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NURS 372 - Maternity & Family Health > Midterm to Final Material > Flashcards

Midterm to Final Material Flashcards

1
Q

What are the 3 stages of the newborn adapting to extrauterine life?

What can be observed in the newborn during each stage?
How long does each stage last?
In which stage is it most likely from meconium to be expelled

A
  1. First period of reactivity: Alert & active best time for breast feeding, suck is strong. tachypneic and tachycardic, lasts 30mins-1 hour after birth.
  2. Period of decreased Responsiveness, 2-3 hours after birth (newborn falls asleep, HR & RR decrease)
  3. Second period of reactivity: (4-6 hours after birth, lasts 10mins to hours). ** most likely to pass meconium
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2
Q

By _____ wks there is enough surfactant in the newborns lungs that they can have a good chance of survival

A

32 weeks

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3
Q

Lack of ________ is what impacted pre-matures infants ability to breath properly

A

surfactant

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4
Q

Fetal respiratory movements have been detected on Ultrasound as early as ______ weeks

A

11

These movements are essential for developing chest wall muscles and diaphragm

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5
Q

By weeks ____ to _____ some fluid moves into the trachea and into the amniotic fluid or is swallowed by the fetus

A

13-16 weeks

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6
Q

By ___ to ___ weeks rhythmic breathing movements occurs

A

29-32 weeks

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7
Q

What are the 2 types of fetal surfactant?

A

lecithin

sphingomyelin

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8
Q

_______ surfactant will increase in amount
&
________ surfactant will remain constant in amount

A

lecithin

sphingomyelin

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9
Q

L:S ratio is used to determine how ________ the fetuses lung are

A

mature

once the L:S ratio is 2:1 (lecithin:sphingomyelin) we can say that the fetus lungs are mature

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10
Q

At what point is the L:S ratio 2:1?

A

35 weeks gestation

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11
Q

what factors can delay fetal lung maturity?

A

gestational diabetes

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12
Q

What chemical reactions occur to the fetal respiratory system during labour to ‘activate the lungs’

A

There are chemoreceptors in the carotid arteries and aorta that are activated by the hypoxia in birth that signal the lungs to begin working

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13
Q

hypoxia and increased CO2 levels during birth stimulate what to kick off the respiratory system

A

signal to the resp center in the medulla that breathing needs to begin

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14
Q

What mechanical factors activate fetal respiratory adaptations after brith

A

intrathoracic pressure&raquo_space; going through the birth canal. once the baby is out of birth canal pressure is released. The negative pressure helps pull air into the lungs .

Crying increases distribution of air in lungs encouraging alveoli to open.

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15
Q

what thermal & sensory factors activate fetal respiratory adaptations after birth

A

Temperature drops when fetus is born» this stimulates receptors in the skin to further stimulate receptors in the medulla.

sensory stimulation: drying the infant, skin to skin, light, air etc all helps to stimulate the resp center.

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16
Q

how is the fluid removed from the lungs after birth?

A

pressure through the birth canal pushes it out, crying opens alveoli helping to push it out.

Any remaining fluid is absorbed back into the body through bloodstream and lymphatic stream

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17
Q

what factors negatively impact fetal respirations after birth?

A

alveoli are immature&raquo_space; risk for inadequate oxygenation

small alveoli and low in #

decreased lung elasticity&raquo_space; this will come in time.

nose breathers (risk of airway obstructions

immature resp control ability&raquo_space; irregular breathing pattern and periods of apnea

not able to rapidly alter the depth of their resps yet.

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18
Q

What are normal findings for newborn resp assessment

A

shallow & irregular resps

30 - 60 breaths per min
Resp rate increases w/ activity

periodic apnea, pauses should be < 20 sec

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19
Q

what are signs of resp distress in newborn?

A 
nasal flaring
retractions
grunting 
apnea lasting > 20 sec
RR < 30 OR 60<
central cyanosis (around the mouth) ** as opposed to acrocyanosis
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20
Q

What 3 shunts are present during fetal life?

A

ductus venosus
ductus arteriosus
Foramen ovale

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21
Q

in utero the ________ is a ____ resistance pathway for gas exchange

A

placenta

low-resistance (blood flows easily)

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22
Q

The ductus venosus connects the umbilical _____ to the _____ vena cava

A

vein

inferior vena cava

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23
Q

the ductus arteriosus connects the main ______ artery to the ______

A

pulmonary artery

aorta

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24
Q

the foramen ovale allows blood to pump the right ____ to the left ____

A

right atria to left atria
closes within the first few mins of life after the pressure changes in the circulatory system push oxygenated blood through the heart

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25
Q

Fetal circulation is:

_____pulmonary vascular resistance (PVR)

_____ aortic systemic vascular resistance (SVR)

A

High PVR

Low SVR

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26
Q

what happens when the umbilical cord is clamped?

A

resistance flips

causes a rise in blood pressure&raquo_space; increases circulation among perfusion

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27
Q

Pulse oximetry screening is performed___ hours to ___ hours post birth.

Why?

A

24-36 hours

Critical congenital Heart disease is the most common congenital heart disease.

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28
Q

Pulse ox is placed where on the infant?

A

right hand and either foot

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29
Q

Bacterial colonization of the gut is established within the first _______ of birth

A

week

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30
Q

Stomach capacity of a newborn is _____ on day 1

A

30mL (1 oz)

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31
Q

infants can be born with 1 or more ______.

If they are born with these, we will remove them, why?

A

teeth

can become a chocking hazard

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32
Q

by the end of the first week stomach capacity is ______

A

90mL

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33
Q

meconium is composed of

A

amniotic fluid and its constituents, intestinal secretions, shed mucosal cells and possibly blood

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34
Q

by the ____ day baby will have a transitional stool

A

3rd after the initiation of feeding

thin and less sticky than meconium

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35
Q

by day 4 baby will have ____ stool

A

milk

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36
Q

When they are born babies have a small amount of _____ and will usually pass it during birth or directly folllowing

A

urine
1 void/day for first 5 days
and then 6-8 voids/day following

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37
Q

for newborns roughly ___% of their body weight is water

A

75%

first few days they undergo diuresis, loss 10% of body weight in the first week and then regain

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38
Q

newborns are more prone to ________ and _______ imbalance

why?

A

acidosis
electrolyte imbalance

decreased GFR at birth (kidneys aren’t fully online) about 30-50% that of an adult

This results in problems removing things from the blood&raquo_space; electrolyte imbalances

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39
Q

what is the appropriate order of the newborn physical assessment?

A

quiet things first
inspect their face/head/ neck
listen to heart, lungs, and abdomen
move to the things that may make them cry

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40
Q

What is neutral thermal environment

A

ideal environment where you conduct your newborn assessment; no heat loss
allows baby to maintain body temp and to minimize glucose or oxygen consumption (trying to stay warm)

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41
Q

What are the 4 main types of heat loss?

