OB-Exam 3 Flashcards
What is APGAR and when do we use it?
It is used immediately after the newborn is delivered It It is used to tell how well the newborn is adapting to extrauterine life. Given at 1 minute of delivery and then 5 minutes of life.
What does APGAR stand for
appearance, pulse, grimace, activity, respiration effort
What is the ballard score used for?
to calculate the approximate gestational age of the newborn. It can often be used if the mother doesn’t know when her last menstrual period etc.
What are typical medications a newborn would receive?
Erythromycin, Vitamin K, Hepatitis B
When and why would we give erythromycin to a newborn?
(eye ointment) applied within 1 hour after birth, eye prophylaxis to prevent gonorrheal conjunctivitis
When and why would we give Vitamin K to a newborn?
Administered within 1 hour after birth to prevent hemorrhage/ excessive bleeding.
(newborn GI tract is sterile at birth and unable to produce Vitamin K)
*especially in circumssion
When and why would we give Hepatitis B to a newborn?
First dose within 12 hours of birth, second dose at month, third dose at 6 months.
-If the mom is positive for hepatitis B surface antigen newborn will also receive hepatitis B immune globulin
Neonatal abstinence syndrome
- neonatal substance withdrawal, mother who took drugs while pregnant, and baby experiencing withdrawal symptoms after being born.
What drugs can cause NAS?
Opioids, narcotics,heroin,methadone,weed, amphetamines, alcohol
Neonatal Abstinence Syndrome expected findings
high pitch shrill cry, irritability, disturbed sleep, tremors, convulsions, hyperreflexia
tachypnea, congestion, sweating, frequent sneezing due to ^ acetylcholine, poor feeding, regurgitation, vomiting, diarrhea, excessive or uncoordinated sucking
NAS complications
risk for skin breakdown, vomiting/ diarrhea risk for dehydration and feeding issues, gaining weight, glucose control
-increase resp.> Hyper ventilation can cause resp. alk.
long-term effects, add, microcephaly, poor maternal bonding, learning/developmental delays
NAS nursing care
-urine/ meconium collection to determine what drugs
-Perform NAS assessment performed every 3-4 hours after baby eats
-monitor ability to feed, offer small frequent feedings
-tight swaddle and dark room little stimuli
- monitor fluid and electrolytes
What are the different categories of the Finnegan NAS Tool
- Central nervous system disturbances
- metabolic, vasomotor, & respiratory disturbance
-Gastrointestinal Disturance
When would treatment be warranted for the baby based on the Finnegan NAS Tool
If they are scoring an 8 or higher
Hypoglycemia in newborn
range: glucose level below 45 can get to as low as 40 in about 4 hours of life (the normal term can tolerate these levels)
What puts a newborn at risk for hypoglycemia
Preterm babies, SGA (small or gestational age) and LGA (large for gestational age) , and stressful birth and infants born of a diabetic mother
Physiological stress on the newborn
Cold stress or improper thermal regulation, asphyxia, or decreases in O2 -> at risk for experiencing hypoglycemia
Expected findings of hypoglycemic baby
initially, they will be jittery, after awhile they will become lethargic and flaccid and have a weak cry and weak suck, and can become poor feeders
Nursing care for hypoglycemic baby
-perform heel stick to monitor glucose
- make sure the baby has a good feeding and early feeding
-monitor feedings and glucose -glucose checked before baby eats Q 2-3 hours
-Skin-to-skin will help baby regulate temp.
What is considered a preterm infant?
an infant that is born before 37 weeks of gestation
- early preterm - 24-34 weeks
-late preterm 34-37 weeks
Risk factors for preterm births
Inadequate nutrition, smoking while pregnant, adolescent pregnancy, and alcohol abuse
preterm complications overview
-Early preterm is more likely to be affected.
-in pre-term overall more likely to be respiratory and cardiovascular issues
preterm complications
-RDS, decreased surfactant which will cause alveoli to collapse
-Aspiration, premature infant gag reflex not intact, therefore, can effectively suck or swallow
-Intraventricular Hemorrhage, bleeding into brain ventricles, due to fragile capillaries and immature development
-Retinopathy of prematurity ROP- due to vasoconstriction of retinal blood vessels
-Necrotizing enterocolitis-inflammatory disease of GI mucosa due to ischemia
-Ineffective thermoregulation, inadequate amount of brown fat
Prematurity Assessment and common labs and Dx procedures
Evaluate any risk factors involved,
Labs: CBC, urinalysis, PT/aPTT, glucose, bilirubin, ABG
Dx: chest x-ray, heart ultrasound, echocardiography
Expected findings for a premature baby
-Ballard assessment- will reveal <37
-Lanugo will be scant in very premature newborns and extensive in late preterm newborns
-Hypotonic muscles, decreased activity, weak cry
-apnea
-increased resp. effort
-head and ears appear larger
Premature infant nursing care
- Continuously monitor vital sings
- assess the ability to gag and suck will help determine ability to consume and digest nutrients
-Because immature infants can not sweat or shiver environmental temperature protection is important
-often on CPAP, intubated, or on O2, monitor resp. rate any signs of distress and monitor O2 levels
-bundle care to reduce stimulation
-Monitor ins and outs
Post-term infant
-born 42 weeks gestation or older
-main concern after 40 weeks placenta looses function and nutrients
-Can still be sga or lga
Complications for post-term newborn
-birth trauma
-Meconium aspiration
-Polycythemia
-Clavicle fracture
-fetal hypoxia
-hypoglycemia
-temperature instability
Post-term expected findings
- decrease in vernix and lack of amnio fluid so they may look dry with peeling skin
-thin due to lack of nutrients and diminished subcutaneous fat
-meconium stained (yellowish appearance)
-difficulty establishing respirations due to the possibility of meconium aspiration
Necrotizing enterocolitis
-happens in preterm babies more than post-term
-necrotic patches within intestines, which can lead to perforation, paralytic ileus, peritonitis
-usually caused by lack of blood flow
-less incidences found in those breastfed vs. formula
- usually can present as abdominal distension, apnea, hypotension, positive occult blood
What is bilirubin?
