Test 3 Flashcards
What is local anesthesia used for ?
- Anesthetizes the lower vagina and part of the perineum
- Provides anesthesia for an episiotomy and vaginal birth
- Mother feels pressure.
What does the nurse do during and after an episiotomy?
- promote gradual stretching of perineum during second stage (perineum massage)
- delay pushing until the urge is felt
- push with an open glottis
- observe for hematoma and edema
Name the two techniques for an episiotomy?
- median
- mediolateral
What 2 kind of drugs are given to dcrease the severity of respiratory distress syndrom in the premature neonate?
- Tocolytics
- Corticosteroids
What are the indications for a cesarean birth?
- dystocia
- cephalopelvic disproportion
- HTN
- maternal diseases
- active genital herpes
- fetal distress
- umbilical cord prolapse
- some previous uterine surgical procedures
- persistent non reassuring FHR pattersn
- prolapsed umbilical cord
- fetal malpresentations
- hemorrhagic conditions
Predisposing factors for a Prolapsed of cord
- ROM
- Shoulder and foot presentations
- Prematurity
- Polyhydraminos
- CPD (large head)
- Breach presentation
- Placenta previa
begins 2-3 days after birth and last about 10 days, usually called transitional milk
lactogenesis II
How can a provider determine true membrane rupture?
- Perform a sterile speculum exam to look for a pool of fluid near the cervix
- Ph swab (amniotic fluid is alkali/ urine is acidic)
- Fern test
- Amnisure test (99% accurate)
Because the medication given during an epidural/spinal causes vasodilation, a nurse must watch for
Hypotension
Risks to operative vaginal birth:
- trauma to maternal and fetal tissues
- hematoma of the vagina
- fetus may have bruising, facial nerve injury, clavicular fractures, cephlahematoma
Advantages to non-pharmacologic pain management
- Non systemic
- Doesn’t effect fetus
- Doesn’t effect labor
- ## Non allergy contraindications
infant crying peaks at ____ weeks and decreases at __ months
6 weeks
3 months
What is the effect of the maternal diet on breast milk?
- fatty acid content influenced by maternal diet
- protein, carbs, and mineral content are the same in a malnourished mother
- vitamins levels are affected by maternal intake and stores
- balanced diet important for breastfeeding women.
lactogenesis is defined as:
the composition of breast milk that changes in three phases
Stimulation of the _________ receptors causes uterine and generalized ____________.
- Alpha
- Vasocontriction
When a women is at risk for a preterm birth, when and what medication is given to help the lungs begin to increase surfactant production and speed maturation
- betamethasone is given prior to 34 weeks
What is a major risk for an amniotomy? What are other risks?
MAJOR = prolapsed cord
- Infection
- Abruptio placenta
Peristalsis in newborns is _______
rapid - twice as fast
the ______, in which infants push the tongue out against anything that touches it, continues until about ____.
extrusion reflex
4-6 months of age
Intervention for a spinal headache includes the use of __________ & Tylenol first and then a __________.
- Alot Caffeine
- blood patch
Why are newborns unable to synthesize vitamin K?
- B/c Vitamin K is synthesized in the intestines, but food and normal intestinal flora are necessary for this process. At birth the intestines are sterile and therefore unable to produce vitamin K
The most common cause of jaundice in breastfed infants is _____________.
Insufficient intake
What are the two types of versions?
- external
- internal
what are some newborn screening tests?
- hearing
- phenylketonuria
- hypothyroidism
- galactosemia
- hemoglobinopathies
- congenital adrenal hyperplasia
How does an infant receive IgA ?
- Some from colostrum and breast milk
- Must be produced by infant
Risks factors for preterm birth
More than one fetus
- Hx of preterm birth
- Abnormal uterus or incompetent cervix
Whats the main defining factors between Physiologic Jaundice vs Nonphysiologic Jaundice?
Nonphysiologic jaundice may occur in the first 24 hours while physiologic Jaundice never occurs before 24 hours
what are some indications for an amniotomy?
- induce labor
- augment labor
- allow internal fetal monitoring
How does initially breastfeeding an infant help with the first meconium stools?
colostrum has a laxative property which helps infant pass initial meconium
Initial feedings should be about ____ ml and then increase very slowly
20 - 25ml
When does the foramen ovale’s flap valve close?
