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Labor/Delivery > Test 2 > Flashcards

Test 2 Flashcards

Normal Newborn Complications

1
Q

Expected infant weight loss in the 1st few days after delivery

A

5-10%

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2
Q

Formula for expected weight loss

A

(Birth Weight-Today’s Weight) x 100/Birth Weight

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3
Q

Ways to enhance thermostability in newborns

A
  1. Skin-to-skin (STS)
  2. Wrap in blankets
  3. Radiant warmers
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4
Q

In order for a newborn to be placed STS immediately upon delivery, the mother’s temperature should be…

A

Greater than 97

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5
Q

An infant who is pallor in color could be a sign of…

A

Hypoxia or Anemia

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6
Q

An infant who is ruddy (plethora) in color could be a sign of…

A

Polycythemia, increased Hct (risk for jaundice)

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7
Q

Apnea up to 15 seconds is normal in a newborn. True or False?

A

True

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8
Q

An infant who has a respiratory rate of 65, nasal flaring, retractions, and is making a grunting noise is exhibiting signs of…

A

Respiratory distress

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9
Q

In what order do you bulb suction a newborn?

A

Mouth first, then nares

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10
Q

An important nursing intervention when caring for a newborn in respiratory distress is…

A

Prevent cold stress

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11
Q

Methods of heat loss in a newborn

A
  1. Evaporation
  2. Radiation
  3. Conduction
  4. Convection
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12
Q

Shivering is often seen in an infant experiencing cold stress. True or False?

A

False

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13
Q

Effects of cold stress on a newborn

A

Increased need for glucose and oxygen

Can lead to respiratory distress and hypoglycemia

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14
Q

An infant with a head lesion that does NOT cross the suture line has a…

A

Cephalhematoma

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15
Q

An infant with a head lesion that DOES cross the suture lines has a…

A

Caput Succedaneum

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16
Q

How soon after birth should a newborn void?

A

Within the first 24 hours

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17
Q

A female newborn who has white genitourinary mucous tinged with blood is experiencing…

A

Pseudomenstruation (withdrawal from maternal hormones)

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18
Q

Male urethral opening on the bottom of the penis

A

Epispadias

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19
Q

Male urethral opening on the top of the penis

A

Hypospadias

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20
Q

An increased accumulation of bilirubin in an infant can lead to…

A

Kernicterus (bilirubin encephalopathy) due to staining of brain tissue

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21
Q

Jaundice that is noted within the first 72 hours of life (after the initial 24 hours)

A

Physiologic Jaundice

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22
Q

Jaundice that is noted within the first 24 hours of life

A

Pathologic Jaundice

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23
Q

When is jaundice treated?

A

When bilirubin levels reach 13 mg/dl

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24
Q

Nursing interventions for a newborn with jaundice

A
  1. Encourage frequent feedings (promotes stooling and the passage of bilirubin)
  2. Phototherapy (UV light)
  3. Ensure hydration in mother
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25
Q

Normal glucose level for a newborn

A

45 mg/dl or higher

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26
Q

An infant experiencing jitters, hypothermia, tachypnea, poor suck, and lethargy is exhibiting signs of…

A

Hypoglycemia

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27
Q

Infants most at risk for hypoglycemia include…

A
  1. Premature
  2. Postmature
  3. Inadequate uterine growth restriction
  4. Cold stress
  5. SGA
  6. LGA
  7. Diabetic mother
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28
Q

Brachial nerve damage in a newborn is referred to as…

A

Erb’s Palsy

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29
Q

A fetus will begin secreting it’s own insulin by what gestational age in a normal pregnancy

A

10 weeks

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30
Q

A mother is at increased risk for developing gestational diabetes if she has a previous history of…

A
  1. Family history
  2. Increased BMI
  3. Age greater than 25
  4. Hypertension
  5. Lipid abnormalities
  6. Race/ethnicity
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31
Q

The majority of gestational diabetes cases can be controlled by…

A

Diet

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32
Q

A mother has a glucose screening result of 145. Is this considered normal or abnormal?

A

Abnormal (anything greater than 140 = abnormal)

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33
Q

Diagnosis of gestational diabetes is made by what results on a glucose tolerance test (GTT)?