A

convection
radiation
evaporation
conduction

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42
Q

flow of heat from the body surface to the cooler air is called

A

convection heat loss

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43
Q

loss of heat from the body surface but not to the direct surface in contact with the infant but rather near it.
ie. basinet in front of a big window

A

radiation

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44
Q

when a liquid is converted to a vapor and heat is lost.

ie. giving a baby a bath and they are not quickly dried

A

evaporation

evaporative heat loss is the most significant type of heat loss in the first few days of life

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45
Q

loss of heat from the body surface to cooler surfaces in direct contact with the infant.
ie. infant sitting on a cooler surface

A

conductive heat loss

can happen when you are weighing the baby without any protective layer (blanket) on the scale surface

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46
Q

T or F

newborns who are placed skin-to-skin are warmer than those who are swaddled and held by their caregivers

A

True

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47
Q

What can you do to ensure heat loss is minimized during the physical assessment?

A

Ensure infant covered, surfaces covered that infant is on, infant is dry, not near a window or cold area

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48
Q

What are safety precautions to consider?

A

Safety Precautions –
Need to check ID
Ensure is warm with head covering
Good lighting
Infection control procedures – washing hands, cleaning stethoscope etc.
Privacy – this is generally done in the mothers room so close the door or pull the curtain

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49
Q

Which aspects of the assessment and procedures require quiet? What can you observe? Do these first.

A

Observe: Breathing, infant state and movement, look at face and head and body, shape and symmetry of head, ears, and eyes, skin colour, perfusion, range of spontaneous movement, posture, muscle tone, look for edema and or trauma,

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50
Q

After observing you auscultate, what will you auscultate

A

heart, lungs, bowels

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51
Q

Perform procedures that may be upsetting to the newborn last. What may these be?

A

auscultation, reflexes and palpating the abdomen

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52
Q

What are normal newborn VS:
temperature
HR (where do we auscultate)
RR

A

temp: taken in the axilla 36.5 - 37.5
HR: 110-160 @ birth, can be as low as 90 during sleep and up to 180 when infant is crying.
Auscultate at the 4th intercostal space to the left of midclavicular line.
RR 30-60 (shallow, irregular in rate, rhythm and depth)

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53
Q

What do we teach the parents about heat loss and how to protect the baby?

A

skin to skin with light blanket
keep a cap on the baby
if baby is hot to touch. might be too warm
when bathing baby dry quickly. and wash hair separate from the body. wash first and place cap n head.

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54
Q

What are the 6 sleep-wake states of the baby

A

deep sleep
light sleep
drowsy
quiet alert (best time for baby to learn)
active alert
crying
** normal for baby to have a fussy period in the late afternoon and crying peaks between months 2-4

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55
Q

why do some babies look a little cross-eyed at birth?

A

eyes are structurally complete but muscles around the eyes are not
accommodation improves over the first few months

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56
Q

Clearest visual distance for baby ____ to____ cm (distance from baby breastfeeding to moms face)

A

17-20cm

can see up to 50cm away

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57
Q

by ____ months of age babys can detect color

A

2 months

newborns are more attracted to black and white patterns when they are first born

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58
Q

by ___ months baby’s vision is as acute as that of an adult

A

6 months

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59
Q

is newborn hearing similar to that of an adult?

A

yes, as soon as the amniotic fluid drains away

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60
Q

Do newborns have a highly developed sense of smell?

A

yes, they can differentiate their mother from other lactating women through smell

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61
Q

what are the 4 primary purposes of bathing baby?

A
  1. cleansing
  2. comfort for baby
  3. observing sensory development of baby
  4. family child interaction
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62
Q

how do we maintain the skin-acid mantel of the baby?

A

neutral pH soap

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63
Q

why is immersion technique the preferred method for bathing baby?

A

less heat loss
less crying
*You want to immerse up until the shoulders

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64
Q

when would you not bathe a baby?

A

when they are unstable.

if they are experiencing heat loss, cardiac or respiratory issues

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65
Q

does a baby need to be bathed daily?

A

no. not necessary and typically dries out skin.
cleaning the perineum after a diaper change and face wash daily should be sufficient

  • typically we delay bathing in the hospital for 24 hours
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66
Q

what are the benefits of delaying bathing for newborns?

A

keep the vernix caseosa on them for longer, where they can absorb nutrients and improve rates of breast feeding.
can also prevent hypoglycemia and hyperthermia

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67
Q

why don’t we use baby powder any more

A
  1. the dust is so fine the infants can inhale it

2. the powder can become moist and lead to a diaper rash

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68
Q

How often should parents be wiping baby’s gums?

A

after each feeding

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69
Q

What are some key elements to washing the baby’s hair during bath time

A

Do not use running water to wash hair as temperature could change suddenly.
Area over the fontanels CAN be washed
Wash the head/hair before or after the body to prevent heat loss
A mild soap or shampoo should be used

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70
Q

what is cradle cap?

A

scalp desquamation. we place a cap on baby’s head when they are coated in the vernix which can become dry and matted.
can apply baby oil or mineral oil 1 hour before bathing and it will help remove it

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71
Q

what are key things for infant cord care

A

Clean cord with plain water and a q-tip
Assess for signs of infection – redness, swelling, exudate, pain in area
Notify healthcare provider if any signs of infection noted
Use an absorbent gauze to remove excess moisture
Roll diaper below umbilicus
Allow area to air dry
The area may be loosely covered with clothing

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72
Q

when will the umbilical cord fall off

A

10-14 days
may see a few drops of blood.
Parents should notify HCP if there is anything other than a few drops of blood

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73
Q

if a diaper rash persists for more than 3 days what might it be?

A

fungal in nature and will need different treatment.

could have gotten a fungal infection from the mom if she has thrush on her nipples

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74
Q

when will the foreskin or uncircumcised babies retract?

A

not until 3 years of age

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75
Q

T or F

Once healed a circumcised penis does not require any special care other than normal cleansing during diaper changes

A

True

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76
Q

What is a simple measure that can aid in minimizing diaper rash and helping it heal should a baby get one?

A

exposing the bottom to open air.
place baby on tummy with absorbent towel underneath and allow bottom to be exposed to the air
this will help dry things out

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77
Q

what are the most common minor complications associated with circumcision

A

bleeding and infection

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78
Q

Important teaching aspects for parents caring for an infant who has been circumcised

A

takes 7-10 days to heal
gently wash penis w/ warm water after each diaper change
put petroleum jelly on incised area as directed by physician
fasten diaper loosely
a thin yellow form will form over incision area - this is normal leave it

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79
Q

instructions for parents on when to call the doctor, post-circumcision procedure for their infant

A

Baby has a fever
If there is severe swelling and redness; a red streak on the shaft of the penis; or a thick, yellow discharge.
Bleeding or has a bloodstained area larger than the size of a quarter on a diaper or on the circumcision site dressing.
Babyis very fussy or cranky, has a high-pitched cry, or refuses to eat.
The baby has not passed urine within 12 hours after the circumcision was completed.