- when the pressure in the left atrium is higher than that in the right atrium.
_________ is a chronic inflammation of the scalp or other areas of the skin characterized by yellow, scaly, oily lesions
seborrheic dermatitis
Psychosocial factors that influence labor pain include
- culture
- anxiety and fear
- previous experiences
- preparation for childbirth
- mother’s support system.
What are problems with the Psyche of labor?
- Catecholamines release inhibits contractionscan
Pudendal Anesthesia
Provides pain relief for episiotomy and delivery
breastfed babies may pass a stool ____or, in older infants, _____
- after every feeding
- every 2-3 days
What can be the result of Metabolism of brown fat ?
- Releases fatty acids which can result in metabolic acidosis
- Elevated fatty acids in the blood can interfere with transport of bilirubin to the liver, increasing the risk of jaundice
What are some contraindications for induction of labor?
- placenta previa
- vasa previa
- umbilical cord prolapse
- abnormal fetal presentation
- fetal presenting part above the pelvic inlet
- previous surgery in the upper uterus
How often do you change the pads of a woman who had a PROM ?
Every 2 hours (more frequently if needed)
the mother should be nursing ____ times a day and a formula fed infants should be fed __ a day
8-12 (breastfeeding)
6-8 (formula)
Medications used for preterm labor include?
- terbutaline
- toradol
- mag sulfate
Breastfeeding or Early-Onset Jaundice presents with bilirubin levels greater than ___ mg/dL develops in 13% of breastfed infants by 1 week of age
12
The fetus may shift to _____________ when it does not have enough oxygen available for uptake
Anaerobic Metabolism
what are some indications for induction of labor?
- hostile intrauterine environment
- post-term pregnancy
- SROM
- chorioamnionitis (inflammation of the amniotic sac)
- HTN
- abruptio placentae
- maternal medical conditions that worsen with continuation of the pregnancy
- fetal death
How do thermal factors support the first breath?
Sensors in the skin respond to a sudden change in temperature by sending impulses to the medulla that stimulate the respiratory center and breathing.
Physiologic Jaundice becomes visible when the bilirubin level is greater than
___ mg/dL. and Peaks between the 2nd and 4th day of life.
5
___ is performed when a continued pregnancy may jeopardize the health of the woman or fetus and labor and vaginal birth are considered safe.
induction of labor
Nursing considerations for a c-section?
- provide emotional support
- teach
- promote safety
- provide post-op care (vitals, fundal checks, care of incision, monitor i/o, assessment of bowel sounds)
a ___ is observed during a home visit
feeding session
Second Period of Reactivity
The second period of reactivity lasts 4 to 6 hours. Infants have alert periods, and parents may enjoy the opportunity to get to know their infant at this time. Infants become interested in feeding and may pass meconium.
What is the appropriate oxygen administration for a women with a prolapsed cord?
Face mask at 8 to 10L/min
What is the principal source of bilirubin?
- The hemolysis of erythrocytes.
Goal of pain management?
- Help ease the anxiety in the moment of labor
in the first 3 months, the average infant gains about ____ each day and ___ per month
1oz
2lb
What are problems with the passage of labor?
- Shape of pelvis
- Maternal soft tissue obstructions
Life-threatening complications occurring with general anesthesia
- Failed intubation
- Aspiration
- Malignant hyperthermia
______, or prickly heat, develops in infants who are too warmly dressed in any weather
miliaria
Clamping of the umbilical cord closes which shunt?
- Ductus Venosus
Benefits of Sedatives
- promote sedation and relaxation
- Decrease release of catecholamines
What are the psychological effects of poorly relieved pain?
- affect the mothers interaction with newborn as she is so depleted/tired
- Poor memories of
- Affect her response to sexual activity
What are the effects of excessive catecholamine secretion?
- Reduced blood flow to and from the placenta,
* Reduced effectiveness of uterine contractions, slowing labor progress
Manifestations of hyperthermia
- metabolic rate rises, causing an increased need for oxygen and glucose and possible metabolic acidosis.
- peripheral vasodilation leads to increased insensible fluid losses.
