Test 2 Flashcards
Normal Newborn Complications
Expected infant weight loss in the 1st few days after delivery
5-10%
Formula for expected weight loss
(Birth Weight-Today’s Weight) x 100/Birth Weight
Ways to enhance thermostability in newborns
- Skin-to-skin (STS)
- Wrap in blankets
- Radiant warmers
In order for a newborn to be placed STS immediately upon delivery, the mother’s temperature should be…
Greater than 97
An infant who is pallor in color could be a sign of…
Hypoxia or Anemia
An infant who is ruddy (plethora) in color could be a sign of…
Polycythemia, increased Hct (risk for jaundice)
Apnea up to 15 seconds is normal in a newborn. True or False?
True
An infant who has a respiratory rate of 65, nasal flaring, retractions, and is making a grunting noise is exhibiting signs of…
Respiratory distress
In what order do you bulb suction a newborn?
Mouth first, then nares
An important nursing intervention when caring for a newborn in respiratory distress is…
Prevent cold stress
Methods of heat loss in a newborn
- Evaporation
- Radiation
- Conduction
- Convection
Shivering is often seen in an infant experiencing cold stress. True or False?
False
Effects of cold stress on a newborn
Increased need for glucose and oxygen
Can lead to respiratory distress and hypoglycemia
An infant with a head lesion that does NOT cross the suture line has a…
Cephalhematoma
An infant with a head lesion that DOES cross the suture lines has a…
Caput Succedaneum
How soon after birth should a newborn void?
Within the first 24 hours
A female newborn who has white genitourinary mucous tinged with blood is experiencing…
Pseudomenstruation (withdrawal from maternal hormones)
Male urethral opening on the bottom of the penis
Epispadias
Male urethral opening on the top of the penis
Hypospadias
An increased accumulation of bilirubin in an infant can lead to…
Kernicterus (bilirubin encephalopathy) due to staining of brain tissue
Jaundice that is noted within the first 72 hours of life (after the initial 24 hours)
Physiologic Jaundice
Jaundice that is noted within the first 24 hours of life
Pathologic Jaundice
When is jaundice treated?
When bilirubin levels reach 13 mg/dl
Nursing interventions for a newborn with jaundice
- Encourage frequent feedings (promotes stooling and the passage of bilirubin)
- Phototherapy (UV light)
- Ensure hydration in mother
Normal glucose level for a newborn
45 mg/dl or higher
An infant experiencing jitters, hypothermia, tachypnea, poor suck, and lethargy is exhibiting signs of…
Hypoglycemia
Infants most at risk for hypoglycemia include…
- Premature
- Postmature
- Inadequate uterine growth restriction
- Cold stress
- SGA
- LGA
- Diabetic mother
Brachial nerve damage in a newborn is referred to as…
Erb’s Palsy
A fetus will begin secreting it’s own insulin by what gestational age in a normal pregnancy
10 weeks
A mother is at increased risk for developing gestational diabetes if she has a previous history of…
- Family history
- Increased BMI
- Age greater than 25
- Hypertension
- Lipid abnormalities
- Race/ethnicity
The majority of gestational diabetes cases can be controlled by…
Diet
A mother has a glucose screening result of 145. Is this considered normal or abnormal?
Abnormal (anything greater than 140 = abnormal)
Diagnosis of gestational diabetes is made by what results on a glucose tolerance test (GTT)?
2 or more plasma glucose levels greater than: 95 (fasting) 180 (after 1 hour) 155 (after 2 hours) 140 (after 3 hours)
Glucose Tolerance Test includes…
High carbohydrate diet for 2 days, fasting after midnight day of test (FBS), ingesting 100g of oral glucose, checking BG at 1, 2, and 3 hours.
A mother with a previous history of DM will require a 2-4 times insulin increase during the second half of pregnancy. This is due to…
Development of insulin resistance
Maternal risks for a women with a previous history of DM include…
- Hydraminos (due to polyuria experienced by fetus)
- Pregnancy induce HTN
- Infections
- Hyperglycemia and Ketoacidosis
Neonatal risks for a fetus with a mother who has a previous history of DM include…
- Macrosomia (large, beefy baby)
- Respiratory distress syndrome (diabetes hormones slow down the production of surfactant)
- Intrauterine Growth Restriction (IUGR)
- Hyperbilirubinemia (decreased O2 leads to increased RBC production)
An infant born to a mother with a previous history of DM is at greatest risk for what 2-4 hours after birth?
