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Families Final > Families Final Review - Duckworth > Flashcards

Families Final Review - Duckworth Flashcards

1
Q

Newborn Vital signs include

A
  • Pulse
  • Respiration
  • Blood pressure
  • Temperature
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2
Q

Newborn HR/Pulse

A
  • Heart rate-Fast, normal 120-140 beats per minute (Can be 110-160)
  • Can vary with sleep or crying
  • Apical pulse must be take for 1 minute
  • Brachial and Femoral pulse can be palpated
  • May hear Murmurs as transition from fetal to newborn circulation
  • Bradycardia- Heart Rate below 80 beats/minute
  • Tachycardia-Heart Rate above 180 beats/minute
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3
Q

Newborn Respirations

A
  • Normal respirations of a newborn is 30-60 breaths per minute
  • May have periodic breathing-which is irregular breathing or pauses that can last for 20 seconds
  • Cessation of breathing for more than 20 seconds is call Apnea- which is abnormal in a full term infant, not in a preterm
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4
Q

Newborn BP

A
  • Blood pressure must be measure using Dinamap machine
  • Blood pressure is sensitive to blood volume
  • Blood pressure can vary, however a normal blood pressure in a newborn 80/46
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5
Q

Newborn Temperature

A
  • Usually taken Axillary
  • Temperature should be stable around 98.6 F or 37 C Axillary around 4 hours
  • Babies usually do not shiver
  • Newborn can conserve heat by constricting blood flow and moving blood away from the skin.
  • BROWN FAT-Special tissue in term newborns. Brown fat helps to conserve or produce body heat by increasing metabolism as well as regulating body temperature.
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6
Q

Signs of illness in a newborn

A
  • If a baby has an infection, unlike an adult or child, their temperature will decrease. (or subnormal)
  • This baby needs immediate attention and a CBC and a Blood Culture
  • Temperature instability is usually an indication of infection
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7
Q

Newborn Assessment

APGAR

A
  • 5 categories of scoring
  • Heart Rate
  • Respiratory Status
  • Muscle Tone
  • Reflex Irritability
  • Color-Appearance
  • It is score at 1 and 5 minutes
  • There are 5 areas of scoring, with a rating of 0-2.
  • Most a baby could earn is 10, lowest 0
  • Correlation between low 5 minute Apgars and neurological issues.
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8
Q

Heat loss (4 kind)

A

Convection
• Flow of heat from the newborn’s service to cooler surrounding air
• Example-Bringing baby out from the Isolette and exposing the baby to the air current

Radiation
• Transfer of body heat to a cooler solid object, not in contact with the baby
• Example-wall

Conduction
• Is the transfer of body heat to a color solid object in contact with baby
• Example-Weighing baby on a cold scale, chilled hands, cold stethoscope

Evaporation
• loss of heat through conversion of a liquid to a vapor
• Example-immediately after birth by wet with amniotic fluid & bath time

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9
Q

Newborn Care

Feedings

A

Bottle q3-4 hours

Breastfed on demand

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10
Q

Newborn Care

Stools

A

If Bottle fed – once a day

If Breastfed – at least once a day up to 6-8/day

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11
Q

Newborn Care

Voiding

A
  • Usually voids within 24 hours after birth

* Normal is 6-8 wet diapers per day.

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12
Q

Newborn

Immunity

A
  • Have limited immunologic protection at birth
  • Not able to produce antibodies until about 2 months
  • Newborn are born with passive immunity
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13
Q

Newborn

Blood Coagulation

A
  • Vitamin K for a full term infant is usually 1 mg
  • Given in the Lateral Anterior Thigh, IM
  • If parents do not want this medication, they must sign a refusal form.
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14
Q

Neuromuscular Reflexes

A
  • Blink reflex-Protect eye from any objects, bright lights
  • Rooting reflex-cheek is brushed or stroked near the corner of mouth, the infant will turn the head in that direction-Find Food
  • Sucking reflex-Lips are touched, the baby makes a sucking sound
  • Swallowing reflex-usually seen in babies at 34 weeks gestation
  • Palmar grasp reflex-Grasp an object, closing their fingers
  • Moro Reflex-Startle Reflex
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15
Q

What 3 medications are given to a newborn?

What 2 Tests?