- Tachypnea
what are some indications for an operative vaginal birth?
- shortened second stage of labor
- maternal indications (exhaustion, inability to push effectively, and cardiac and pulmonary disease)
- fetal indications (nonreassuring FHR)
What are three major risks for an amniotomy?
- prolapsed cord
- placental abruption
- infections
what are common infant problems that could interfere with breastfeeding?
- sleepiness
- nipple confusion
- suckling problems
- infant complications such as jaundice, prematurity, illness and congenital defects.
What occurs anatomically in newborns that makes them more prone to regurgitation
Cardiac sphincter is relaxed
What factors that influence perception and tolerance of pain
- Labor intensity
- Cervix that is not ready results in longer labor which leads to lowered level of pain tolerance
- Fetal position such as posterior is more painful
- Pelvic readiness - abnormal pelvis
- Fatigue and Hunger reduce a woman’s ability to tolerate pain
- Interventions by medical personnel
Why can cyanosis be seen in the hands and feet for 1 -2 hours after birth?
- Because the oxygenated blood is shunted to vital organs immediately after birth (heart, lungs, brain)
infants “coo” at ____ and laugh at ________
1-4 months
3-6 months
How often do you monitor vital signs after an epidural is placed?
Every 3 Min
Peristalsis is _________ in newborns especially after the ingestion of _________
humane milk
well-baby check-ups are done____
48hrs-2weeks after discharge from hospital and then 1,2,4,6,9, and 12 months of age
What role do Chemoreceptors play in the First breath?
The chemoreceptors in the carotid arteries and the aorta respond to changes in blood chemistry, partial pressure of oxygen and pH and partial pressure of carbon dioxide all help to stimulate the respiratory center in the medulla
what are the major benefits to circumcision?
- reduces penile cancer
- reduces UTI’s in the first year of life
- reduces HIV infections
- reduces the risk of transmission of other sexually transmitted diseases
How are post term babies affected by poor placental perfusion?
- hyperbilirubinemia
- Meconium (baby is stressed - craps its fluid)
- Decrease in nutrition - decreased fat stores
- decreased amniotic fluid
What is done in preparation for a c-section?
- anesthesia
- medication
- lab studies
- prophylactic antibiotics
- skin prep
- foley catheter
- IV insertion
- trim pubic hair
Steroids (betamethasone) is give to premature fetus less than _____ weeks gestation.
37
Risks for an episiotomy?
- infection
- perineal pain
Management of preterm labor?
Detect early and adminster medications to stop contractions
the ____ should be checked to see if the infant is warm enough
abdomen
What are the hazards of cold stress?
- Increased oxygen need
- Decreased surfactant production
- Respiratory distress
- Hypoglycemia
- Metabolic acidosis
- Jaundice
_____ is given IM to infants right after birth because they cannot synthesize it in the intestines without bacterial flora.
vitamin K
The 2 combined effects of excessive catecholamine secretion are as follows:
- Reduced blood flow to and from the placenta, restricting fetal oxygen supply and waste removal
- Reduced effectiveness of uterine contractions, slowing labor progress
At birth the stomach holds __ml/kg
6ml/kg
When are bowel sounds heard in a newborn?
within the first hour
infants do not need solid food until _______ months of age
4-6
by 12 months infants take ____ naps a day and sleep _____ hours a night
2 naps
10 hours
How long after a woman’s water breaks do providers give them to got into labor without interventions?
12hrs
The goal of __ is to change the fetal position from a breech, shoulder (traverse lie), or oblique presentation
external cephalic version
the normal newborn has little difficulty clearing the airway after the first few hours of life. the expected outcomes are met if:
- the RR is between 30-60 breaths per minute
- the infant shows no signs of respiratory distress
formula fed infants generally pass ______ a day
one stool
What are the risks to induction and augmentation of labor?
- hypertonic uterine activity
- uterine rupture
- maternal water intoxication
- greater risk for chorioamnionitis
- greater risk for cesarean birth
___ change the position of a second twin a vaginal birth
internal version
What are 4 causes of pain in labor in stage 2 ?
