TEST 4 Flashcards
Sepsis Neonatorum - EARLY-ONSET SEPSIS
- acquired during birth, often from complications of labor such as prolonged rupture of membranes, prolonged labor, or chorioamnionitis.
- Infants often show signs during the first hours after birth, and 90% show signs within 24 hours
- Rapidly progressive multisystem illness with high mortality and morbidity rates.
- Pneumonia and meningitis are commonly present
Regarding SGA infants, ________ growth restrictions involve the whole body
Symmetric
Symmetric growth restrictions may be caused by what 5 things?
- congenital anomalies
- genetic disorders
- exposure to infections
- drugs early in pregnancy
- normal genetic predisposition.
Measurements of the head, chest, length, and weight are _____________ in the infant with symmetric growth restriction.
below normal.
Sepsis Neonatorum - LATE-ONSET SEPSIS
90 days after birth in healthy term infants or after 72 hours of life in very-low-birth-weight infants
- It is acquired during or after birth, before or after hospital discharge. It usually is a localized infection such as meningitis, and serious long-term effects are common.
SEPSIS NEONATORUM
- Infection that occurs during or after birth may result in sepsis neonatorum, a systemic infection from bacteria in the bloodstream.
- COMMON CAUSES - agents of neonatal sepsis include bacteria such as GBS, Escherichia coli, coagulase-negative Staphylococcus, Staphylococcus aureus, Haemophilus influenzae, and fungi such as Candida albicans
- Infection. In the newborn, early signs of infection are not as specific or obvious as those in the older infant or child. Instead, they tend to be subtle and could indicate other conditions.
Characteristics of Preterm Infants - APPEARANCE
- frail and weak, with decreased muscle tone/flexion - Their extremities are limp and offer little or no resistance when moved.
- Typically lie in an extended position
- The infant’s head is large in comparison with the rest of the body.
- Preterm infants lack subcutaneous or white fat, which makes their thin skin appear red and translucent, with blood vessels being clearly visible.
- The nipples and areola may be barely perceptible,
- vernix caseosa and lanugo may be abundant.
- Plantar creases are absent in infants of less than 32 weeks of gestation
- The pinnae of the ears are flat and soft and contain little cartilage, lack the rolled-over appearance of the pinnae of a full-term infant.
- In the female infant, the clitoris and labia minora appear large and are not covered by the small, separated labia majora.
- The male infant may have undescended testes, with a small, smooth scrotal sac
Danger signs that women need to seek emergency care POST BIRTH
Pain in chest
Obstructive Breathing
Seizures
Thoughts of hurting yourself or baby
Bleeding Incision that's not healing Red or swollen leg that is painful & warm to the touch Temp over 104 Headache that does not get better
Signs & Symptoms to watch Postpartum
Excessive bright red bleeding
- Boggy fundus deviated to the right
- Difficult to locate the fundus
- Fundus above expected level
- Large clots
- Backache
- Elevated Temp, Pulse, Resp; low B/P
- If hematoma; perineal pain
Patient teaching regarding HEMORRHAGE
- Void 1-2 hrs after delivery
- Fundal massage
- teach patient
- Encourage breastfeeding
- Patient teaching report clots/excessive bleeding
Postpartum Hemorrhage interventions
CALL FOR HELP
- Monitor Fundus
- Monitor bleeding - weigh pads etc
- Check Uterine Tone
- Measure blood loss - 1 gram = 1ml
- A drop of 1 gram in Hgb or 3% drop in Hct is = 500 ml of blood loss
Medications used for Hemorrhage
- Oxytocin 10-40 units (10 units im if not IV access)
- Cytotec (misoprostol) PO, Rectally- 800mcg, Vaginally
- Methergine - 0.2mg IM, IV, or PO
- Prostin (Hemabate) IM 250mcg - Diarrhea, elevated diastolic fever flushing, (DON’T GIVE IF PT HAS ASTHMA)
- Action-prostaglandin to control bleeding after delivery. Side effects-headache, nausea/vomiting, and diarrhea. Note-often given with Lomotil. Don’t give with history of asthma
Interventions for Hemorrhage
- D&C - dilation and curettage (stretching of the cervical os to permit suctioning or scraping of the walls of the uterus)
- Manual removal of placenta
- Bakri Balloon - A balloon may be inserted into the uterus to apply pressure against the uterine surface to stop bleeding
- Hysterectomy is a last resort to save the life of a woman with uncontrollable postpartum hemorrhage.