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80
Q

what is the recommended time frame for collecting blood sample for universal metabolic newborn screening

A

24-48 hours

it is a heel stick to collect the blood sample

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81
Q

SIDS peaks between __ to ___ months of age

A

2-4 months

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82
Q

SIDS is higher for these 3 categories of babies

A

male babies
low birth weight babies
premature babies

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83
Q

What are the modifiable risks to try and prevent SIDS

A

sleeping on their backs is best
exposure to cigarette smoke
prenatally & postnatally

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84
Q

What are some factors that can protect an infant from SIDS

A

breastfeeding for at least 2 months
pacifiers
vaccinations

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85
Q

What is positional plagiocephaly

A

flattened area that may develop on the head when infants are left supine while awake or in an infant seat

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86
Q

Shaken baby syndrome has been changed to

A

THI - CM

traumatic head injury - child maltreatment

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87
Q

what are some of the VS changes that can arise form THI-CM

A

lethargy, vomiting, inability to cry, hypotension

** inconsolable crying is the # 1 trigger

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88
Q

a yellow - orange bile pigment produced by the breakdown of red blood cells

A

bilirubin

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89
Q

bilirubin is conjugated by the _______

what does this mean?

A

liver
Conjugated (joined) with glucuronic acid
Conjugated form (direct bilirubin) is soluble and can be excreted through urine and stool

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90
Q

why can we palpate a newborns liver?

why is the liver so important?

A

because it takes up about 40% of the space in the abdominal cavity

  • iron storage
  • conjugates bilirubin
  • metabolizing carbohydrates
  • coagulation
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91
Q

during pregnancy the placenta conjugates bilirubin and removes it, once the baby is born the _____ takes over this function

A

liver

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92
Q

Describe the process of RBC breakdown

A

RBC reaches the end of their life cycle
will be phagocytosed by macrophages» broken down into HEME & GLOBIN
the HEME&raquo_space; further broken down into Iron & UNconjugated bilirubin.
** bilirubin cannot be excreted on its own, needs to be conjugated (joined with albumin to become soluble and excretable

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93
Q

Unconjugated bilirubin is also called _________ bilirubin

A

indirect

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94
Q

most unconjugated bilirubin will bind to albumin to be excreted, if it does not bind to albumin what happens to it?

A

unconjugated bilirubin will leave the vascular system and enter extravascular tissues:
skin, sclera, oral mucosa

** can cross the BBB&raquo_space; neurotoxicity

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95
Q

Urobilinogen is excreted via _____

Stercobilin is excreted via ______

A

urine

stool

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96
Q

yellowing of the skin, sclera and mucous membranes

A

Jaundice

d/t increased bilirubin blood levels

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97
Q

physiologic jaundice is common in term newborns(___%) and ____% of preterm infants

A

60%

80%

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98
Q

physiologic jaundice appears ___ hours of age.
* usually resolves without treatment

pathophysiological jaundice appears before ___ hours of age

A

24 hours

24 hours

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99
Q

peak bilirubin levels are reached between days ___ and ____

A

3-5 days

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100
Q

jaundice typically appears when serum bilirubin levels exceed ____ to ____ umol/L

A

85-102 umol/L

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101
Q

what are the 4 physiologic reasons for jaundice

A
  1. high RBC mass, short RBC lifespan
  2. Reduced ability of liver to conjugate
    (liver can only conjugate about 2/3 of the circulating bilirubin in the first few days of life)
  3. Fewer bilirubin binding sites (bc newborns have lower serum albumin levels)
  4. Conjugated changes in unconjugated in intestines
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102
Q

____________ refers to elevated serum bilirubin levels and its toxic to the brain

A

hyperbilirubinemia

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103
Q

acute bilirubin encephalopathy

A

high levels of serum bilirubin

symptoms include: lethargy, irritability, hypotonia, seizures, coma, death

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104
Q

if hyperbilirubinemia is left untreated it can lead to ______

A

kernicterus
irreversible long term consequences of bilirubin toxicity
hypotonia
delayed motor skills, hearing loss and gaze abnormalities

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105
Q

what are some contributing factors to hyperbilirubinemia

A

hemolysis of excessive RBCs (erythrocytes)
short RBC life
liver immaturity; cannot process all the breakdown of RBCs
lack of intestinal flora to help process
delayed feeding, which promotes meconium and excretion of bilirubin
fatty acids from cold stress or asphyxia
trauma resulting in bruising or cephalohematoma

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106
Q

how do fatty acids contribute to hyperbilirubinemia

A

fatty acids will displace bilirubin preventing them from binding to albumin and becomes conjugated (ready for excretion)

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107
Q

what are some risk factors for jaundice

A

premature baby
birth trauma or bruising
baby is Asian or Indigenous
baby’s siblings had newborn jaundice

108
Q

__________________occurs when serum levels of unconjugated bilirubin rise beyond normal limits.

A

Hyperbilirubinemia

109
Q
  1. In high concentrations, bilirubin is toxic to the brain. _______ refers to the irreversible, long term consequences of bilirubin toxicity, such as delayed motor skills and hearing loss
A

_Kernicterus____

110
Q
  1. In newborns, the _____ plays a major role in the metabolism of bilirubin and conjugates it.
A

__liver___

111
Q
  1. _______bilirubin is also called indirect bilirubin, which is ________ soluble, has not yet been metabolized by the liver, and is bound to circulating albumin in the blood stream.
A

_Unconjugated__

____lipid_

112
Q

_______ bilirubin, also called direct bilirubin, is ______ soluble.

A

Conjugated

_water____

113
Q

Two ways in which we can help the newborns reduce serum levels of unconjugated bilirubin

A

phototherapy and exchange blood transfusions

114
Q
  1. _________ bilirubin is the sum of the indirect and direct bilirubin values.
A

Total Serum_

115
Q
  1. Any delay in intestinal movement or ________ in intestinal flora increases the risk of direct bilirubin to convert to indirect bilirubin, thus necessitating re-entry to the liver to begin the excretion process again.
A

decrease

116
Q

T or F

Jaundice in lighter-skinned newborns may be assessed by blanching the skin over a bony prominence.

A

True

117
Q

T or F

In darker-skinned newborns, the oral mucosa, hard palate, and conjunctival sacs may be assessed for yellow pigmentation.

A

True

118
Q

T or F

Jaundice progresses from lower extremities, to the trunk and then face.

