Study Guide Flashcards
1
Q
Normal blood glucose for new born
A
40-45 mg/dL
2
Q
Where should your take blood glucose on a newborn
A
Heel stick
3
Q
Increased risk for hypoglycemia
A
Large for gestational age/SGA, mother is diabetic, late preterm, or low birth weight
4
Q
When should you check newborn blood glucose
A
30 mins after first feeding, then always before feedings. With diabetics check after feedings
5
Q
How to prevent hypoglycemia in newborn
A
Ensure effective breastfeeding
6
Q
When are emergency c-sections performed
A
With prolapse umbilical cord, malpresentation that cannot be resolved, and to preserve the life of the mother and fetus
7
Q
Normal C-section blood loss
A
Normal <1L
8
Q
Dilation
A
(0-10 cm), how open/closed the uterus is.
9
Q
Effacement
A
(0-100%), how much of the uterus has been shed
10
Q
Station
A
(-5 - +5), the position of the baby, - is deep and + is closer to exit
11
Q
What is an amniotomy
A
Performed to rupture the membranes of a pregnant woman
12
Q
What should the nurse monitor after an amniotomy
A
FHR due to the risk of cord compressions (variable decelerations will be present in this case)
13
Q
What is common after an amniotomy and is common
A
Tachycardia, doesn’t require action
14
Q
postpartum hemorrhage vaginal birth number
A
> 500mL
15
Q
Postpartum hemorrhage c-section number
A
> 1L
16
Q
Postpartum hemorrhage risk factors
A
uterine atony (boggy uterus), genital lacerations, hematomas, retained placenta (especially if its nonadherent)
17
Q
What is Involution
A
the process when the uterus returns to a nonpregnant state following birth (~6 weeks)
18
Q
What is Subinvolution
A
the failure of the uterus to return to nonpregnant state. (folds on itself)
19
Q
What can cause subinvolution
A
Late bleeding, and placental fragments/ pelvic infection
20
Q
Normal vaginal birth bleeding
A
<500mL
20
Q
In normal postpartum bleeding, what can be decrease in the blood (levels)
A
Hematocrit (3-4 days, 33% is normal after 8 weeks)
Hemoglobin (11g/dL)
21
Q
Hypothermia appearance in newborns
A
appear pale and mottled
22
Q
What can hypothermia progress to and what happens
A
Cold stress, RR increase, and vasoconstriction occurs.
Metabolic acidosis can occur which exacerbates jaundice
Can cause hypoglycemia, can make infants quiver/ shake
23
Q
Post-term complications for the mother
A
Hemorrhage, infection, dysfunctional labor, perineal injury r/t macrosomia, fatigue, etc.
24
Post term complications in the newborn
LGA/SGA, macrosomia, higher risk for birth injuries
25
What is forceps-assisted birth
Using a tool to wrap around the baby's head to assist in pulling it out
25
When are forceps used (fetal)
Abnormal FHR, certain abnormal presentations, arrest of rotation, head delivery in breech presentation.
25
When are forceps used (maternal)
Prolonged 2nd stage of labor (delivery)
26
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)
27
Vital signs for newborn
RR: 30-60 BPM
HR: 100-160 BPM
Temp: 98-98.9
Weight: 5lbs 12oz- 8lbs-12oz
27
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
28
Normal weight for newborns
5lbs 12oz- 8lbs 12oz
29
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.
29
when should Breastfeeding be done
first 6 months and up to 12 months, complementary foods can be introduced at 6 months
30
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)
31
What can cause breast engorgement
Mastitis (breast infection)
32
How to prevent breast engorgement
Good hygiene, make sure the baby is latching appropriately.
Ice can decrease swelling
33
Pain assessment scale for children over 5 years old
Faces scale
34
Pain assessment scale for children under 5 or mentally disabled
FLACC scale (their appearance/ behavior)
35
Pain relief for infants
Acetaminophen and NSAIDS for mild-moderate pain
Lidocaine, opioids and topical pain relief for moderate-severe pain
36
What med can you not give infants
NO ASPIRIN
37
Newborn non-pharm relief.
oral sucrose (sugar water), non-nutritive sucking, breastfeeding, distraction, and swaddling.
38
What age can kids verbalize pain
3-6 (preschoolers age)
39
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
40
How to get correct BP cuff
cuff bladder width 40% of arm circumference, length 80-100% of circumference, measured at heart level.
41
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.
42
Four modes of heat loss
Convection, radiation, evaporation, and conduction
43
Convection
Heat is lost due to cooler air around the baby
44
Radiation
heat is lost due to cooler solid surface close to baby.
45
Evaporation
heat is lost when moisture on the skin vaporizes, especially after failing to dry the baby after a bath. Most significant cause
46
Conduction
heat is lost due to direct contact with a cooler surface.
47
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.
47
Physiologic Jaundice treatment
phototherapy (protect eyes), blood exchange transfusions.
