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
Defects of the Great Vessels - CHF symptoms (the great wall is dusky, ruddy, and can’t breathe)
CHF symptoms
Ruddiness
Dusky or gray color
Dyspnea
To support life interventions to mix arterial & venous blood
Neural Tube Defects (just 2)
Anencephaly
Spina Bifida
Anencephaly
The most severe NTD
1,000-2,000 infants born with this
Both genetic & environmental causes
Mostly Incompatible with life
Spina Bifida
Caudal defects failure to close the spinal column in an area
Microcephaly
Small brain formed in a normal sized cranium.Develops by age 2
Educate on cognitive deficiencies.
Hydrocephalus - where is the tube placed?
Increase in the CSF in the ventricles of the brain.
Overproduction, obstruction, or impaired circulation or absorption
Usually will have another defect as well
Normal brain growth is altered due to the pressure of the CSF.
Surgical placement of a valve and tube into the abdomen to drain excess CSF. Needs to be replaced as the child grows.
Hydrocephalus
Increase in the CSF in the ventricles of the brain.
Overproduction, obstruction, or impaired circulation or absorption
Usually will have another defect as well
Normal brain growth is altered due to the pressure of the CSF.
Surgical placement of a valve and tube into the abdomen to drain excess CSF. Needs to be replaced as the child grows.
Choanal Atresia - what will the baby look like? (choann is choking)
concave abdomen
Narrowing or occlusion of the nasal airway - baby won’t want to breast feed. baby will be blue.
Dyspnea nasal airway
Rare condition
Unable to pass a suction catheter through the nasal airway
Neonate is cyanotic and pinks with crying
Congenital Diaphragmatic Hernia (concave diaphragm)
concave abdomen
Severe development of the diaphragm into the thoracic cavity
Abdominal organs found in the thoracic cavity
Most often found with other congenital anomalies
Pulmonary hypoplasia (lungs don’t develop)
Decreased pulmonary vasculature
Support respiratory effort
Surgery required
Cleft Lip & Palate - when is surgical repair done?
Most common congenital malformation of head & neck
Fissure of the lip or a fissure of the lip and palate
Surgical repair between 6-12 weeks of age
Unilateral or bilateral
Immediate feeding problems
Dentition and language acquisition
Esophageal Atresia & Tracheoesophageal Fistula - when does it develop? (atresia has saliva)
Abnormal separation development of the esophagus and the trachea during the 3-6 weeks of embryonic development.
Esophagus is not patent***
Omphalocele (Om, it’s your abdomen)
Omphalocele weakened area of the umbilical ring allowing the peritoneal membrane to protrude and abdominal organs follow.
Gastroschisis (no sac for the stomach)
Gastroschisis is a full wall abdominal opening with protruding abdominal organs. No peritoneal sac protecting the organs
Omphalocele & Gastroschisis - how to treat? (only one way)
Both require surgical intervention
Omphalocele & Gastroschisis - how to manage? (Not much)
Gastroschisis has a high morbidity & mortality rate.
Orogastric tube for suctioning
Thermal regulation
Infection precautions
Imperforate Anus
Congenital malformation of the anorectal area
May have a pouch ending not connected to the colon
It may have fistulas with opening into either the vagina or the urinary tract.
Classified as low or high
Surgical repair – may need a colostomy
Gastric decompression and continous suctioning
Hypospadias & Epispadias - when to do surgeries?
Urethra opening is not on the tip of the penis
Epispadias in females in conjunction with Bladder exstrophy
Might accompany testicle & scrotum abnormalities
Surgical repair with good outcomes
Repair should be done in the first 6 months of life
Bladder Exstrophy - what about rectal muscles?
Bladder is outside the abdominal wall, failure to close during embryonic stage.
Wide spacing of the rectal muscles and symphysis pubis are noted with this defect.
