Exam 4 Flashcards
1
Q
What is a shoulder dystocia
A
obstruction of fetal decent and birth after delivery of the head due to the fetal shoulderse
2
Q
What are risks for shoulder dystocia
A
macrosomia, excessive weight gain, and history of shoulder dystocia
3
Q
What is the warning sign for shoulder dystocia
A
Turtle sign
4
Q
What are some of the maternal negative outcomes of shoulder dystocia
A
Postpartum hemorrhage and laceration
5
Q
What are some negative fetal outcomes of shoulder dystocia
A
brachial plexus injury and clavicle fracture
6
Q
What is an umbilical cord prolapse
A
the cord precedes the fetus in delivery causing occlusion of blood flow and rapid fetal deterioration
7
Q
What are some risks for cord prolapse
A
malpresentation, high station, preterm labor, low birth weight, multiple gestations, and polyhydramnios
8
Q
What is the priority with umbilical cord prolapse
A
prompt recognition and we need to relieve compression of the cord
9
Q
What is uterine rupture
A
tearing of the uterus into the abdominal cavity
10
Q
A
11
Q
What is the cardinal sign of uterine rupture
A
sudden fetal bradycardia
12
Q
What are some risks for uterine rupture
A
uterine scar, prior rupture, trauma, hypertonic contractions
13
Q
What do we do when we have a uterine rupture
A
urgent cesarean section
14
Q
What is an amniotic fluid embolism
A
Amniotic fluid containing hair, skin, vernix, or meconium enters maternal circulation and obstructs pulmonary vessels
15
Q
Describe the DIC pathway that begins with exposure of fetal tissue to maternal circulation
A
Infant tissue activates inflammation - DIC - bleeding - hypotension - neurologic injury
16
Q
Describe the ARDS pathway that begins with exposure of fetal tissue to maternal circulation
A
Infant tissue activation inflammation - ARDS - Hypoxemia (potentially causing neurologic injury already) - right heart failure - left heart failure - hypotension - neurologic injury
17
Q
What is the typical outcome of amniotic fluid embolism
A
rapid maternal deterioration and a poor prognosis
18
Q
What are risks for amniotic fluid embolism
A
placental abruption, uterine overdistention, fetal demise, uterine trauma, amnioinfusion, amniocentesis, ROM
19
Q
What are our hallmark symptoms of amniotic fluid embolism
A
Difficulty breathing, sudden hypotension, hypoxia, and coagulation failure (DIC)
20
Q
What is dystocia of labor
A
“failure to progress” It is a lack of progressive dilation and/or descent
21
Q
Which phase of labor does dystocia of labor become apparent, and what is required to declare dystocia of labor
A
It is apparent during the active phase of labor and we need an adequate trial of labor to declare.
22
Q
What are some complications of dystocia of labor
A
Postpartum hemorrhage, infection, and perineal lacerations
23
Q
What is the #1 reason for a cesarean delivery
A
dystocia of labor
24
Q
Name 10 risk factors for dystocia of labor
A
epidural analgesia/excessive analgesia, maternal exhaustion (ineffective pushing), abnormal fetal position (occiput posterior), multiple gestation, nulliparity, short stature (less than 5 ft), fetal birth weight over 8.8 lbs, maternal age over 35 years, overweight, and ineffective contractions
25
What are the 5 Ps of dystocia of labor
Passageway, passenger (position), powers, psychological response
26
What does the passageway refer to
the pelvis/birth canal. If this is small the baby has less room to descend
27
Describe some factors of the passenger that can lead to dystocia of labor
position (the 5th p) if baby is occiput posterior, if presentation is face, brow, or breech, and if there are multiples, macrosoma, or structural abnormalities all increase risk for dystocia of labor.
