Labour + Delivery + postpartum + newborn Flashcards
what are the 5 P’s of labour
1) Passenger
2) passageway
3) powers
4) position of mother
5) psychological response
What are the external forces effecting labour?
- place of birth
- type of provider
- availability of labour support
- procedures
what are the internal forces effecting labour?
-physiology / sensations
does the placenta usually cause birthing complications?
NO it rarely impedes the labour process
What are the factors that effect the passenger
- size of fetal health
- Fetal presentation
- fetal lie
- fetal altitude
- fetal position
what are the 3 parts of fetal position
- fetal lie
- fetal attitude
- fetal position
what are sutures
the cranial joints
what are fontanelles
where the sutures intersect
the soft spots on babies head
what shape is the front fontanelle
diamond (large)
what shape is the back fontanelle
triangle (small)
during labour… the sutures & fontanelles are:
flexible to accommodate brain growth
can slide over each other (mould) to fit maternal pelvis
when will the brain assume its normal shape after birth?
It’ll take shape 3 days after
do the babies shoulders usually cause an issue at birth?
No they can be moved so they usually aren’t problems
what is the fetal “presentation”
The part the enters the pelvic inlet first
What are the 3 main presentations
- Cephalic
- Breech (butt or feet)
- shoulder presentation
what percentage of births are cephalic
96%
what percentage of births are breech
3%
what percentage of births are shoulder
<1%
what would be the region presented for cephalic
the occiput (vertex)
what would be the region presented for breech
the sacrum
what would be the region presented for shoulder
the scalpula
What is the fetal lie
The relation of long axis (spine) of fetus to long axis (spine) of mother
What are the types of fetal lies
- Longitudinal/vertical
- transverse / horizontal
- oblique
what is a longitudinal lie
paralel axis’s with mom
what is a transverse lie
long axis @ right angle with mom
what is a oblique lie
long axis at an angle (will usually correct itself)
what is fetal attitude
the relation of fetal body parts to each other
what is the normal fetal attitude
- General flexion
- rounded back, chin flex, thighs flexed, sarcasm crossed over chest, cord between arms & legs
what are the consequence of an abnormal attitude
- prolonged labour
- forceps/ vacuum
- cesarean
what is the largest transverse diameter
the biparietal diameter
9.25 cm
what is the fetal position
the relationship of a reference pt on the presenting point to the 4 quadrants of the moms pelvis
What does the first letter mean in fetal position
Left or Right side of mom
What does the second letter mean in fetal position
The part that is presenting
what does the 3rd letter mean in fetal position
if it’s posterior, anterior or transverse
what is the “station”
Relationship of fetal part to an imaginary line drawn down the maternal ischial spines
***the measure of degree of descent of preceding part through the birth canal
What does it mean if the station is a negative number
it is above the ischial spine
what does it mean if the station is a positive number
it is below the ischial spine
at what station does birth take place
usually +4 or +5
what is engagement
the largest transverse diameter of the presenting part has passed through maternal pelvic brim or inlet into the true pelvis
when does engagement occur
usually +2 station
- can often occur weeks before labour in nulliparas
- in muiltiparas it happens during labour
how can engagement be determined
can be determined by abdominal or vag expansion
describe the passageway
rigid bony pelvis, soft cervix, pelvis floor, vag & introits
what part plays the biggest role in birth
the pelvis size & shape
What is the false pelvis
part above the brim, no role in child bearing
what is the true pelvis
part involved in birth (brim, mid-pelvis, cavity, outlet)
what is the pelvic inlet/ brim
upper boarder of true pelvis
What is the pelvic cavity
curved passage w/ short anterior wall
what is the pelvic outlet
lower boarder of pelvis (ovoid/ diamond shape)
what are the factors that are important to determine if natural birth is possible
- subpubic angle / pubic arch
- length of pubic rami
- subpubic arch
what are the 4 types of pelvis’s
1) gynecoid
2) Android
3) Anthropoid
4) Platypelloid
% & shape? (Gynecoid)
circle - 50%
% & shape? (android)
Resembles a male pelvis (23%) heart
% & shape? (anthropoid)
24% and it’s an oval
% & shape? (platypelloid)
3% flat pelvis
is the pelvis size tested?
