OB Exam 3 Flashcards
Newborn BP range
60-80/40-50
Newborn temp range
Hyperthermia not common in NB (>99.5)
Hypothermia common and dangerous (cannot constrict and shiver)
Head=1/3 body surface and loses large amounts of heat-cap/hat!
Newborn RR range
30-60
Newborn HR range
110-160
Newborn O2 range
95-100%
Newborn jaundice
Pathological vs physiologic
Either can be neurotoxic
-acute bilirubin encephalopathy
-kernicterus
Pathological jaundice
Result of underlying disease, appears before 24 hours of age
Bili levels inc by >6mg/dL in 24 hrs or bili level exceeds 15mg/dL
-usually caused by hemolysis
Physiological jaundice
Considered benign
-everyone goes through walk outside->sunshine
-unconjugated bilirubin levels 72-120 hr after birth with rapid decline to 3mg/dL 5-10 days after birth
Thermoregulation in newborns-heat loss routes
Convection, radiation, evaporation, conduction
Thermoregulation in newborns-interventions
Non-shivering thermogenesis- creating heat by metabolism of brown fat
Hypoglycemia s/s in infants
Poor feeding (LGA=worst)
-jitteriness/tremors
-hypothermia
-weak cry
-lethargy
-flaccid muscle tone
-seizures/coma
-irregular respirations
Hypoglycemia in infants
Glucose levels decrease 30-90 min after birth
-inadequate Gluconeogenesis or inc use of glycogen stores
-asymptomatic at risk NB offered oral feedings to inc levels greater than 45 mg/dL
-symptomatic= IV dextrose (D15 and up=central line)
-frequent oral and/or gavage feedings or continuous parenteral nutrition early after birth to treat
Phototherapy and how it works
Tx for jaundice
Reduces unconjugated bilirubin serum by changing molecules to be excreted faster
Signs of NEC in babies and tx
bowel death
More premature babies=higher risk
-feeding issues, stomach swelling discoloration and pain, stool changes,hypotension, periods of apnea. Issues with temp regulation
-connection with formula, BF=best
Newborn medications given after birth
-Vitamin K prophylaxis (injection IM 0.5-1mg)-prevents bleeding
-Eye prophylaxis: erythromycin, tetracycline or silver nitrate ointment (if eyes=open), mandatory in US, 1-2cm ribbon within 1-2 hrs of brith
-Hep B vaccine?
S/s of NAS in Newborns
-high-pitched shrill cry
Irritability, tremors, hyperactivity with inc Moro, inc muscle tone, disturbed sleep pattern
-poor feeding, diarrhea, excessive and uncoordinated constant sucking
-nasal congestion with flaring, frequent yawning, skin mottling, retractions, tachypnea, sweating, temp greater than 99
med for NAS NB
Morphine sulfate first, if not working, then phenobarbital
Postpartum diuresis
Within 12 hours of birth
-UOP 3,000mL or more each day first 2-3 days
-profuse diaphoresis nightly for first 2-3 days
-urethral swelling and dec bladder tone=high risk for retention
-keep bladder emptied (distension= push uterus up and to the side->excessive bleeding)
Breastfeeding and how it affects hormones
Breast feeding increases oxytocin release= increase uterine tone
Infant’s suck also affect prolactin levels
Which hormone produced during breastfeeding for milk production
Prolactin
Lactating clients: prolactin elevated and suppress ovulation
Nonlactating: prolactin declines and reaches pregnant level by third week postpartum, menses resume by 12 was PP
Postpartum fundus and how it is measured
Fingerbreadths from umbilicus (cm) above or below, midline or displaced to the right/left
U+1, +1, 1/U (above
-1, U-1, U/1(below
Fundal height progression
-fundal height descends one finger breadth (1cm)/day
-end of third stage of labor= palpable midline 2 cm below umbilicus
-1hr after delivery=rise to level of umbilicus
-every 24 hr fundus descend ~1-2cm,halfway between symphasis pubis and umbilicus by 6th PP day
What is uterine involution
Shrinking to normal size post-birth (trying to go back to the way it use to be)
What is uterine subinvolution
Uterus doesnt return to normal size after birth
-causes=infection or retained fragments of placenta
S/S: inc/prolonged Lochia, cramps/abd pain, distended Lower abd,lower back pain
How long is the postpartum phase
Traditionally, 6 weeks
Lochia assessment
Color, amount (scant, light, moderate, heavy, excessive), consistency
Scant:less than 2.5 cm
Light: 2.5-10cm
Moderate:more than 10 cm
Heavy: one pad saturated within 2 hr
Excessive: one pad saturated in 15 min or less, pooling of blood under buttocks
Lochia rubra
dar red color, bloody consistency, flesh odor, small clots
-transient flow inc during BF(inc oxytocin, inc uterine contraction=inc bleeding) and upon rising
-1-3 days post delivery
Lochia serosa
Pinkish brown, serosanguinous, small clots and leukocytes
-day 4-days after delivery
Lochia alba
Yellowish white creamy color, flesh odor, can consist of icons and leukocytes
-approx. day 10 up to 8 weeks postpartum
Complications of meconium stained amniotic fluid and why does it happen
Newborn skin-acrocyanosis
Normal, blue/purple hands and feet
Newborn skin- milia
Look like white pimples on face, go away on own-dont pop
Newborn skin-Mongolian spots
More common on darker skin, commonly on buttocks
Newborn skin-vernix
“Cheesy” coating from the womb
Caput vs cephalohematoma
Caput succedaneum does cross suture lines and a cephalohematoma does not
-Caput=scalp edema over occiput
-Ceph=blood between skull and periosteum, can cause hyperbilirubinemia (inc RBC from bleeding)