28
Describe how the powers can contribute to dystocia of labor
Hypertonic uterine activity leads to the uterus never fully relaxing thus inhibiting delivery, while hypotonic uterine activity we have the uterus being too relaxes and thus there's no pushing force, also contributing to dystocia of labor
29
Describe how the psychological response can lead to dystocia of labor
If the mom has fear or anxiety it can inhibit her ability to push effectively leading to dystocia of labor
30
what is a risk for hypertonic uterine dysfunction, and which phase does it prolong potentially leading to dystocia of labor
The main risk is primagravida. We have a prolonged latent stage where we stay at 2-3cm.
31
What assessments would we see with hypertonic uterine dysfunction and what would our treatment be as it relates to dystocia of labor
We'd see minimal relaxation, and compromised placental perfusion. The main treatment is relaxation
32
What is a risk for hypotonic uterine dysfunction and what phase does it occur during
Overstretching of the uterus is our primary risk, and it occurs during the active phase of labor
33
What are assessments we'd see with hypotonic uterine dysfunction and what would our treatment be
mild and infrequent contractions and our main treatment will be stimulation
34
Name 5 assessments we will complete for dystocia of labor
Review risk factors, assess signs of stress and support, evaluate uterine contractions and FHR, assess fetal position, and perform vaginal exams
35
Name 3 primary forms of management we will use for dystocia of labor
provide physical and emotional support, promote comfort for relaxation and normal labor progress, prepare family for cesarean delivery if labor does not progress
36
What is precipitate labor
When labor is completed in less than 3 hours from start of contractions to birth
37
What are some common causes of precipitate labor
Hypertonic labor, use of oxytocin, multiparity, and drug use
38
What are maternal risks associated with precipitate labor
Uterine rupture, lacerations, amniotic fluid embolism, postpartum hemorrhage
39
What are fetal risks that can result from precipitate labor
hypoxia, intracranial hemorrhage, and nerve damage
40
What is preterm labor
Regular uterine contractions with cervical effacement and dilation before the end of 37 weeks
41
What are risk factors for preterm labor
African american, smoking, cocaine, multiples, infections, and cervical insufficiency
42
Name 5 infant risks resulting from preterm labor
respiratory distress syndrome, infections, thermoregulation, feeding difficulties, and hypoglycemia
43
Name the four tocolytics we typically use for preterm labor
Indomethacin, nifedipine, mag sulfate, and terbutalin
44
Describe indomethacin (indocin)
inhibits prostaglandins and uterine contraction, given PO. Contraindicated if greater than 32 weeks because of risk for neonatal side effects
45
Describe nifedipine (procardia)
blocks calcium movement into muscle cells, inhibits uterine contractions, is given PO. Contraindicated with cardiovascular disease
46
Describe Mag Sulfate
Reduces muscle's ability to contract, given IV
47
Terbutaline (brethine)
betamimetic, prevents and slows uterine contractions, given SubQ, do not give beyond 48-72 hours
48
Describe assessment cues for preterm labor
indistinct signs, contraction pattern of 4 contractions q 20 minutes and 8 contractions in 1 hour. Cervical exam we find dilation and effacement. Lab and diagnostic testing - CBC, UA, amniotic fluid analysis, fetal fibronectin, cervical length
49
Describe fetal fibronectin as it pertains to preterm labor
Fetal fibronectin is found at the junction of fetal membranes and uterus. It acts as glue attaching fetal membranes to uterine lining. Usually not detected between 24-34 weeks unless there has been a disruption
50
When testing for fetal fibronectin what is our primary concern
Nothing in the vagina for 24 hours prior to the test
51
Describe cervical length as it pertains to preterm labor
It is a measurement of the closed portion of cervix by transvaginal ultrasound.