A 
Clindamycin (for gonorrhea and chlamydia)
 Vit K (clotting)
Hep B (with consent)

PKU blood test
Hearing test

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16
Q

Pregnancy Care

A
  • Monitor blood pressure and pulse frequently
  • Observe for signs and symptoms of shock
  • Count and weigh pads to assess amount of bleeding
  • Save any tissue or clots expelled
  • If pregnancy >12 weeks’ gestation assess fetal heart tones with Doppler
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17
Q

Diagnostic tools

Chorionic Villi sampling

A
  • Small sample of chorionic villi taken from developing placenta
  • Early in pregnancy 10-12 weeks
  • Used for genetic testing
  • Risks-Invasive/Risk of miscarriage
  • Done Vaginally, with abdominal ultrasound
  • Performed in some medical centers for first-trimester diagnosis of genetic and deoxyribonucleic acid (DNA) studies
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18
Q

Diagnostic tools

Amniocentesis

A
  • A small amount of amniotic fluid is removed through the abdominal wall, into the uterus
  • Removed by a needle aspiration
  • Early detection can evaluate for Chromosome Analysis-Genetic Disease (Trisomy 21) 15-18 weeks
  • L/S ratio Can determine lung maturity-Later in pregnancy
  • Lecithin and sphingomyelin are the components of the lung enzyme surfactant
  • Normal lung maturity is 2:1
  • Risk-Invasive/Risk of Miscarriage in early/ labor in late use
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19
Q

Diagnostic tools

Alpha fetal protein

A
  • Blood Test drawn around 15-20 weeks
  • Substance produced by fetal liver
  • Abnormally high if fetus has an open spinal or abdominal wall defect
  • Can also detect genetic disorders
  • Remember this test, is not specific, if further levels are high, need to have better testing
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20
Q

Diagnostic tools

Ultrasound

A
  • Identifying pregnancy and determining gestational age as early as 5 or 6 weeks
  • Identifying fetal heart rate and fetal breathing movements
  • Estimating size of the fetus
  • Screen for fetal anomalies such as facial, anencephaly, hydrocephalus
  • Identify placental location and grading
  • Detect fetal position and presentation
  • Detect fetal death
  • Assist with accompanying procedures (Amniocentesis)
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21
Q

Diagnostic tools

Maternal Assessment of Fetal Activity

A
  • Monitors fetal well-being
  • Begins at approximately 28 gestational weeks
  • Reduction in movement may indicate fetal hypoxia, growth restriction, or fetal death
22
Q

Diagnostic tools

Fundal Height

A
  • Fetal growth, the uterus expands to accommodate its size.
  • McDonald’s rule-symphysis fundal height measurement. Measurement is from the notch of the symphysis pubis to over the top of the uterine fundus. Usually done is cM/which correlates to weeks pregnant.
23
Q

Diagnostic tools

Doppler Blood Flow

A
  • Noninvasive ultrasound test
  • Measures blood flow changes that occur in maternal and fetal circulation to assess placental function
  • Creates “picture” (waveform) that looks like a series of waves
24
Q

Diagnostic tools

Non-stress test

A
  • Widely used method of evaluating fetal status (alone or as part of biophysical profile [BPP)
  • Adequately oxygenated fetus with intact fetal central nervous system should demonstrate accelerated fetal heart rate (FHR) in response to fetal movement
  • Shows at least two accelerations of FHR with fetal movements of 15 beats/min, lasting 15 seconds or more, over 20 minutes
25
Q 
Diagnostic tools
Biophysical Profile (BPP)
A
  • Performed after 28 weeks
  • Five variables assessed by ultrasound:
  • Fetal breathing movement
  • Fetal movements of body or limbs
  • Fetal tone (extremity extension and flexion)
  • Fetal reactivity (Reactive fetal heart rate (FHR) with activity (reactive non-stress test [NST])
  • Amniotic fluid volume (pockets of fluid around the fetus)
26
Q

Diagnostic tools

Contraction Stress Test

A
  • Evaluates placental respiratory function (oxygen and carbon dioxide exchange)
  • Allows identification of fetus at risk for intrauterine asphyxia
  • Requires presence of contractions
27
Q

Gravida/Para

A
  • Gravida =G
  • Any pregnancy regardless of duration, including current pregnancy
  • Para=P
  • Birth after 20 weeks’ gestation, regardless of whether the baby is born alive or dead
28
Q

Types of Abortions

1 of 2

A
  • Threatened abortion
  • Embryo or fetus is jeopardized
  • May be followed by partial or complete expulsion of products of conception
  • Imminent abortion
  • Increased bleeding and cramping
  • Term “inevitable abortion“ applies
  • Complete abortion
  • All products of conception expelled
  • Incomplete abortion
  • Some products of conception are retained, most often the placenta
29
Q

