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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

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2
Q

What are risks for shoulder dystocia

A

macrosomia, excessive weight gain, and history of shoulder dystocia

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3
Q

What is the warning sign for shoulder dystocia

A

Turtle sign

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4
Q

What are some of the maternal negative outcomes of shoulder dystocia

A

Postpartum hemorrhage and laceration

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5
Q

What are some negative fetal outcomes of shoulder dystocia

A

brachial plexus injury and clavicle fracture

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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

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7
Q

What are some risks for cord prolapse

A

malpresentation, high station, preterm labor, low birth weight, multiple gestations, and polyhydramnios

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8
Q

What is the priority with umbilical cord prolapse

A

prompt recognition and we need to relieve compression of the cord

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9
Q

What is uterine rupture

A

tearing of the uterus into the abdominal cavity

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10
Q
A
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11
Q

What is the cardinal sign of uterine rupture

A

sudden fetal bradycardia

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12
Q

What are some risks for uterine rupture

A

uterine scar, prior rupture, trauma, hypertonic contractions

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13
Q

What do we do when we have a uterine rupture

A

urgent cesarean section

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14
Q

What is an amniotic fluid embolism

A

Amniotic fluid containing hair, skin, vernix, or meconium enters maternal circulation and obstructs pulmonary vessels

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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

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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

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17
Q

What is the typical outcome of amniotic fluid embolism

A

rapid maternal deterioration and a poor prognosis

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18
Q

What are risks for amniotic fluid embolism

A

placental abruption, uterine overdistention, fetal demise, uterine trauma, amnioinfusion, amniocentesis, ROM

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19
Q

What are our hallmark symptoms of amniotic fluid embolism

A

Difficulty breathing, sudden hypotension, hypoxia, and coagulation failure (DIC)

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20
Q

What is dystocia of labor

A

“failure to progress” It is a lack of progressive dilation and/or descent

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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.

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22
Q

What are some complications of dystocia of labor

A

Postpartum hemorrhage, infection, and perineal lacerations

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23
Q

What is the #1 reason for a cesarean delivery

A

dystocia of labor

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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

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25
Q

What are the 5 Ps of dystocia of labor

A

Passageway, passenger (position), powers, psychological response

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26
Q

What does the passageway refer to

A

the pelvis/birth canal. If this is small the baby has less room to descend

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27
Q

Describe some factors of the passenger that can lead to dystocia of labor

A

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.

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28
Q

Describe how the powers can contribute to dystocia of labor

A

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

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29
Q

Describe how the psychological response can lead to dystocia of labor

A

If the mom has fear or anxiety it can inhibit her ability to push effectively leading to dystocia of labor

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30
Q

what is a risk for hypertonic uterine dysfunction, and which phase does it prolong potentially leading to dystocia of labor

A

The main risk is primagravida. We have a prolonged latent stage where we stay at 2-3cm.

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31
Q

What assessments would we see with hypertonic uterine dysfunction and what would our treatment be as it relates to dystocia of labor

A

We’d see minimal relaxation, and compromised placental perfusion. The main treatment is relaxation

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32
Q

What is a risk for hypotonic uterine dysfunction and what phase does it occur during

A

Overstretching of the uterus is our primary risk, and it occurs during the active phase of labor

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33
Q

What are assessments we’d see with hypotonic uterine dysfunction and what would our treatment be

A

mild and infrequent contractions and our main treatment will be stimulation

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34
Q

Name 5 assessments we will complete for dystocia of labor

A

Review risk factors, assess signs of stress and support, evaluate uterine contractions and FHR, assess fetal position, and perform vaginal exams

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35
Q

Name 3 primary forms of management we will use for dystocia of labor

A

provide physical and emotional support, promote comfort for relaxation and normal labor progress, prepare family for cesarean delivery if labor does not progress

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36
Q

What is precipitate labor

A

When labor is completed in less than 3 hours from start of contractions to birth

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37
Q

What are some common causes of precipitate labor

A

Hypertonic labor, use of oxytocin, multiparity, and drug use

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38
Q

What are maternal risks associated with precipitate labor

A

Uterine rupture, lacerations, amniotic fluid embolism, postpartum hemorrhage

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39
Q

What are fetal risks that can result from precipitate labor

A

hypoxia, intracranial hemorrhage, and nerve damage

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40
Q

What is preterm labor

A

Regular uterine contractions with cervical effacement and dilation before the end of 37 weeks