52
What is the single most reliable parameter for preterm labor in high-risk women and when is it best taken
cervical length and it is best obtained at 16-24 weeks
53
What does a cervical length of 3cm or more indicate
unlikely to deliver in the next 2 weeks
54
What is a post term labor
pregnancy continuing past 42 weeks
55
What are maternal risks resulting from post term labor
Cesarean birth, dystocia, birth trauma, postpartum hemorrhage, and infection
56
What are fetal risks resulting from post term labor
Macrosomia, shoulder dystocia, brachial plexus injuries, low apgars, postmaturity syndrome (loss of subcutaneous fat and muscle and meconium staining)
57
Describe assessment we would carry out with post term pregnancy
Determine gestational age, daily fetal movement, BPP twice weekly, and weekly cervical exams
58
Compare induction to augmentation
Induction is starting contractions by medical or surgical means, augmentation is enhancing ineffective contractions after the start of labor
58
What is required for induction
Must have a clear medical indication
59
Name 9 indications for induction of labor
Postterm pregnancy is our primary, prolonged premature rupture of membranes, gestational hypertension, cardiac disease, chorioamnionitis, dystocia, intrauterine fetal demise, diabetes, IUGR
60
Name 6 contraindications for induction of labor
Complete previa, placenta abruption, malpresentation, classical uterine incision, active genital herpes, abnormal FHR
61
Name 5 risks associated with induction
infection, cesarean birth, prolonged labor, instrumented delivery, epidural analgesia
62
What are the 5 categories for the bishop scoring system
Dilation (cm), effacement (%), station, cervical consistency, and position of cervix
63
What gives a 0 score in every bishop category
Closed dilation, 0-30% effacement, -3 station, firm cervical consistency, and posterior position of cervix
64
What gives a 1 score in every bishop category
1-2cm dilated, 40-50% effaced, -2 station, medium cervical consistency, midposition position of cervix
65
What gives a 2 score in every bishop category
3-4cm dilated, 60-70% effaced, -1 or 0 station, soft cervical consistency, anterior position of cervix
66
What gives a 3 score in every bishop category
5-6cm dilated, 80% effaced, +1 or +2 station, very soft cervical consistency and anterior position of cervix
67
Name 4 method for cervical ripening
surgical methods, alternative methods, mechanical methods, and meds: misoprostol (cytotec) and dinoprostone (cervidil)
68
Name four assessments we'd carry out for induction and augmentation
review indications and contraindications. Gestational age determination. Fetal status. Cervical readiness; bishop score.
69
Describe management for induction and augmentation
Explanations; informed consent. Medication administration with continued monitoring of maternal and fetal status. Pain relief and support
70
What is amnioinfusion
Normal saline (or potentially another isotonic fluid) is instilled into the uterus through an intrauterine pressure catheter
71
What are indications for amnioinfusion
Severe variable decelerations due to cord compression often related to oligohydramnios, and rupture of membranes, also thick meconium fluid
72
Describe nursing management related to amnioinfusion
teaching, maternal and fetal assessment, preparation for possible cesarean
73
What is a forceps or vacuum assisted birth
Application of traction to the fetal head
74
What are the main risks of forceps or vacuum assisted birth
tissue trauma - maternal: laceration, hematoma, hemorrhage, infection. Newborn: laceration, facial nerve injury, cephalohematoma, caput succedaneum
75
Name 4 criteria required for forceps or vacuum assisted birth
membranes ruptured, complete dilation, vertex position and engaged, adequate pelvis size
76
Name 6 indications for forceps or vacuum assisted birth
Prolonged 2nd stage. Nonreassuring FHR/fetal distress. Maternal heart disease. Inability to push effectively. Maternal fatigue. Failure of head to fully rotate and descend.