A

FALSE] – MORE NOTICEABLE IN EYES AND FACE FIRST

119
Q 
T or F
Transcutaneous bilirubinometry (TcB) monitors may be used to screen clinically significant jaundice and decreases the need for serum bilirubin levels. [TRUE]
A

True

120
Q

T or F
The nomogram, used to determine risk zone, depicts the bilirubin value recorded on the TcB monitor on one axis and the postnatal gestational age (in weeks gestation) on the other axis.

A

[FALSE] – POSTNATAL GESTATIONAL AGE IS MEASURED IN HOURS

121
Q

T or F

Exposing newborns to sunlight or placing the newborn in a bright, sunlit room, is recommended to treat jaundice.

A

[FALSE]

122
Q

T or F
It is recommended that healthy infants (35 weeks’ or greater) receive assessment of bilirubin between 24 and 72 hours of life.

A

TRUE

123
Q

T or F

Adequate hydration increases peristalsis and excretion of bilirubin in the newborn.

A

TRUE

124
Q

T or F

The purpose of phototherapy is to reduce the level of circulating conjugated bilirubin.

A

[FALSE] –“LEVEL OF CIRCULATING UNCONJUGATED BILIRUBIN”

125
Q

T or F

Phototherapy causes constipation in the newborn. [FALSE] – PHOTOTHERAPY MAY BE ASSOCIATED WITH LOOSE STOOLS

A

[FALSE] – PHOTOTHERAPY MAY BE ASSOCIATED WITH LOOSE STOOLS

126
Q

T or F

During phototherapy, the newborn should be placed supine for maximum exposure to the light source.

A

[TRUE]

127
Q

What are some of the factors that contribute to hyperbilirubinemia?

A
  • Hemolysis of excessive RBC
  • Short RBC life
  • Liver immaturity (liver is what processes bilirubin)
  • Lack of intestinal flora
  • Delayed feeding (unable to pass their meconium)
    Fatty acids from cold stress or asphyxia ( FA displace bilirubin- and it is unable to bind to albumin as well).
    -trauma resulting in bruising or bleeding ie. cephalohematoma - build up of RBC
128
Q

What are the 8 key checklist items that are required to evaluate / assess a baby for risk of hyperbilirubinemia?

A
  • Was the baby premature
  • Did the baby experience birth trauma or bruising?
    Is the baby of Asian or Indigenous ethnicity?
  • Did the baby’s siblings have newborn jaundice?
  • Is the baby being exclusively or partially breastfed?
    Are fewer than 6 diapers saturated w/ urine each day ? dehydration&raquo_space; prevents urobilin
  • Is the baby a boy?
  • Is the mother Rh negative or blood type O
129
Q

Why is breastfeeding so important to prevent hyperbilirubinemia ?

A

breastfeeding should be started within the first hour, and then infant should be fed 8-12 times within the first 24 hours.
colostrum is a laxative which promotes stooling and helps the baby pass meconium

130
Q

What is the best therapy for hyperbilirubinemia?

A

Prevention

131
Q

What is the TCB (transcutaneous bilirubin screening) tool used for?

A

It is measuring the amount of bilirubin via light refraction.
placed on the sternum of the newborn. 3 measurements are taken
TcB can reduce the need for a blood serum test TSB . more accurate at lower levels and no longer accurate once phototherapy is initiated.

132
Q

What would we check if the mother is Rh negative or Type O ?

A

DAT (direct antiglobulin test).
Which checks to see if there are antibodies that can cause hemolytic disease of the newborn.
DAT is used to determine whether the newborn RBCs have been attacked by the mother’s antibodies.
DAT is also referred to as a Coombs test.

133
Q

what is the purpose of phototherapy?

A

used to reduce the amount of circulating unconjugated bilirubin.
It uses blue wavelengths to change the shape of unconjugated bilirubin so it is more easily excreted

134
Q

physiologic jaundice peaks at what days?

A

days 3-5

135
Q

Why are newborns at higher risk of thermal dysregulation

A

Thin layer of subcutaneous fat and blood vessels are close to the surface of their skin
newborns have brown fat reserve

136
Q

What will happen physiologically if the newborn is cold?

A

They will cry and wiggle to try and generate heat (thermogenesis)
increase in cellular metabolism which increases oxygen and glucose demand
newborn will assume the position of flexion&raquo_space; to decrease heat

137
Q

Newborns typically do not shiver, what do they do to warm themselves?

A

non-shivering thermogenesis, metabolize their brown fat supply.
reserves of brown fat are quickly depleted with cold-stress.
Also term infants have greater stores of brown fat than preterm infants.

138
Q

Is heat lost or gained?

  1. Baby’s naked, dried body is placed on mom, skin-to-skin
  2. Warm, wet newborn covered with amniotic fluid is delivered
  3. Baby is removed from incubator for a procedure
  4. Baby is placed in an incubator with warm, circulating air
  5. Baby is bathed
  6. Baby is placed near a cold exterior wall
  7. A cool stethoscope is used when determining the newborn’s heart rate
A
  1. Gained - best if covered with a blanket
  2. Heat loss – evaporation
  3. Convection - heat loss
  4. Heat Gain - convection
  5. Evaporation – heat loss
  6. Radiation – heat loss
  7. Conduction- heat loss

`

139
Q

How is non-shivering thermogenesis triggered?

A

Usually triggered at a mean skin temperature of 35-36° C
↓
Thermal receptors in the skin perceive a drop in environmental temperature and transmit impulses to the hypothalamus
↓
Stimulates the sympathetic nervous system
↓
Release of norepinephrine
↓
Stimulates brown fat metabolism by the breakdown of triglycerides
↓
Generates heat
↓
Increases body temperature

140
Q

What are the physiological adaptations that occur when the newborn experiences cold stress?

A 
Peripheral vasoconstriction
less activity, lethargy, hypotonia
depleted brown fat stores
respiratory distress
Metabolic acidosis >> kidneys are unable to remove acid
Hypoglycemia
141
Q

What are the differing displays of hyperthermia in a newborn for external vs internal sources?

A

External source (too many blankets): flushed skin, hands and feet warm to touch, posture of extension

Internal source (d/t sepsis): pale from vasoconstriction, hands and feet are cool

142
Q

When does the newborn experience the peaks of hypoglycemia post birth?

A

30-90 minutes after the cord is cut
we want to see newborns glucose stabilize within the first 3 hours of life 2.5-3mmol/L
and by the third day should be between 4-5mmol/L

143
Q

“The _______ period begins after the delivery of the placenta and lasts approximately 8 weeks.

A

puerperium

144
Q

Acronym for the post-partum assessment of the mother.