RDS
respiratory distress syndrome
Why RDS happens in newborns
Result of surfactant deficiency with poor gas exchange and ventilatory failure
-surfactant=aid to alveoli expansion, keeps form collapsing
-atelectasis=inc WOB
Risk factors RDS
-Preterm gestation
-Perinatal asphyxia(meconium staining, cord prolapse, unchallenged cord)
-maternal DM
- PROM
-maternal use of barbiturates/narcotics
-C section w/o labor
-hypovolemia
-genetics: white males
S/S RDS
Tachypnea (>60)
Nasal flaring
-expiratory grunting
-retractions
-labored breathing with prolonged expiration
-fine crackles
-cyanosis
Meds given for RDS
Surfactant
-<27-30 weeks=intubate and round of surfactant then ideally extubate
-resp assess before and after
-suction prior
-assess endotracheal tube placement(listen RR)
-avoid suctioning of endotracheal tube for 1 hr after admin (if ET tube staying in)
Actions immediately following birth for mother and infant
Baby is dried off and warmed up, bulb suctioning, stimulate baby to breathe, 1 min and 5 min APGAR scoring
-mother delivers placenta, ensure no fragments retained
-skin to skin
Postpartum hemorrhage medications
Oxytocin, methergine, misoprostol, carboprost
PPH-methergine
Uterine stimulant
-controls postpartum hemorrhage
-assess uterine tone and vaginal bleeding
-DO NOT admin to clients with HTN
PPH-misoprostol
Cytotec
(Also used for cervical ripening-topical)
-controls hemorrhage
-assess uterine tone and vaginal bleeding
-tablets
PPH meds-carboprost
Hemabate (makes clients feel nasty)
-uterine stimulant
Controls hemmorhage
-assess uterine tone and vaginal bleeding
Postpartum hemorrhage med side effects-Carboprost
Fever, HTN, chills, HA, N/V, diarrhea(most common)
Postpartum hemorrhage med side effects-Methergine
HTN, N/V, HA
PPH-oxytocin
Uterine stimulant, promotes uterine contractions
-assess uterine tone and vaginal bleeding
Postpartum hemorrhage med side effects-oxytocin
Water intoxication (lightheadedness, N/V, HA, malaise)
-rxns can progress to cerebral edema with seizures, coma, death
-hypertonic uterus
Postpartum hemorrhage contraindication for meds-methergine
DO NOT ADMIN TO CLIENTS WITH HTN
What medication is given to Rh- mothers of Rh+ infants
Rho-gam immunoglobulin
How do we determine infant is getting enough input?
Voiding patterns
Newborn reflexes
Moro, tonic neck (fencing), stepping/walking, sucking and rooting, swallowing, babinski, pull-to-sit, planar grasp, plantar grasp
Moro reflex
“Startle reflex”
symmetric abduction and Extension of arms and splayed fingers followed by flextion of limbs, slight tremor may be noted
Tonic neck(fencing) reflex
When head turned to side, same side arm and leg extended and opposite limbs flexed into body
Babinski reflex
Stroke baby foot from heel to toes on lateral side of foot
-big toe dorsiflexes and other toes splay out and “fan”
Plantar grasp
Finger on baby’s foot and baby grasps fingers/wraps fingers around
Palmar grasp
Finger in baby’s palm and baby wraps fingers around
Sucking reflex
Finger on roof of mouth (hard palate) and baby suckles
Rooting/latching reflex
Touch lip or cheek and baby turns head to stimulus and attempts to suckle
Which reflex assists with latching?
Rooting and sucking
SGA
Below 10th percentile Small for gestational age
LGA
Large for gestational age
Above 90th percentile
What do we monitor for in SGA
Respiratory distress, temperature instability, feeding difficulties, hyperbilirubinemia
New Ballard score
What do we monitor for in LGA
Respiratory distress, temperature instability, feeding difficulties, hyperbilirubinemia
-new Ballard score
What actions to take for a postpartum hemorrhage
Massage fundus until firm
-monitor amount of blood/cots coming out with massage
-admin meds
-check tone of fundus and position r/t umbilicus
Instructions for bulb syringe
“M then N”
Suction mouth first then the nose
-depress bulb outside of mouth/nose and insert and release to apply suction
-squeeze contents out off to the side after before depressing bulb again for reinsertion
Ballard score
Assesses neuromuscular and physical maturity, estimation of gestational age by maturity rating
What is Ballard score used for
Comparing actual gestational age and the Ballard score= tracking to see if actual neuromuscular and physical maturity is on par for gestational age (are they where they need to be?
S/S NB sepsis
TORCH
Complex of infection types in newborns
TORCH infections
Toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex virus
Toxoplasmosis
R/F: consuming raw meat, handling cat feces, manifestations similar to influenza
Other infections- TORCH
Hep A and B, HIV, parvovirus, syphilis, mumps, varicella-zoster
Rubella-TORCH
Check immunity-pregnant healthcare workers should avoid
R/F: contracted through children who have rashes or neonates who are born to pts who had rubella during
Cytomegalovirus
Member of herpes virus family
R/F:
1. transmitted by droplet from person-person, through semen, cervical and vag secretions, breast milk, urine, blood
2.latent virus can be reactivated and cause disease in utero or during vaginal birth
Herpes simplex virus
Anti-viral prophylaxis, if not high fatality
R/F: direct contact with oral or genital lesions
Transmission to fetus is greatest during vaginal birth w/active lesions