77
What are the two incision types for c section
Low transverse or classic ( vertical incision midline on abdomen)
78
What are maternal indications for c section
advanced maternal age, previous c section (classical incision), active genital herpes, dystocia of labor
79
What are fetal indications for c section
distress, breech presentation, congenital anomalies, macrosomia
80
What are placenta related indications for c section
previa and abruption
81
How do risks with c section compare to vaginal
It is a major surgical procedure with increased risks compared to vaginal delivery
82
Describe assessment we'd carry out with c section
History and physical exam for maternal and fetal indications
83
Describe preoperative management for c section
client teaching, blood type and crossmatch, CBC, surgical site prep, foley catheter, IV antibiotics, SCDs, epidural/spinal
84
Describe postoperative management for c section
assess vitals, lochia, fundus, abdominal dressing, and pain; auscultate bowel sounds; early ambulation; encourage use of incentive spirometer
85
What are the risks associated with vaginal birth after cesarean
uterine rupture and hemorrhage
86
What are contraindications for vaginal birth after cesarean
classical incision, myomectomy, ripening agents
87
What are special considerations for vaginal birth after cesarean
consent, documentation, surveillance, readiness for emergency
88
What is important for nurses to do with vaginal birth after cesarean
advocate for client; expertise in fetal monitoring to identify nonreassuring pattern and institute measures for emergency delivery.
89
Describe the post acronym for post birth warning signs
call 911 if you have: pain in chest, obstructed breathing or shortness of breath, seizures, or thoughts of hurting yourself or someone else
90
Describe the birth acronym for post birth warning signs
bleeding, soaking through one pad/hour or blood clots the size of an egg or bigger, incision that is not healing, red or swollen leg that is painful to the touch, temperature of 100.4 degrees or higher, headache that does not get better, even after taking medicine, or a bad headache with vision changes
91
Describe stage 0 management and who it pertains to
All births, we assess for risk factors. Active management of the 3rd stage of labor includes oxytocin infusion of 10-40 units/1000mL infusion or 10 units IM. Quantitative evaluation of blood loss. Ongoing evaluation of vital signs
92
Name 9 risk factors for postpartum hemorrhage
multiparity, multiple gestation, polyhydramnios, macrosomic newborn, chronic coagulation disorders, prolonged labor, induction of labor, uterine inversion, and general anesthesia
93
Describe the prevention or first key point for PPH
identify risk factors. Active management of third stage of labor via controlled umbilical cord traction, administration of IV or IM oxytocin, fundal massage, and empty bladder
94
Describe the Assess or 2nd key point for PPH
Assess for four T's; tone (uterine atony), tissue (retained placental fragments), trauma (lacerations, rupture, or inversion), and thrombin (coagulopathy)
95
Describe the early resuscitation or 3rd key point for PPH
Have OB at bedside, monitor vitals and patient status. 2 large bore IV access and necessary labwork. Administer oxygen and IV fluid resuscitation PRN. Type and screen and put 2 units of pRBC's on hold
96
What makes up 70% of PPH and what is the treatment
Uterine atony (tone)- fundal massage. Uterotonic meds: oxytocin, cytotec, methergine, hemabate. Empty the bladder
97
What makes up 10% of PPH and what is the treatment
Retained placenta (tissue) - Inspect placenta for missing pieces. Ultrasound. Manual removal of adherent placenta (d and c or vaginal)
98
What makes up 20% of PPH and what is the treatment
Laceration or uterine rupture (trauma) - inspect for lacerations of vaginal tissue or cervix. Inspect for rupture/inversion of uterus. Hematoma (increased pain, decreased BP, increased HR), repaid any tissue trauma and evacuate hematomas.
99
What makes up less than 1% of PPH and what is the treatment
Coagulopathy (thrombin) - Obtain CBC, PT/PTT/INR, fibrinogen levels. Consider FFP, factor VIIa, PLTs (avoid DIC). Assess hx of hemophelia, von willebrands, ITP, TTP, or other bleeding disorders. TXA to promote clotting.
100
What is the leading cause of maternal mortality in the united states
postpartum hemorrhage
101
Describe mild degree of shock, it's blood loss, and signs and symptoms
20% blood loss. Diaphoresis, increase capillary refilling. Cool extremities. Maternal anxiety
102
What are our factors that make us very concerned when it comes to blood loss
Any amount of bleeding that places the mother in hemodynamic jeopardy - 10% drop in hematocrit or shock
103
Describe severe degree of shock blood loss, and it's signs and symptoms
greater than 40%. Hypotension. Agitation/confusion. Hemodynamic instability
104
Describe moderate degree of shock blood loss, and it's signs and symptoms
20-40% blood loss. Tachycardia, postural hypotension. Oliguria
105
What labs will we typically want to get with bleeding
CBC to tell current hemodynamic status. Fibrinogen is generally elevated/ if it's decreased there could be an issue. Pt/PTT/INR for coagulation. Type and screen or cross for blood type for transfusion or consider rhogam.