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41
Q

What are risk factors for preterm labor

A

African american, smoking, cocaine, multiples, infections, and cervical insufficiency

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42
Q

Name 5 infant risks resulting from preterm labor

A

respiratory distress syndrome, infections, thermoregulation, feeding difficulties, and hypoglycemia

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43
Q

Name the four tocolytics we typically use for preterm labor

A

Indomethacin, nifedipine, mag sulfate, and terbutalin

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44
Q

Describe indomethacin (indocin)

A

inhibits prostaglandins and uterine contraction, given PO. Contraindicated if greater than 32 weeks because of risk for neonatal side effects

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45
Q

Describe nifedipine (procardia)

A

blocks calcium movement into muscle cells, inhibits uterine contractions, is given PO. Contraindicated with cardiovascular disease

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46
Q

Describe Mag Sulfate

A

Reduces muscle’s ability to contract, given IV

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47
Q

Terbutaline (brethine)

A

betamimetic, prevents and slows uterine contractions, given SubQ, do not give beyond 48-72 hours

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48
Q

Describe assessment cues for preterm labor

A

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

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49
Q

Describe fetal fibronectin as it pertains to preterm labor

A

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

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50
Q

When testing for fetal fibronectin what is our primary concern

A

Nothing in the vagina for 24 hours prior to the test

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51
Q

Describe cervical length as it pertains to preterm labor

A

It is a measurement of the closed portion of cervix by transvaginal ultrasound.

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52
Q

What is the single most reliable parameter for preterm labor in high-risk women and when is it best taken

A

cervical length and it is best obtained at 16-24 weeks

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53
Q

What does a cervical length of 3cm or more indicate

A

unlikely to deliver in the next 2 weeks

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54
Q

What is a post term labor

A

pregnancy continuing past 42 weeks

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55
Q

What are maternal risks resulting from post term labor

A

Cesarean birth, dystocia, birth trauma, postpartum hemorrhage, and infection

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56
Q

What are fetal risks resulting from post term labor

A

Macrosomia, shoulder dystocia, brachial plexus injuries, low apgars, postmaturity syndrome (loss of subcutaneous fat and muscle and meconium staining)

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57
Q

Describe assessment we would carry out with post term pregnancy

A

Determine gestational age, daily fetal movement, BPP twice weekly, and weekly cervical exams

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58
Q

Compare induction to augmentation

A

Induction is starting contractions by medical or surgical means, augmentation is enhancing ineffective contractions after the start of labor

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58
Q

What is required for induction

A

Must have a clear medical indication

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59
Q

Name 9 indications for induction of labor

A

Postterm pregnancy is our primary, prolonged premature rupture of membranes, gestational hypertension, cardiac disease, chorioamnionitis, dystocia, intrauterine fetal demise, diabetes, IUGR

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60
Q

Name 6 contraindications for induction of labor

A

Complete previa, placenta abruption, malpresentation, classical uterine incision, active genital herpes, abnormal FHR

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61
Q

Name 5 risks associated with induction

A

infection, cesarean birth, prolonged labor, instrumented delivery, epidural analgesia

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62
Q

What are the 5 categories for the bishop scoring system

A

Dilation (cm), effacement (%), station, cervical consistency, and position of cervix

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63
Q

What gives a 0 score in every bishop category

A

Closed dilation, 0-30% effacement, -3 station, firm cervical consistency, and posterior position of cervix

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64
Q

What gives a 1 score in every bishop category

A

1-2cm dilated, 40-50% effaced, -2 station, medium cervical consistency, midposition position of cervix

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65
Q

What gives a 2 score in every bishop category

A

3-4cm dilated, 60-70% effaced, -1 or 0 station, soft cervical consistency, anterior position of cervix

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66
Q

What gives a 3 score in every bishop category

A

5-6cm dilated, 80% effaced, +1 or +2 station, very soft cervical consistency and anterior position of cervix

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67
Q

Name 4 method for cervical ripening

A

surgical methods, alternative methods, mechanical methods, and meds: misoprostol (cytotec) and dinoprostone (cervidil)

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68
Q

Name four assessments we’d carry out for induction and augmentation

A

review indications and contraindications. Gestational age determination. Fetal status. Cervical readiness; bishop score.