no it’s approximate b/c radiographic exam is bad for baby
What are the soft tissues
lower uterine segment, cervix, pelvic floor muscles, vagina & introitus
the uterus becomes… ( once birth begins)
very muscular so that it can push against the cervix
To allow the first fetal position to descend into vagina….
the cervix (effaces) thins & dilates opens)
what is efface
thin (happens first)
what is dilate
opens (happens after)
what is the pelvic floor
muscular layer that separates pelvic cavity from perineal space below & helps rotate fetus
the soft tissues …
develope throughout pregnancy until the vagina can dilate to accommodate fetus
what are the 2 types of powers
involuntary & voluntary
What are the primary powers?
involuntary contractions that originate from certain pace maker points in upper uterine muscles
they move downward in waves, separated by short rests
How are primary powers described?
1) Freq. (from beginning of one to the beginning of next one)
2) Duration ( length of contraction
3) Intensity (strength of contraction @ peak)
What are the primary powers responsible for?
Effacement- shortening/ thinning of cervix
this usually happens before dilation
facts about dilation
- goes from <1 cm to 10cm.
- can’t be palpated when fully dilated
- marks end of 1st labour stage
- due to pressure AND hormones
Are uterine contractions independent or dependent of external forces
uterine contractions are independent of external forces
-may reduce if given narcotics which can cause prolonged labour
When do the secondary powers begin
As soon as the presenting part reaches the pelvic floor
What are the secondary powers contractions like?
explosive- involuntary urge to push
-bearing down efforts: contracts diaphragm & abs
What is the result of secondary powers?
intra-abdominal pressure
do secondary powers have an effect on dilation?
No
Are frequent positions changes good or bad
good
what are the benefits of position change
reduce fatigue
increase comfort
increase circulation
What are the benefits of upright birth
- gravity promotes descent
- contractions are stronger & more effective in dilating cervix
- labour is shorter
- improves blood flow
- pressure on vena cava reduce
If the woman wants to lie down…
lateral ( on side) is best
benefits of all 4’s birth
- relieve back ache
- decreases length
- decreases need for assistance
how is a birthing position determined
- woman preference
- condition
- environment
- HC provider confidence
What is lightening
dropping of the baby into the pelvis
- happens 2-4w before term in first time pregnancy
- in multipara’s lightening won’t happen till the uterus contracts
signs of labour coming
- lightening
- strong frequent irregular contraction
- low back pain
- bloody show: mucus
- cervix soften
- membranes rupture
signs of days proceeding labour
1) loss of 0.5-1.5kg (water weights)
2) surge of energy (nesting)
or diarrhea, nausea, vomit & indigestion
3) return of frequent urination
is there a single cause of labour?
no there is no single cause
- hormones
- distention of uterus & pressure
- result in strong, regular rhythmic contractions
What are the stages of labour
1) regular progression of uterine contractions
2) Effacement & progressive dilation of cervix
3) progress in descent of presenting part
Describe stage one of labour
- last onset of regular uterine contractions to full dilation of the cervix
- longest stage
- can take 1-18hr
- 2 phases: -latent (early)
- active labour - quicker dilation & descent
Describe stage two of labour
- fully dilated to brith
- latent (passive)
- active (urge to push stretch receptors)
describe stage three of labour
birth of fetus - birth of placenta
3-5 mins or an hour
Describe stage four of labour
2hr after placenta
recovery, bonding & breastfeed
What are the mechanisms of labour
- engagement
- descent
- flexion
- internal rotation
- extensions
- restitution & external rotation
- expulsion
What is meant by engagement
- when the biparietal diameter of head passes pelvic inlet
- in nulliparas - this occurs b4 active labour
what is asyclitsm
- head is deflected in pelvis
- head is positioned so that it cannot descend
- this is an error in engagement
what is meant by the descent
- progression through the pelvis by 4 forces
- slow & steady in first baby
- Rapid in second baby
What are the 4 forces that determines descent
1) pressure via amniotic fluid
2) direct pressure exerted by contracting fundus on fetus
3) force of contraction of diaphragm & abs
4) extension & straighten fetal body
why does the head flex into the chest
to produce a smaller diameter
what is internal rotation
head must rotate in order to exit
what is extension
the head emerges vis extension
the occiput, then face, then chin
what is restitution & external rotation
after the head is born , baby rotates to position it was in, in inlet (restitution)
the anterior shoulder will descend first
what is expulsion
trunk is born by flexing laterally
fetal heart rate?