A 
BUBBLE
Breasts & Nipple
Uterine
Bladder
Bowel
Lochia
Legs
Episiotomy/Laceration
Emotional status / Energy Level
145
Q

What are the physiological changes that occur with the following hormones to directly following delivery of the placenta:

  • Progesterone
  • Estrogen
  • Prolactin
  • hPL
A
  1. decrease
  2. decrease
  3. increases
    4 decreases
146
Q

What causes significant drops in insulin of the mother directly after birth

A

decrease in hPL
a type diabetic mother will need less insulin
HCG disappear from the maternal system pretty quickly after birth

147
Q

What impacts a womans serum prolactin levels?

A

How frequently and much she breast feeds
How long breastfeeding goes for
woman who doesn’t breastfeed, prolactin levels decrease rapidly and return to pre-pregnancy levels in 3 weeks

148
Q

What changes occur to menstruation after birth

A

woman who is not breastfeeding, menstruation will return within 27 days after birth
woman who is breastfeeding it will return in about 6 months

149
Q

The term ______________ is used to describe the return of the uterus to a nonpregnant state following birth.
How does the fundal shape change?

A

puerperium

becomes a globular shape that returns to below the level of the pelvis

150
Q

_______________ is any slowing of uterine descent (failure of the uterus to return to a nonpregnant state) which may be a result of retained placental factors or ___________.

A

uterine atony

bladder distention

151
Q

what factors enhance involution (movement of the uterus back into its pre-pregnancy state)
what slow it?

A

breast feeding & fundal massage

full bladder and placenta fragments that remain

152
Q

What are after pains? Who is more likely to experience afterpains? Why? How can they be relieved?

A

cramping of the uterus

more likely to experience, if the baby was really big, polyhydramnios, anything that causes uterus to be over-extended.
women with multiple pregnancies will get more after-pains

heating pad, lying prone.
After pains are more severe before and after breast feeding so any pain meds should be given 30 mins before breastfeeding.

153
Q

___________ medication decreases the flow of lochia.

Why is there less lochia with C-sections

A

oxytocic medications

The surgeon sucks out a lot of the blood and clears the uterine lining

154
Q

what is the transition of lochia?

A

lochia rubra: dark red
lochia serosa: pinking brown
lochia alba: creamy white

155
Q

How do we determine if a clot that has been expelled with lochia is a true clot?

A

we don gloves and try to pull it apart.

if it doesn’t pull apart it could be placental tissue: this is a concern and needs to be discussed with the physician

156
Q

not all bleeding is lochial bleeding, what are some other potential causes of bleeding?
How can you tell the difference between them

A

if there are tears or lacerations they can bleed.

Lochial bleeding tends to trickle from the vagina.

non-lochial bleeding: bloody discharge will spurt and be excessive and bright red

157
Q

What are signs of excessive blood loss

A

pad soaked through in 15 mins and blood pooling under the buttocks

158
Q

what are the changes of the cervix after birth?

A

soften immediately after birth, will be 2-3 cm after 3 days and typically returns to no dilation after 1 week.

the cervical os never returns to its normal shape and will look like a ‘slit’&raquo_space; ‘fish mouth’

159
Q

how long does it take for the episiotomy to heal?

A

can take 4-6 months for the incision to be completely healed

160
Q

What nursing care and patient teaching may we provided associated with prevention of perineal infection and promotion of comfort?

A

peri bottle to cleanse after going to the bathroom
sitz bath
ice packs for the first 24 hours
anesthetic spray (prescribed by the physician)
tux pads: witch hazel on them
hemorrhoid cream

161
Q

what are the 3 types of vaginal hematomas?

A

Vulvar: most common generally visible
Vaginal: associated w/ forceps, episiotomy or primigravidity
retroperitoneal: least common&raquo_space; may be life threatening»caused by laceration of one of the vessels that are attached to hypogastric artery.

162
Q

what are some of the common complaints from the women that we would suspect vaginal hematoma?

A

lots of rectal pain
persistent peritoneal pain
internal pain/ache

163
Q

what are some ovarian changes that occur for lactating women?

A
  • prolactin levels remain high for 6 months
    ovulation is delayed in women who breastfeed exclusively
    a woman needs to consider their contraceptive options
164
Q

what are some ovarian changes that occur for lactating women?

A

70% of non-lactating women with experience first period 7-9 weeks post partum.
some start as early as 27 days postpartum

165
Q

when can a post-partum woman resume sexual intercourse?

A

once perineal area is comfortable and lochia has stopped

Breastfeeding is not a reliable contraceptive method.

166
Q

persistent or recurrent genital pain that occurs just before, during or after sex

A

dyspareunia

167
Q

what changes happen to the urinary system post-partum?

A

should void spontaneously within first 6-8 hours
need to measure first few voids should be at least 150mL / void

Reduced renal function postpartum
Kidney function returns to normal within 1 month
Urine components
glycosuria disappears
BUN ↑
pregnancy induced proteinuria resolves
ketonuria may occur

Postpartal fluid loss – postpartal diuresis (d/t estrogen decrease)

168
Q

if a woman is voiding spontaneously after child birth the bladder should return to normal tone __ to __ days after child birth

A

5-7

169
Q

What is happening in the first weeks postpartum that attributes to an additional 2-3 kg weight loss?

A

there is fluid loss from perspiration and increased urinary output

170
Q

Why may there may a decreased sensation to void?
What may impede urination?
How can bladder distension be prevented?

A

trauma during birth
give her a bedpan, encourage voiding, listening to running water, pain control meds
** if she does not void we need to do an in and out cath

171
Q

What nursing care and patient teaching may be provided associated with gaseous distension? Constipation? Hemmorhoids?

A

BM can take up to 2-3 days
important to educate for increased fluid, hydration, mobility and potentially stool softener.

gaseous distention is more common with C-section. encourage mobility and no carbonated beverages

172
Q

generally hemorrhoids decrease in size within___ weeks

A

6 weeks

173
Q

what foods are important for constipation

A 
kiwi fruit
oats 
fruits 
whole grains
carrots, celery
174
Q

What is the normal progression of breast filling for a breastfeeding mother post-partum

A

irst 24 hrs → little or few changes in breast tissue
On palpation:
Days 1-2: soft
Days 2-3: slightly firm (associated with filling)
Days 3-5: full, soften with breastfeeding
Colostrum
Mild Engorgement: common on days 2-3 and is associated with milk coming in.

manually expression of milk and standing a hot shower can help the milk flow. feeding frequently is the best option

175
Q 
ave. blood loss:
vaginal birth, single fetus  \_\_\_\_ to \_\_\_\_\_ ml 
    (10% of blood volume)
Cesarean birth \_\_\_\_\_ ml to \_\_\_\_\_ ml 
    (15-30% of blood volume)
A

300 - 500ml

500 -1000ml

CO remains increased for 48hrs after birth d/t increased stroke volume
and increased vascular fluid

176
Q

What are some abnormal findings to VS post-partum

A

Temp: greater than 38C after 24 hrs
Rapid pulse
hypoventilation
pregnancy induced hypertension

177
Q

what are some of the changes that occur to blood components in post-partum women

A

Hematocrit
with average blood loss during birth, level drops moderately for 3-4 days
reaches nonpregnant level by 8 weeks

White Blood Cell Count
↑ in first 10-12 days after childbirth
may obscure diagnosis of acute infection

178
Q

why is the woman in a hypercoagulable state post partum, what is she at risk of , how can we minimize the risk?

