Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Maternal/Child > Lecture 4 - Epidural/Newborn Assessment and Care > Flashcards

Lecture 4 - Epidural/Newborn Assessment and Care Flashcards

1
Q

What is the major complication of an epidural?

A

Marked maternal hypotension
–> d/t widespread vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some adverse effects of an epidural?

A

HypoTN
Pruritis
Loss of sense of control or urge to push
Increased length of labour in second stage
Increased need for augmentation
Postural puncture headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the benefits of epidurals?

A

Relaxation, and comfort while remaining alert and able to participate

Airway reflexes remain intact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes pruritis with epidural analgesia

A

Opioid-Induced histamine release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a postdural puncture headache?

A

When the needle used to insert the catheter punctures the Dura and causes a leaking of CSF and changes pressure changes intracranially
–> Worse when head is above heart level (upright), improved by lying down. Significantly painful.

Can last after the epidural has ended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is nursing care prior to an epidural?

A

Assess coping, assure information has been provided
–> Asses VS, hydration, labour progress, FHR, platelets and CBC
–> Give 500-1000ml bolus 15-30 minutes prior
–> Assist client to void

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why do we assist clients to void prior to epidural?

A

The sensation of a full bladder will be inhibited after epidural, and until it is removed the client will be required to void via intermittent catheterization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why is an IV bolus given prior to epidural? How much fluid over what time period?

A

500-1000 ml 15-30 minutes before epidural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why are ephedrine and phenylephrine made available during epidural?

A

Vasoconstriction - increase BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What position should patients be in during an epidural?

A

Comfortable position on back with pillow wedged under right buttock
–> Close to supine to facilitate even distribution of medication, wedged to prevent occlusion of vena cava

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How often should a person be changing positions while receiving an epidural infusion?

A

q60-30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How can we prevent bladder distention for a patient with an epidural infusion?

A

Intermittent catheterization - sensation to void will be inhibited

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What kind of anesthesia is typically used for an emergency c/s?

A

General Anesthesia
–> So immediate skin-to-skin will have to be with another family member

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the purpose of an APGAR score?

A

To assess how the baby is doing in the moment - not indicative of course of progression or future health

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When are APGAR scores given?

A

1&5 minutes
–> If less than 7, repeat at 10&20 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the four factors that stimulate breathing in the newborn?

A

Mechanical, sensory, thermal, and chemical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the chemical factors that stimulate breathing in a newborn?

A

Lower O2, higher Co2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the mechanical factors that stimulate breathing in a newborn?

A

Negative intrathoracic pressure following vaginal delivery (or pressure from c/s) initiates first breath

Surfactant required to decrease surface tension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

At what GA does a neonate have enough surfactant to not require administration

A

34 weeks GA
–> Premature before then would likely require surfactant administered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the temperature factors that stimulate breathing in a newborn?

A

Drop in temperature in room following delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the sensory factors that stimulate breathing in a newborn?

A

Suddenly being bombarded by lights, sounds, smells can make baby more alert, initiate crying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why do newborns need patent nares?

A

Obligate nose breathers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When is the first period of reactivity?

A

First 30 minutes of life
–> HR decreases from 160-180 to consistent baseline, RR up to 80
–> Irregular RR with fine crackles, grunting, nasal, flaring (should cease by 1 hour)

Followed by sleep period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How long is the sleep period following the first period of reactivity?

A

60-100 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the six states of NB consciousness?

A

Sleep: deep, light

Wake: Drowsy, quiet alert, active alert, crying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the second period of reactivity? When does it occur?

A

Occurs roughly 2-8 hours after birth, lasts 10 minutes-several hours
–> Increased mucus production, tachycardia/tachypnea may occur. Muscle tone increases + skin colour changes. Meconium often passes at this time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the optimal state of arousal for bonding with baby?

A

Quiet alert

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

At what ages do babies have accommodation? At what age is their vision most acute

A

Accommodation: 3 months
Acute vision: 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

At what distance do babies have the best vision for at birth?