Congenital Clubfoot (when is surgery) (go to the club between 4 and 9)
Extremely turned in foot
Lack of normal ROM
Serial Casting – Ponseti treatment
Surgery at 4 – 9 months
Bathing, diapering and developmental goals are a priority
Developmental Dysplasia of the Hips
Subluxated, luxated, or malformed acetabulum (hip bone)
Pavlik harness (soft splint)
Earlier the better to identify
Bathing, diapering, & developmental goals are a priority
extra skin folds on one side
knees and feet flat on surface
Inborn Errors of Metabolism - this is the state test
Genetic disruption of normal metabolism of carbohydrate, protein, fatty acid oxidation, or glucose.
Best outcomes with early detection.
Newborn screening
club foot - 2 types - and which one can move?
extrinsic - can move
intrinsic - can’t move (look in the book)
how long does TTN last? (Dynamite for 3 days)
usually less than 72 hours. diagnose with chest x-ray or ultrasound.
RDS - is an issue with what?
don’t develop surfactant
silverman anderson test (Silverman has rsd)
for RDS, score over 7 means RDS.
what groups are susceptible to retinopathy?
with low birth weight and preterm babies
Extremely low-birth-weight (ELBW) infant
less than 1000 g (2.2 lb)
SGA - glucose and temp?
Hypoglycemia (usually insulin resistance)
Temperature instability (no shivering reflex and no sub q fat)
SGA - hemoglobin levels?
Polycythemia (high RBCs - at risk for blood clots)
hemoglobin greater than 20 (check hct #)
Septal wall defects do what to pulmonary blood flow?
cause increased pulmonary blood flow
Defects of the great vessels (mixing at the great wall)
defects involving mixing of saturated and desaturated blood
anacephaly
neural tube doesn’t fuse w/ the cranial - most severe NTD. usually only live a few days. No brain.
spinal bifida
incomplete development of the brain, spinal cord, and/or their protective coverings caused by the failure of the fetus’s spine to close properly during the first month of pregnancy
Congenital Diaphragmatic Hernia - appearance
barrel-shaped chest
Congenital Diaphragmatic Hernia - positioning (the diaphragm is affected)
Position the newborn on the affected side with the head and chest elevated to promote normal lung expansion.
also pathological jaundice - bilirubin level at any time of what? for preterm and newborn (not exactly 12)
- A serum bilirubin level in a term newborn that exceeds 12.9 mg/dl at any time
- A serum bilirubin level in a preterm newborn that exceeds 15 mg/dl at any time
pathological jaundice - visible jaundice? (not 12)
- Any case of visible jaundice that persists for more than 14 days of life in a term infant
how quickly should bili levels drop w/ phototherapy?
Bili levels SHOULD drop in 4 – 6 hrs
septal wall defect - symptoms (murmur over the wall because I can’t eat)
Asymptomatic
Murmur
CHF symptoms
Feeding difficulties bc they’re tired
cyanotic heart lesions cause what disorders? (poly has a cyanotic heart that murmurs)
Polycythemia
Murmur
Hypoxemia
Dyspnea
Increased cardiac workload
obstructive defects - symptoms
Decrease in volume to the systemic flow
Symptoms of CHF
Decreased cardiac output
Pump failure
Spina bifida cystica
Occulta
rare cause of disability
Meningocele (mengie is bony but doesn’t get on my nerves)
bony defect with protrusion of the meninges and spinal fluid, no nerves involved
Myelomeningocele (mylo gets on my nerves) and where is the defect located?
involves spinal cord and root nerves herniated into the sac through the bony defect.
Disability occurs below the protrusion.
microcephaly - causes (micro mom took aspirin for her zika)
Genetics, alcohol use, drug abuse, low maternal BMI, NSAID use, Zika virus and toxin exposure.
Esophageal Atresia & Tracheoesophageal Fistula - how do they communicate?
The esophagus communicates with the trachea at its distal end.
Esophageal Atresia & Tracheoesophageal Fistula - what are the problems? (Atresia has 3 Cs)
Unable to swallow their own saliva
Aspiration
The 3 C’s – coughing, choking & cyanosis with feeding***
Esophageal Atresia & Tracheoesophageal Fistula - how to treat?