- Traction on the stretching of perineum
- Distention of the vagina and perineum
- Compression of the nerve ganglia in cervix and lower uterus
- Pressure on urethra, bladder & rectum during fetus decent
What is the most frequent cause of respiratory difficulty in the first few hours of birth ?
-Use of sedatives, tranquilizers, analgesics and anesthetics
What are some early problems with infants?
- infant crying
- colic
- shaken baby syndrome
- sleep
- concerns of working mothers
- concerns of adoptive parents
Pain is both physiologic and psychological. The Physiological pain can be affected by increased secretion of _____________
Catecholamines
infants also receive a prophylactic eye treatment to prevent ______.
ophthalmia neonatroum
breastfed babies need ___kcal/kg daily and formula fed babies need ____kcal/kg daily
85-100
100-110
What are some contraindications for Version?
- uterine malformation
- previous cesarean
- fetal size >4000g
- cephalopelvic disproportion
- multifetal gestation
- oligohydraminos
- ruptured membranes
- cord around the fetal body
- engagement of the fetal head
- placenta previa
When is the optimum time of discharge?
- usually 24-48 hours after delivery
- based on individuals needs
- follow-up essential with early discharge
- nurses maintain phone contact with family at home
- variety of services available after discharge
Methods of heat loss
- Evaporation
- Conduction
- Convection -
- Radiation
True Breast Milk Jaundice also called late-onset breast milk jaundice, occurs after the first ____- ____ days of life. It lasts 3 weeks to as long as 3 months for some infants.
3 to 5
Commonly infants that are stressed in utero have a _________ lung maturation
increased
The fetus begins to produce surfactant at ___-___ weeks in small amounts and by ___-___ weeks of gestation sufficient Surfactant is produced to prevent respiratory distress syndrome.
- 24-25
- 34 - 36
What type of after care is provided after an amniotomy?
- FHR is assessed for at least one full minute
- quantity, color and odor of amniotic fluid are charted
- the woman’s temp should be assess at least every 2-4 hours after the membranes rupture
- provide comfort
Newborns cannot digest complex carbs & has a hard time with fatsa but can easily digest _______ and ________.
- Simple carbs
- Proteins
Daily intake and output in the newborn AFTER First 3-5 Days of Life
INTAKE:
- 150 to 175 mL/kg (68 to 80 mL/lb)
OUTPUT:
- At least 6 voidings by the fourth day
babies may lose less than ____ of birth weight but should be evaluated after a _____ loss of weight.
10%
7%
Risks to the fetus in a prolonged pregnancy?
- Placental insufficiency
- Reduced amniotic fluid
- Meconium aspiration
- Post date growth retardation
What are some mechanical methods to cervical ripening?
-foley balloon
What is the technique for external version?
- non stress test to evaluate fetal well-being
- determine gestational age beyond 37 weeks
- administer tocolytic drug to relax uterus
- use ultrasound to guide manipulations
- Rho(D) immune globulin (RhoGAM) given if indicated
Priority nursing interventions of a Prolapsed cord?
- Position -
a. Knee-chest position - on her knees and lying on her chest, elevate buttocks
b. Trendelenburg position -
c. Hips elevated with pillows, with side-lying position maintained - Push the presenting fetal part off the cord
- Minimize manual palpation or handling of the cord as much as possible to minimize cord vessel vasospasm.
- Cover wet gauze on the prolapsed cord - Ultrasound examination may be used to confirm presence of fetal heart activity before cesarean delivery.
What occurs when heat is lost through conduction
Placing infants on cold surfaces or toughting them with cool objects.
Placing warm objects on them or skin to skin can warm them
What do you do as a nurse to prepare a patient for version?
- provide information
- promote maternal and fetal health (vitals, women should be NPO at least 4 hours before procedure)
- reduce anxiety
A complication of PROM is Chorioamnionitis which is characterized by Chorioamnionitis, characterized by ___________ & ___________
- maternal fever
- uterine tenderness.
3 Types of prolapsed umbilical cord?
- COMPLETE cord can be seen protruding from the vagina
- An OCCULT (Hidden) prolapse of the cord is one in which the cord slips alongside the fetal head or shoulders.
- FORELYING - The cord cannot be seen but can probably be felt as a pulsating mass during vaginal examination.
What is the kernicterus?
