Final Flashcards
What is our most common concern for LGA babies after delivery? (what lab do we need to monitor?)
Monitor for glucose and sx of respiratory distress
Common concern: birth trauma, polycythemia: abnormal increase in hemoglobin BLOOD CANCER, hypocalcemia. High risk of developing type 2 later in life
How do you identify a transfusion reaction and what actions do you take?
Hives, itching, SOB
Stop transfusion
What are TORCH infections?
Toxoplasmosis
Other (Hep B, Varicella-Zoster, Parvovirus, B19, Group B Strept
Rubella
Cytomegalovirus
Herpes Simplex Virus - localized, disseminated, CNS
What are common ways TORCH infections are passed?
Toxoplasmosis = parasite, undercooked meats or cat feces
Other =
HIV: A virus spread through sexual contact or direct contact with HIV-infected blood (like from sharing needles).
Fifth disease: A mild rash caused by parvovirus B19. It spreads through saliva and mucus when an infected person coughs or sneezes.
Chickenpox: A highly contagious disease caused by the varicella-zoster virus (VZV).
Zika virus: A virus spread by an infected mosquito in areas where the virus is common. It can also be passed through sex with an infected person.
Rubella = if you didn’t get a vaccine. if someone is sick, can cause blindness. Need to give the live attenuated vaccine after birth
Cytomegalogivrus = generalized infection via droplets (saliva and other bodily fluids), daycare, healthcare delivery centers
Herpes = sexual or direct contact. transplacental (RARE), commonly transmitted via birth canal during active infection
What are late preterm babies at risk for? (THIRJ)
Temperature instability
Hypoglycemia
Intravenous Infusions
Respiratory distress
Jaundice
What is the difference b/w birth injury and congenital anomaly?
Birth Injury: structural destruction or functional deterioration of the neonate’s body due to a traumatic event at birth
Congenital Anomaly: structural or functional anomalies that occur during intrauterine life and can be identified prenatally, at birth, or sometimes detected later in infancy
What are common birth injuries?
Skull/Clavicle Fractures: clavicle most fractured bone
Head bleeds
Subgaleal hemorrhage: risky = above periosteum and between EA large space. Swelling past eyebrows
Extradural hemorrhage
PNS
Erb-duchenne: brachial plexus injury resulting in paralysis*
Facial paralysis
Cranial nerve - only one side of the face
Phrenic nerve injury
Diaphragmatic paralysis on affected side - respiratory distress
Bruising: occur more with traumatic/breech deliveries
Increased risk of hyperbilirubinemia
Ecchymosis and bruising greater than in preterm than term infants
Birth trauma: asphyxiated infant - prolonged lack of adequate perfusion and oxygenation to the baby’s organs leading to brain damage, damage to other organs, or death
Born hypoxic and acidotic
Prepare for resuscitation
Neurologic: ischemic injuries, periventricular/intraventricular hemorrhage.
Most common in low birth weight and very low birth weight
Don’t milk the chord.
Therapeutic head or body cooling reduces severity of neurological damage if used early after birth
May result in major (CP, seizures) or minor (ADHD, poor coordination)
What are the s/sx of a diaphragmatic hernia in a newborn?
incomplete closure of diaphragm resulting in ABD contents entering thoracic cavity
What are signs and symptoms and risk factors of newborn sepsis?
SX: Hypothermia/hyperthermia
Respiratory distress
Tachycardia/bradycardia
Lethargy/irritability
Poor feeding
Apnea
Poor perfusion/hypotension
Vomiting
Jaundice
Hepatomegaly
Cyanosis
Seizures
Abd distention
diarrhea
Risk factors: premature rupture of membrane (PROM), meconium stained amniotic fluid (MSAF), foul smelling liquor, low birth weight, prematurity and low Apgar score at birth.
How does bili lights contribute to jaundice treatment? How do you care for a child under bili lights?
Bili lights = makes bilirubin more water soluble so it can be more easily excreted
Eyes must be covered to prevent retinal damage
Adequate hydration
Exchange transfusion
Appropriate follow up
Why do we give betamethasone?
If the person will give birth preterm to increase lung maturation
Administered b/w 23-24 wks if mother has possibility of delivering within the next 7 days
What are symptoms and treatment of hypoglycemia in infants?