106
What is stage 1 OB hemorrhage bundle protocol
Ensure 16g or 18g IV access. Increase IV fluid (crystalloid without oxytocin). Insert urinary catheter. Fundal massage. Increase oxytocin amount. confirm active type and screen and consider crossmatch of 2 units PRBCs with blood bank. Determine etiology of bleeding and prepare OR if clinically indicated.
107
What are the criteria for stage 1 blood loss
Greater than 1000mL after delivery with normal vital signs and lab values. Vaginal delivery of 500-999mL should be treated as in stage 1.
108
What are the criteria for stage 2 blood loss
continued bleeding of up to 1500mL or equal to or greather than 2 uterotonics with normal vital signs and lab values. This is in addition to routine oxytocin administration or it could be greater than or equal to 2 administrations of the same uterotonic
109
What is the bundle protocol for stage 2
Mobilize additional help. Place 2nd IV (16-18g). Draw STAT labs (CBC, Coags, Fibrinogen), Prepare OR. continue stage 1 medications and consider TXA. Obtain 2 units PRBCs (don't wait for labs) Thaw 2 units of FFP. For uterine atony consider uterine balloon or packing, possible surgical interventions. Consider moving patient to OR. Escalate therapy with goal of hemostasis
110
What is the criteria for stage 3
EBL over 1500mL or greater than 2 RBCs given or at risk for occult bleeding/coagulopathy or any patient with abnormal vital signs/labs/oliguria
111
What is the bundle protocol for stage 3
Mobilize additional help, move to OR, announce clinical status (VS, cumulative blood loss, etiology). Outline and communicate plan. Continue stage 1 medications and consider TXA. Initiate massive transfusion protocol (iff coagulopathy add cryoprecipitate. Achieve hemostasis.
112
What is the criteria for stage 4
cardiovascular collapse (massive hemorrhage, profound hypovolemic shock, or amniotic fluid embolism)
113
What is the bundle protocol for stage 4
ACLS medications. Simultaneous aggressive massive transfusion. Immediate surgical intervention to ensure hemostasis (hysterectomy)
114
What is a perineal hematoma
collection of blood underneath skin related to trauma from delivery, may report severe perineal or rectal pain and difficulty voiding. It is a localized bluish bulging area in perineum.
115
What are some signs and symptoms of perineal hematoma and what is treatment
signs or symptoms of shock, with a firm fundus and appropriate bleeding. Requires surgical management by evacuating the hematoma via incision, with a pressure bandage applied to prevent reformation
116
Describe the pathophysiology of thromboembolic conditions
venous stasis, injury to innermost layer of blood vessel. Hypercoagulation (increased clotting factors in pregnancy like fibrinogen).