110-160bmp
fetal circulation is affected by…
- Maternal position
- uterine contractions (contractions decrease circulation)
- bp
- umbilical cord flow
fetal respiration
decreases during labour
maternal cardiac changes during labour
- increase cardiac output will return to baseline after both
- increased bp during contractions
- increased HR
- increased WBC
- flushed or hot or cold cheeks & hemmorhoids
maternal respiratory changes during labour
- increased respiratory rate
- o2 consumption doubles
maternal renal changes during labour
spontaneous voiding becomes hard
proteinuria is common
integumentary system changes during labour
skin will stretch and tear
increased temperature
musculoskeletal maternal changes during labour
- diaphoresis, fatigue
- joint pain
neurological changes maternal during labour
euphoric, serious, elated or fatigued
-decreased perception of pain
GI tract maternal changes during labour
- motility & ability to absorb food decrease
- nausea & vomiting is common
endocrine maternal changes during labour
decreased progesterone, increased estrogen. Increased metabolism
moms with a history of sexual abuse may be triggered by
- memories during invasive procedures
- loss of control or feeling of being restrained
- being watched by students or intense sensations
women with a history of sexual abuse may…
fight labour process
be controlling
be submissive or dependent
mentally retreat or dissociation
the nurse can help women in labour with history of sexual abuse by
- help associate feelings with present
- maintain sense of control by informing her
- validate needs
- fulfil requests
- permission before touch
- be conscious about words
- limit invasive procedures
- help her come an advocate
- *** care for all women like this you don’t know who is a victim
What is assessed during a psychosocial assessment of labouring woman
- verbal interaction
- body language
- perceptual ability
- discomfort level
women reactions to labour reflect their life experiences with:
childbirth, physical, social, cultural & religion aspects
some society expectations of birthing women:
- pain is inevitable and must be endured by birthing moms
- pain can be avoided in childbirth
- pain in childbirth indicates sin
- pain can be managed by a women
muiltiparas base their expectations on…
their last birth & may only voice their concerns when asked
how will stress effect labour
it will cause a slower labour
how can the nurse help with stress during labour
- provide trust & support
- explain things in detail
- let woman know that there aren’t any expectations
- explain the role of the nurse
- encourage the woman to trust her ability to give birth
- acknowledge that the support person may also feel stressed
- be sensitive to needs
how to better accommodate LGBTQ+ labour
- transmen can give birth (biologically female)
- ask how they describe their gender identity
- document their gender identity & pronoun
- best if met before birth to plan
- ask permission to touch
indigenous birth is a….
family event & community - the hospital vistitor limit may effect this
what questions should you ask to provide culturally safe care during labour
- value/ meaning of childbirth
- view of wellness or sickness of childbirth
- private vs social
- diet, med, activity, emotional & physical support
- appropriate maternal/ paternal behaviour
- birth companions
- views of immediate newborn care
a birth companion is a source of…
- support
- encouragement
- comfort
- *not always the partner!!!
- *some woman prefer another women
- *woman will determine their role
- *some women modesty is very important
how a non-english speaking women in labour feels:
- increased anxiety
- loss of control
- panic
- withdrawn
- agression
- *some only want a female interpreter
- *over the phone is better than nothing
- *speak slow w/ no jargon
How long is postpartum / puerperium / 4th trimester
6 weeks
what is the postpartum involution process of the uterus
it means to return to non-pregnant state
when does involution begin
immediately after explosion of placenta with contraction of uterus
where is the uterus at the end of the 3rd stage of labour
- uterus midline
- 2cm above from umbilicus
- fundus rest on sacral promontory
- weights about 1000g
within 12hr uterus is
1cm below umbilicus
within 24hr the uterus is
the same size as @ 20 w
the fundus descends…. (rate)
1-2cm /24hr
by day 6 the uterus is
half way between symphysis pubis & umbilicus
when should the uterus no longer be palpable
by 2 weeks
how much more does the term uterus weight than prepregnancy
11X the pre-pregnant weight
after 1 week the uterus weighs:
500 g
after 2 weeks the uterus weighs
350g
after 6 weeks the uterus weighs
60-80g
why does the uterus grow?
