Study Guide Flashcards
Normal blood glucose for new born
40-45 mg/dL
Where should your take blood glucose on a newborn
Heel stick
Increased risk for hypoglycemia
Large for gestational age/SGA, mother is diabetic, late preterm, or low birth weight
When should you check newborn blood glucose
30 mins after first feeding, then always before feedings. With diabetics check after feedings
How to prevent hypoglycemia in newborn
Ensure effective breastfeeding
When are emergency c-sections performed
With prolapse umbilical cord, malpresentation that cannot be resolved, and to preserve the life of the mother and fetus
Normal C-section blood loss
Normal <1L
Dilation
(0-10 cm), how open/closed the uterus is.
Effacement
(0-100%), how much of the uterus has been shed
Station
(-5 - +5), the position of the baby, - is deep and + is closer to exit
What is an amniotomy
Performed to rupture the membranes of a pregnant woman
What should the nurse monitor after an amniotomy
FHR due to the risk of cord compressions (variable decelerations will be present in this case)
What is common after an amniotomy and is common
Tachycardia, doesn’t require action
postpartum hemorrhage vaginal birth number
> 500mL
Postpartum hemorrhage c-section number
> 1L
Postpartum hemorrhage risk factors
uterine atony (boggy uterus), genital lacerations, hematomas, retained placenta (especially if its nonadherent)
What is Involution
the process when the uterus returns to a nonpregnant state following birth (~6 weeks)
What is Subinvolution
the failure of the uterus to return to nonpregnant state. (folds on itself)
What can cause subinvolution
Late bleeding, and placental fragments/ pelvic infection
Normal vaginal birth bleeding
<500mL
In normal postpartum bleeding, what can be decrease in the blood (levels)
Hematocrit (3-4 days, 33% is normal after 8 weeks)
Hemoglobin (11g/dL)
Hypothermia appearance in newborns
appear pale and mottled
What can hypothermia progress to and what happens
Cold stress, RR increase, and vasoconstriction occurs.
Metabolic acidosis can occur which exacerbates jaundice
Can cause hypoglycemia, can make infants quiver/ shake
Post-term complications for the mother
Hemorrhage, infection, dysfunctional labor, perineal injury r/t macrosomia, fatigue, etc.
Post term complications in the newborn
LGA/SGA, macrosomia, higher risk for birth injuries
What is forceps-assisted birth
Using a tool to wrap around the baby’s head to assist in pulling it out
When are forceps used (fetal)
Abnormal FHR, certain abnormal presentations, arrest of rotation, head delivery in breech presentation.
When are forceps used (maternal)
Prolonged 2nd stage of labor (delivery)
What should the nurse focus on with the newborn immediately after birth
Maintaining clear airways and oxygenation
Maintain body temp., put cap on the baby, prevent cold stress as well as assess for hypothermia
Promote parent-infant interaction, give eye prophylaxis (erythromycin), vit. K (for blood clotting)
Vital signs for newborn
RR: 30-60 BPM
HR: 100-160 BPM
Temp: 98-98.9
Weight: 5lbs 12oz- 8lbs-12oz
Vital signs for mother after birth
Temp: can be elevated (100.4) during first 24 hours, and normalize after that
HR: remains elevated for one hour after delivery that returns
BP: normally only slightly altered
WBCs: 20,000-25,000 for the first 10-12 days are common
Normal weight for newborns
5lbs 12oz- 8lbs 12oz
What is the Ballard Assessment
An estimate of gestational age that’s done with babies that have no prenatal care, gives subjective results.
Max 50 points should be done within first 12 hours of birth.
when should Breastfeeding be done
first 6 months and up to 12 months, complementary foods can be introduced at 6 months
Breastfeeding tips
Baby should have their whole mouth around the nipple (whole face in the breast), should hear audible swallowing.
Baby should have 6-8 dirty diapers a day
Very beneficial for the mother and nutritious from the baby.
Makes the baby poop less than formula (quality over quantity)
What can cause breast engorgement
Mastitis (breast infection)
How to prevent breast engorgement
Good hygiene, make sure the baby is latching appropriately.