48
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
49
Pathologic Jaundice treatment
Phototherapy, exchange transfusions (rare)
49
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
50
Pathologic Jaundice risk factors
Premature birth, significant bruising during birth, blood type, breastfeeding.
50
Lochia rubra
dark red, musty odor
51
Lochia serosa
pink or brown, odorless, watery
52
Lochia alba
yellow, white
52
Inversion of the uterus
Turning inside out of uterus, (comes out)
Potentially life threatening (1 in 3,000 births)
53
Postpartum peri care
Clean it up, give NSAIDs, ice packs.
Wipe front to back
54
Leading cause of death for children
preventable causes, such as car accidents or drowning.
Watch for suicidal actions
55
What does umbilical cord prolapse cause to the fetus
fetal hypoxia
55
What is umbilical cord prolapse
when the cord lies below presenting part of fetus
55
Car seat safety
Have a rear facing car seat for the first 2 years, don't leave child unsupervised.
56
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.
56
Risk factors of umbilical cord prolapse
Long cord (>100 cm)
Malpresentation (breech)
Transverse lie
Unengaged presenting part
Baby's head is high up
Amniotomy
57
Fentanyl
Synthetic opioid used for moderate-severe pain relief
58
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.
58
Carboprost (Hemabate)
Used for postpartum hemorrhage
The first med used --> crunches the uterus by stimulating contractions
59
Magnesium sulfate dosage
4-6g loading dose/ bolus over 20-30 minutes, 2-3g/hr maintenance dose
59
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.
60
Magnesium sulfate therapeutic level
4-7mEq/L
61
Magnesium sulfate toxicity
Presents w/ absent DTRs Resp below 12, pulse ox below 95% even with O2
Decreased LOC
61
Magnesium sulfate antidote
Calcium gluconate, but stop the IV flow first!
62
Magnesium sulfate interventions
Padded siderails
Dim lights
Lower activity (seizure precautions)
VS q 15 min
Excreted through urine so I&O are important
63
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
64
Physical Dependance
when abrupt cessation of the opioid results in a withdrawal state
64
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
65
Addiction
Pattern of dysfunctional opioid use
66
General anesthesia
Given for c-section in emergency situations
Monitor VS closely
Usually causes hunger afterwards
67
Bulb suctioning use
to clear the airways of infants with excess mucus in them
68
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
69
Bulb suctioning stop
when the infants cry becomes clear and doesn't sound muffled by mucus
70
Vaginal laceration causes
use of forceps to rotate the fetal head, rapid fetal descent, or precipitous birth
71
vaginal laceration appearance
circular, can extend deep
fundus can be firm or uterus boggy with this kind of bleeding
71
What cause vaginal lacerations lead to
postpartum hemorrhage, often accompanied by perineal laceration
72
Ineffective breastfeeding fetal signs
inadequate weight gain
minimal output and feeding constantly.
72
Uterine infection risk factors
amniocentesis
prolonged labor
72
Uterine infection intervention
antibiotics
analgesics
adequate nutrition/hydration
good hang hygiene
72
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
73
Cephalhematoma
Skeletal injury head bleed that doesn't cross sutures.
Between the scalp and the skull, this is a concern!
73
Cephalhematoma
Caused from birth, occurs more with quick births
74
Tetanus (Tdap)
vaccine given at 2,4,6 months.
Booster is recommended every 10 years for adults, within 5 years for children
75
Hep. B
Vaccine is given right at birth, another dose a month later, and a 3rd before 15 months
75
Anterior Fontanels close
by 12-18 months (LAST)
76
Posterior fontanels closing
by 2-5 months (FIRST)
76
What percentile indicates obesity
above 95%
77
What percentile indicates underweight
below 10%
77
What percentile indicates overweight
85-95%
78
What percentile indicates failure to thrive
below 5%
79
Age 3-6 (preschool) weight gain
4.4-6.6lbs in a year
80
Age 6-12 (school age) weight gain
2-3 kgs a year
81
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
81
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
81
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
82
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
82
Postpartum depression with psychotic features risk factor
Bipolar disorder
83
Miscarriage
A pregnancy that ends as a result of natural causes before 20 weeks of gestation
84
Miscarriage signs and symptoms
bleeding, contractions, and abdominal pain
84
Miscarriage risk factors
1-12 weeks --> diabetes, hypothyroidism, and endocrine disorders
12-20 weeks --> age extremes, minority group, and history of miscarriage.
84
Threatened Miscarriage
bed rest, FHR is not great but still alive, some bleeding but cervix is closed, can be saved.
85
Inevitable Miscarriage
Heavy bleeding, cervix opens and the baby is going to die no matter what
85
Incomplete Miscarriage
The placenta isn't delivered early along with the fetus, can occur with contraception, requires procedure to get placenta out
86
Complete Miscarriage
All products of conception are evacuated
86
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.
86
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