- increased estrogen & progesterone
- hypertrophy & hyperplasia
- pressure from baby inside
what is autolysis
self destruction of hypertrophied tissue (AKA happens to uterus)
will the uterus ever be the same size again?
no due to extra cells it’ll be a tiny bit bigger
what is sub-involution
failure for uterus to return to size
what are common causes of sub-involution
placental fragments
infection
how is postpartum hemostasis achieved
mostly be compression of intramometrial blood vessels as uterine muscles contract & not as much clot formation
***oxytocin coordinates these contractions
why are woman often give oxytocin after birth of placenta
to make sure that uterus contracts so that they won’t lose blood
what does breastfeeding do to oxytocin
increased it & decreases likely hood to hemorrhage
what are afterpains & who are they experienced by
- Uterus firm in 1st mothers (only mild cramps)
- vigorous contractions in subsequent pregnancies (more pain) (breastfeeding & oxytocin will make these pains worse)
what is placental sight
post-partum vascular constriction & thromboses
an upward growth of endometrium that causes sloughing of dead tissues
what does placental sight do
prevents scaring of womb so it can function again
when is endometrial regeneration completed by
day 16 (except placenta site) (w6)
what is lochia
post-birth vaginal discharge
what is lochia rubra
bright red with clots (first 2hr)
- like a heavy period but it’s a steady decreased
- its blood a trophoblastic waste
what is lochia serosa
- pink/brown (starts 3-4 days after) (22-27 days long)
- old blood, rum, WBC, & debris
what is lochia alba
- starts 10 days after
- yellowish white
- WBC, decidua, epithelial, serum, mucus, bacteria
- can go on for 4-8 weeks
common facts about lochia
- less in cesarean
- blood gushes when walk
- persistent bleeding can mean a fragmented placenta
- 10-15% of ppl will have serosa at week 6
- endometriosis can be the cause if there is still serosa at week 4-5 with pain & fever
- an offensive odour means infection
what would indicate non local bleeding
- if it spurts out
- could be cervical or vaginal tear
characteristics of the cervix after birth
- soft
- the ectocervix is bruised
- gradually closes but id edamtous, thin & fragile several days after birth
how dilated is the cervix after day 2 post partum
2-3cm
a week = 1 cm
does the cervix go back to the way it was?
no it never regains its pre pregnant appearance
postpartum estrogen deprivation causes
1) thinness of mucosa
2) absence of rugae
3) vagina is drier
Does the vagina go back to the way it was?
no it never completely regains it’s prepregnat tone
the reggae reappear after 3 weeks but aren’t as prominent
what is a scared hymen called
a myrtiform carnuckles
postpartum the introitus is
erythematous & edematous but after 2 weeks i looks just like a nullipara if lacerations are carefully prepared, good hygiene & hematoma treated
what to know about healing an episteotomy
- signs of infection
- any loss of approximation
- 2-3 w to 4-6 months for complete heal
when will hemorrhoids decrease size by
6 weeks
how long will it take for pelvic floor muscles to regain strength
- may take 6 months
- kegels are encouraged
how long for abdominal wall to relax after birth
2 weeks (still has pregnant appearance) within 6 weeks it'll look almost preprgnant
what are the factors that determine if you regain ur muscle tone
- previous tone
- proper exercise
- adipose
what happens to hormones when the placenta leaves
decreased hormones
- diuresis of extra cellular fluid due to decreased estrogen
- woman who don’t breast-fed regain estrogen quicker
- HCG will disappear 3-4 weeks after
what happens to prolactin
rises throughout pregnancy
even more @ birth (highest first month after)
remains high if breast feeding continues
determined by: - freq. duration & degree of supplementary feeding
-in non-breast feeding woman prolactin will go back to normal within a week
when will ovulation occur?
