eye prophylaxis: Erththromycin ointment for STIs -Vitamin K: IM Vastus lateralis. 1 dose for clotting -Hep B vaccine: IM Vastus lateralis in 3 doses. 1st one 1 hour after delivery. Signed consent needed if refused
30
Ballard scoring
Used to determine gestational age
31
Dubowitz exam
he method used at our institution to determine the baby's gestational age. This examination evaluates both physical characteristics and neurological characteristic
32
How is weight recorded?
On a warm scale and in grams
33
How is length measured?
-In cm -Crown to heal is the recumbent length
34
How is head circumference measured?
-Place tape measure immediately above eyebrows and pinna of the ear and wrap around the occipital prominence at the back of the head -Measure three times and record the largest finding
35
How is chest circumference measured?
-Place measurement tape on nipple line and wrap around entire thoracic area -Head and chest may be equal during first few days of life
36
How is abdominal circumference measured?
-Place tape above umbilicus and circle infants' body -Abdomen should be same size as chest
37
What is included in the integumentary system for a newborn?
*Assess skin color visually first *Always wear gloves during skin assessment to protect yourself from any infection processes *Assess for any lesions, bruising or rashes * Nevi * Port Wine Spots * Mongolian Spots * Vernix * Erythema toxicum * Milia * lanugo *Sclera and conjunctiva *Eye/Ear alignment *Check head for size and shape of fontanels *Check head for caput, molding, cephalohematoma *Epstein pearls/natal teeth *Cleft lip and palate
38
What is a nevi (stork bite) & when will it go away?
* Birth Mark * On back of neck or forehead * Usually disappears by 2 years old * Gets more red when baby cries
39
Does a port wine stain (nevus flammeus) blanch or disappear?
No
40
What is a mongolian spot and when will it go away?
* Appear gray, dark blue, or purple * Back & buttocks, shoulders, wrists, forearms, ankles * Usually disappear by 2 yrs old * More often seen in infants whose ethnic background include African American, Mediterranean, Latin American, Asian, or African
41
Why do babies have vernix caseosa?
To protect their skin
42
What is erythema toxicum? -How long will it last and what is the tx?
* Normal newborn rash * Transient rash * May start on face and spread to rest of body * Persists up to one month * No treatment needed
43
What is milia?
* Small white papule or sebaceous cysts * Disappear spontaneously
44
What is lanugo?
Fine, downy hair on back, shoulders, head * Preterm -more lanugo present * Post term -skin is tough, leathery, cracked, peeling skin
45
What is a normal ear/eye alignment supposed to look like?
* Look for symmetry, noting placement of the eyes, nose, lips, mouth & ears A. Normal ear B. Low set ear C. Slanted low-set ear (chromosomal abnormalities)
46
What should the fontanels not look like and will require emergency intervention?
-Bulging fontanelle in absence of crying can indicate increased intracranial pressure
47
What is caput succedaneum?
* Generalized tissue swelling that will go away * Edema that crosses suture lines
48
What is a cephalohematoma?
* Does not cross the suture line * Can predispose newborn to jaundice
49
What shape is the anterior and posterior fontanelles?
A-diamond P-Triangle
50
What are natal teeth?
Natal teeth are usually loose and will need to be pulled to eliminate choking hazard
51
What are epstein pearls?
-Will disappear within a few weeks (normal finding) * Whitish hardened nodules on the gums or roof of the mouth
52
What interventions are used to treat club feet?
* Stretching * Casting * Surgery
53
What is hypospadias & the tx?
* Urethra on ventral side of penis * DO NOT CIRCUMCISE * Surgery to repair
54
What are the type of circumcisions?
* Yellen/Gomco -protects head of penis * Mogan -credit card * Plastibell -plastic ring & string lef
55
What is needed in preparation of a circumcision?
Sterile, lidocaine, oral sucrose, consent needed, radiant warmer
56
Care for circumcision:
Q30min x 2hrs, check for bleeding/infection, petroleum ointment (NOT for plastibell), UOP by 8 hrs
57
What are some risks for an uncircumcised penis?
UTI, cancer, STIs
58
What should be included in the discharge teaching for a newborn?
▪Discharge Tests: Blood Pressure, PKU, O2 Sats ▪Bathing ▪Feeding: Breast & Bottle Feeding ▪Safety ▪Child Care ▪Follow-up Care
59
What complications can happen a newborn that is small for gestational age?
-Cold stress -Pain -Hypoglycemia -Polycythemia
60
What complications can happen a newborn that is large for gestational age?
-Transient Tachypnea of the Newborn -Hypoglycemia -Hypocalcemia -Hypomagnesemia -Birth Injuries
61
What are signs and symptoms of cold stress?
* Lethargy * Bradycardia * Respiratory distress * Poor feeding * Cold pale or bluish skin
62
What are s/s of pain in a newborn?
* Tachycardia * Increased blood pressure * Shallow respirations * Pallor * Flushing * Diaphoresis
63
What are complications of pre-mature newborns?
