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L & D > Final Review > Flashcards

Final Review Flashcards

1
Q

Fetal Circulation

A

Clamping the umbilical cord after birth eliminates the placenta as a reservoir for blood.
Onset of respirations causes a rise in PO2 in the lungs and a decrease in pulmonary vascular resistance, which…
Increases pulmonary blood flow and increases pressure in the left atrium, which…
Decreases pressure in the right atrium of the heart, which causes closure of the foramen ovale (closes within minutes after birth secondary to a decreased pulmonary vascular resistance and increased left heart pressure).
With an increase in oxygen levels after the first breath, an increase in systemic vascular resistance occurs, which…
Decreases vena cava return, which reduces blood flow in the umbilical vein (constricts, becomes a ligament with functional closing).
Closure of the ductus venosus (becomes a ligament) causes an increase in pressure in the aorta, which forces closure of the ductus arteriosus within 10 to 15 hours after birth.

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2
Q

More insulin in the infant

A

Less surfactant (lubrication in the lungs)

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3
Q

Infant Respirations

A

30 to 60 breaths per minute; irregular,
shallow, unlabored; short periods of apnea (<15 seconds); symmetrical chest movements

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4
Q

T/F
A respiratory rate of 44 breaths per minute
would be considered a normal finding in a
newborn.

A

TRUE

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5
Q

Retractions

A

Chest muscles pull in around the bones

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6
Q

Grunting

A

snoring/

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7
Q

apnea

A

pauses in breathing 15-20 secs

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8
Q

cyanosis

A

blue skin color lips/chest/stomach
oxygen level too low

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9
Q

Jaundice

A

Yellow skin. Bilirubin build-up in the blood/

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10
Q

Heat Loss

A
  • Thin skin; blood vessels close to the surface
  • Lack of shivering ability; limited stores of metabolic
    substrates (glucose, glycogen, fat)
  • Limited use of voluntary muscle activity
  • Large body surface area relative to body weight
  • Lack of subcutaneous fat; little ability to conserve heat by changing posture
  • No ability to adjust own clothing or blankets to achieve warmth
  • Infants cannot communicate that they are too cold or too warm
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11
Q

Conduction

A

transfer of heat from object to object
when the two objects are in direct contact with each other

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12
Q

Convection

A

flow of heat from body surface to cooler
surrounding air or to air circulating over a body surface

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13
Q

Evaporation

A

loss of heat when a liquid is converted
to a vapor

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14
Q

Radiation

A

loss of body heat to cooler, solid surfaces
in close proximity but not in direct contact

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15
Q

Thermoregulation

A

Balance btwn heat production and heat loss
- Heat production: primarily through nonshivering thermogenesis
- Heat loss via four mechanisms leading to cold stress

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16
Q

weight gain calories

A

To gain weight the newborn requires an intake of 108 kcal/kg/day from birth to 6 months of age
Newborns usually lose 10% of the body weight due to burning brown fat

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17
Q

Infant Stool

A

Meconium: first 24 hours dark green/black/tarry
- Breast-fed newborns: yellow-gold, loose, stringy to pasty, sour-smelling
- Formula-fed newborns: yellow, yellow-green, loose, pasty, or formed, unpleasant odor

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18
Q

T/F
When assessing the stools of a 1-week-old newborn who is being breast-fed, which would the nurse expect to find?

A

Yellow gold loose stool

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19
Q

Natural Immunity

A

physical barriers, chemical
barriers, and resident nonpathologic organisms

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20
Q

Acquired Immunity

A

Development of circulating immunoglobulins; formation of activated lymphocytes
- Absent until after first invasion by foreign
organism or toxin
- Newborn primarily dependent on three
immunoglobulins: IgG, IgA, and IgM

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21
Q

IgG

A

major immunoglobulin and the most abundant, making up about 80% of all circulating antibodies
ONLY immunoglobulin the crosses the PLACENTA (starting 20-22 wks)

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22
Q

IgA

A

is the second most abundant immunoglobulin in the serum.
This immunoglobulin is believed to protect mucous membranes from viruses and bacteria. IgA is predominantly found in the gastrointestinal and respiratory tracts, tears, saliva, COLOSTRUM, and BREAST MILK

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23
Q

IgM

A

found in blood and lymph fluid and is the first immunoglobulin to respond to infection.
You have to GET SICK

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24
Q

T/F
A nurse is assessing the sensory capabilities of a newborn. Which is the least mature sense at birth?

A

Vision

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25
Q

Neurological development

A

cephalocaudal and proximal–
distal patterns

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26
Q

5 Senses

A
  • Hearing—well developed at birth, responds to noise by turning to sound
  • Taste—ability to distinguish between sweet and sour by 72 hours old
  • Smell—ability to distinguish between mother’s breast milk and breast milk from others
  • Touch—sensitivity to pain, responds to tactile stimuli
  • Vision—incomplete at birth; maturation is dependent on nutrition and visual stimulation.
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27
Q

Assess Newborn Reflexes
(how the nerve reflexes are developing and functioning)

A
  • Reflex Names
  • Get a response
  • Time they should disappear
    GRASP Reflex: palmer grab your finger (4-6 mths age)
    PLANTAR grab: toes toes grab your finger (9 mths -1yr)
    MORO Reflex: loud noise or unexpected movement throwing out arms 6 months
    ROOTING reflex: infant turns head when cheek is stroked 4 months
    SUCKING reflex: touch top palate infant sucks. 4 months age
    BABINSKI reflex: bottom foot stroke heal to toes. toes fan or spread out 1 year age
    CRAWLING reflex: place on stomach and apply pressure on the sole of foot. infant will push out. (weeks to months)
    STEP reflex: hold infant upright with legs and feet touching a surface. Infant will try to walk 3-4 months
    TONIC NECK reflex (fencing reflex): infant head is turns to one side, the leg will extend other 4 months
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28
Q

Behavior patterns

A

FIRST period of reactivity
o Birth to 30 minutes to 2 hours after birth
o Newborn is alert, moving, may appear hungry
Period of decreased responsiveness
o 30 to 120 minutes old
o Period of sleep or decreased activity
SECOND period of reactivity
o 2 to 8 hours
o Newborn awakens and shows an interest in stimuli

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29
Q

T/F
During the first period of reactivity, a newborn is quite sleepy.

A

False

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30
Q

Orientation

A

response to stimuli

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31
Q

Habituation

A

ability to process and respond to
auditory and visual stimuli; ability to block out external stimuli after newborn has become used to activity

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32
Q

Motor Maturity

A

ability to control movements

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33
Q

Self-quieting ability

A

Consolability

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34
Q

Social Behaviors

A

cuddling and snuggling

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35
Q

Infant HR

A

intrauterine: 110-160
Extrauterine: 120-160
can go to 180 if crying

36
Q

APGAR SCORE

A

Scale of 1-10 (7-9 is normal, no one gets a 10)
1 min of life: transition to extrauterine Life
5 mins of life is overall CNS status
10 min is done with a 6 and below.
A = appearance (color)
P = pulse (heart rate)
G = grimace (reflex irritability)
A = activity (muscle tone)
R = respiratory (respiratory effort) respiration, each of which is given a score of 0, 1, or 2.
What can affect APGAR scores: Infection, prematurity, mothers age, congenital abnormalities, physiologic immaturity, neuromuscular disorders, cns depressant close to delivery

37
Q

Temp

A

97.7-99.5 F

38
Q

Blood Pressure

A

50-75 systolic
30-45 diastolic

normally not taken unless in NICU

39
Q

Neuromuscular Maturity and Physical Assessment

A

FIGURE 18.3
Page 586

40
Q

Ballard Score

A

based on the neonate’s physical and neuromuscular maturity

41
Q

prior to 37 weeks’ gestation

A

Preterm or premature

42
Q

37 to 42 weeks’ gestation

A

Term

43
Q

after week 42 gestation

A

Post term or postdate

44
Q

after week 42 gestation/placental aging

A

post mature

45
Q

SGA

A

small for gestational age
- lower 10th percentile

46
Q

AGA

A

appropriate for gestational age

47
Q

LGA

A

large for gestational age
- upper 10th percentile

48
Q

T/F
Arm recoil is one measure of assessing a newborn’s physical maturity.

A

False

49
Q

Vitamin K

A

Assist with clotting. helps prevent brain bleeds.

50
Q

Eye Prophylaxis

A

medication percaution chlamydia/gonorrhea’s or ANY infection or bacteria in the birth canal. Left untreated can lead to blindness.

51
Q

Anthropometric Measurements

A

length, weight,
head circumference, chest circumference (usually 2-3 cm less than head circumference)

52
Q

Newborn physical assesment

A
  • Prenatal History
  • physical exam: measurements, vitals, skin,
  • Neurological exam
53
Q

Skin

A
  • Vernix caseosa: white creamy film after the birth. wipe off
  • Stork bites or salmon patches: om forehead, nape of the neck or eyelids. clears by itself
  • Milia: little white heads. clears by itself. (Epstein pearl is milia in the mouth)
  • Mongolian spots: looks like bruises
  • Erythema toxicum: newborn rash clears in a couple of weeks
  • Harlequin sign: pooling of blood when laying on one side. looks red half face.
  • Nevus flammeus: Port wine stain. permanent
  • Nevus vasculosus: Strawberry mark normally goes away by age 3.
54
Q

Caput succedaneum

A

soft tissue injury. head can indent if you touch it. caput crosses the suture like

55
Q

Cephalhematoma

A

does not crosses the suture line. hard collection of blood.

56
Q

TTN transiet tachypnea of newborn

A

an infant does not have a full explosion of amniotic fluid from the lungs.
try to suction them deeper.

57
Q

Galactocemia

A

lactose intolerant. enzyme to break down lactoce. doesnt wrk

58
Q

Infant frequency of feeding

A

every 2-3 hours

59
Q

Measures to decrease air swallowing

A

breast-feeding: solid latch

60
Q

Storage of Milk

A

sealed and chilled: within 24 hr
disregard milk refrigerated for 24 hrs
use frozen expressed milk within 3 months
discard any unused milk
do not refreeze breast milk
dethaw in warm water
only make what they baby is going to drink.