117
How long does the risk remain high for thromboembolic conditions in pregnancy and what is the incidence rate
risk remains highest until 3 weeks postpartum but could occur for 12 weeks post delivery. Seen in 1 out of 1000 pregnancies. Risk is 10x higher in pregnancy
118
Name 7 risk factors for thromboembolic conditions
Pregnancy, obesity, bedrest/sedentary lifestyle. Poor venous return. Abdominal surgery. Elevated fibrinogen. Past smoker/hormones (birth control)
119
What are the 3 most common types of thromboembolic conditions
superficial thrombosis, deep vein thrombosis, and pulmonary embolism
120
What are assessment cues for DVT and what test will be done
leg pain, tenderness, redness. Unilateral swelling. Sharp, burning pain. Doppler studies
121
Describe nursing management for DVTs
prevention will consist of lovenox, ambulation, SCD/TED and ERAS. Management after a DVT occurs will be NSAIDs, bed rest, anti embolism stockings, anticoagulant therapy (heparin), emergency measures for pulmonary embolism
122
What are assessment cues for pulmonary embolism and what 3 tests will be done
Shortness of breath at rest (decreased O2). Tachypneic, shallow, rapid breathing, Tachycardia/chest pain/hypotension, change in level of consciousness. Tests will be D-dimer/ V/Q scan, CT-PA
123
Describe nursing management for PE
goal is to prevent further clots. CPR, oxygen, IV heparin, bedrest/analgesia, tPA (thrombolytic agents)
124
What is metritis and describe common organisms
Metritis is inflammation of the uterus. Organisms are usually maternal normal flora: Staph Aureus, E. coli, Klebsiella, Gardnerella Vaginalis, Gonorrhea/Chlamydia, Group A or B Strep
125
What temperature are we concerned about
100.4 or above
126
Describe signs and symptoms of metritis
Lower abdominal tenderness or pain on one or both sides. Temp above 100.4. Foul smelling lochia, anorexia, nausea, fatigue and lethargy, leukocytosis and elevated sedimentation rate
127
Describe signs and symptoms of urinary tract infection
urgency, frequency, dysuria, flank pain, low grade fever, urinary retention, hematuria, urine positive for nitrates, cloudy urine with strong odor
128
Describe signs and symptoms of mastitis
flu like symptoms including malaise, fever, and chills. Tender hot red painful area on one breast. Inflammation of breast area. Breast tenderness. Cracking of skin around nipple or areola. Breast distention with milk
129
Describe our therapeutic management for each type of postpartum infection
Metritis - broad spectrum antibiotics. Would infection - wound care. UTIs - fluids and antibiotics. Mastitis - breast emptying and antibiotics
130
What is the REEDA assessment
redness, edema, ecchymosis, discharge, approximation of skin edges
131
What are the signs of postpartum blues
Emotional lability, irritability, insomnia
132
What is treatment for postpartum blues
typically is self limiting and resolves within 2 weeks (postpartum day 10)
133
What are the signs and symptoms of postpartum depression
major depressive episode associated with childbirth. Symptoms lasting beyond 2-6 weeks and worsening. Symptoms include hopelessness, worthlessness, guilt, anhedonia, loss of libido, feeling sad
134
What is the treatment for postpartum depression
lifestyle changes, medication, and cognitive behavioral therapy
134
What are the signs and symptoms of postpartum psychosis
surfaces within 3 weeks of giving birth. Increased risk with history of mental illness. Symptoms are sleep disturbances fatigue, depression, hypomania, hallucinations, and delusions
135
What is the treatment for postpartum psychosis
Don't leave child alone with mother. Hospitalization. Psychotropic drug treatment. Individual group therapy
136
What are criteria for small for gestational age
weight less than 2500g (5 lb 8 oz) at term. Below the 10th percentile
137
What are criteria for large for gestational age
weight greater than 4,000g (8lb 13 oz) at term. Above 90th percentile
138
What are considerations for SGA infants
perinatal asphyxia. Difficulty with thermoregulation. Hypoglycemia (big), polycythemia, meconium aspiration, and hyperbilirubinemia
139
What are considerations for LGA infants
Birth trauma, hypoglycemia (big), polycythemia, hyperbilirubinemia
140
What is a late preterm infant
born 34-36 weeks
141
What is a preterm infant
anything born before 37 weeks
142
What is a full term infant
38-41 weeks
143
What is a post term infant
born after 42 weeks
144
What are considerations for preterm newborns
body system immaturity affecting transition to extrauterine life with increased risk for: hypothermia, hypoglycemia, hyperbilirubinemia, and other problems related to body system immaturity
145
What are considerations for post term new borns