RDS, Apnea, Bronchopulmonary Dysplasia, Jaundice, Anemia, NEC, GERD, Retinopathy (from hyper oxygenation), Intraventricular Hemorrhage
64
Necrotizing enterocolitis: Def and interventions
-Immature gut -Do not give formula -If suspected, stop feedings and report to PCP -Antibiotics and complete rest
65
What are complications for a post-term newborn?
Persistent Pulmonary Hypertension, Meconium Aspiration Syndrome
66
What is physiological jaundice? Solution?
Appears after 24 hours -Total bili rises by less than 5mg per day, gradual -Bili is not extreted in the stool -Serum stays at 15mg or lower -Feed the baby so they poop
67
What is pathological jaundice? Solution?
Appears within first 24 hours of age -Increased of >5mg per day -Serum is > 15mg -Is persistent, 14+ days -Stool is clay/white colored and urine will stain clothes -TX: light therapy and feeding
68
What can a serum bilirubin of over 15mg cause (in pathological jaundice) ?
Toxicity -Kernicterus: Increase in bili circulating in the body and goes to the brain leading to neurological/ development disorders/issues
69
What are s/s of Jaundice?
 Slight yellowish tint on the skin  Yellow stains on the whites of the eye  Yellow discoloration becomes more pronounced when you press on the skin  Aversion to feeding or unusually low appetite  Increased drowsiness  Restlessness  More irritable than usual  Dark, yellow urine  Light-colored or pale stools  Arching of the back  A high-pitched cry
70
What should be monitored when the baby is undergoing bilirubin light therapy (phototherapy)?
-Adequacy of hydration (urine output) and nutrition (weight gain). Assess diapers (count and COACH), cap refill, s/s of dehydration) -Temperature continuous. Not on chest or areas of discoloration bc yellowing starts at the head and works its way down -Clinical improvement in jaundice -TSB or SBR levels (total serum bilirubin or serum bilirubin) -Potential signs of bilirubin encephalopathy -Cover eyes at all times and keep a diaper on -Keep all other skin exposed for proper tx
71
What should Phenylketonuria PKU avoid?
Phenylalanine Free Diet for Life
72
What should galactosemia avoid?
Galactose-Free Diet for Life
73
What should a patient with Maple Syrup Urine Disease (Branched-Chain Ketoaciduria) have in their diet?
Low Protein Diet and Thiamine Supplements for life
74
What are s/s of congenital hypothyroidism?
Lethargy, Poor Feeding, Constipation, Prolonged Jaundice, Hoarse Cry, Hypotonia, Slow Reflexes, Delayed Growth and Neurodevelopment
75
How is congenital hypothyroidism dx?
Newborn Screening, Elevated TSH, Low T3/T4
76
What medication is given for congenital hypothyroidism?
Levothyroxine
77
What is anencephaly? How can it be prevented?
-Lack of skull & brain tissue formation -Pre-pregnancy folic acid intake of 400mcg/day
78
What is an encephalocele? Nursing care?
-Area where the skull did not fully form and there is blood tissue and fluids in a sack. -Cover defect with warm sterile gauze to prevent infection until surgical intervention
79
What is microcephaly? Nursing care?
-Small skull and brain growth is stunned due to lack of space - No treatment; supportive on-going care
80
What is congenital diaphragmatic hernia (CDH)?
Hernia of the diaphragm that normally seperates the lungs from the bowels -Bowels are in/near the lungs & can hear bowel sounds in the chest
81
What are the nursing interventions in priority order for congenital diaphragmatic hernia?
-Protect airway -NG tube insertion for decompression -Surgical repair
82
What is gastroschisis?
Bowels are exposed
83
Nursing interventions for gastroschisis:
▪Sterile moist gauze and wrap in plastic ▪Fluid replacement at 1.5 times the normal ▪TPN, NO ORAL feedings ▪Prevention of infection (priority) ▪Pain management
84
What is the prevention & tx plan for herpes simplex?
▪Prevention: No vaginal delivery with active lesions ▪Treatment: Acyclovir
85
What are the s/s of neonatal sepsis?
Subtle signs, behavioral changes, hypothermia, lethargy, hypoglycemia, poor feeding, apnea, bradycardia
86
What are the s/s of neonatal abstinenence syndrome?
Irritability, tremors, wakefulness, uncoordinated feeding patterns, loose stools, yawning, hiccups, poor weight gain, hypertonia, seizures, exaggerated rooting reflex, vomiting, tachypnea, apnea, sneezing, stuffy nose, profuse sweating Essentially withdrawal
87
TPN benefits
Promotes positive nitrogen balance, energy, and infant growth
88
When can babt start breast/bottle feedings?
Begins at 32 weeks... if baby stable High calorie formula (preterm formula
89
When should surfactant therapy be done?
-1st 2-6 hours of life in baby more than 1000g -Continued mechanical ventilation after administration helps the medication to be spread throughout the lung tissue. - DO NOT SUCTION NEWBORN AFTER SURFACTANT IS PLACED IN TUBE
90
What is the criteria for the baby to be discharged?
Eating/tolerating full feedings Maintaining own temperature Consistently gaining weight No apnea, bradycardia or desaturation events for 5 to 7 days
91
What should be included in discharge planning?
-Nutrition -Condition Based -Follow-up Care -Safety -CPR

Maternal Health (4 decks)

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