SX: jittery, hypothermic, grunting, flaring, retracting, poor feeding, lethargy
Prompt treatment with IV dextrose
How do we know when a baby needs to be resuscitated? What are the first steps in newborn resuscitation?
Is the baby breathing or crying? Good tone?
Warm, clear airway if necessary, dry, stimulate
HR below 100, gasping, or apnea?
PPV, SpO2, monitoring
HR below 100
Take ventilation corrective steps
HR below 60
Consider intubation, chest compressions, coordinate with PPV
HR below 60
IV epinephrine
What are signs and symptoms of neonatal abstinence syndrome and nursing care/medications for infants?
NAS: Neonatal withdrawal after intrauterine exposure to certain drugs. Occurs with abrupt cessation of drug exposure at birth, most commonly with opioids or sedatives, polysubstances, barbiturates, alcohol
SX: Hypertonia, tremors, hyperreflexia, seizures, irritability/restlessness, high pitched cry, excessive crying, sleep problems,
TX: Promote infant and maternal regulation and to minimize the signs of NAS expression
Quiet, calm, dark environment
Feed well
Give medication = morphine or similar opioid to help withdraw comfortably
Don’t give: narcan
What is the difference between physiological vs pathologic jaundice?
Physiological
Seen in > 50% of all neonates
SX occur AFTER first 24 hrs of life
Cause: inability to metabolize bilirubin r/t to immature liver
Pathological
Less common but more serious
Jaundiced AT birth or WITHIN first 24 hrs of life
Cause: hemolysis in utero r/t to Rh factor or ABO incompatibility
What are common complications of infants who are preterm (below 1500g)?
Poor placental function- infant not receiving enough glucose, nutrients, etc. to support adequate fetal growth- Maternal infections, congenital malformations, chromosomal anomalies, genetic factors preeclampsia, severe diabetes smoking, drinking ETOH abuse, severe maternal malnutrition.
Hypoglycemia is common because of inadequate glycogen stores in the liver poor thermal regulation due to white fat and brown fat have been used up in utero to maintain the infant
What is the importance of fetal movement to assessing the wellbeing of the fetus?
Fetal movement - reassuring sign of fetal health
Decreased fetal movement = warning sign of impaired fetal oxygenation status and needs to be reported and evaluated
During 3rd semester, fetus makes 30 gross motor movements an hour, birthing parent feels 70-80%
Sleep cycles = 40 mins
What are the common causes of hemorrhages in immediate postpartum period?
80% of cases - uterine atony
Over distended uterus
Retained placenta fragments
Anesthesia and analgesia
Previous hx of atony
High parity
Prolonged labor, use of oxytocin
Trauma during labor and birth - forceps, vacuum, c section
What is the cause of early postpartum hemorrhage vs late postpartum hemorrhage?
Early postpartum hemorrhage = within the 24 hrs of birth, uterine atony
Late postpartum hemorrhage = after 24 hours but less than 6 weeks, retained placental fragments
What are signs and symptoms of thrombophlebitis, risk factors, and diagnostic methods?
SX: Swelling of veins. Blood clot in the vein can cause swelling.
Redness, pain
Risk factors:
Obesity
Length of labor/c section
Advanced maternal age
Diagnostic methods:
ask about discomfort and look for affected veins near the skin’s surface.
Can use ultrasound
What are signs, symptoms, and causes of various types of postpartum hemorrhages?
Cervical lacerations
Perineal Hematoma
Late PPH
Lacerations:
- Signs: continued bleeding despite firm fundus
- Causes: first baby, large baby, malpositioned head, use of VE or forceps
Hematoma:
- signs: blood collects in connective tissue of reproductive tract. bulging mass
Uterine inversion: fundal location
Late PPH: after 24 hrs PP up to 6 wks. Usually 7-14 days PP.
Uterine subinvolutino r/t retained placental fragments/infection
What are the most common medications used to manage PPH, what are the major contraindications to each of these medications?
Pitocin
Lactated ringers, titrated to uterine firmness
Contracts uterus
Methergine (methylergonovine)
Same family as LSD
Causes smooth muscle contractions
Contraindicated in people w severe hypertension (preeclampsia)
Hemabate (carboprost)
Causes massive uncontrolled diarrhea due to due to smooth muscle contractions
Causes uterine contraction and bronchoconstriction
Contraindicated in asthmatics
Cytotec (misoprostol)
Early abortion, induce labor in small amounts
Given after labor to cause contractions
rectally
Tranexamic acid
Antifibrinolytic drug
Helps clotting cascade
Reduces bleeding in surgical and trauma pts
Dinoprostone
Not given as much
What is the differences between and treatment of postpartum blues, postpartum depression and postpartum psychosis?