Hypoglycemia
Nursing management goal for a mother with a history of DM includes…
- Maintain glucose between 80-120 mg/dl (promote bedtime snacks to increase blood sugar through night)
- Report FBS of greater than 105 or if greater than 120 post partum (2 hours)
- Encourage exercise
- Infection prevention
Important patient education regarding breastfeeding and diabetes is…
Insulin does NOT transfer into milk, but glucose DOES
Acronym for the group of viral/infectious diseases that can occur during pregnancy
T (toxoplasmosis) O (Other diseases: STDs) R (Rubella) C (Cytomegalic Inclusion Disease: CMV) H (Herpes Virus serotype 2: HSV-2)
Infections that have the potential to cause the greatest harm to a neonate during pregnancy
- CMV
- Rubella
- Varicella-zoster
- Herpes simple
- Hepatitis B
- HIV
An infant who has been exposed to toxoplasmosis could develop…
Blindness, neurological disorders, retardation
If contracted at less than 20 weeks, miscarriage results
An infant who has been exposed to STDs could develop…
Conjuctivitis, pneumonia
Increased risk for ectopic pregnancy in mother (should be screened at prenatal visits)
An infant who has been exposed to Rubella could develop…
Congenital anomalies (NEONATAL CATARCTS), retardation, deafness Monitor rubella titers (can cross over placental barrier)
An infant who has been exposed to CMV could develop…
Nervous system disorders, low birth weight, deafness
An infant who has been exposed to Herpes virus could develop…
Serious neurological deficits, blindness
Over 50% infant death if left untreated
If mother has active lesions during delivery, definitive C/S (no exceptions!)
An infant born to a HIV positive mother and has a positive titer indicates the infant has HIV. True or False?
False - Sero levels will convert to normal at 18-24 months (use PCR for earlier determination of infection)
A HIV positive mother has a viral load of 1500. Will she deliver vaginally or via C/S?
Will deliver via C/S (greater than 1000)
When is HIV at greatest risk for transfer to the fetus?
If contracted as a primary infection during the pregnancy
Leading cause of life-threatening perinatal infections
Group Beta Streptococcus
An infant with early onset GBS will manifest what symptoms?
- Sepsis
- Pneumonia
- Meningitis
An infant with late onset GBS will most likely manifest… after the first week of birth.
Meningitis (may cause death or permanent neurological deficits)
Optimal screening for GBS is…
35-37 weeks gestation
A patient who is GBS positive needs at least 1 dose of anitibiotics how long before delivery to be considered “safe”?
4 hours, otherwise infant will require complete course of antibiotics after birth
Hypertension that precedes pregnancy or develops at less than 20 weeks gestation
Chronic Hypertension
What is the cardinal sign of pre-eclampsia?
Proteinuria
Methyldopa (Aldomet) is used to treat…
Mothers with chronic hypertension
Development of a blood pressure greater than 140/90 during the SECOND HALF of pregnancy with no development of proteinuria
Gestational hypertension (will regress after delivery)
What causes the proteinuria seen in pre-eclampsia?
Renal involvement
Generalized vasospasm during pre-eclampsia leads to…
Decreased tissue perfusion (can lead to cerebral hemorrhage, liver damage, and decreased placental perfusion)
A pregnant patient experiencing a blood pressure greater than 140/90, generalized edema, proteinuria, clonus, and double vision is exhibiting signs of…
Pre-eclampsia
What causes epigastric pain in worsening pre-eclampsia?
Liver involvement
Only cure for pre-eclampsia
Delivery (risk still continues for several days post-partum)
Self-care patient education for pre-eclampsia includes…
- Rest
- Well-balanced diet (increased protein)
- No salt restrictions
- Take daily weights
- Awareness of signs/symptoms
Magnesium Sulfate (MgSO4), hydralazine, and oxytocin are administered for..
Severe pre-eclampsia
This drug competes with calcium and depresses the CNS (used to treat pre-eclampsia or preterm labor)
Magnesium Sulfate
Antidote for MgSO4
Calcium Gluconate (1 gm slow IVP)
Therapeutic levels of MgSO4
4-8 mg/dL
Toxic effects of magnesium sulfate that are seen when serum levels are greater than 8
- Decreased LOC
- Lethargy, drowsiness
- Slurred speech
- Hypotension
Antihypertensive agents used to treat pre-eclampsia
Labetolol
Hydralazine
Patients with eclampsia are at risk for…
Generalized, grand mal seizures
HELLP Syndrome involves…
H (Hemolysis) E (Elevated) L (Liver enzymes) L (Low) P (Platelets)
HELLP Syndrome is characterized by…
Pain in the RUQ (jaundince, N/V, edema may be present)
Betamethasone is given to treat…
HELLP Syndrome (if less than 34 weeks gestation)
Implantation of the placenta in the lower uterus
Placenta Previa
Common cause of planceta previa
Scar tissue (limits the number of areas for the placenta implantation)
Pregnancies in which placenta previa occurs can be delivered vaginally. True or False?