A 
2 or more plasma glucose levels greater than: 
95 (fasting)
180 (after 1 hour)
155 (after 2 hours)
140 (after 3 hours)
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34
Q

Glucose Tolerance Test includes…

A

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.

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35
Q

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…

A

Development of insulin resistance

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36
Q

Maternal risks for a women with a previous history of DM include…

A
  1. Hydraminos (due to polyuria experienced by fetus)
  2. Pregnancy induce HTN
  3. Infections
  4. Hyperglycemia and Ketoacidosis
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37
Q

Neonatal risks for a fetus with a mother who has a previous history of DM include…

A
  1. Macrosomia (large, beefy baby)
  2. Respiratory distress syndrome (diabetes hormones slow down the production of surfactant)
  3. Intrauterine Growth Restriction (IUGR)
  4. Hyperbilirubinemia (decreased O2 leads to increased RBC production)
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38
Q

An infant born to a mother with a previous history of DM is at greatest risk for what 2-4 hours after birth?

A

Hypoglycemia

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39
Q

Nursing management goal for a mother with a history of DM includes…

A
  1. Maintain glucose between 80-120 mg/dl (promote bedtime snacks to increase blood sugar through night)
  2. Report FBS of greater than 105 or if greater than 120 post partum (2 hours)
  3. Encourage exercise
  4. Infection prevention
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40
Q

Important patient education regarding breastfeeding and diabetes is…

A

Insulin does NOT transfer into milk, but glucose DOES

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41
Q

Acronym for the group of viral/infectious diseases that can occur during pregnancy

A 
T (toxoplasmosis)
O (Other diseases: STDs)
R (Rubella)
C (Cytomegalic Inclusion Disease: CMV)
H (Herpes Virus serotype 2: HSV-2)
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42
Q

Infections that have the potential to cause the greatest harm to a neonate during pregnancy

A
  1. CMV
  2. Rubella
  3. Varicella-zoster
  4. Herpes simple
  5. Hepatitis B
  6. HIV
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43
Q

An infant who has been exposed to toxoplasmosis could develop…

A

Blindness, neurological disorders, retardation

If contracted at less than 20 weeks, miscarriage results

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44
Q

An infant who has been exposed to STDs could develop…

A

Conjuctivitis, pneumonia

Increased risk for ectopic pregnancy in mother (should be screened at prenatal visits)

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45
Q

An infant who has been exposed to Rubella could develop…

A 
Congenital anomalies (NEONATAL CATARCTS), retardation, deafness
Monitor rubella titers (can cross over placental barrier)
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46
Q

An infant who has been exposed to CMV could develop…

A

Nervous system disorders, low birth weight, deafness

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47
Q

An infant who has been exposed to Herpes virus could develop…

A

Serious neurological deficits, blindness
Over 50% infant death if left untreated
If mother has active lesions during delivery, definitive C/S (no exceptions!)

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48
Q

An infant born to a HIV positive mother and has a positive titer indicates the infant has HIV. True or False?

A

False - Sero levels will convert to normal at 18-24 months (use PCR for earlier determination of infection)

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49
Q

A HIV positive mother has a viral load of 1500. Will she deliver vaginally or via C/S?

A

Will deliver via C/S (greater than 1000)

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50
Q

When is HIV at greatest risk for transfer to the fetus?

A

If contracted as a primary infection during the pregnancy

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51
Q

Leading cause of life-threatening perinatal infections

A

Group Beta Streptococcus

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52
Q

An infant with early onset GBS will manifest what symptoms?

A
  1. Sepsis
  2. Pneumonia
  3. Meningitis
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53
Q

An infant with late onset GBS will most likely manifest… after the first week of birth.

A

Meningitis (may cause death or permanent neurological deficits)

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54
Q

Optimal screening for GBS is…

A

35-37 weeks gestation

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55
Q

A patient who is GBS positive needs at least 1 dose of anitibiotics how long before delivery to be considered “safe”?

A

4 hours, otherwise infant will require complete course of antibiotics after birth

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56
Q

Hypertension that precedes pregnancy or develops at less than 20 weeks gestation

A

Chronic Hypertension

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57
Q

What is the cardinal sign of pre-eclampsia?