- in lactating women it’ll occur within 6 months b/c prolactin suppresses ovulation
- in non lactating women: 27 days (7-9 weeks ) (70% by week 12)
- 1st flow after birth quite heavy (3-4 cycles & it’ll be back to normal)
what happens to the urinary system postpartum urinary system
-diminished steroid levels after birth (reduced renal function)
back to normal within a month
-dilation of ureters & hypotonia (6w to normal)
-can persist for 3 months ( increased risk for UTI)
what are the important facts about urine components
glycosuria is gone by 1 week
lactosuria may occur in lactating women
blood urea nitrogen b/c autolysis of involuting uterus
protein uria will resolve in 6 weeks
ketonuria happens with women of prolonged labour & dehydration
what happens to do with partpartum fluid loss
-within 12 hr, begin to lose excess tissue fluid
-profuse diaphoresis occurs for 2-3 days b/c of low estrogen, removal of increased venous pressure & loss of pregnancy induced fluid volume
Will lose about 2.25kg of “water weight”
What happens to the urethra & bladder post partum
-experiance decreased urge to void due to birth induced trauma, increased bladder capacity & effects of anaesthesia, and pelvic floor soreness
what causes pelvic floor soreness
- forces of labour
- vagina lacerations
- episteotomy
if bladder is distended it causes the uterus to have…
excessive bleeding, cannot contract as well, higher risk of UTI
when does a postpartum women regain bladder tone?
5/7 days
are postpartum woman hungry or full?
HUNGRRY
why may bowel evacuation not occur for 2/3 days
- drecreased muscle tone of intestines
- prelabour diarrhoea
- lack of food
- dehydration
- may resist urge to defecate
- *should increase fluid & fiber
- operative births have increased risk of anal incontinence (shouldn’t last more than 6mo)
- cesarean birth also may have a build up of gas
when does the breast milk come in
within 72-96hr
breasts will feel warm, from & tender
when will engorgement go away
24-48hr
what happens when moms decide to not breast feed
prolactin levels will drop very quickly
engorged but will resolve within 24-36hr
milk present but shouldn’t be expressed
-comfort measures: binder, bra, ice packs, pain meds
-avoid stimulating nipples
-lactation will cease in days to 1 week
how much blood is lost in vaginal birth
300-500ml (10%)
how much blood is lost during cesarean
500-100ml (15-30% )
when will blood plasma volume be replenished by
3rd day
what are the 3 major blood volume changes
1) elimination of uteroplacental circulation
2) loss of placental endocrine function removes the stimulus for vasodilation
3) mobilization of extra vascular water stored during pregnancy
what will happen to cardiac output postpartum
it will increase for 48hr
then it will remain increased for 12 weeks after birth & may not stabilize until 24 weeks
what will happen to vital signs post partum
hr & bp will return to normal within a few days
RR will rapidly return to normal
temperature will rise b/c dehydration will resolve in a day
orthostatic hypotension for 48hr
what will happen to the postpartum circulation
increased WBC, increase plasmofibrinogen
immune system is mildly suppressed but will go back to normal
what will happen to the postpartum respiratory system
decreased pressure
increased chest compliance
rib cage elasticity can take months to regain
stretched intercostals may never return to normal
normal metabolism by 1-2 weeks
in the neurological & musculoskeletal system
all changes will be revered
what will happen to the postpartum immune system
- melasma mask will sometimes stay
- hyper pigmentation of areolae & lineament nigra may not go away
- stretch marks will fade
- hair growth slows
- spider angiomas, palmar erethema, & elupis go away
how is attachment maintained
through proximity & interaction with infants as the parent becomes acquainted with the infant
identifies infant as an individual
claims infant as a family member
**THIS IS A MUTUALLY SATISFYING PROCESS
attachment includes mutuality
an infants behaviour elicit a corresponding set of parental behaviours
attachment occurs most easily when
the temperament, social characteristics, appearance & sex match characteristics
*** DISSAPOINTMENT can cause delays in attachment
how do parents become aquainted
by touch, eye contact, talk, & exploring
what is the claiming process
ID baby - terms of likeness, difference, uniqueness incorporated into fam
**CAN BE NEGATIVE OR POSITIVE
how do labour processes effect attachment
-long labour, drugs, breast-feed probs, premature birth, separation can all delay initial positive feelings
What should be known about close contact
-it facilitates attachment, affection, breastfeeding less crying, increased thermoregulation, increased cardiorespiratory stability
but isn’t an essential
extended contact is especially good for:
those @ risk for parenting difficulties
- adolescents
- low social/ financial support
best ways to facilitate eye contact
enface position: 20cm apart
dim light
right after birth
what is etrainment
when newborn moves in time with structure of adult speech
what is biorhythmicity
fetus in toon with mothers natural rhythms such a heartbeat