Permanent neurologic injury caused by chronic bilirubin toxicity
how is hep b administered to a newborn whose mother is infected?
- give hep b vaccine
- give hep b immune globulin
- give te globulin within 12 hours of birth
What occurs when heat is lost through radiation
Heat is lost to surrounding coller areas. Or heat from radiant warmer can warm the infant
Technique to operative vaginal birth:
- preparation of woman (empty bladder, cervix completely dilated and membranes ruptured, adequate anesthesia)
- classification of techniques (outlet: fetal head on perineum, Low: leading edge of fetal skull at station +2, mid: leading edge of fetal skull between 0 and +2)
- forceps: locking blades applied to fetal head
- vacuum extraction: cup attached to fetal head and traction applied
Catecholamines act on what two receptors?
- Alpha
- Beta
What are 4 sources of labor pain
- Tissue Ischemia
- Cervical Dilation
- Pressure and pulling on pelvic structures
- Distention of Vagina and Perineum
If you have a mom with a history of drug addiction, she is on heroin or she is on a drug treatment program such as methadone, what drugs should be avoided?
Stadol
Nubain
Labor _______ a woman’s metabolic rate and her demand for __________.
- increases
- oxygen
what are primary ways nurses protect newborns:
- ensuring that infants always go to the correct parents
- taking precautions to prevent infant abductions
- preventing infections or recognizing early signs
- preventing infant falls
Describe a breastfed infant stool vs a formula fed infant stool
BREAST FED- Stools are seedy and mustard colored and have a sweet-sour smell. Mor
FORMULA - Pale yellow to light brown, firmer consistency
Fetal Complications of a prolapsed cord
- Prematurity
- Complications resulting from hypoxia
- Fetal death
First period of reactivity
- first period of reactivity begins at birth and lasts for 30 minutes.
- Infants are active at this time and appear wide awake, alert, and interested in their surroundings.
What immunoglobulin crosses the placenta and provides temporary immunity?
IgG
This brown fat is mainly accumulated in the third __________ , thus infants that are born prematurely have less brown fat and are unable to keep themselves warm.
trimester
Initiation of respirations includes what four factors?
- Chemical Factors
- Mechanical Factors
- Thermal Factors
- Sensory Factors
What occurs when heat is lost through convection
Transfer of heat to cooler surrounding air. *Keep them in a draft free area
________ is a general term that describes any difficult labor or birth.
Dystocia
Possible causes of ineffective contractions include the following:
- Early or excessive use of analgesia
- Overdistention of the uterus _ (polyhydramnios, twins etc)
- Excessive cervical rigidity
- Grand multiparity
- Mild pelvic contraction
- Postmature and large infants - CPD
Because an infant is less effective to fighting infection due to their immature immune system, typical responses such as fever is sometimes not present. Only subtle signs such as _________, ____________, ___________ may be the only signs of sepsis. .
- change in color,
- tone
- feeding
What are problems with the powers of labor?
- Ineffective Contractions (hypotonic/hypertonic)
- Ineffective maternal pushing
What are some medical methods to cervical ripening?
- prostaglandin
- cervidal
- cytotec
How should an infant be dressed to maintain proper thermoregulation
Dressed in an outfit with one more layer
How do pain and anxiety affect a woman’s already high metabolic rate.
Increase
a common practice is to feed the newborn if the glucose screening shows __ or less to prevent further depletion of glucose.
40-45 mg/dl
What is a precipitate labor and what is a precipitate birth?
Precipitate labor - birth occurs within 3 hrs of its onset
Precipitate birth - Occurs after a labor of any length, when a trained attendant is not present to assist
How can mag given to a mother in preterm labor help the fetus after birth?
improve neurological outcomes of premature fetus
___________ acidosis and does not resolve as quickly after birth as __________ acidosis, which results from shorter periods of ___________.
- Metabolic
- Respiratory
- hypoxia
what are common signs of illness in infants:
- axillary temp above 100.4F
- vomiting all of a feeding more than once or twice in a day
- watery stools or a significant increase in the number of stools
- blister, sores, or rashes that are unusual
- unusual changes in behavior
- coughing, frequent sneezing, runny nose
- pulling or rubbing at the ear, drainage from the ear
Why must bilirubin go through the conjugation process?
Unconjugated bilirubin, also called indirect bilirubin, is soluble in fat but not in water. Before excretion can occur, the liver must change it to a water-soluble form by a process called conjugation.
the normal axillary temperature range for newborns is ____
between 97.7 - 99.5
When hemolysis of RBC’s occur, bilirubin is released in an ________ form.
unconjugated
for newborns to qualify for early discharge they must:
- be appropriate for gestational age
- VS wnl
- feeding successfully
- making transition from fetal to neonatal life
- passed urine and stool
- mother able to care for infant
what does the nurse during and after an operative vaginal birth?
- observe mother for trauma (bright red bleeding with firm fundus)
- observe neonate for trauma after birth (facial asymmetry)
What are the 3 shunts in the fetal cardiovascular system and what do they do?
- Ductus Venosus- Directs blood away from liver to inferior vena cava
- Foramen Ovale - a flap valve in the septum between the right and left atria of the fetal heart. As blood flows into the right atrium, 50% to 60% crosses the foramen ovale to the left atrium
- Ductus Arteriosus - Connects the pulmonary artery and the descendin aorta
name fetal risk associated with a C-section?
- lung immaturity
- inadvertent preterm birth
- transient tachypnea
- persistent pulmonary HTN of the newborn
- traumatic injury
What is Non shivering thermogenesis?
Metabolism of brown fat to produce heat
what are the artificial methods to stimulate uterine contractions?
induction and augmentation
What is malignant hyperthermia?
Condition that causes sustained muscle contractions in the presence of certain anesthetic agents?
Four causes of initial respiration of a new born?
Chemical Factors
Mechanical Factors
Thermal Factors
Sensory Factors
Factors influencing perception or tolerance of pain?
- labor intensity
- Cervical readiness
- Fetal Position
- Pelvic readiness
- Fatigue & hunger
- Caregiver interventions
beings 10 days after birth and called mature milk
lactogenesis III
A mother who is going to receive an epidural should receive a bolus of _______ ml normal saline prior to the procedure to prevent hypotension
1000
How is Pudendal Anesthesia administered?
transvaginally
What is a Premature Rupture of Membranes?
When a woman’s water breaks before the start of labor
The intestines are long in proportion to infants size thus there is more surface space for absorption making infants more prone to ________
Rapid water loss with diarrhea
What are contraindications to a C-section?
- fetal death
- immature fetus
- maternal coagulation defects
Why can terbutaline be used during a cord prolapse?
to stop or slow the contractions and stop pushing the head down on the cord
Advantages of pharmacological Interventions
- Increases women’s ability to cope
- Medication may be administered by the nurse
The _______ test is more diagnostic of true rupture of membranes because it is less likely to be affected by vaginal infections, recent intercourse, or other factors.
fern
Factors that increase risk for increased bilirubin?
- Excess production
- Red blood cell life
- Liver immaturity
- Intestinal factors
- Delayed feeding
- Trauma can result in increased hemolysis of
red blood cells. - Fatty acids are released when brown fat is used
Medicine used to counteract hypotension
Ephedrine
Complications associated with Epidural and Spinal Anesthesia
- Hypotension
- Maternal fever
- Shivering
- Pruritus
- Inadvertent injection into the blood stream
- Spinal headache
- Fetal distress
Stimulation of the ______ receptors relaxes the uterine muscle and cause __________
- Beta
- Vasodilation
What are 3 causes of pain in labor in stage 1?
- Stretching of the cervix
- Uterine Anoxia - Tissue ischemia
- Stretching of the uterine ligaments
infants should be placed _____ for sleeping
on their backs
Infants have brown fat primarily located
- around the back of the neck
- axillae
- around the heart, kidneys and adrenals,
- between the scapullae
- along the abdominal aorta.
- Around the sternum
What are the 3 shunts in the fetal cardiovascular system and what do they do?
- Ductus Venosus- Directs blood away from liver to inferior vena cava
- Foramen Ovale - a flap valve in the septum between the right and left atria of the fetal heart. As blood flows into the right atrium, 50% to 60% crosses the foramen ovale to the left atrium
- Ductus Arteriosus - Connects the pulmonary artery and the descending aorta
How does an increase in metabolic rate affect the fetus?
- significantly alter placental exchange causing less oxygen to be available for the fetus
A spinal anesthesia is typically given for a ___________ birth
Cesarean
Name the type of incisions used for a c-section?
- low transverse (can have VBAC)
- low vertical
- classical (not likely to have VBAC)
What are problems with the passenger of labor?
- fetal size
- presentation or position
- multifetal pregnancy
- fetal anomalies
What are techniques to induction and augmentation of labor?
- cervical ripening
- oxytocin administration
- serial induction of labor
Daily intake and output in the newborn for the First 3-5 Days of Life
INTAKE
- 60 to 100 mL/kg (27 to 45 mL/lb)
OUTTAKE
- At least 1 to 2 voidings
What are some risks to version?
- few risks are present and few serious risk to fetus
- fetus may become entangled in the umbilical cord
- abruptio placentae may occur
- mixing of fetal and maternal blood
infants sleep ___ hours a day
16-17
what is an amniotomy?
artificial rupture of amniotic sac
What changes in blood flow occurs after the umbilical cord is clamped and the newborn takes its first breath?
- increase blood flow to the liver and lungs
- Decrease blood flow through the shunts
each month infants grow__ and have a head circumference of __
- 4”
0. 8”
Sedatives are given to …
- promote sedation and relaxation
labor is ____ induced if term gestation, fetal lung maturity, or both are not established unless a compelling reason exists
not
How does chest compression in the narrow birth canal support the first breath?
- Helps force fluid out of the lungs into the upper air passages during birth.
- When the pressure against the chest is released at birth, recoil of the chest draws a small amount of air into the lungs and helps remove some of the viscous fluid in the airways.
- This reduces the amount of negative pressure needed for the first breath after birth
Contraindications for performing a Version
- Uterine malformations
- Previous cesarean
- Fetal size ≥4000 g
- Cephalopelvic disproportion
- Multifetal gestation
- Oligohydramnios
what are the infection-promoting benefits of breast milk?
- promotes growth of intestinal flora
- protects against common intestinal pathogens
- leukocytes
- immunoglobulins high in colostrum
If preterm birth is suspected, the mother is given _________ to help the baby breath after birth at least ______ before birth.
- Steroids (betamethasone)
- 48 hrs
When the water bag breaks before
___ weeks of pregnancy and labor has not started, it is considered a Preterm Premature Rupture of Membranes (PPROM)
37
generally, the newborn’s temperature & respiratory rate are assessed every ____ until it has been stable for 2 hours.
30 mins
transient strabismus is normal the first __ months of life
2-3
______________ is a transient hyperbilirubinemia (excess bilirubin in the blood) and is considered normal.
Physiologic Jaundice
what are some interventions for bilirubin?
- identify infants at risk for hyperbilirubinemia
- explain the importance of adequate feedings
- explain the significance of skin color changes
- continue to monitor during home or clinic visits.
common breastfeeding maternal concerns:
- breast problems
- illness in mother
- medications
- breast surgery
- employment
- milk expression
- storing milk
- multiple births
- weaning
- home care
Excessive pain can heighten a woman’s fear and anxiety, which stimulates an increased secretion of ___________________.
Catecholamines
Management of PROM at 37 weeks gestation or greater focuses on ________
Delivery
Disdvantages of pharmacological Interventions
- Side affects - itching, vomiting, pruritus, drowsiness, and neonatal depression
- Pain is not eliminated completely
- The fetus can be effected by medicatiosn
name maternal risks associated with a C-section?
- infection
- hemorrhage
- urinary tract infection or trauma
- thrombophlebits
- paralytic ileus
- atelectasis
- anesthesia complications
_______________ may give a reddish color to the urine that is sometimes mistaken for blood.
Uric acid crystals
Home visits are usually schedule _____ after discharge
24-72 hrs
Where is bilirubin excreted and how is it eliminated?
- Duodenum
- Stool
The babies temp should be maintained at ____F or ____ - ___ C
98.6 F 36.4 -37.2C
Definition of Preterm labor includes what 4 manifestations?