A

Proteinuria

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58
Q

Methyldopa (Aldomet) is used to treat…

A

Mothers with chronic hypertension

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59
Q

Development of a blood pressure greater than 140/90 during the SECOND HALF of pregnancy with no development of proteinuria

A

Gestational hypertension (will regress after delivery)

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60
Q

What causes the proteinuria seen in pre-eclampsia?

A

Renal involvement

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61
Q

Generalized vasospasm during pre-eclampsia leads to…

A

Decreased tissue perfusion (can lead to cerebral hemorrhage, liver damage, and decreased placental perfusion)

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62
Q

A pregnant patient experiencing a blood pressure greater than 140/90, generalized edema, proteinuria, clonus, and double vision is exhibiting signs of…

A

Pre-eclampsia

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63
Q

What causes epigastric pain in worsening pre-eclampsia?

A

Liver involvement

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64
Q

Only cure for pre-eclampsia

A

Delivery (risk still continues for several days post-partum)

65
Q

Self-care patient education for pre-eclampsia includes…

A
  1. Rest
  2. Well-balanced diet (increased protein)
  3. No salt restrictions
  4. Take daily weights
  5. Awareness of signs/symptoms
66
Q

Magnesium Sulfate (MgSO4), hydralazine, and oxytocin are administered for..

A

Severe pre-eclampsia

67
Q

This drug competes with calcium and depresses the CNS (used to treat pre-eclampsia or preterm labor)

A

Magnesium Sulfate

68
Q

Antidote for MgSO4

A

Calcium Gluconate (1 gm slow IVP)

69
Q

Therapeutic levels of MgSO4

70
Q

Toxic effects of magnesium sulfate that are seen when serum levels are greater than 8

A
  1. Decreased LOC
  2. Lethargy, drowsiness
  3. Slurred speech
  4. Hypotension
71
Q

Antihypertensive agents used to treat pre-eclampsia

A

Labetolol

Hydralazine

72
Q

Patients with eclampsia are at risk for…

A

Generalized, grand mal seizures

73
Q

HELLP Syndrome involves…

A 
H (Hemolysis)
E (Elevated)
L (Liver enzymes)
L (Low)
P (Platelets)
74
Q

HELLP Syndrome is characterized by…

A

Pain in the RUQ (jaundince, N/V, edema may be present)

75
Q

Betamethasone is given to treat…

A

HELLP Syndrome (if less than 34 weeks gestation)

76
Q

Implantation of the placenta in the lower uterus

A

Placenta Previa

77
Q

Common cause of planceta previa

A

Scar tissue (limits the number of areas for the placenta implantation)

78
Q

Pregnancies in which placenta previa occurs can be delivered vaginally. True or False?

A

False - Automatic C/S

79
Q

Sudden onset of PAINLESS uterine bleeding is a classic sign of…

A

Placenta Previa

80
Q

Should a vaginal exam be performed on a pregnant patient with placental previa?

A

No! Risk for placental disruption

81
Q

Separation of the implanted placenta before the fetus is born

A

Abruptio Placental (Abruption)

82
Q

There is vaginal bleeding in a concealed placental abruption. True or False?

83
Q

A patient presenting with uterine tenderness, abdominal pain, and a board-like abdomen is exhibiting symptoms of…

A

Placental Abruption

84
Q

Maintenance fluid of choice for volume replacement in hemorrhagic conditions

A

Lactated Ringers

85
Q

Implantation of fertilized ovum outside uterine cavity

A

Ectopic Pregnancy

86
Q

Major nursing role in ectopic pregnant

A

Maintaining hemodynamic status

87
Q

Ectopic pregnancies are most commonly caused by…

A

Scar tissue (STDs, IUD, multiple abortions)

88
Q

Methotrexate is used to treat…

A

Ectopic pregnancy in an UNRUPTURED tube (inhibits cell division)

89
Q

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…

A

Ruptured tube

90
Q

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…

A

Gestational Trophoblastic Disease (Hydatiform Mole)

91
Q

The biggest danger with Gestational Trophoblastic Disease

A

Persistent disease may undergo malignant change and metastasize to distant sites (VERY aggressive)

92
Q

Why is a bicornuate uterus more at risk for spontaneous abortion?