Types of Abortions

2 of 2

A
  • Missed abortion
  • Fetus dies in utero but is not expelled
  • If fetus is retained beyond 6 weeks, disseminated intravascular coagulation (DIC) may develop
  • Dilatation and curettage or suction evacuation if first trimester
  • Induction of labor or dilatation and evacuation (D&E) if second trimester
  • Recurrent pregnancy loss
  • Formerly called habitual abortion
  • Abortion in three or more consecutive pregnancies
  • Septic abortion
  • Prolonged, unrecognized rupture of membranes
  • Pregnancy with intrauterine device (IUD) in utero
  • Attempts by unqualified individuals to terminate pregnancy
  • Products of Conception (POC)
30
Q

Naegele’s Rule

A

First days of LMP, subtract 3 months, add 7 days

31
Q

Monitor Strips- (Early, Variable/ Late decelerations) Variability

A 
VEAL CHOP
•	Variables – Cord Compression
•	Earlies – Head Compression
•	Accels – OK!
•	Lates – Placental insufficiency
32
Q

Prolonged decels interventions:

A

Left side and give O2

33
Q

Progression of labor

A
  • Cervical dilation (cm) and effacement (%)
  • Goal is 10 cm dilated and 100% effacement
  • Membrane status (intact or ruptured)
  • Fetal descent and presentation
34
Q

Stages of Labor

A
  • First stage of labor. Thinning (effacement) and opening (dilation) of the cervix.
  • Second stage of labor. Your baby moves through the birth canal.
  • Third stage of labor. Afterbirth.
  • Fourth stage of labor. Recovery.
35
Q

Delivery Assessments and Interventions

A

Assessment
• Placental separation; placenta and fetal membranes examination; perineal trauma; episiotomy; lacerations

Interventions
• Instructing to push when separation apparent
• Giving oxytoxic if ordered
• Assisting woman to comfortable position
• Providing warmth; applying ice to perineum if episiotomy
• Explaining assessments to come
• Monitoring mother’s physical status
• Recording birthing statistics; documenting birth in birth book

36
Q

Analgesia

Epidural Patient Preparation

A
  • *typically for delivery
  • Pt on edge of bed with feet on stool
  • Frequent monitoring of material BP and pulse
  • Initiate intravenous infusion (18 gauge)
  • Bolus of 500 to 1000 mL of IV fluid
37
Q

Analgesia

Spinal Patient Preparation

A
  • *typically for cesarian
  • Insert 16-18 gauge IV catheter
  • Bolus of 500 to 1000 mL of IV fluid
  • Assess maternal vital signs, pain level, and FHR
  • Position woman sitting or lateral
  • Pt sit up in bed with feet on bed (so can lay down directly after)
38
Q

What anesthesia is used for episiotomy (if no epidural)?

A

Pudendal Block

39
Q

Naloxone [Narcan]

A
  • Reverses mild respiratory depression associated with fentanyl, meperidine butorphanol tartrate, and nalbuphine hydrochloride
  • Maternal dose 0.4-2 mg IV, may be repeated
  • Neonatal dose 0.1 mg/kg, may be repeated
40
Q

Complications of Labor/Delivery

Placental Previa

A
  • Placental implantation in the lower uterine segment- p 537
  • As lower uterine segment contracts and dilates, placental villi are torn from uterine wall
  • Uterine sinuses exposed at placental site
  • Amount of bleeding may range from scanty to profuse
  • NO PAIN + BLEEDING!! Develops during the last 3 months of pregnancy
  • 4 degrees – total, partial, marginal, low-lying
41
Q

Complications of Labor/Delivery

Abruption

A
  • Premature separation of a normally implanted placenta from the uterine wall
  • Cause is largely unknown
  • Marginal, Central, or Complete
  • PAIN + BLEEDING!!
  • Leads to massive obstetric hemorrhage
  • Have type and cross for blood, with blood ready to go -> 3000-5000 mL blood
  • Have 2 large bore IVs
  • Baby will have 0-1 APGAR so be ready!
42
Q

Complications of Labor/Delivery

Preeclampsia

A
  • Most common hypertensive disorders in pregnancy
  • Defined as an increase in BP after 20 weeks and accompanied by proteinuria
  • It is mild or severe and is a progressive disease
  • HELLP syndrome
  • Hemolysis
  • Elevated liver enzymes
  • Low platelet count
  • Mild: Blood pressure elevated to ≥140/90 mmHg or higher, Proteinuria ≤1 g in 24 hours (2+ dipstick)
  • Severe: Blood pressure ≥160/110 mmHg on two occasions at least 6 hours apart during bed rest, Proteinuria ≥5 g/L in 24-hour urine collection
  • Magnesium Sulfate
43
Q