False - Automatic C/S
Sudden onset of PAINLESS uterine bleeding is a classic sign of…
Placenta Previa
Should a vaginal exam be performed on a pregnant patient with placental previa?
No! Risk for placental disruption
Separation of the implanted placenta before the fetus is born
Abruptio Placental (Abruption)
There is vaginal bleeding in a concealed placental abruption. True or False?
False
A patient presenting with uterine tenderness, abdominal pain, and a board-like abdomen is exhibiting symptoms of…
Placental Abruption
Maintenance fluid of choice for volume replacement in hemorrhagic conditions
Lactated Ringers
Implantation of fertilized ovum outside uterine cavity
Ectopic Pregnancy
Major nursing role in ectopic pregnant
Maintaining hemodynamic status
Ectopic pregnancies are most commonly caused by…
Scar tissue (STDs, IUD, multiple abortions)
Methotrexate is used to treat…
Ectopic pregnancy in an UNRUPTURED tube (inhibits cell division)
A patient with a positive pregnancy test and that is experiencing sudden pain in RLQ (or LLQ), hemorrhage, and pain radiating under scapula is exhibiting signs of…
Ruptured tube
A patient exhibiting exaggerate signs/symptoms of pregnancy, increased hCG levels, an absence of a fetal sac on ultrasound, and has an early diagnosis of pre-eclampsia may be have…
Gestational Trophoblastic Disease (Hydatiform Mole)
The biggest danger with Gestational Trophoblastic Disease
Persistent disease may undergo malignant change and metastasize to distant sites (VERY aggressive)
Why is a bicornuate uterus more at risk for spontaneous abortion?
Diminished capacity due to heart shape
Stitch used to keep cervix closed during early gestational dilation
Cervical cerclage
Ideal labor pattern
Contraction every 2 minutes lasting 60 seconds
Coordinated, weak contraction common during the active phase of labor
Hypotonic contractions
Uncoordinated, irregular, painful contractions occurring during the latent phase of labor
Hypertonic contractions
Why are hypertonic contractions dangerous for the fetus?
Decreased blood flow to placenta and fetus
Condition in which the head of the infant is born, but the anterior shoulder cannot pass under the pubic arch
Shoulder dystocia
Why is shoulder dystocia a medical emergency?
Risk of asphyxia
McRobert’s maneuver is used to correct…
Shoulder dystocia (apply pressure to help move the shoulder out)
A breech presentation in an infant increases the risk for…
Prolapsed cord
One of the most common problems with the passage during a delivery
Soft tissue obstruction (distended bladder or no recent BM)
Multifetal pregnancies can result in uterine overdistension causing…
Dysfunctional labor (Hypotonic contractions)
When assessing for an intrapartum infection, one of the most common signs is…
Fetal tachycardia (monitor both mother and fetal HR)
Delivery that occurs within 3 hours of the onset of labor is known as…
Precipitate Labor
Pharmacological measures can be used during precipitate labor. True or False?
False - Baby will be born sedated
Spontaneous rupturing of membranes before the onset of labor
Premature Rupture of the Membranes (PROM)
How can membrane rupture be tested for?
- Nitrazine - Paper turns blue (pH of 6.5-7.5) indicates positive rupture
- Ferning (DO NOT do vaginal exam before ferning test)
Management for PROM includes…
- Delivery within 12-24 hours if near term
2. Conservative management if pre-term to allow for fetal lung maturation
Complications involved with PROM could include…
Infection (monitor amniotic flluid) Prolapsed cord (monitor fetal VS)
Labor that occurs after 20 weeks of gestation, but before the completion of the 37th week
Pre-term labor
Pre-term labor usually has very subtle signs/symptoms. True or False?
True
An initial intervention with pre-term labor is…
Hydration!! Dehydration can stimulate the release of oxytocin
Terbutaline, MgSO4, and Bethamethasone are all referred to as…
Tocolytics (used to treat pre-term labor)
A positive fetal fibronectin after 20 weeks will indicate…
Delivery within the next 2 weeks
False positive fetal fibronectin results can occur due to…
- Bleeding
- Intercourse
- Infection
Bronchodilator used to prevent and treat pre-term labor in pregnancies greater than 20 weeks
Terbutaline Sulfate (Brethine)
Always assess what before administering Terbutaline Sulfate (Brethine)?