A

Diminished capacity due to heart shape

93
Q

Stitch used to keep cervix closed during early gestational dilation

A

Cervical cerclage

94
Q

Ideal labor pattern

A

Contraction every 2 minutes lasting 60 seconds

95
Q

Coordinated, weak contraction common during the active phase of labor

A

Hypotonic contractions

96
Q

Uncoordinated, irregular, painful contractions occurring during the latent phase of labor

A

Hypertonic contractions

97
Q

Why are hypertonic contractions dangerous for the fetus?

A

Decreased blood flow to placenta and fetus

98
Q

Condition in which the head of the infant is born, but the anterior shoulder cannot pass under the pubic arch

A

Shoulder dystocia

99
Q

Why is shoulder dystocia a medical emergency?

A

Risk of asphyxia

100
Q

McRobert’s maneuver is used to correct…

A

Shoulder dystocia (apply pressure to help move the shoulder out)

101
Q

A breech presentation in an infant increases the risk for…

A

Prolapsed cord

102
Q

One of the most common problems with the passage during a delivery

A

Soft tissue obstruction (distended bladder or no recent BM)

103
Q

Multifetal pregnancies can result in uterine overdistension causing…

A

Dysfunctional labor (Hypotonic contractions)

104
Q

When assessing for an intrapartum infection, one of the most common signs is…

A

Fetal tachycardia (monitor both mother and fetal HR)

105
Q

Delivery that occurs within 3 hours of the onset of labor is known as…

A

Precipitate Labor

106
Q

Pharmacological measures can be used during precipitate labor. True or False?

A

False - Baby will be born sedated

107
Q

Spontaneous rupturing of membranes before the onset of labor

A

Premature Rupture of the Membranes (PROM)

108
Q

How can membrane rupture be tested for?

A
  1. Nitrazine - Paper turns blue (pH of 6.5-7.5) indicates positive rupture
  2. Ferning (DO NOT do vaginal exam before ferning test)
109
Q

Management for PROM includes…

A
  1. Delivery within 12-24 hours if near term

2. Conservative management if pre-term to allow for fetal lung maturation

110
Q

Complications involved with PROM could include…

A 
Infection (monitor amniotic flluid)
Prolapsed cord (monitor fetal VS)
111
Q

Labor that occurs after 20 weeks of gestation, but before the completion of the 37th week

A

Pre-term labor

112
Q

Pre-term labor usually has very subtle signs/symptoms. True or False?

113
Q

An initial intervention with pre-term labor is…

A

Hydration!! Dehydration can stimulate the release of oxytocin

114
Q

Terbutaline, MgSO4, and Bethamethasone are all referred to as…

A

Tocolytics (used to treat pre-term labor)

115
Q

A positive fetal fibronectin after 20 weeks will indicate…

A

Delivery within the next 2 weeks

116
Q

False positive fetal fibronectin results can occur due to…

A
  1. Bleeding
  2. Intercourse
  3. Infection
117
Q

Bronchodilator used to prevent and treat pre-term labor in pregnancies greater than 20 weeks

A

Terbutaline Sulfate (Brethine)

118
Q

Always assess what before administering Terbutaline Sulfate (Brethine)?

A

Pulse! Hold if HR is greater than 120

119
Q

Antidote for Terbutaline Sulfate

120
Q

Nursing interventions for the administration of Terbutaline Sulfate include…

A
  1. Monitor for s/s of pulmonary edema, hypoglycemia, and hypokalemia
  2. Administer before other medications
  3. Educate patient to check pulse before taking
121
Q

Why are higher doses of MgSO4 given during pre-term labor as opposed to pre-eclampsia?

A

Trying to prevent labor

122
Q

Corticosteroid given during pre-term labor to stimulate the production of lecithin in fetal lungs

A

Betamethasone (Celestone)

123
Q

Sign of a prolapsed cord

A

Change in FH (variables, bradycardia)

124
Q

What should always be done when FH changes or with a sudden rupture of membranes (SROM)

A

Vaginal exam to check for prolapsed cord

125
Q

In the incidence of a prolapsed cord, the mother should assume what position?