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69
Q

Describe management for induction and augmentation

A

Explanations; informed consent. Medication administration with continued monitoring of maternal and fetal status. Pain relief and support

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70
Q

What is amnioinfusion

A

Normal saline (or potentially another isotonic fluid) is instilled into the uterus through an intrauterine pressure catheter

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71
Q

What are indications for amnioinfusion

A

Severe variable decelerations due to cord compression often related to oligohydramnios, and rupture of membranes, also thick meconium fluid

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72
Q

Describe nursing management related to amnioinfusion

A

teaching, maternal and fetal assessment, preparation for possible cesarean

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73
Q

What is a forceps or vacuum assisted birth

A

Application of traction to the fetal head

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74
Q

What are the main risks of forceps or vacuum assisted birth

A

tissue trauma - maternal: laceration, hematoma, hemorrhage, infection. Newborn: laceration, facial nerve injury, cephalohematoma, caput succedaneum

75
Q

Name 4 criteria required for forceps or vacuum assisted birth

A

membranes ruptured, complete dilation, vertex position and engaged, adequate pelvis size

76
Q

Name 6 indications for forceps or vacuum assisted birth

A

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
Q

What are the two incision types for c section

A

Low transverse or classic ( vertical incision midline on abdomen)

78
Q

What are maternal indications for c section

A

advanced maternal age, previous c section (classical incision), active genital herpes, dystocia of labor

79
Q

What are fetal indications for c section

A

distress, breech presentation, congenital anomalies, macrosomia

80
Q

What are placenta related indications for c section

A

previa and abruption

81
Q

How do risks with c section compare to vaginal

A

It is a major surgical procedure with increased risks compared to vaginal delivery

82
Q

Describe assessment we’d carry out with c section

A

History and physical exam for maternal and fetal indications

83
Q

Describe preoperative management for c section

A

client teaching, blood type and crossmatch, CBC, surgical site prep, foley catheter, IV antibiotics, SCDs, epidural/spinal

84
Q

Describe postoperative management for c section

A

assess vitals, lochia, fundus, abdominal dressing, and pain; auscultate bowel sounds; early ambulation; encourage use of incentive spirometer

85
Q

What are the risks associated with vaginal birth after cesarean

A

uterine rupture and hemorrhage

86
Q

What are contraindications for vaginal birth after cesarean

A

classical incision, myomectomy, ripening agents

87
Q

What are special considerations for vaginal birth after cesarean

A

consent, documentation, surveillance, readiness for emergency

88
Q

What is important for nurses to do with vaginal birth after cesarean

A

advocate for client; expertise in fetal monitoring to identify nonreassuring pattern and institute measures for emergency delivery.

89
Q

Describe the post acronym for post birth warning signs

A

call 911 if you have: pain in chest, obstructed breathing or shortness of breath, seizures, or thoughts of hurting yourself or someone else

90
Q

Describe the birth acronym for post birth warning signs

A

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
Q

Describe stage 0 management and who it pertains to

A

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
Q

Name 9 risk factors for postpartum hemorrhage

A

multiparity, multiple gestation, polyhydramnios, macrosomic newborn, chronic coagulation disorders, prolonged labor, induction of labor, uterine inversion, and general anesthesia

93
Q

Describe the prevention or first key point for PPH

A

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
Q

Describe the Assess or 2nd key point for PPH

A

Assess for four T’s; tone (uterine atony), tissue (retained placental fragments), trauma (lacerations, rupture, or inversion), and thrombin (coagulopathy)

95
Q

Describe the early resuscitation or 3rd key point for PPH

A

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
Q

What makes up 70% of PPH and what is the treatment

A

Uterine atony (tone)- fundal massage. Uterotonic meds: oxytocin, cytotec, methergine, hemabate. Empty the bladder

97
Q

What makes up 10% of PPH and what is the treatment

A

Retained placenta (tissue) - Inspect placenta for missing pieces. Ultrasound. Manual removal of adherent placenta (d and c or vaginal)

98
Q

What makes up 20% of PPH and what is the treatment

A

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
Q

What makes up less than 1% of PPH and what is the treatment

A

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
Q

What is the leading cause of maternal mortality in the united states

A

postpartum hemorrhage

101
Q

Describe mild degree of shock, it’s blood loss, and signs and symptoms

A

20% blood loss. Diaphoresis, increase capillary refilling. Cool extremities. Maternal anxiety

102
Q

What are our factors that make us very concerned when it comes to blood loss

A

Any amount of bleeding that places the mother in hemodynamic jeopardy - 10% drop in hematocrit or shock