A

Coagulation Factors
clotting factors and fibrinogen remain elevated
“hypercoaguable state”
increased risk of thromboembolism (esp with C-section)
compression stockings, mobilization, exercises in bed (flexion/extension, rotating ankles) if she doesn’t wish to get up and moving

179
Q

What women are at higher risk of thromboembolism.

A
  • women who are obese
  • unexpected C section
  • had any problem such as this during pregnancy
    will likely be put on low-molecular weight heparin.
180
Q

What changes occur to the respiratory system post partum??

A

Following birth, breathing becomes easier
Intra-abdominal pressure decreases
Diaphragmatic pressure decreases

181
Q

What changes occur to the integumentary system post pregnancy

A

chloasma: lines on the face
linea nigra: goes away
stretch marks: will fade but don’t go away completely

182
Q

After birth some women made need these two vaccines

A

rubella and varicella

183
Q

Baby blues is experienced by ______ of women

A

50-80%

184
Q

When do postpartum blues normally occur?
What are symptoms of postpartum blues?
What patient teaching can help a new mother (and her family) cope with postpartum blues?

A

tends to peak around the 5th day
anxious, sad, emotionally on edge, lots of tears etc.
tends to go away by 10-14 days

normalize this
educate the parents

185
Q

What are Rubin’s 3 phases

A
  1. Taking- in first 24-48 hours dependent behavior, accepting of help and comfort
  2. taking-hold: begins: 2-3rd day ; lasts 10 days. becomes preoccupied with the present. trying to adjust and adapt
  3. letting go: forward movement of the family as a unit. re-established relationships with other people and moves forward
186
Q

what is the nurses role in dealing with postpartum blues for new mothers

A

Educate mother and family on what PP blues is, and how to cope with it with rest, relaxation, taking a break, sharing feelings, monitoring for signs of depression and what to do about it.

Refer to community resources.

187
Q

PPD tends to begin around __ weeks.

and affect ___ to ___ % of women

A

4 weeks

8-23%

188
Q

What are some of the clinical manifestations of PPD

A 
low mood/energy
irritability
lack of enjoyment
sleep disturbances
feelings oof hopelessness & guilt
Negative attitudes/rejection of infant
189
Q

What is the typical treatment for PPD

A 
antidepressant and antianxiety meds
psychotherapy
ECT
psychosocial intervention
support groups
alternative: massage etc
190
Q

incidence of paternal postpartum depression is __ to ___ %

A

10-50%

191
Q

What are some treatment options for Post-partum anxiety disorders

A 
CBT
SSRIs
Education
Anticipatory guidance
family & social supports
sensory interventions: music therapy
192
Q

What are the 3 primary 3 post-partum mood disorders that can occur?

A
  1. postpartum blues (last about 2 weeks- very normal)
  2. postpartum depression (13% of mother in the 1st year)
  3. postpartum psychosis (0.01% mothers in first 3 months)
193
Q

If a post-partum mom is agitated, delusional and experiencing hallucinations with low insight and high levels of suspicions we would suspect what diagnosis?

A

Postpartum psychosis

if caught within the first year and treated aggressively it can be addressed.
This is an emergency and they need inpatient treatment.

194
Q

3 common physiological complications that occur postpartum

A

hemorrhage
infection
thromboembolic disease

195
Q

A blood loss greater than ____ml with a vaginal delivery and _____ ml with a cesarean section

A

500mL

1000mL

196
Q

healthy women can ______ for post-partum hemorrhage and it often goes unrecognized until it is too late

A

compensate

197
Q

Reasons for PPH

What are the 4Ts

A

Tone: uterine atony»leading cause of PPH
tissue: retained placenta
Trauma: of genital tract
Thrombin: abnormalities of coagulation

198
Q

Uterine _______ is the leading cause of PPH

A

Atony

75-90% of PPH is d/t Uterine atony

199
Q

what are the 2 types of PPH

A
  1. Early (acute. primary)
    Occurs within first 24 hours after childbirth
  2. Late (secondary)
    Occurs more than 24 hours to 6 weeks after childbirth
    *d/t retained products, trauma or both
200
Q

Key ways in which we can address and attempt to minimize PPH.

A

prevention, early detection and prompt intervention

Oxytocin w/ the delivery of the anterior shoulder.

201
Q

What factors influence uterine tone?

A 
multiple pregnancies
polyhydramnios
fetal macrosomia
multi fetal gestations
uterus becomes over stretched and does contract properly after birth
Rapid or prolonged labour 
chorioamniotis : infection of the uterus
202
Q

What factors affect the potential of trauma leading to PPH

A

lacerations: can occur from rapid birth, if the fetus is deeply engaged in the pelvis before birth
uterine rupture
uterine inversion (uterus turning inside out)
Pelvic hematomas

203
Q

What are some interventions to prevent PPH

A
  • Routine oxytocin admin after the delivery of the anterior shoulder
  • Delayed cord clamping
  • Gentle cord traction
  • Immediate fundal massage after the complete birth
204
Q

If it takes longer than ____ mins to deliver the placenta the risk of PPH increases ____ fold

A

30 mins

6 fold

205
Q

90% of PPH result from _______ ________

A

uterine atony
Interventions:
fundal massage, ensuring the bladder isn’t distended
expression of any clots

206
Q

What is bimanual compression?

A

Insertion of a fist into the vagina, knuckles pressing on the outside wall of the uterus to try and get it to contract.

207
Q

What compensatory mechanisms occur with the BP after a
1. 500 to 1000 ml blood loss (10 – 15%)

  1. 1000 to 1500 ml blood loss (15 – 20 %)
  2. 1500 to 2000 ml blood loss
    (25 - 35%)
  3. 2000 to 3000 ml blood loss (35 – 45%)
A 
1. No BP changes occur
Signs & symptoms may include:
Palpitations
Dizziness
Tachycardia
2 Slight fall in BP
(80-100 mmHg)
Weakness
Sweating
Tachycardia
3.Marked fall
(70-80 mmHg)
Restlessness
Pallor
Oliguria
4. Profound 
fall
(50-70 mmHg)
 CV Collapse
Air Hunger
Anuria
208
Q

What is the main causes of LATE (secondary) PPH

A

Generally result of subinvolution (failure to return to normal size) of the placental site or retention of placental fragments
Rarely poses same risk as immediate PPH
Much less common than early PPH

S&S: prolonged lochia discharge, foul odor to lochia discharge, main complain of prolonged ongoing pain, complain of a fever, irregular or excessive bleeding, larger than normal or boggy uterus.