Postpartum blues: subsyndromal depressive sx
Mild transient mood disturbance - emotionally labile. Restless, fatigue, easily cries, sad
Peaks at 5 days, subsides by 10
Postpartum depression: major mood disorder
SX: far more persistent than pp blues, irritability, tearful, despondent, feelings of inadequacy, guilt, unable to cope, fatigue, difficulty concentrating, sleeping, lack of interest in activities and appearance, guilt about depressive feelings. Severe anxiety &panic attacks.
Red flags: inability to sleep and thoughts of self harm or harm to infant
Treatment:
Medication: ssri & tricylics
Psychotherapy
Peer support groups
Individualized care
Family education
Postpartum psychosis
SX
Sleep disturbance, agitation, irritability
Delusions
Hallucinations
Potential for suicide and/or infanticide
Tx:
Psychiatric emergency
Hospitalization
Recover w aggressive tx
What are s/sx of a puerperal (postpartum) infection? Endometritis, wound infections, UTI, mastitis
Endometritis: most common
Infection of lining of uterus beginning at placental site.
Fever, uterine tenderness, tachycardia that parallels the rise of temp, midline lower abd pain
Wound infections
UTI
Mastitis
Initial lesion: Nipple fissure, then ductile system
Fever, chills, localized tenderness, palpable, hard reddened mass
Predisposition to puerperal infection
How do you calculate QBL?
Weigh chux and pads and anything else with blood, subtract dry weight and any amount of solutions like saline that we used
1 G = 1 ML of blood
First actions in a postpartum hemorrhage- what is the first thing that a nurse should do when an increase in bleeding is noted?
Massage fundus with only the force needed to obtain contractions and express clots
Provide uterotonic drugs to manage PPH.
What is the purpose, side effects of magnesium and how do you identify magnesium toxicity?
Mag Sulfate = CNS depressant used to prevent seizure activity
Side effects: nausea, cramping, diarrhea
Magnesium Toxicity: hypotension, nausea, vomiting, facial flushing, retention of urine, ileus, depression, and lethargy before progressing to muscle weakness, difficulty breathing, extreme hypotension, irregular heartbeat
What is a hydatifidorm mole pregnancy? What should be involved in patient teaching after a hydatifidorm mole pregnancy?
Definition: noncancerous tumor that develops in uterus = nonviable pregnancy
Teaching: Follow up serum hCG levels for at least 1 year to detect trophoblastic neoplasia, if normal for a year, may consider pregnancy
Avoid pregnancy for a year and come in to be assessed for trophoblastic neoplasia.
Why do we put in cerclages and what are the goals?
Placed due to cervical insufficiency - inability of uterine cervix to retain a pregnancy in the 2nd trimester in absence of clinical contractions, labor, or both
Placed at 11-15 wks, removed when 37 wks or spontaneous labor
What do biophysical profiles tell us? How are they scored?
BPP = noninvasive, easily learned and performed antepartum test for eval fetal well being.
Ultrasound used to assess
Fetal movement
Fetal tone
Fetal breathing
Amniotic fluid vol
Non Stress Test
Separate nonstress tests of the fetal HR can also be performed as a component of BPP.
Placenta previa- what is it? What is contraindicated when a person is diagnosed with one?
Late pregnancy bleeding that covers opening of cervix
Placenta implanted in lower uterine segment near or over internal cervical os
Contraindications: delivering vaginally with complete previa. Never do a vaginal exam on a patient – plan for a c section
What is the difference in fetal issues between patients dx with gestational diabetes and type 1,2 diabetes?
Pregestational diabetes
Type 1: absolute insulin deficiency
Type 2: relative insulin deficiency
Risk of fetal anomalies increases due to diabetes
Gestational diabetes (develops after 20 wks of pregnancy)
When pancreas is unable to meet increased demand for insulin production during pregnancy
A1: 2 or + abnormal values on the oral glucose tolerance test but fasting and postprandial glucose values are diet controlled
A2: was not know to have diabetes prior to pregnancy but now requires medication for glucose control
Risk of fetal anomalies doesn’t increase due to diabetes