infant musst establish own through routine and consistent learning & care
what is reciprocity
behaviour that provides the observer with clues to respond to cues
what is synchrony
the fit between the infants cues & parents response
describe transition to parenthood
time of disorder & satisfiaction normal coping may not work may become unsupportive the transition is harder on the father limited knowledge
what are the phases to becoming a mother
1) dependent ( taking in phase)
2) dependent- independent phase (taking hold)
3) Interdependent (letting go phase)
what happens in the mothers dependent phase of motherhood
first 1-2 days
-focus on self& basic needs
excited
what happens in the motherhood dependent - independent stage
2-3 days lasts 10day-2 week
-focus is the care of baby
this is optimal teaching time
what happens in the motherhood interdependent phase
Focus is forward as a family
reassertion of relationship with partner
4 stages of becoming a mother
1) commitment, attachment to unborn baby & prep
2) Acquaintance/ attachment for infant, learning care (2-6 weeks)
3) moving ward new normal
4) achievement of maternal identity through redefining self (4m)
Maternal sensitivity to needs deremines the relationship
awareness, affect, timing, perception, flexibility, acceptance, responsivensss to cutes
mothers may feel overwhelmed for
3-6 mo
plan additional supportive consoling for
- 1st time mom
-in experienced with child care
carreer provided stimulation
lack friends or fam
adolescent
What are the phases to become a father
- Expectations + intentions (desire for emotional involvement)
- confronting reality (deal w/ expectations - frustration, disappointment, guilt, helpless)
- creating role of father (alter expectations, refine role, learn to care & struggle for recognition)
- Reaping rewards (smile, meaning 6w-2 mo)
what happens to fathers first 4-10 weeks
- uncertin
- increased responsibility
- bad sleep
- re-establish relationship with partner
common adjustment issue for couples
- changes in relationship
- division of household & infant duties
- finance
- balance
- social activities
was to cope for couples
- share expectations & assess relationships
- date nights
- appreciation
- be flexible
what are the factors of changes in woman sexuality
- hormone shift
- increased breast size
- body not pre-preg yet
- fatigue
- exhaustion
what is a contingent response
occurs within a specific time & are similar to a stimulus behaviour
(smile, cooing, eye contact)
how long does postpartum blues last for
3-5 days
behaviour characteristics influencing behaviour adjustment
1) modulation of rhythm
2) modification of behavioural repertoire
3) mutual responsivity
birth -2 hour period focus?
assess & stabilizing
-signs of distress & interventions
immediate after birth care
primary goal = effective respiration’s
routine care can begin if…
- term
- cry/breath
- good muscle tone
assessment
airway, dried, hr, color, resuscitation, stimulation
when to wear gloves
- physcial assessment
- breast milk contact
- diaper change
apgar score
low = bad rapid exam 1) hr via palpate umbilical cord or auscultate 2) resp rate movement or auscultation 3) muscle tone (flexion) 4) reflex irritability 5) skin color occurs 1 & 5 minutes after birth 0-3 = sever distress 4-6 = moderate difficulty 7-10 = little to no difficulty **reassessed @ 10 & 20 min if less than 7 **doesn't predict future neurooutcome, just transition to extrauterine life
if resuscitation is required it happens
-after drying
b4 one minute apgar
infant hr
110-160
infant resprate
30-60
if baby is having trouble breathing
side laying until they clear their throat
are crackles normal after birth?
yes fine crackles
what are the 4 conditions for adequate O2 supply
1) clear airway
2) adequate establishment of respiration’s
3) adequate circulation, perfusion, function
4) adequate thermoregulation
Abnormal resp
tacky = over 60
brady = under 30
O2 sat = less than 95
how hot to keep nursery
22-26degrees
what is babies usual temp
37 (36.5-37.5)
will stabillize around 8hr use auxiliary
post pone bath until stable
what does eye prophylaxis do
prevent ophthalmia neonatorum
what does vitamin K prophylaxis do
prevent hemorrhagic disease
infant assessment: proceed head to toe except
-procedures that need quite first
then more distracting
ave newborn bp
60-80 / 40-50
average birth weight
2500-4000g F: 3400 M: 3500
average head circumference
32-36.8cm
average length
45-55 cm
head makes up
1/4 of body length
assess umbilical cord for
2 arteries 1 vein, dry & odourless
should bowel sounds be heard right after birth in infant?
yes melconium 24-48hr
voiding schedule of newborn
1 void a day till day 5
then 6-8 wet diapers
how soon should ballard score be done? (test for gestational age)
less than 26w- within 12 hr
over 26w - 96 hr ok
Neuromuscular maturity is based on
- posture
- square window (angle between base of thumb & forearm)
- arm recoil (hold em out they should flex back in)
- popluteal angle (flex legs in & & put down)
- scarf sign (elbow shouldn’t reach midline)
- heel to ear (measure distance of food to ear & degree of knew flex)
what is considered an early term infant
37-38 and 6 days.