A

17-20 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How well is the sense of hearing developed in a newborn?

A

Similar to that of an adult once amniotic fluid drains from ears
–> Infants respond to mother’s voice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Do neonates have an intact sense of smell?

A

Yes. Infants can differentiate the breastmilk of their mother from another person’s milk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What taste do newborns prefer?

A

sweet - can be used for analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

To what areas are newborns most responsive to touch?

A

Face, hands, soles of feet.

33
Q

What infections is erythromycin ointment used to prevent? When is it given?

A

Gonorrhea or chlamydia
–> Within 2 hours after delivery

34
Q

Canadian Pediatric Society (CPS) no longer recommends routine administration to all newborns provided there has been negative STI screening in pregnancy (chlamydia and gonorrhea) and there are no risk factors for these infections post screening. Why is it still available to all parents?

A

It is a legal prescription for all NBs in Ontario
–> Parents have right to refuse

35
Q

Why is vitamin K given to NBs?

A

Prevent hemorrhage by promoting clotting factor formation in the liver
–> NB does not have intestinal flora to produce vitamin K int he first week after birth

36
Q

What route is vitamin K given to NBs? What dose? Under what time frame?

A

1.0 mg for babies > 1500g
0.5 mg of babies < 1500g

Administered IM within 6 hours after birth.

37
Q

Persistent bradycardia (HR < 80) might indicate what in NB?

A

Congenital heart block

38
Q

Persistent tachycardia (HR >180) in NB might indicate what?

A

RDS, pneumonia, fever

39
Q

Bradypnea in NB (persistent RR < 30) may indicate what?

A

birth trauma or be d/t maternal narcosis from analgesics or anesthetics

40
Q

Tachypnea in NB (persistent RR > 60) may indicate what?

A

RDS, TTN, CDH

41
Q

Suboptimal temperature in the NB might indicate what?

A

Infection, dehydration

42
Q

Increased temperature in a NB might indicate what?

A

Infection, chemical dependence, diarrhea, dehydration

43
Q

Why are NBs are risk of hypothermia?

A

Unable to shiver
Larger surface area ratio
Born wet in a cold room
Blood vessels are superficial
Smaller energy stores

44
Q

How to NBs create heat?

A

Fetal position

Brown fat & glycogen stores
–> Breakdown can produce heat

45
Q

What are the different ways a NB can lose heat?

A

Convection, radiation, evaporation, conduction

46
Q

Cold stress can lead to which complications?

A

Increased need for energy leads to hypoglycemia and glycolysis which leads to acidosis

Hyperbilirubinemia d/t increased metabolic rate that results from glycolysis and FFAs that will compete to bind to albumin

Decreased pulmonary perfusion, resp distress, return of fetal circulation d/t increased O2 consumption

47
Q

What causes hypoglycemia in newborns with cold shock?

A

Increased energy expenditure

48
Q

What causes respiratory distress, decreased pulmonary perfusion, and return of fetal circulation with cold shock in NB?

A

Widespread vasoconstriction and increased oxygen consumption

49
Q

What causes glycolysis and acidosis in NBs with cold shock? What else does this lead to?

A

Increased metabolic rate d/t vasoconstriction and hypoglycemia
–> Hyperbilirubinemia d/t fatty acid breakdown attaching to albumin instead on bili

50
Q

Newborns are weighed when?

A

At birth and at discharge

51
Q

What loss in weight in the NB is acceptable for discharge?

A

10%

52
Q

What is the average birth weight at term?

A

2500-4000 g

53
Q

When is head circumference taken in a NB?

A

At birth

54
Q

What is Nevus Simplex (Stork Bite)? Does it fade?

A

Large immature blood vessels below the surface
–> Can fade over time

55
Q

What is erythema toxicum neonatorum (NB rash)? Does it fade?

A

Blotchy papules
–> Immune response to extrauterine environment
–> Will fade

56
Q

What is congenital dermal melanocytosis? Does it fade?