Inability of placenta to provide adequate oxygen and nutrients to fetus after 42 weeks with complications like: perinatal asphyxia, hypoglycemia, hypothermia, polycythemia, meconium aspiration
146
Describe acquired disorders
typically occur at or soon after birth. Can be caused by problems or conditions experienced by the woman during her pregnancy or at birth. Potentially no identifiable cause
147
Describe congenital disorders
Present at birth. Usually due to some type of malformation occurring during the prenatal period. Often related to an inheritance issue. Majority have a complex etiology
148
Name 6 common acquired disorders
Respiratory distress syndrome. Birth Trauma. Newborns of substance-abusing mothers. Infants of diabetic mothers. Newborn infections. Hyperbilirubinemia
149
Name 10 common newborn labs
Cord blood (infant blood type, coombs test), CBC (for H+H), blood glucose, TcB or serum bilirubin, PKU (metabolic screening), CRP, cultures, Blood gases, urine/meconium drug screens, genetic testing
150
Describe transient tachypnea of the neonate
caused by fluid in the lungs and generally resolves within 72 hours (although it can require treatment)
151
Describe respiratory distress syndrome in neonates
caused by lung immaturity and a lack of alveolar surfactant, can take longer to resolve and requires additional treatments
152
Name 10 assessment cues for neonatal respiratory distress syndrome
preterm infant, expiratory grunting, nasal flaring, chest wall retraction, see-saw respirations, generalized cyanosis, heart rate 150-180, fine inspiratory crackles, RR over 60, chest xray shows under expansion of lungs and ground glass pattern
153
When is surfactant produced
37 weeks so this is more common with preterm infants but can still happen with term infants
154
Name 11 interventions for nursing management of respiratory distress syndrome in neonates
betamethasone for mother before birth if preterm. Supportive care. Close monitoring. Ventilation (CPAP, HFNC), exogenous surfactant, antibiotics for positive cultures, fluid replacement and correction of acidosis. Gavage or IV feedings. Blood glucose level monitoring. Clustering of care. Positioning prone or side-lying. Parental support and education
155
Describe surfactant administration for RDS in neonates
intubate, administer surfactant, and rapidly extubate with improvement of symptoms (works very quicklY)
156
What is meconium aspiration
Inhalation of particulate meconium with amniotic fluid into lungs during labor and delivery. Secondary to hypoxic stress in the labor/delivery process. this is why nursery cares when labor nurse says light mec, thick mec etc.
157
Name 9 assessment cues for meconium aspiration
Staining of amniotic fluid, nails, skin, or umbilical cord. Barrel-shaped chest. Prolonged tachypnea. Increasing respiratory distress. Intercostal retractions. Grunting. Cyanosis. Chest xray shows patchy infiltrates and hyperaeration with atelectasis
158
Compare the types of meconium
terminal meconium isn't concerning because it's at delivery. Light meconium doesn't pose a huge risk, while thick meconium is very concerning
159
Describe the withdrawal acronym for withdrawal assessment
Wakefulness - sleep duration less than 3 hours after feeding. Irritability. Temperature variation, tachycardia, tremors. Hyperactivity, high pitched persistent cry, hyperreflexia, hypertonus. Diarrhea, diaphoresis, disorganized suck. Respiratory distress, rub marks, rinorrhea. Apneic attacks, autonomic dysfunction. Weight loss or failure to gain weight. Alkalosis (respiratory), and lacrimation
160
What are the top 3 substances used that can cause withdrawal syndrome
alcohol, tobacco, and marijuana
161
when we suspect neonatal abstinence syndrome what tests should we do
urine drug screen from mother and stool drug screen from baby
162
What is fetal alcohol syndrome
physical and mental disorders appearing at birth and remaining problematic throughout the child's life
163
What is neonatal abstinence syndrome
drug dependency acquired in utero and manifested by neurologic and physical behaviors
164
What is the largest concern with substance abusing mothers
Largest concern is weight loss-higher percent of substance - seizure risk
165
Describe nursing management for newborns of substance abusing mothers
Comfort and stimuli reduction. Meet nutritional needs (infant can breastfeed per IBCLC), prevention of complications. Manage weight loss. Promote parent newborn interaction. Phenobarbital can be used to decrease CNS Irritability and reduce seizure risk. Morphine or methadone can be given for opiate withdrawal
166
What are types of birth trauma
fractures, brachial plexus injury, cranial nerve trauma, head trauma.