-breast feed difficult, resp distress, transient achy, learning difficulty, mortality
late term pre term infant risks
34-36 & 6 days.
resp distress, temp instability , hypoglycaemia, apnea, feeding difficulty, hyperbulirubinea
soft tissue injuries of infant
- subconjunctive hemorage will clear within 5 days
- all other rashes will clear by 2-3 days
What are the infant tasks of physiological adjustment
1) establish & maintain respiration
2) adjust circulatory changes
3) regulate temperature
4) ingesting & retaining nutrients
5) eliminating waste
6) regulating weight
behaviour adjustments of infant
1) establishing a regulated behavioural tempo independent of mom
- arousal, change in state, sleeping pattern)
2) process, storing organizing multiple stimuli
3) establishing a relationship with caregivers & environment
* *usually not much difficulty
what happens during the transition to extrauterine life
6-8hr
- monitored by sympathetic nervous system
- change hr, rrr, temp, GI function
1) period of reactivity
2) period of decreased responsiveness
3) 2nd period of reactivity
what happens in the period of reactivity
(30min)
- hr rapidly falls to 110-160
- rr is 60-80bmp
- fine rachel’s
- tremors, crying, bowel sounds
what happens in the period of decreased responsiveness
60-100 min
- pink
- increased shallow respoations
what happens in the 2nd period of reactivity
2-8 hr can last 10 min to hours -tahycardia & tachypnea -increased muscle tone skin color change -increased mucus meconium
factors that cause initiation of breath
- clamping cord causes increased bp, cirulation
- chem factors (hypoxia in labour)
- mech factors (changed intrathoracic pressure)
- thermal factor ( cold stress)
- sensory factors (being handed, dried, pain, light, sound, smells)
what are the signs of respiratory distress
nasal flare, retraction, grunting, stridor / gasping, seesaw, apnea (increased temp, hypo or hyperglycaemia, sepsis)
tachypnea (fluids not cleaned, sepsis, pneumonia, surfactant deficiency)
how long is acrocyanosis normal for
first 7-10 days
how low can HR be while asleep
90 when asleep, 180 when cry
is a drop in bp within first hour normal?
yes 15 is normal
what is an infants blood volume
80-100ml/kg of body weight
increases by 300mL immediately after birth
preterm have more blood b/c more plasma
late clamp expands blood volume
what are the advantages to late clamp
increase birth weight, increase hct. increased iron & decreased anemia can last up to 6 months. increased fine motor control by 4yr increased risk of jaundice
what could persistent tachycardia mean
anemia, hypervolemia, hyperthema, sepsis
what could persistent bradycardia mean
heart block, hypoxemia, hypothermia
what could infant pallor mean
anemia, peri-vasoconstriction, difficult delivery or sepsis
what causes increased risk of cardiac defects
- rubella
- diabetes
- drugs
do platelets change after labour for infant
no they’re same as adults
what happens to RBC’s after baby is born
- RBC’s are high & slowly fall
- polycythemia (delayed clamp, maternal hypertension & diabetes, intrauterine growth & restriction)
- @ birth 70% fetal hemoglobin, week 5 55%, 5% by week 20
why might a baby have neutrophilia
- crying
- high altitude
- hemolytic disease
- maternal fever
- melonconium aspiration
- lactation
- surgery
- difficult labour
what are the factors for heat loss
- temp/humidity
- flow & velocity
- surface in contact w/ infant
what does a neutral thermal environment do
allow infant to maintain normal temp & minimize O2 & glucose consumption
how does heat loss occur
1) convection - head loss body surface to air
2) radiation - head form body surface to cooler surface not in direct contact (keep baby away from)
3) evaporation - liquid to labour
4) conduction- cooler surface (direct contact)
what is thermogenesis
generation of heat via music. avtity
metabolize brown fat
what happens during cold stress
-increased RR
decreased perfusion
hypoglycaemia
what happens to the renal system
-@ birth 40 ml of urine (usually during birth )