A

Knee-Chest. Requires immediate delivery via emergency C/S

126
Q

When the uterus completely or partially turns inside out as the placenta is delivered

A

Uterine Inversion

127
Q

Signs/Symptoms of uterine inversion are…

A
  1. Interior uterus seen through the cervix

2. Massive hemorrhage, shock

128
Q

Most common form of uterine rupture

A

Dehiscence (splitting of an old scar)

129
Q

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…

A

Uterine rupture

130
Q

Risk factors associated with an amniotomy (artificial rupture of membranes) include…

A
  1. Infection

2. Prolapsed cord (be sure to assess fetal HR!)

131
Q

What is a Bishops Score?

A

Pre-labor scoring system (involves dilation, effacement, station, cervix consistency, and cervical position)

132
Q

Indications for induction of labor

A
  1. Pre-eclampsia
  2. Maternal diabetes
  3. PROM
  4. Chorioamnionitis
  5. Post-term pregnancy
  6. Fetal demise
  7. Oligohydraminos
133
Q

Medication used to ripen/soften the cervix to promote labor

A

Prostaglandins (Cervidil/Cytotec)

134
Q

Make sure to monitor what VS after administration of prostaglandins?

A

Fetal HR 30 minutes after insertion

135
Q

Most important thing to monitor for what administering prostaglandins

A

Uterine hypertonicity - If hypertonic, discontinue medication

136
Q

Drug used to induce or augment labor by stimulating uterine smooth muscle contractions

A

Oxytocin (Pitocin)

137
Q

What is the onset time of Pitocin?

A

Immediately

138
Q

How many cc’s is 1 mu/min of Pitocin?

139
Q

Goal for Pitocin

A

Well contracted uterus

140
Q

Important nursing assessment when administering Pitocin

A

Uterine Hypertonicity

141
Q

What should be done if uterine hyperonicity or non-reassuring FH pattering are observed during an infusion of Pitocin?

A 
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
142
Q

Important post-op nursing care after a C/S delivery

A

Assess for uterine tone (fundal check)

143
Q

What is the biggest risk for a vaginal birth after cesarean (VBAC)?

A

Uterine rupture

144
Q

Pregnancy over 40 weeks gestation

A

Post-term pregnancy

145
Q

Main risk to a post-term newborn are the result of…

A

Placental insufficiency

146
Q

Infants require extra water in addition to feedings. True or False?

A

False - Breast milk and properly prepared formula fulfill water requirements

147
Q

Average calorie need for an infant

A

110-120 cal/kg/day

148
Q

Three phases of breastmilk

A
  1. Colostrum - thick, yellow secretion during first week of lactation (contains antibodies and proteins)
  2. Transitional milk - appears 48-72 hours after delivery; lasts for 7-10 days
  3. Mature milk - Bluish tint, appears after 2 weeks
149
Q

Cause of milk production

A

Sucking stimulation leads to the release of prolactin

150
Q

Cause of milk ejection reflex

A

Nipple stimulation leads to the release of oxytocin

151
Q

An infant who is rooting or smacking hand-to-mouth is exhibiting…

A

Early hunger cues

152
Q

Ideal time for first breastfeeding of newborn

A

Within the 1st hour

153
Q

How often and for what length of time should infants be fed?

A

Every 2-3 hours for no defined length of time

154
Q

Causes of insufficient milk supply include…

A
  1. Dehydration
  2. Smoking
  3. Inadequate diet
  4. Inadequate rest
  5. Use of caffeine or alcohol
155
Q

Signs of breast milk letdown

A

Tingling in breast around 48 hours after delivery

Mother feels uterine cramping (be sure to keep hydrated)

156
Q

Formula feeding for newborns

A

1 oz on the 1st day
2 oz on the 2nd day
3 oz on the 3rd day

157
Q

How long can breast milk be stored for?

A

Refrigerated - 48 hours
Refrigerated freezer - 1 month
Deep freeze - 6 months
Never thaw, then refreeze

158
Q

Why is back-sleeping the preferred sleeping position?

A

Decreased re-breathing of air
Decreased overheating potential
Increased arousal
Less compression of vertebral arteries

Labor/Delivery (2 decks)

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