209
Q

What are important Nursing care and intervention for PPH

A

Evaluate prenatal history and labour and birth experience

Identify risk factors for PPH

Nursing interventions after birth (admin of oxytocin, inspection of placenta, uterine massage, monitoring lochia)

Assess for signs of PPH
Teach self-care

210
Q

Most common PP infection:

infection of the lining of the uterus

A

Endometritis

more common after C-section births

211
Q

What are some self-care techniques / teachings to prevent infections

A
  • Using peri squeeze bottle to clean with
  • bandaging as appropriate
  • maintain hydration
  • clean hands
  • assessing to perineum to determine early signs of infection.
  • wiping front to back
212
Q

Immunization introduces an _______(a foreign substance, that triggers an immune system response) in the body allowing immunity against a disease to develop.

A

antigen

213
Q

The person produces _______ which are proteins capable of responding to specific antigen

A

antibodies

also referred to as immunoglobulins

214
Q

ANTIBODIES PROTECT THE BODY FROM DISEASE BY:

A
  1. binding to the surface of the antigen to block its biological activity (neutralization)
  2. binding to the antigen that coats the surface of the infectious agent to make it more susceptible to clearance (phagocytosis) by phagocytes (opsonization)
  3. binding to specialized cells of the immune system, allowing them to recognize and respond to the antigen
  4. activation of the complement system to directly cause disintegration (lysis) of the infectious agent (pathogen) to enhance its phagocytosis, and to attract other immune cells towards the pathogen.
215
Q

In _______ immunity, antibody production is stimulated without causing actual disease. The antigen is given in the form of a vaccine

A

active

216
Q

In _______ immunity, antibodies are produced in another human or animal host; protection is limited, usually a few weeks or months.

A

passive

transplacental transfer

217
Q

_________immunity - Example
The mother has acute or chronic hepatitis B infection
The infant, born to the infected mother, receives an IM dose of HBIg immediately after birth (within 12 hours)
AND
the first dose of the three-dose course of Hepatitis B vaccine

A

Passive
HBIg provides short term protection
Hep B vaccine provides long term protection

218
Q

Introducing a person to a germ (whether it is from a natural infection or from a vaccine) creates ________ _________

A

immune memory

219
Q

Through ______ immunity, immunization against many diseases also prevents the spread of infection in the community and indirectly protects infants too young to be vaccinated, those who can’t be immunized, or those who don’t adequately respond to immunization.

A

herd

220
Q

What are the 4 primary components of a vaccine

A
  1. Immunogen
  2. Adjuvant: substance that is added to a vaccine that enhances immune response and increases B & T cell response. (required for immunological memory)
    aluminum salts
  3. Preservative: chemicals added to prevent a serious bacterial infection from the vaccine. thimerosal
  4. Additives: minute amounts of chemicals» potassium or sodium salts that support the stability of the vaccine.
    eggs or yeast proteins. formaldehyde used to inactivate any toxins
221
Q

___________ is a Preservative used in some vaccines
No longer in childhood vaccines since 2001 (except influenza vaccine)

**this was controversial as individuals originally thought to cause autism ** not true this has been debunked.

A

Thimerosal

222
Q

__________ is Used in production process to kill/inactivate viruses and bacteria
Vaccines are then purified

There is more ________ in body than in a vaccine as it is essential for DNA synthesis

A

formaldehyde

223
Q

________________ is an adjuvant used to enhance the immune response after immunization

A

Aluminum salts

This is a common salt in air, food and water

224
Q

this additive is used as a stabilizer

A

gelatin “porcine in original
very low rates of anaphylaxis from gelatin.
Muslim & Jewish communities have agreed that transformation of porcine products into gelatin makes them safe for consumption.

225
Q

In Canada how can we assess for issues with vaccines in the general population?

A

IMPACT centers across Canada
Pediatric hospital based surveillance program for vaccination associated adverse effects
monitor vaccine safety and monitor adverse effects (hospitalizations) in relation to vaccines

226
Q

__________ (inactivated) - Contains micro-organisms (bacteria/viruses) that have been killed, but still capable of inducing the body to produce antibodies

A

Killed vaccine

227
Q

_________ A toxin treated by heat or chemical to weaken its toxic effects but retains its antigenicity

A

Toxoid

Diphtheria and Tetanus

228
Q

___________ - Vaccine contains a microorganism in live, but attenuated, or weakened form

A 
Live Virus Vaccine
virus is attenuated or in a weakened form
measles, mumps, rubella (MMR)
Chicken pox- varicella
Yellow Fever
Rotavirus

create long lasting immune response but they don’t travel well. Need very specific storage state.

229
Q

________ - An organism has been genetically altered for use in vaccines

A

Recombinant Forms

Hep B, influenza, HPV
strong immune response

230
Q

_________ - An altered organism joined with another substance to increase the immune response

A

Conjugated Forms
pneumococcal
meningococcal
influenza type B

Booster shots are needed
Can be used on those with weakened immune systems.

231
Q

Prior to _______vaccine Canada would see roughly 60,000 cases a year

A

measles

232
Q

Measles is caused by contagious virus called

_________

A

morbillivirus

233
Q

How is measles spread?

A

contaminated droplets that are spread through the air, with coughing and sneezing.

234
Q

Typical signs and symptoms of measles

A

appear 7-14 days after exposure; high fever, cough , runny nose and watery eyes
measles rash appears 3-5 days after the first symptoms.

235
Q

Which viruses do these vaccines prevent against
DTaP
IPV
Hib

A

Diphtheria, tetanus, acellular pertussis

Inactivated Polio

Hemophilus influenza type B (can cause bacterial meningitis for kids)

236
Q

when do children get the MMR- Var vaccine

A

12 months

237
Q

Rotavirus causes ____________ issues in children

A

gastroenteritis

238
Q

mumps is spread by _____

A

droplets.

causes inflammation testes and ovaries

239
Q

varicella is _________

spread by airborne and droplet from shed ______ _______

A

chicken pox
skin cells
adults and pregnant women are at risk of severe disease: TSS, stroke etc

240
Q

Every ____ years you should get your tetanus and diphtheria vaccines updated

A

10 years

Td

241
Q

tetanus is a _________

spread in the spores of animals and soil

A

neurotoxin

symptoms: extreme muscle spasms that can lead to serious complications and death.

242
Q

_____management tends to be a big concern for parents when their children get vaccines

A

pain

243
Q

after immunization we get individuals to wait ____mins

if they have a hx of reactions we ask that they wait _____ mins

A

15 mins

30 mins

244
Q

potential precautions to monitor when an individual is getting a vaccine?