Ice can decrease swelling
Pain assessment scale for children over 5 years old
Faces scale
Pain assessment scale for children under 5 or mentally disabled
FLACC scale (their appearance/ behavior)
Pain relief for infants
Acetaminophen and NSAIDS for mild-moderate pain
Lidocaine, opioids and topical pain relief for moderate-severe pain
What med can you not give infants
NO ASPIRIN
Newborn non-pharm relief.
oral sucrose (sugar water), non-nutritive sucking, breastfeeding, distraction, and swaddling.
What age can kids verbalize pain
3-6 (preschoolers age)
Taking vital signs on a child
Pulse: taken apically, count for a full min
RR: watch abdomen, count for a full min
Temp: taken rectally only when absolutely necessary
BP: correct BP cuff
How to get correct BP cuff
cuff bladder width 40% of arm circumference, length 80-100% of circumference, measured at heart level.
Suicidal Assessment for mother and child
Ask straight forward questions about this to the mother before and after birth and include questions about homicidal thoughts. Same goes for child.
Four modes of heat loss
Convection, radiation, evaporation, and conduction
Convection
Heat is lost due to cooler air around the baby
Radiation
heat is lost due to cooler solid surface close to baby.
Evaporation
heat is lost when moisture on the skin vaporizes, especially after failing to dry the baby after a bath. Most significant cause
Conduction
heat is lost due to direct contact with a cooler surface.
Physiologic Jaundice
Not present at birth, the liver wasn’t ready to handle all the RBC’s, we want them to poop a lot. Shows up 24 hours after birth.
Physiologic Jaundice treatment
phototherapy (protect eyes), blood exchange transfusions.
Physiologic Jaundice Risk factors
premature birth, significant bruising during birth, blood type, breast feeding (less poop=less bilirubin being excreted)
Can lead to kernicterus—> irreversible toxicity that causes brain damage
Pathologic Jaundice treatment
Phototherapy, exchange transfusions (rare)
Pathologic Jaundice
happen inside the uterus before birth, shows up within fist 24 hours of birth. Goes higher and farther than phys. and causes more problems
Pathologic Jaundice risk factors
Premature birth, significant bruising during birth, blood type, breastfeeding.
Lochia rubra
dark red, musty odor
Lochia serosa
pink or brown, odorless, watery
Lochia alba
yellow, white
Inversion of the uterus
Turning inside out of uterus, (comes out)
Potentially life threatening (1 in 3,000 births)
Postpartum peri care
Clean it up, give NSAIDs, ice packs.
Wipe front to back
Leading cause of death for children
preventable causes, such as car accidents or drowning.
Watch for suicidal actions
What does umbilical cord prolapse cause to the fetus
fetal hypoxia
What is umbilical cord prolapse
when the cord lies below presenting part of fetus
Car seat safety
Have a rear facing car seat for the first 2 years, don’t leave child unsupervised.
Umbilical cord prolapse treatment
with 2 gloved fingers, push the cord back into the uterus and call for help
-Push on presenting part, to not let the cord get compressed.
Risk factors of umbilical cord prolapse
Long cord (>100 cm)
Malpresentation (breech)
Transverse lie
Unengaged presenting part
Baby’s head is high up
Amniotomy
Fentanyl
Synthetic opioid used for moderate-severe pain relief
Betamethasone
Glucocorticoid given in 2 doses to promote fetal lung maturity when a preterm birth goes wrong.
The most significant benefits occur within the first 24 hours.
Carboprost (Hemabate)
Used for postpartum hemorrhage
The first med used –> crunches the uterus by stimulating contractions
Magnesium sulfate dosage
4-6g loading dose/ bolus over 20-30 minutes, 2-3g/hr maintenance dose
Magnesium sulfate uses
prevent/treat convulsions via relaxing uterus smooth muscle. Indicated in severe gestational hypertension and severe preeclampsia. Also prevents contractions in preterm labor.
Magnesium sulfate therapeutic level
4-7mEq/L
Magnesium sulfate toxicity
Presents w/ absent DTRs Resp below 12, pulse ox below 95% even with O2
Decreased LOC
Magnesium sulfate antidote
Calcium gluconate, but stop the IV flow first!
Magnesium sulfate interventions
Padded siderails
Dim lights
Lower activity (seizure precautions)
VS q 15 min
Excreted through urine so I&O are important
Rho immune globulin
Given to Rh- mothers when they have a Rh+ fetus, prevents the mom’s immune system from attacking the body.
