maternity 5-4 Flashcards
Low-birth-weight (LBW) infant
Low-birth-weight (LBW) infant: 2500 g (5.5 lb), regardless of gestational age
Very low-birth-weight (VLBW) infant
Very low-birth-weight (VLBW) infant: less than 1500 g (3.3 lb)
Appropriate for gestational age (AGA) - what percentile?
Appropriate for gestational age (AGA): birth weight falls between the 10th and 90th percentiles on intrauterine growth curves
Small for date (SFD) same as SGA
Small for date (SFD) or small for gestational age (SGA) :falls below the 10th percentile on intrauterine growth curves
Large for gestational age (LGA)
Large for gestational age (LGA):falls above the 90th percentile on intrauterine growth curves
IUGR - how will they look?
baby will have disproportionate body parts
SMALL FOR GESTATIONAL AGE - breathing? (not surfactant)
Asphyxia
Aspiration (not coordinated) (sucking reflex at 32 weeks)
LARGE FOR GESTATIONAL AGE (breathing and cardiac?) (LGA fetish)
Birth Trauma
Hypoglycemia (due to high blood sugar)
Asphyxia (it causes acidosis (looks like decreased variability on FHR strip)
Cardiac Anomalies
reasons for SGA (infections?)
smoking, nutrition, drugs, uterine infections, thyroid disease, multiple gestation
polycythemia - associated with weight? (poly is polyamorous when it comes to weight)
a concern for SGA and LGA
Preterm***(premature] - how old? (the premi is 37)
Preterm (premature):born before completion of 37 weeks of gestation
Late preterm***(late but right before premi)
Late preterm:from 34 0/7 through 36 6/7 weeks of gestation
Early term***(early is after premi)
Early term:from 37 0/7 through 38 6/7 weeks of gestation
Full term***
Full term:from 39 0/7 weeks through 40 6/7 weeks of gestation
Late term***
Late term:from 41 0/7 through 41 6/7 weeks of gestation
Post term*** (postmature)
Post term (postmature):born after 42 weeks of gestation
issues that cause preterm birth
infection and inflammation, maternal stress, bleeding and stretching of uterus cells.
preterm risks (cabbage patch couch)
Respiratory Distress Syndrome (lack of surfactant)
Temperature regulation
Intraventricular hemorrhage (fragile veins, and risk of increased pressure in brain)
Jaundice
Sepsis (infection)
Feeding problems
can’t give too much O2 to babies bc there is a risk of
retinopathy
neonatal hypoglycemia is the main cause of (no blood to the brain)
brain injury
ASSESSMENT OF INFANT OF DIABETIC MOTHER - what blood tests? and the lungs?
Macrosomia
increased Risk for Anomalies (heart, brain, and neural tubes)
RDS - resp. distress syndrome
Hypoglycemia
Hypocalcemia
Hyperbilirubinemia (from polycythemia)
HYPOGLYCEMIA Risk Factors (both can get it)
- LPI (late preterm infants)
- IUGR
- SGA, LGA
- < 2500 gm
- IDM (insulin diabetic mom)
- GDM (gestational diabetic mom)
HYPOGLYCEMIA: Symptomatic - Concerning symptoms
Seizure
Lethargy/decreased responsiveness
Hypotonia
Apnea
Cyanosis
if symptomatic at 40 glucose,
will start an IV
look at slide
29
interventions for hypoglycemia - how much glucose? (not even a gram of glucose)
0.2 Grams Glucose/kg/dose (orange syringe is for oral meds)
HYPOGLYCEMIA Interventions: Symptomatic - how much to infuse?
10% - it’s HIGHLY concentrated
IV DEXTROSE
IV dextrose is given with an initial bolus (0.2 g/kg) over 5 to 15 minutes (2 mL/kg of 10% dextrose in water [D10W]), followed by continuous infusion at an initial rate of 5 to 8 mg/kg per minute. If hypoglycemia persists, the infusion rate should be increased as needed.
HYPOGLYCEMIA Interventions: Asymptomatic - feedings?
Early Frequent Feedings
Thermoregulation (but we don’t want them too warm)
Assess all newborns for S&S of hypoglycemia
Follow unit protocol for high-risk newborns
Hyperbilirubinemia
PATHOLOGIC
Onset < than 24 hours
PHYSIOLOGIC
Onset > 24 hours (dehydration, meconium passage, late feeding)
Pathologic Jaundice - what is the level of bilirubin? and how much an hour?