103
Q

Describe severe degree of shock blood loss, and it’s signs and symptoms

A

greater than 40%. Hypotension. Agitation/confusion. Hemodynamic instability

104
Q

Describe moderate degree of shock blood loss, and it’s signs and symptoms

A

20-40% blood loss. Tachycardia, postural hypotension. Oliguria

105
Q

What labs will we typically want to get with bleeding

A

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
Q

What is stage 1 OB hemorrhage bundle protocol

A

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
Q

What are the criteria for stage 1 blood loss

A

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
Q

What are the criteria for stage 2 blood loss

A

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
Q

What is the bundle protocol for stage 2

A

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
Q

What is the criteria for stage 3

A

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
Q

What is the bundle protocol for stage 3

A

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
Q

What is the criteria for stage 4

A

cardiovascular collapse (massive hemorrhage, profound hypovolemic shock, or amniotic fluid embolism)

113
Q

What is the bundle protocol for stage 4

A

ACLS medications. Simultaneous aggressive massive transfusion. Immediate surgical intervention to ensure hemostasis (hysterectomy)

114
Q

What is a perineal hematoma

A

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
Q

What are some signs and symptoms of perineal hematoma and what is treatment

A

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
Q

Describe the pathophysiology of thromboembolic conditions

A

venous stasis, injury to innermost layer of blood vessel. Hypercoagulation (increased clotting factors in pregnancy like fibrinogen).

117
Q

How long does the risk remain high for thromboembolic conditions in pregnancy and what is the incidence rate

A

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
Q

Name 7 risk factors for thromboembolic conditions

A

Pregnancy, obesity, bedrest/sedentary lifestyle. Poor venous return. Abdominal surgery. Elevated fibrinogen. Past smoker/hormones (birth control)

119
Q

What are the 3 most common types of thromboembolic conditions

A

superficial thrombosis, deep vein thrombosis, and pulmonary embolism

120
Q

What are assessment cues for DVT and what test will be done

A

leg pain, tenderness, redness. Unilateral swelling. Sharp, burning pain. Doppler studies

121
Q

Describe nursing management for DVTs

A

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
Q

What are assessment cues for pulmonary embolism and what 3 tests will be done

A

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
Q

Describe nursing management for PE

A

goal is to prevent further clots. CPR, oxygen, IV heparin, bedrest/analgesia, tPA (thrombolytic agents)

124
Q

What is metritis and describe common organisms

A

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
Q

What temperature are we concerned about

A

100.4 or above

126
Q

Describe signs and symptoms of metritis

A

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
Q

Describe signs and symptoms of urinary tract infection

A

urgency, frequency, dysuria, flank pain, low grade fever, urinary retention, hematuria, urine positive for nitrates, cloudy urine with strong odor

128
Q

Describe signs and symptoms of mastitis

A

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
Q

Describe our therapeutic management for each type of postpartum infection

A

Metritis - broad spectrum antibiotics. Would infection - wound care. UTIs - fluids and antibiotics. Mastitis - breast emptying and antibiotics

130
Q

What is the REEDA assessment

A

redness, edema, ecchymosis, discharge, approximation of skin edges

131
Q

What are the signs of postpartum blues

A

Emotional lability, irritability, insomnia

132
Q

What is treatment for postpartum blues

A

typically is self limiting and resolves within 2 weeks (postpartum day 10)

133
Q

What are the signs and symptoms of postpartum depression

A

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
Q

What is the treatment for postpartum depression

A

lifestyle changes, medication, and cognitive behavioral therapy

134
Q

What are the signs and symptoms of postpartum psychosis

A

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
Q

What is the treatment for postpartum psychosis

A

Don’t leave child alone with mother. Hospitalization. Psychotropic drug treatment. Individual group therapy

136
Q

What are criteria for small for gestational age

A

weight less than 2500g (5 lb 8 oz) at term. Below the 10th percentile

137
Q

What are criteria for large for gestational age

A

weight greater than 4,000g (8lb 13 oz) at term. Above 90th percentile

138
Q

What are considerations for SGA infants

A

perinatal asphyxia. Difficulty with thermoregulation. Hypoglycemia (big), polycythemia, meconium aspiration, and hyperbilirubinemia

139
Q

What are considerations for LGA infants

A

Birth trauma, hypoglycemia (big), polycythemia, hyperbilirubinemia

140
Q

What is a late preterm infant

A

born 34-36 weeks

141
Q

What is a preterm infant

A

anything born before 37 weeks

142
Q

What is a full term infant

A

38-41 weeks

143
Q

What is a post term infant

A

born after 42 weeks

144
Q

What are considerations for preterm newborns

A

body system immaturity affecting transition to extrauterine life with increased risk for: hypothermia, hypoglycemia, hyperbilirubinemia, and other problems related to body system immaturity