Orogastric tube placed for suctioning of saliva
Surgery
bladder extrophy - treatment? and what to do before surgery?
Surgical repair
Might need some cosmetic surgery to correct genitalia
Suprapubic catheter needed before surgery
Infection precautions
TTN - higher in boys or girls?
boys
TTN - nursing management
(IV) fluids and/or gavage feedings until the respiratory rate decreases enough to allow safe oral feeding. Withhold oral feedings until the respiratory status has improved
meconium MAS - will pH be high or low?
low - acidic
main sign of persistent pulmonary hypertension - and how fast? (self-explanatory)
demonstrates tachypnea within 12 hours after birth
persistent pulmonary hypertension - what sound will you hear in the lungs?
harsh murmur
necrotizing enterocolitis - most common among which babies?
premature (esp with enteral feedings)
Spina bifida cystica (cysts are serious)
more severe than occulta, and includes meningocele and myelomeningocele
Meningocele (mengi is not serious) - does not go where?
less severe, spinal cord does not go into dural sac. can range from no symptoms to complete paralysis.
myelomeningocele - and what other issue do these patients have?
more severe, also involves CNS. patients usually have hydrocephalus also.
myelomeningocele - lay in what position?
prone or side-lying
disorder where infant can’t stop crying (choann, stop crying)
Choanal Atresia - they can’t breathe - tongues goes up to palate
EA (esophageal atresia) (esop atresia can’t communicate)
congenitally interrupted esophagus in which the proximal and distal ends do not communicate
TEF (Te can’t communicate) - and what happens to the lungs?
abnormal communication between the trachea and esophagus. Fluid may flow directly into lungs***
what is the first sign of EA (esophageal atresia)?
hydraminos (the fetus can’t swallow amniotic fluid)
Gastroschisis differs from omphalocele in that
there is no peritoneal sac protecting the herniated organs, and thus exposure to amniotic fluid makes them thickened, edematous, and inflamed
Gastroschisis and omphalocele - main concern (the hole is the concern)
hypothermia
newborn stomach capacity
30 - 90 mL
ductus veinous
left umbilical vein to the inferior vena cava
where is the ductus arterious?
between the the aorta and the pulmonary artery
normal newborn bp
64/41
normal newborn temp
36.6 - 37.6 (97.9°F to 99.7)
cold stress
excessive heat loss that requires a newborn to use compensatory mechanisms (such as nonshivering thermogenesis and tachypnea) to maintain core body temperature
3 types of jaundice
Bilirubin overproduction, such as from blood incompatibility (Rh or ABO), drugs, trauma at birth, polycythemia, delayed cord clamping, and breast milk jaundice
Decreased bilirubin conjugation, as seen in physiologic jaundice, hypothyroidism, and breast-feeding
Impaired bilirubin excretion, as seen in biliary obstruction (biliary atresia, gallstones, neoplasm), sepsis, hepatitis, chromosomal abnormality (Turner syndrome, trisomies 18 annd 21), and drugs (aspirin, acetaminophen, sulfa, alcohol, steroids, antibiotics)
newborns need how many calories a day?
108/kg
hypothermia leads to
hypoglycemia
if glucose is less than 25 in first hour and baby is asymptomatic
feed and recheck in 1 hour`
1st glucose check
30 min after first feed
low glucose - symptomatic and below 40
iv glucose
possible signs of hypoglycemia - what reflex?
Jitteriness
Irritability
Exaggerated Moro reflex
High Pitched Cry
Poor feeding
Excessive sleepiness and drowsiness
acidosis causes what?
jaundice
low apgar score - at risk for what?
jaundice
Septal Wall Defect - may have trouble with what?
feedings
Defects of the Great Vessels - aorta is hooked to
right ventricle, and pulmonary artery from the left
occulta has
tuft of hair
Omphalocele & Gastroschisis - main concern?
temp regulation (what should be inside is now exposed to outside air)