Serum bilirubin concentrations of greater than 5 mg/dl in cord blood
* Clinical jaundice evident within 24 hours of birth
* Total serum bilirubin levels increasing by more than 5 mg/dl in 24 hours or increasing at a rate of 0.5 mg/dl/hr
conjugation of bilirubin
RBC - heme - bilirubin and iron - bilirubin + plasma to liver - unconjugated to conjugated - excreted through feces
JAUNDICE RISK FACTORS - small or large? hypo or hyperglycemia? (small yellow baby with no sugar)
- ABO incompatibility
- Sepsis
- Delayed mec passage
- Bruising
- Asphyxia / hypoxia
- Hypothermia
- Hypoglycemia
- Prematurity / SGA
- Hepatitis
NURSING CARE FOR NEONATAL JAUNDICE
Assess for risk factors
Encourage frequent breastfeeding
Prevent kernicterus ( = bilirubin can cause brain damage)
Assess level of visual jaundice
Transcutaneous monitor and/or serum bilirubin
Notify primary care-giver of findings
Kernicterus most commonly causes (keri has cerebral palsy)
cerebral palsy
learn slide
46
slide 51
on test
PHOTOTHERAPY - what type of light?
Goal to reduce unconjugated bili levels
Blue fluorescent spectrum; NO Ultraviolet
Lamp, fiberoptic pad or LED mattress
PHOTOTHERAPY NURSING CARE - diapers and temp?
Safety, eye protection
Cover genitals
Assess for dehydration
Monitor Temperature
I & O
Weigh diapers
Limit time outside lights
Monitor skin breakdown
Feed regularly
Cephalhematoma - suture lines?
don’t cross suture lines
Cephalohematoma - how long to resolve? and how does it compare to caput? (cephalohemotama 28 weeks later)
- Collection of blood between skull bone and periosteum
- Does NOT cross suture lines
- Firmer and more well-defined than caput
- Resolves in 2 – 8 weeks
BIRTH INJURIES - Facial Paralysis - how quickly does it resolve? And who gets it?
- LGA @ risk
- Forceps
- Prolonged 2nd
Stage - Resolves within
hours to days
NEONATAL SEPSIS - when is it acquired? (anytime)
Immature immune system
Acquired in utero, during L&D, during resuscitation or during the hospital stay
problem w/ sepsis symptoms
they are not very specific
NEONATAL SEPSIS SIGNS/SYMPTOMS - what would blood sugar be?
Apnea
Bradycardia
Tachypnea
GFR
Decreased 02
Tachycardia
Hypotension
Decreased perfusion
Temperature instability
Lethargy
Hypotonic
Seizures
Feeding intolerance
Abdominal distention
Vomiting, Diarrhea
Hyperglycemia
Neonatal Sepsis Nursing Care - what antibiotics?
Asepsis
Review prenatal and intrapartum record
Close monitoring/assessments
Labs
Encouragement of breastfeeding
Antibiotics (amp and gent)
labs for sepsis (just 3)
ABGs, WBC, and glucose
Goals of Nursing Care for NAS (neonatal abstinence syndrome)
decrease s/s of withdrawal
increase feedings and weight gain
Prevent seizures
reduce mortality
Support normal neurological development
eat, sleep and console for opiate babies
need to eat or drink 1 ounce in an hour, and sleep for 1 hour, and get consoled in 10 min
NEONATAL WITHDRAWAL NURSING CARE - pacifier?
Urine toxicology screen
Assess for worsening withdrawal
Administer Rx per MD order and withdrawal s/s score
Quiet environment, reduce stimuli
Pacifier for sucking reflex
Tightly wrap, rock infant
Promote nutrition
FETAL ALCOHOL SYNDROME - risk for (extra what?) and the main one you knew before
CLEFT LIP, PALATE
CERVICAL VERTEBRAE (neck) MALFORMATION
SPINAL BIFIDA
CONGENITAL HEART AND KIDNEY DEFECTS
EXTRA DIGITS
Septal Wall Defect (ASD - atrium,PSD, & PDA - pulmonary) - shunting - which side is stronger?
Increased pulmonary blood flow, left to right shunting - A left-to-right shunt allows the oxygenated, pulmonary venous blood to return directly to the lungs rather than being pumped to the body
Left side of heart has greater pressures than the right side
Cyanotic Heart Lesions (Tetralogy of Fallot & Tricuspid Atresia) (atresia kills the flow)
Decreased Pulmonary blood flow
Anatomical defect ASD or VSD (atrial or ventricular hole)
Mild to severe desaturation
Cyanotic Heart Lesions (Tetralogy of Fallot & Tricuspid Atresia = tricuspid valve doesn’t work) (Poly is cyanotic)
Polycythemia
Murmur
Hypoxemia
Dyspnea
Increased cardiac workload
Obstructive Defects (Pulmonary Stenosis, Aortic Stenosis, & Coarctaction (on backwards) of the Aorta) - where is the blood obstructed?
Blood flow exiting the heart is obstructed.
Narrowing or constricting of an anatomical opening.
Increase pressure behind the constriction
ceptal wall defects - what helps them close?
NSAIDs help close them up
Defects of the Great Vessels (the great wall mixes and gets congested)
Mixing of saturated blood with unsaturated blood
Pulmonary congestion
Decrease in cardiac output - aorta gets blood from right AND left ventricle - it mixes