Complications of Labor/Delivery

Prolapse Cord

A
  • Definition- Loop of Umbilical cord slips down and precedes the fetal presenting part.
  • Dependent on station of the baby -> higher the baby, higher the chance
  • Relieve compression with gloved fingers
  • Position for gravity to help relieve compression-Knee chest position.
  • Oxygen via mask-Face Mask
  • Prepare for cesarean birth; however vaginal birth is possible if cervix is completely dilated and measurements are adequate
44
Q

Complications of Labor/Delivery

Group B Strep

A
  • Can be transmitted to neonate through vertical transmission during birth and horizontal transmission after birth (colonized nursing personnel or colonized babies).
  • Prenatal screening at 35-37 weeks gestation Intrapartum antibiotic therapy
  • Intrapartum antibiotic therapy is recommended:
  • Penicillin G 5million units IV followed by 2.5-3 million units IV every 4 hours until baby is born.
  • If allergic to Penicillin-Clindamycin or Vancomycin
45
Q

Magnesium Sulfate

A
  • dications- vasodilation, prevention and treatment of eclamptic seizures Given IV
  • Loading dose-4-6 grams in 100ml of fluid over 15-20 minutes
  • Followed by 2 grams as a continuous IV infusion
  • Magnesium levels daily (normal 4-7 mEq)
  • Mag toxicity- Respiratory rate less than 12, absence of DTR’s, decrease urinary output
  • As levels increases, so does the problems
  • 10mEq/L –possible loss of DTR
  • 15mEq/L- possible respiratory depression
  • 25mEq/L- possible cardiac arrest
  • HAVE CALCIUM GLUCONATE AVAILABLE AS ANTIDOTE
46
Q

Postpartum Assessment

BUBBLEHE

A 
Breast
Uterus
Bladder
Bowel
Lochia
Episiotomy
Homans/Hemorrhoids
Emotional
47
Q

Hemorrhage

A
  • Blood loss of 500 ml or more following a vaginal birth (up to 500 mL normal finding)
  • Blood loss of 1,000 ml or more or 10% decrease in hematocrit level after cesarean birth
  • The normal mechanism for hemostasis after delivery of the placenta is contraction of the uterine muscles to occlude the open sinuses that brought blood into the placenta. Absence of prompt or sustained uterine contraction can result in significant blood loss
  • S/S of shock: tachycardia, decreased BP, dizziness, pallor
  • Stop the hemorrhage
  • Correct the hypovolemia – large bore IV (2) NS or LR
  • Call Provider
  • massage uterus
  • meds, O2
48
Q

Postpartum Blues

A
  • Onset 1-10 days after birth
  • Symptoms- Sadness, tear
  • Incidence-70% of all births
  • Etiology-Probable-Hormonal changes, stress in life
  • Therapy-support, empathy
  • Nursing role-Compassion, understanding
49
Q

Postpartum Depression

A
  • Onset-1-12 months after birth
  • Symptoms-Anxiety, feeling of loss, sadness
  • Incidence-10% of all births
  • Etiology-Hx. Of previous depression, hormonal response, lack of social support
  • Therapy-Counseling/ Drug therapy
  • Nursing-Screen for depression, refer for service
50
Q

Postpartum Psychosis

A
  • Onset- within first year after birth
  • Symptoms-Delusions/ Hallucinations (Harming self or infant)
  • Incidence-1%-2% of births
  • Etiology-Possible activation of previous mental illness, hormonal changes, family history of bipolar
  • Therapy-inpatient mental health facility/ drug therapy/ outpatient treatment
  • Nursing Role-Refer to psychiatric care, safeguarding mother from injury to self and newborn
51
Q

Involution of the fundus

A

The fundus is the top portion of the uterus.

Fundus will be at the level of the umbilicus 6−12 hours postpartum
Fundus will be 1 cm below the umbilicus on the first postpartum day
Fundus will descend 1 cm per day until it is in the pelvis on the 10th day

52
Q

Lochia changes

A

Uterine debris in the uterus is discharged through lochia

Consists of Blood, fragments of decidua, white blood cells, mucus and some bacteria

Lochia rubra is red (first 2–3 days, or longer)
Lochia serosa is pink (day 3 to day 10)
Lochia alba is white (continues until the cervix is closed)

Families Final (3 decks)

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