145
Q

What are considerations for post term new borns

A

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
Q

Describe acquired disorders

A

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
Q

Describe congenital disorders

A

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
Q

Name 6 common acquired disorders

A

Respiratory distress syndrome. Birth Trauma. Newborns of substance-abusing mothers. Infants of diabetic mothers. Newborn infections. Hyperbilirubinemia

149
Q

Name 10 common newborn labs

A

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
Q

Describe transient tachypnea of the neonate

A

caused by fluid in the lungs and generally resolves within 72 hours (although it can require treatment)

151
Q

Describe respiratory distress syndrome in neonates

A

caused by lung immaturity and a lack of alveolar surfactant, can take longer to resolve and requires additional treatments

152
Q

Name 10 assessment cues for neonatal respiratory distress syndrome

A

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
Q

When is surfactant produced

A

37 weeks so this is more common with preterm infants but can still happen with term infants

154
Q

Name 11 interventions for nursing management of respiratory distress syndrome in neonates

A

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
Q

Describe surfactant administration for RDS in neonates

A

intubate, administer surfactant, and rapidly extubate with improvement of symptoms (works very quicklY)

156
Q

What is meconium aspiration

A

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
Q

Name 9 assessment cues for meconium aspiration

A

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
Q

Compare the types of meconium

A

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
Q

Describe the withdrawal acronym for withdrawal assessment

A

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
Q

What are the top 3 substances used that can cause withdrawal syndrome

A

alcohol, tobacco, and marijuana

161
Q

when we suspect neonatal abstinence syndrome what tests should we do

A

urine drug screen from mother and stool drug screen from baby

162
Q

What is fetal alcohol syndrome

A

physical and mental disorders appearing at birth and remaining problematic throughout the child’s life

163
Q

What is neonatal abstinence syndrome

A

drug dependency acquired in utero and manifested by neurologic and physical behaviors

164
Q

What is the largest concern with substance abusing mothers

A

Largest concern is weight loss-higher percent of substance - seizure risk

165
Q

Describe nursing management for newborns of substance abusing mothers

A

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
Q

What are types of birth trauma

A

fractures, brachial plexus injury, cranial nerve trauma, head trauma.

167
Q

What are some things we’ll assess for in the context of birth trauma

A

risk factors, bruising, swelling, paralysis, symmetry of structure and function, loss of reflexes

168
Q

Describe nursing management for birth trauma

A

Supportive care. Assessment for resolution or complications such as elevated bilirubin levels. Community referral for ongoing follow up care

169
Q

What is neonatal sepsis

A

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
Q

What will we look for in newborn infection assessment

A

Risk factors, CRP elevated, non-specific symptoms such as respiratory distress, fever, lethargy, or poor feeding. Positive cultures

171
Q

Describe nursing management of newborn infection

A

collect CBC, CRP, and cultures. Antibiotic therapy. Circulatory, respiratory, nutritional, and developmental support. Education for prevention and early recognition. Family education

172
Q

What is occurring in infants of diabetic motherse

A

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
Q

What are assessment cues for infants of diabetic mothers

A

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
Q

What is the criteria for neonatal hypoglycemia

A

Plasma glucose of less than 40mg/dL in first 4 hours or less than 45 after that

175
Q

Describe nursing management of hypoglycemia

A

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
Q

What is kernicterus

A

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
Q

What is occurring with hyperbilirubinemia

A

Imbalance of bilirubin production and elimination.

178
Q

What is the criteria for hyperbilirubinemia

A

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
Q

What is physiologic jaundice

A

Levels peak at 3-5 for term and 5-7 days for preterm. Considered early or late onset “breastfeeding jaundice”

180
Q

What is pathologic jaundice

A

within first 24 hours of life. Coombs/dat positive. Rh isoimmunization. ABO incompatibility. Kernicterus/neurological concerns

181
Q

How can kernicterus be diagnosed

A

definitively only postmortem with autopsy

182
Q

What are assessment cues for hyperbilirubinemia

A

risk factors, jaundice, signs of ABO or Rh incompatibiltiy. Indirect coombs test/DAT test. Bilirubin levels via TcB or TSB

183
Q

Describe nursing management of hyperbilirubinemia

A

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
Q

What does ACOG recommend for cord clamping

A

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
Q

Polycythemia in the newborn can be a result of

A

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.

OB (3 decks)

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