Pulse! Hold if HR is greater than 120
Antidote for Terbutaline Sulfate
Inderal
Nursing interventions for the administration of Terbutaline Sulfate include…
- Monitor for s/s of pulmonary edema, hypoglycemia, and hypokalemia
- Administer before other medications
- Educate patient to check pulse before taking
Why are higher doses of MgSO4 given during pre-term labor as opposed to pre-eclampsia?
Trying to prevent labor
Corticosteroid given during pre-term labor to stimulate the production of lecithin in fetal lungs
Betamethasone (Celestone)
Sign of a prolapsed cord
Change in FH (variables, bradycardia)
What should always be done when FH changes or with a sudden rupture of membranes (SROM)
Vaginal exam to check for prolapsed cord
In the incidence of a prolapsed cord, the mother should assume what position?
Knee-Chest. Requires immediate delivery via emergency C/S
When the uterus completely or partially turns inside out as the placenta is delivered
Uterine Inversion
Signs/Symptoms of uterine inversion are…
- Interior uterus seen through the cervix
2. Massive hemorrhage, shock
Most common form of uterine rupture
Dehiscence (splitting of an old scar)
A patient in labor with constant uterine pain and tenderness, burning at the peak of contractions, and whose fetus is showing signs of impaired oxygenation, may be experiencing…
Uterine rupture
Risk factors associated with an amniotomy (artificial rupture of membranes) include…
- Infection
2. Prolapsed cord (be sure to assess fetal HR!)
What is a Bishops Score?
Pre-labor scoring system (involves dilation, effacement, station, cervix consistency, and cervical position)
Indications for induction of labor
- Pre-eclampsia
- Maternal diabetes
- PROM
- Chorioamnionitis
- Post-term pregnancy
- Fetal demise
- Oligohydraminos
Medication used to ripen/soften the cervix to promote labor
Prostaglandins (Cervidil/Cytotec)
Make sure to monitor what VS after administration of prostaglandins?
Fetal HR 30 minutes after insertion
Most important thing to monitor for what administering prostaglandins
Uterine hypertonicity - If hypertonic, discontinue medication
Drug used to induce or augment labor by stimulating uterine smooth muscle contractions
Oxytocin (Pitocin)
What is the onset time of Pitocin?
Immediately
How many cc’s is 1 mu/min of Pitocin?
3 cc’s
Goal for Pitocin
Well contracted uterus
Important nursing assessment when administering Pitocin
Uterine Hypertonicity
What should be done if uterine hyperonicity or non-reassuring FH pattering are observed during an infusion of Pitocin?
STOP infusion Increase main fluid rate Position mother on left side to increase perfusion to baby Administer O2 at 8-10 L Notify the physician
Important post-op nursing care after a C/S delivery
Assess for uterine tone (fundal check)
What is the biggest risk for a vaginal birth after cesarean (VBAC)?
Uterine rupture
Pregnancy over 40 weeks gestation
Post-term pregnancy
Main risk to a post-term newborn are the result of…
Placental insufficiency
Infants require extra water in addition to feedings. True or False?
False - Breast milk and properly prepared formula fulfill water requirements
Average calorie need for an infant
110-120 cal/kg/day
Three phases of breastmilk
- Colostrum - thick, yellow secretion during first week of lactation (contains antibodies and proteins)
- Transitional milk - appears 48-72 hours after delivery; lasts for 7-10 days
- Mature milk - Bluish tint, appears after 2 weeks
Cause of milk production
Sucking stimulation leads to the release of prolactin
Cause of milk ejection reflex
Nipple stimulation leads to the release of oxytocin
An infant who is rooting or smacking hand-to-mouth is exhibiting…
Early hunger cues
Ideal time for first breastfeeding of newborn
Within the 1st hour
How often and for what length of time should infants be fed?
Every 2-3 hours for no defined length of time
Causes of insufficient milk supply include…
- Dehydration
- Smoking
- Inadequate diet
- Inadequate rest
- Use of caffeine or alcohol
Signs of breast milk letdown
Tingling in breast around 48 hours after delivery
Mother feels uterine cramping (be sure to keep hydrated)
Formula feeding for newborns
1 oz on the 1st day
2 oz on the 2nd day
3 oz on the 3rd day
How long can breast milk be stored for?
Refrigerated - 48 hours
Refrigerated freezer - 1 month
Deep freeze - 6 months
Never thaw, then refreeze
Why is back-sleeping the preferred sleeping position?
Decreased re-breathing of air
Decreased overheating potential
Increased arousal
Less compression of vertebral arteries