then they will pee 15-60 a day gradual increase
-they must void at least once
-not very concentrated urine
can be cloudy, crystals is normal
water = 75% of weight
decreased ability to remove wast
what are epstein pearls
normal white cysts on gums
when is an infant coordinated enough to swallow
32/33 weeks
- neuromusc maturity
- maternal needs
- initial feeding
when does amylase appear in saliva
by 3m
what could no meconium be
-malrotation
atresia
inborn error of metabolism
congenital defect
what would ab distension mean
very serious
what is meconium made of
amniotic fluid, intestine secretions, shed cells & blood
what is transition stool made of
3rd day after feed (yellow or green)
what is milk stool made of
(4th day)
yellow, pasty, sour milk
how much room does the liver occupy
40%
-iron storage, carb metabolism, conjugations of billiruibn
coagulation
what is jaundice
increased serum levels of unconjugated billirubin
what are bilirubin levels effected by
- gestational age
- weight
- race
- blood type nutrition
- mode of feed
asian & indigenous have…
higher bilirubin
-most risk if breast fed
what is physiological jaundice
60% term, 80% preterm
2 phases: 1) bilirubin increases for 60-72
2) decreases to plateau by day 5
3) slowly decrease for 2-4w
pathological jaundice
if exceeds 256 mol
symptoms of pathological jaundice
- lethargy
- hypotonia
- delayed motor skills
- hearing loss
- cerebral palsy
- gaze abnormalities
when will baby reach adult levels of coagulation
9 months
how long are maternal IGG antibodies effective for
3 months
-adult concentration by 4-6 yr
when is acidic stomach
3/4 weeks
are newborns @ risk for infection?
yes all newborns especially premies are at high risk
leading causes
Dysperunia
dryness
signs of newborn infection
-fever, lethargy, irritability, poor feed, vomit, diarrhea, decrease reflexes, pale skin
signs of pneumonia
apnea, tachypnea, grunting, retracting
what are some risk factors of infection
- rupture of membranes
- choriamnionitis
- maternal fever
- asphxia
- invasive procedures & stres
- congenital abnormalities
babies over 35 weeks will have
vernix caseosa
decrease ph, decrease erythema, increase hydration
when is acrocyanosis normal for
first 7-10 days
what is milia
distended white sebaceous glands on face
when will babies start to sweat
day 3
desquamation
peeling
what are nevi
will go away in a few years
what is erythema toxic
transient rash (24-74 hr) last up to 3 weeks
signs of integumentary problems
pallor, plethora (purple), petechiae, central cyanosis, jaundice
why is hypospadias
urethra not @ tip
skeletal system characteristics
- arms longer than legs
- legs 1/3 of length 15% weight
- disapears within 3-4 days
what is caput succedaneum
generalized deem of scalp (gone by 3-4 days)
what is cephalic hematoma
- blood between skull & peropsteum
- goes away by 3-6 week
subgaleal hemorrhage
associated w/ vacuum
what is oligodactyly
missing digit
what is polydactyly
extra digit
what is syndactyly
fused digit
what tests for dysplasia of hip
- easily siloactate
- asymetrical gluteal fold
- ortolani test
- barlow test
what babies are at high risk for hypoglycaemia
- diabetic mom
- macrosomic or stimuli
- prolonged birth
- hypoxia
- preterm
what are transient tremors
normal until a month
what is myerson/ glabellar reflex
tap on face& will blink for first 4-5 times
truncal incurvation (gallant) reflex
trunk flexes & pelvis swings to stimulated side
what is magnet reflex
pressure against feed will flex back
infant vision
can see 50 cm away but clearest 17-20 cm
by 5 days they’re attracted to black &white
hearing, taste, small and touch
highly developed
what is habituation
ability to respond & inhibit responding to descrete stimulus
- protective mechanism
- helps avoid overload
- especially responsive to human void, soft light, soft sound
what is orientation
quality of alert states & ability to attend to stimuli
what is autonomic stability
signs of stress
what does crying signal
hunger, discomfort, pain, want attention, fussy, cold, overstim, held by to many people