61
Q

LATCH Method

A

L: How well infant latches onto the breast
A: Amount of audible swallowing
T: Nipple type
C: Level of comfort
H: Amount of help mother needs

62
Q

An infant typically requires how many calories per kilogram per day during the first 3 months?

A

110

63
Q

SGA newborn assessment
Small for gestational age

A
  • Head disproportionately large compared to rest of body
  • Wasted appearance of extremities; loose dry skin
  • Reduced subcutaneous fat stores
  • Decreased amount of breast tissue
  • Scaphoid abdomen (sunken appearance)
  • Wide skull sutures
  • Poor muscle tone over buttocks and cheeks
  • Thin umbilical cord
64
Q

T/F
The majority of small-for-gestational-age
newborns experience IUGR (intrauterine growth restriction)

A

False

65
Q

T/F
An LGA newborn has a wasted appearance.

A

False

66
Q

Post term Newborn

A
  • Inability of placenta to provide adequate oxygen and nutrients to fetus after 42 weeks
  • Nursing assessment: typical characteristics
  • Dry, cracked, wrinkled skin; possibly meconium stained
  • Long, thin extremities; long nails; creases cover entire soles of feet
  • Wide-eyed, alert expression
  • Abundant hair on scalp
    Thin umbilical cord
    Limited vernix and lanugo
67
Q

When assessing a preterm newborn, which would the nurse expect to find?

A

Fewer palmar creases

68
Q

T/F
Neonatal asphyxia commonly resolves within 72 hours after birth.

A

False
Neonatal asphyxia requires immediate
resuscitation measures; transient tachypnea of the newborn typically resolves by 72 hours of age

69
Q

S/S necrotizing enterocolitis

A

Signs and symptoms: abdominal distention and tenderness, bloody stools, feeding intolerance
(bilious vomiting), sepsis, lethargy, apnea,
shock

70
Q

Which finding would the nurse expect to assess in a newborn with necrotizing enterocolitis?

A

Abnormal distention
A newborn with necrotizing enterocolitis would
exhibit abdominal distention and tenderness
with bloody stools, bilious vomiting, feeding intolerance, lethargy, sepsis, apnea, and shock.
Seizures are not associated with NEC

71
Q

How to treat meconium aspiration syndrome

A
  • Antibiotics to treat infection.
  • Breathing machine to keep the lungs inflated.
  • Use of a warmer to maintain body temperature.
  • Tapping on the chest to loosen secretions.
72
Q

Albumin

A

is given before an exchange transfusion

73
Q

T/F
The underlying problem associated with
meconium aspiration syndrome in utero involves hypoxic stress.

A

True
Meconium may be passed in utero secondary to hypoxic stress.

74
Q

T/F
Neonatal asphyxia commonly resolves within 72 hours after birth

A

False
Neonatal asphyxia requires immediate
resuscitation measures; transient tachypnea of the newborn typically resolves by 72 hours of age

75
Q

Which finding would the nurse expect to assess in a newborn with necrotizing enterocolitis?

A

Abnormal Distension
A newborn with necrotizing enterocolitis would exhibit abdominal distention and tenderness with bloody stools, bilious vomiting, feeding intolerance, lethargy, sepsis, apnea, and shock. Seizures are not associated with NEC

76
Q

Intrauterine congenital causative organism

A
  • Cytomegalovirus
  • Rubella
  • Toxoplasmosis
  • Syphilis
77
Q

Early Onset infections

A
  • Prolonged rupture of membranes
  • Urinary tract infections
  • Preterm labor
  • Prolonged or difficult labor
  • Maternal fever
  • Colonization with group B streptococci
  • Maternal infections
78
Q

Decreased pulmonary blood flow
Tetralogy of Fallot (TOF)
Tricuspid atresia

A

Mild to severe oxygen desaturation, polycythemia, murmur, hypoxemia, dyspnea, increased cardiac workload, and marked exercise

79
Q

MIXED DEFECTS
Transposition of the great arteries
Total anomalous pulmonary venous connection
Truncus arteriosus
Hypoplastic left heart syndrome

A

Defects involving mixed (desaturated or saturated) blood
Decreased cardiac output, CHF, ruddiness, dusky or gray color, dyspnea

80
Q

3 types of spina bifida

A

Prevent this by folic acid
Myelomeningocele is the most severe and most common. It has nerves inside.

81
Q

All viruses that can cause

A
  • toxoplasmosis
    -herpes
  • PKU
  • Radiation exposure
82
Q

Omphalocele

A

Hernia of abdominal contents into a closed pouch

83
Q

gastroschisis

A

abdominal contents are out and in the open.

84
Q

Esophageal Atresia and
Tracheoesophageal Fistula
Nursing assessment

A
  • Hydramnios
  • Copious frothy bubbles of mucus and drooling; abdominal distention
  • Coughing, choking, and cyanosis
85
Q

Hypospadias and
epispadias

A

location of the urethera.
Hypo is below, epi is above

L & D (5 decks)

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