A

allergy to part of the vaccine

anaphylactic rxn to vaccine in the past

245
Q

Contraindication for a vaccine

A

anaphylactic rxn to vaccine in the past

246
Q

which vaccine are unsuitable for pregnant women?

A

Live attenuated vaccines

MMR

247
Q

NACI recommends that immunization with_____ vaccine should be offered in _______ pregnancy, irrespective of ________ _________immunization history.

A

Tdap (tetanus, diphtheria, pertussis)

every

previous Tdap

248
Q

NACI recommends that immunization with Tdap vaccine should ideally be provided between ____ and _____ weeks of gestation.
Can be provided from _____ weeks up to the time of delivery

A

27 and 32

13 weeks

249
Q

T or F

No evidence of an adverse influence on maternal or infant immune response

A

True

250
Q

two non-routine vaccines that are not recommended in breastfeeding women as the safety is not known

A

yellow fever

oral typhoid vaccine

251
Q

most instances of anaphylaxis to a vaccine occur when?

A

within 30 minutes from administration

252
Q

what are the signs and symptoms of anaphylaxis?

A

typically occur over several minutes. so if someone is going into anaphylaxis you have time to act.
- involves 2 body systems ie (GI and Resp or Skin and Resp) combo of 2 body systems

  • Cardinal features: itchy red rash, progressive painless swelling in the nose and mouth
  • resp system: sneezing, coughing, wheezing, narrowing and inflammation of the upper airway&raquo_space; labored breathing
  • GI: crampy abdominal pain and N&V (45%)
  • Cardiovascular symptoms occur in about 45% of pts: chest pain, tachycardia
  • CNS: dizzy, nervous, confused
253
Q

Risk factors for anaphylaxis to vaccine:

A

very young and very old, pregnancy and cardiac issues, asthma.
certain cardiac meds (ACE inhibitors, B-blockers)

254
Q

How do you tell the difference btw syncope and anaphylaxis

A

Fainting: vasovagal syncope&raquo_space; typically anxious and hyperventilating

Breath holding typically happens in very young children. upset and crying will become silent. may faint but start to breath again once they pass out.

SYNCOPE: occurs within seconds/minutes, pale nausea, dizzy, ringing in ears, blurred vision, sweating, rhythmic jerking in limbs, can become unconscious in a few minutes, place in recumbent position.

ANAPHYLAXIS: Develops over several mins, usually involves 2 body systems, pt does not pass out immediately,&raquo_space; treatment = epinephrine

255
Q

steps for basic management of anaphylaxis in a non-hospital setting.

A
  1. Assess circulation, airway, breathing, mental status, skin, and body weight (mass). Secure an oral airway if necessary. Direct someone to call 911(where available) or emergency medical services.
  2. Position the vaccine recipient on their back or in a position of comfort if there is respiratory distress; elevate the lower extremities. Place the vaccinee on their side if vomiting or unconscious.
  3. Inject epinephrine intramuscularly in the mid-anterolateral aspect of the thigh: 0.01 mg/kg body weight of 1:1000 (1 mg/mL) solution

ADOLESCENT or ADULT: maximum - 0.5 mg
CHILD: maximum - 0.3 mg
Record the time of the dose.

Repeat every 5 to 15 minutes as needed, for a maximum of three doses

  1. Stabilize vaccinee; perform cardiopulmonary resuscitation if necessary, give oxygen and establish intravenous access if available and give adjunctive treatment (i.e. diphenhydramine hydrochloride or Benadryl®) if indicated.
  2. Monitor vaccinee’s blood pressure, cardiac rate and function, and respiratory status.
  3. Transfer to hospital for observation.

** helpful if you can have someone writing this all down. Need the time for when the epinephrine was administered.

256
Q

Important things to remember when giving a vaccine:

A

No gloves are required
Aspiration for blood return in not required
Z-tracking is Not required.
Cannot pre-load syringes, doses need to be prepared just before administration
cold-chain needs to be maintained
always check the basics: expiration date, cloudy vs clear solution,

257
Q

What is the cold chain for vaccine maintenance

A

All equipment and procedures used to ensure that vaccines are protected from inappropriate temperature and light, from the time of transport from the manufacturer to the time of vaccine administration

Most products should be stored at +2° C to +8° C

also most vaccines are not meant to be exposed to light

we only store 1 month of vaccine supplies and not on the door shelf.

258
Q

tools for reducing pain and anxiety in children when immunizing

A 
Breastfeeding
Cuddling with parent
Skin to skin contact with mother
Diversion of attention
Sweet tasting solution
Proper Positioning
Topical Local Anesthetics
Oral Analgesics
Injection without aspiration
Order of vaccine >> give the most painful injection last.
administration
259
Q

3 primary types of Caesarean Births

A

Unplanned: emergency
Elective
Scheduled

260
Q

Reasons for a scheduled C-section could include

A

Active genital herpes infection
Placenta previa
Breech
Not able to induce labor d/t hypertensive states

261
Q

What is the major concern with VBAC

A

uterine rupture

262
Q

Maternal contraindications for VBAC

A

Specific cardiac disease
Specific respiratory disease
Conditions associated with increased intracranial pressure
Mechanical obstruction of the lower uterine segment
Mechanical vulvar obstruction History of two or more previous Caesarean births
Elective Caesarean birth

263
Q

Fetal contraindications for VBAC

A

Abnormal fetal heart rate (FHR) or pattern
• Malpresentation (e.g., breech or transverse lie)
• Active maternal herpes lesions
• Maternal human immunodeficiency virus (HIV) with a viral load of more than 1000 copies/mL
• Congenital anomalies

264
Q

Maternal-fetal contraindications for VBAC

A

Dysfunctional labour (e.g., cephalopelvic disproportion, “failure to progress” in labour)
Placental abruption: placental pulls away from the uterus too soon&raquo_space; during the labour
Placenta previa&raquo_space; placenta is over the vaginal opening&raquo_space; baby can’t come out. need surgery

265
Q

Cesarean birth risks for mother and fetus

A

Maternal:
Higher maternal mortality rate than a vaginal birth
Other risks

Fetus :
Increase in neonatal respiratory problems
Injuries from surgery
fetal asphyxia can occur, especially if there is maternal hypotension from the sedative.

266
Q

What is the most common type of Cesarean section incision

A 
Lower (transverse) uterine 
segment ….
thinnest & narrowest portion… 
less blood loss in comparison to
other uterine incisions, e.g., 
classic
267
Q

What would be some reasons for the physician choosing a vertical cesarean section incision

A 
under developed lower uterine segment
transverse lie
preterm breech presentation
anterior placental previa 
vertical; classical incision

** has a higher chance of uterine rupture with subsequent pregnancies.

NURS 372 - Maternity & Family Health (2 decks)

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