A

Melanocyte development in the dermis
–> often fades, should be documented clearly in chart

57
Q

What is milia in the NB?

A

Small white bumps, often on nose. Buildup of keratin
–> Fade on their own

58
Q

What is caput succedaneum? Does it extend across the suture line? When does it disappear?

A

Edema of the scalp - common in long or vacuum assisted delivery
–> Extends across suture line
–> Disappears spontaneously within 3-4 days

59
Q

Is molding a normal finding?

A

Yes, variation of normal after vaginal delivery

60
Q

What could cause bulging of the fontanels?

A

Hemorrhage, hydrocephalus

61
Q

What is cephalohematoma? Does it extend across the suture line? When does it disappear?

A

Collection of blood between skull and periosteum - occurs with pressure against bony pelvis or with forceps extraction
–> Does not cross suture lines
–> Resolves in 3-6 weeks

Often occurs with caput succedaneum - irreducible fullness that does not bulge with crying

62
Q

What is subgaleal hemorrhage? What causes it?

A

Bleeding in the subgaleal compartment - associated with difficult operative vaginal delivery, especially with vacuum assist.

63
Q

What are the complications of a subgaleal hemorrhage?

A

Hypovolemic shock, DIC, death - medical emergency

64
Q

How is a subgaleal hemorrhage detected? What are early and diagnostic signs?

A

Signs: boggy scalp, pallor, tachycardia, increasing head circumference

Diagnose with CT or MRI to confirm diagnosis

65
Q

How is subgaleal hemorrhage treated?

A

Replace lost blood, clotting factors may be needed

66
Q

What might it indicate if the pinna of the ear does not recoil quickly?

A

Assesses GA - will not recoil quickly in premature infant

67
Q

What is transient tachypnea of the newborn?

A

Signs of respiratory distress seen during first 1-2 hours following birth
–> Tachypnea > 100 rpm
–> Grunting + nasal flaring + mild retractions

68
Q

How can mild transient tachypnea of the newborn be treated?

A

Supplemental oxygen or non-invasive ventilator support

69
Q

Respiratory distress in newborns is more serious if…

A

–> Extends beyond first 2 hours of birth
–> RR > 120 rpm

70
Q

Respiratory distress in newborns is often accompanied by what other else?

A

HypoTN, temp instability, hypoglycemia, acidosis, signs of cardiac issues

71
Q

What might a pilonidal sinus/sacral dimple indicate?

A

Spina bifida - especially with a tuft of hair present

72
Q

What are the s/s of biliary atresia?

A

Pale stool
Jaundice lasting > 2 weeks
Irritability
Weight loss
Abdominal distension

73
Q

How is biliary atresia treated?

A

Surgically

74
Q

What is physiological jaundice?

A

Starts after 24 hour mark
–> Normal finding with NBs d/t immature livers

75
Q

What is pathological jaundice?

A

Prior to 24 hours
–> Indicates something is going wrong

76
Q

What are some risk factors for jaundice?

A

Injury that results in bleeding
Pre-term
Poor feeding - breastfeeding increases risk d/t delay in milk let down
ABO incompatibility
Sepsis

Previous siblings with jaundice

77
Q

What is kernicterus?

A

Brain damage caused by bilirubin crossing BBB

78
Q

What is the Moro reflex?

A

Startle reflex - arm adduction + c-shaped hands
–> 3-6 months

79
Q

What is part of the 24 hours screening for newborns?

A

Bili levels
NB metabolic screening
CCHD screening
Hearing screening - handout given to parent

+ CMV, weights (At TOH, not on slides)

80
Q

How soon are the follow up appointments in the medical model?

A

Baby: 48-72 hours after discharge

Maternal: 1-2 weeks c/s; 6 weeks vaginal delivery

81
Q

How soon are the follow up appointments in the midwife model?

A

Home visits within 24 hours and during first week - usually 6 visits in the first 6 weeks.

Maternal/Child (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions