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