- 20 to 37 weeks of pregnancy
- Uterine contractions
- 8-% thinning of the cervix
- Cervical dilation > 1cm
The first meconium stool is usually passed within ___hours of life, and 99% of neonates pass meconium within 48 hours
12
If the mother has diabetes, how will the infants lungs be affected?
- slower lung maturation
Adverse effects of Epidural block
- Maternal hypotension
- Bladder distention
- Catheter migration
- Cesarean Birth
Maternal Complications of a prolapsed cord
- infection
- Risk for increased blood loss from emergency delivery
- Fear and anxiety
car safety seat considerations:
- current recommendation is that rear-facing seats be used for infants until they are 2 years of age or have reached the highest weight or height allowed by the car seat manufacturer
- shoulder straps should be at lowest position
- restraint clip should be placed at mid-chest
- seats should be tightly secured in car
What are the things you would do as a nurse for an amniotomy?
- obtain baseline fetal heart rate (20-30 mins before procedure)
- assist with the amniotomy (place absorbent pads under buttocks)
- provide after care
the infants should have ____ wet diapers by the fourth day of life
6
begins during pregnancy and continues during the early days after giving birth, contains colostrum.
lactogenesis I
Oxytocin Administration:
- dilute in isotonic solution
- secondary (piggyback) infusion
- insert oxytocin into the primary IV line
- start slowly, increase gradually
- monitor uterine activity, FHR, and fetal heart patterns frequently
What is the first immunoglobulin produced when exposed to infection?
IgM
Induction and Augmentation of Labor: Indications
- Hostile intrauterine environment
- Spontaneous rupture of the membranes (SROM)
- Post-term pregnancy
- Chorioamnionitis (inflammation of the amniotic sac)
- Hypertension
- Abruptio placentae
- Maternal medical conditions that worsen with continuation of the pregnancy
- Fetal death
colic is irritable crying for no reason lasting about ___ hours a day, __ days a week, and for ____ weeks.
3,3,3
The fetus shifts to _____________ when it does not have enough oxygen available for uptake
Anaerobic Metabolism
Nursing considerations for induction and augmentation of labor:
- observe the woman and fetus for complication and takes corrective actions if abnormalities are noted
- observe fetal response
- observe the mothers response
What are some indications for an episiotomy?
- shoulder dystocia
- vacuum or forceps-assisted births
- face presentation
- preterm fetus
What occurs when heat is lost through evaporation
Air drying of the skin that results in cooling. Water loss from skin and respiratory tract increases heat loss.
What are ongoing assessments and care of a newborn?
- assess every 8 hours
- provide skin care
- bathing
- cord care
- cleansing the diaper area
- feedings
- positioning
- protecting the infant
Treatment approaches for preterm labor include?
- bedrest
- hydration
- Medications
The liver is responsible for what functions?
- Blood glucose maintenance
- Conjugation of Bilirubin
- Factors produced to help with blood clotting
- Storage of iron
- Metabolism of drugs
In the term infant, glucose levels should be ___-___ mg/dL on the first day and ____ - ____ mg/dL thereafter
- 40 to 60
- 50 to 90
Why are post term babies at risk for hyperbilirubinemia ?
When baby becomes hypoxic, it makes more RBC to hold on to more oxygen. When these extra rbc are broken down, bilirubin is a byproduct which can accumulate
A person with a spinal headache severe head pain in what position?
- Sitting up
assess for jaundice every _____ hours along with vital signs
8-12
What shot is given to newborns in order to help activate several clotting factors thus preventing hemorrhagic disease?
- Vitamin K
Saliva production is limited until ___ month
3rd
what are the hormonal changes at birth in relation to breast milk production?
- prolactin is secreted after the delivery of the placenta and it activates milk production
- oxytocin increases in response to nipple stimulation
How does a new born crying affect the respiratory process?
As the infant cries, pressure within the lungs increases, causing remaining fetal lung fluid to move into the interstitial spaces, where it is absorbed by the pulmonary circulatory and lymphatic systems.
a social smile begins___
1-3 months
Risk factors associated with PPROM?
- Infection
- Previous
- Polyhydramnios
- Incompetent cervix
- Multiple gestation
- Abruptio placentae
by 12 weeks infants sleep ___ a night
5 hours