167
What are some things we'll assess for in the context of birth trauma
risk factors, bruising, swelling, paralysis, symmetry of structure and function, loss of reflexes
168
Describe nursing management for birth trauma
Supportive care. Assessment for resolution or complications such as elevated bilirubin levels. Community referral for ongoing follow up care
169
What is neonatal sepsis
Bacterial, fungal, or viral microorganisms or their toxins in blood or other tissues. Can be congenital (intrauterine), early onset (perinatal period) or late onset.
170
What will we look for in newborn infection assessment
Risk factors, CRP elevated, non-specific symptoms such as respiratory distress, fever, lethargy, or poor feeding. Positive cultures
171
Describe nursing management of newborn infection
collect CBC, CRP, and cultures. Antibiotic therapy. Circulatory, respiratory, nutritional, and developmental support. Education for prevention and early recognition. Family education
172
What is occurring in infants of diabetic motherse
High levels of maternal glucose cross the placenta and stimulate increased fetal insulin production leading to somatic fetal growth. Can be due to any type of diabetes (gestational, type 1, type 2
173
What are assessment cues for infants of diabetic mothers
full rosy cheeks, ruddy skin color, short neck, large shoulders, distended upper abdomen, excessive subcutaneous fat, hypoglycemia, potential birth trauma, hypocalcemia, hypomagnesemia, polycythemia, hyperbilirubinemia
174
What is the criteria for neonatal hypoglycemia
Plasma glucose of less than 40mg/dL in first 4 hours or less than 45 after that
175
Describe nursing management of hypoglycemia
prevention via oral feedings and supplementation. Glucose therapy (oral or IV) as necessary. Pre-feed blood sugar assessments are a must. Neutral thermal environment. Rest periods. Maintenance of fluid and electrolyte balance alongside calcium and bilirubin monitoring and fluid therapy
176
What is kernicterus
A severe condition that occurs when bilirubin levels are so high they move from blood into brain tissues causing brain damage and permanent injury if not diagnosed and treated in a timely manner
177
What is occurring with hyperbilirubinemia
Imbalance of bilirubin production and elimination.
178
What is the criteria for hyperbilirubinemia
total serum bilirubin level of greater than 5 mg/dL although it usually follows a curve and there's not a static level that requires treatment but rather a percentile (often 95th)
179
What is physiologic jaundice
Levels peak at 3-5 for term and 5-7 days for preterm. Considered early or late onset "breastfeeding jaundice"
180
What is pathologic jaundice
within first 24 hours of life. Coombs/dat positive. Rh isoimmunization. ABO incompatibility. Kernicterus/neurological concerns
181
How can kernicterus be diagnosed
definitively only postmortem with autopsy
182
What are assessment cues for hyperbilirubinemia
risk factors, jaundice, signs of ABO or Rh incompatibiltiy. Indirect coombs test/DAT test. Bilirubin levels via TcB or TSB
183
Describe nursing management of hyperbilirubinemia
reduction of bilirubin levels via: early feeding leads to increased elimination which decreases bilirubin levels. Phototherapy. We need to monitor for dehydration and provide education and support as well as potential home phototherapy
184
What does ACOG recommend for cord clamping
30-60 seconds of delayed cord clamping for vigorous infants. Because more time attached to placental blood flow increases blood supply and oxygen to neonate. Decreasing risk for anemia, hemorrhage, and NEC especially in preterm infants
185
Polycythemia in the newborn can be a result of
Hypoxia, bleeding, VERY delayed cord clamping which leads to increased RBC production and thus increased blood viscosity, decreased oxygen transport, and increased risk for jaundice. Also called newborn plethora.