It is a substance that your body makes when there is a breakdown of red blood cells. An accumulation of bilirubin can cause jaundice.
Types of Jaundice
-Physiologic Jaundice is caused by the breakdown of fetal red blood cells and an immature liver. It is a normal process after the first few days of life. Elevation of unconjugated bilirubin typically peaks on days 3-5, rapidly declines, and then comes back to normal on days 5- 10. This bilirubin excretes through bile and urine.
-Pathological Jaundice: Result of an underlying disease and usually appears 24 hours before life. This could be due to blood group incompatibility, infection, or blocked bile duct, or red blood cell disorder, which excretes through the stool.
-Breastfeeding Jaundice: due to something in the breastmilk called preganalol, progesterone metabolite that interferes with converting indirect bilirubin to direct bilirubin. can be treated with an increase in breastfeeding
Hyperbilirubinemia risk factors
- ABO blood incompatibility If mom is O and baby is a or b blood. (the mother’s immune system can react and make antibodies that fight against baby blood cells)
-Increase in RBC production will lead to breakdown aka hyperbiirubin
-cephalohematoma and ecchymosis are a collection of RBCs that need to be monitored and may develop hyperbilirubinemia or jaundice
-The liver is responsible for converting fat-soluble bilirubin to water-soluble and due to the immature nature of newborns’ liver it can prevent the process and cause a build-up of bilirubin.
Hyperbilirubinemia expected findings
- yellowing tint to the skin (jaundice) usually starts in the head and works its way down. Blanch test, note the timing of onset.
Labs
-Bilirubin- if at risk monitored every 4 hours, if not tested at 24 hours
-Direct Coombs: detects the presence of antibodies due to rh + newborn and if mom is Rh- and there is an exposure then the test would be +
Hyperbilirubinemia Nursing Care
-Observe the newborn’s skin and note any signs of jaundice
-monitor vital signs
-one treatment option is phototherapy if levels are above 10-12 may vary and depend on age and baby-specific
-Education to parents is important (as much contact and time as possible
- monitor for dehydration: turgor, decreased urinary output, any signs of dry mucous membranes
Hyperbilirubinemia Complications
Acute Bilirubin encephalopathy (kernicterus)
-permanent brain cell damage if levels reach 20 or higher can cause developmental delays, hearing/vision loss, cognitive impairment
Developmental Hip Dysplasia and how do you assess it
-improper formation and function of the hip socket (socket of the hip is flat so the head of the femur won’t stay in the socket)
- Ortolani is done while a newborn is supine and flat place fingers over the greater trochanter and abduct the hips listen for a clicking sound, then keep hips and knees bent at 90 and apply downward pressure and apply towards the body feel for slipping
- if a positive finding ultrasound will be the preferred method of finding it. Needs to be found earlier rather than later.
What is considered a high risk pregnancy?
one in which a concurrent disorder pregnancy related complication or external factor jeopardize the health of the pregnant person, fetus or both
Cardiac disease in pregnancy
a disease that can affect the heart or blood vessels during pregnancy like coronary artery disease, high blood pressure, valvular disease
What happens with blood and cardiac output during pregnancy
blood volume and cardiac output increases about 30% and up to as much as 50%
what are the four categories of heart disease
class I, II, III, IV
I or II: heart disease can expect to experience a normal pregnancy and birth
III: can complete a pregnancy by maintaining special interventions like bed rest
IV: usually advised to avoid pregnancy because they are in cardiac failure even at rest and when they aren’t pregnant
What is the danger behind pregnancy in a person with cardiac disease
There’s an increased workload that can cause heart failure and then cause pulmonary edema. there is an increase in circulatory volume. it can be very dangerous in weeks 28-32 just after blood volume peaks.
Nursing care in cardiac disease in pregnancy
Monitor and get a baseline respiratory rate and blood pressure, pulse rate when they go in for visits. most likely an EKG and echo on file to monitor.