Always given to Rh- moms for amniocentesis
Physical Dependance
when abrupt cessation of the opioid results in a withdrawal state
Tolerance
When chronically administered opioid require higher doses to be effective indicated by needing to increase the amount or frequency of doses of medication to achieve initial effect of drug
Addiction
Pattern of dysfunctional opioid use
General anesthesia
Given for c-section in emergency situations
Monitor VS closely
Usually causes hunger afterwards
Bulb suctioning use
to clear the airways of infants with excess mucus in them
Bulb suctioning approach
suction mouth before the nose.
compress the bulb before inserting, and insert into the side of the mouth
suction the nostrils one at a time
clean with soapy warm water with each use
Bulb suctioning stop
when the infants cry becomes clear and doesn’t sound muffled by mucus
Vaginal laceration causes
use of forceps to rotate the fetal head, rapid fetal descent, or precipitous birth
vaginal laceration appearance
circular, can extend deep
fundus can be firm or uterus boggy with this kind of bleeding
What cause vaginal lacerations lead to
postpartum hemorrhage, often accompanied by perineal laceration
Ineffective breastfeeding fetal signs
inadequate weight gain
minimal output and feeding constantly.
Uterine infection risk factors
amniocentesis
prolonged labor
Uterine infection intervention
antibiotics
analgesics
adequate nutrition/hydration
good hang hygiene
Uterine infection signs and symptoms
Temp >100.4
abnormal lochia
tachycardia
delayed involution of uterus
pain/tenderness
inflammation of perineum
backache, fatigue, malaise, chills
abnormal labs
causes the urge to pee to decrease
Cephalhematoma
Skeletal injury head bleed that doesn’t cross sutures.
Between the scalp and the skull, this is a concern!
Cephalhematoma
Caused from birth, occurs more with quick births
Tetanus (Tdap)
vaccine given at 2,4,6 months.
Booster is recommended every 10 years for adults, within 5 years for children
Hep. B
Vaccine is given right at birth, another dose a month later, and a 3rd before 15 months
Anterior Fontanels close
by 12-18 months (LAST)
Posterior fontanels closing
by 2-5 months (FIRST)
What percentile indicates obesity
above 95%
What percentile indicates underweight
below 10%
What percentile indicates overweight
85-95%
What percentile indicates failure to thrive
below 5%
Age 3-6 (preschool) weight gain
4.4-6.6lbs in a year
Age 6-12 (school age) weight gain
2-3 kgs a year
Postpartum Blues
Mild depression after birth that usually resolves in a few days without help, occurs in 80% of women.
Women become emotionally labile and cry easily, restlessness, fatigue, insomnia, HA, and anger
Usually follows the first day or two of birth
Postpartum Depression
An intense and pervasive afterbirth with severe and labile mood swings (irritable) accompanied by guilt and a feeling of inadequate sleep and diet changes may occur, lasts longer than 2 weeks
Postpartum depression treated
with anti-depressants, antitoxic agents, mood stabilizers and electroconvulsive therapy.
psychotherapy focuses on fears and concerns of new responsibilities and roles, monitoring for suicidal or homicidal thoughts
Postpartum depression with psychotic features
syndrome characterized by depression, delusions, and thoughts of harming either infant of self after birth that come and go frequently, usually occurs within first 2 weeks.
supervised visits to baby and give meds
Postpartum depression with psychotic features risk factor
Bipolar disorder
Miscarriage
A pregnancy that ends as a result of natural causes before 20 weeks of gestation
Miscarriage signs and symptoms
bleeding, contractions, and abdominal pain
Miscarriage risk factors
1-12 weeks –> diabetes, hypothyroidism, and endocrine disorders
12-20 weeks –> age extremes, minority group, and history of miscarriage.
Threatened Miscarriage
bed rest, FHR is not great but still alive, some bleeding but cervix is closed, can be saved.
Inevitable Miscarriage
Heavy bleeding, cervix opens and the baby is going to die no matter what
Incomplete Miscarriage
The placenta isn’t delivered early along with the fetus, can occur with contraception, requires procedure to get placenta out
Complete Miscarriage
All products of conception are evacuated
Missed Miscarriage
the baby died but is still in the mom, they need to deliver the still born. They come into the office for a checkup.
APGAR score
score of 0-10 to determine fetal well-being.
Appearance, pulse, grimace, activity, and respirations.
0 = none/ no response
1 = some/ weak/ low
2 = normal/ above