Asymmetric growth restriction is caused by complications such as preeclampsia that begin in the ____ Trimester and interfere with uteroplacental function
3rd
Physical characteristics of an SGA infant with Asymmetric growth restrictions
- Normal head size but seems large for the rest of the body
- Normal brain growth and heart size
- Normal Length
- Weight is below the 10th percentile
- Abdominal circumference is decreased because the liver, spleen, and adrenals are smaller than normal
An SGA infant with Asymmetric growth restriction appears ………
- The infant appears long, thin, and wasted.
- The dry, loose skin has longitudinal thigh creases from loss of subcutaneous fat.
- sunken abdomen, sparse hair, a thin cord, and the facial appearance of being elderly.
- The anterior fontanel may be large with wide or overlapping cranial sutures
How do SGA infants with Asymmetric growth continue to develop?
- They generally “catch up” in growth, particularly in the first 2 years, if they are adequately nourished after birth.
Risk factors in the immediate post-partum in women related to heart disease
- The fourth stage of labor is associated with special risks.
- To minimize the risks of overloading the heart, abrupt positional changes should be avoided.
- The uterus should not be massaged to expedite separation of the placenta.
- Careful assessment for signs of circulatory overload, such as a bounding pulse, distended neck and peripheral veins, and moist rales in the lungs, is performed throughout labor and the postpartum period.
Although no evidence of distress during pregnancy, labor, and childbirth, women may have cardiac decompensation during the postpartum period due to …….
- After delivery of the placenta, about 500 mL of blood is returned to the intravascular volume. Blood from the placenta and uterus increases the workload on the heart.
What conditions can act together to precipitate postpartum heart failure.
- infection, hemorrhage, and thromboembolism
Signs and symptoms of postpartum congestive heart failure include:
- Cough (frequent, productive, hemoptysis)
- Progressive dyspnea with exertion
- Orthopnea
- Pitting edema of legs and feet or generalized edema of face, hands, or sacral area
- Heart palpitations
- Progressive fatigue or syncope with exertion
- Moist rales in lower lobes, indicating pulmonary edema
Early-onset newborn GBS disease occurs during the first week after birth, often within 48 hours. What are the primary infections in early onset GBS disease?
-Sepsis, pneumonia, and meningitis
Late-onset GBS disease occurs after the first week of life, and _________ is the most common clinical manifestation.
meningitis
Regarding Late-onset GBS, what patients are neurologic consequences are more likely in
- infants who survive meningeal infections
Optimal identification of the GBS carrier status is obtained by vaginal and rectal culture between _________ weeks of gestation.
- 35 and 37 weeks (BONNIE SAYS 34 - 36)
Maternal THERAPEUTIC MANAGEMENT of GBS includes
- Penicillin is the first-line agent for antibiotic treatment of the infected woman during birth.
- Cephazolin is the alternative for the patient with non–life-threatening penicillin allergy.
- Clindamycin is used for the woman at high risk for anaphylaxis.
NAS Neonatal Abstinence Syndrome
a disorder in which infants exposed to maternal drugs before birth demonstrate signs of drug withdrawal.
Fetal diagnostic tests such as _______, _____ & ______ help identify problems.
- ultrasonography
- nonstress tests
- biophysical profiles
In addition to toxicology screening, a pregnant woman who uses illicit drugs must be assessed throughout pregnancy for ____, _______ , & ________.
- STDs
- hepatitis,
- exposure to HIV.
Define Puerperal infection
- a term used to describe bacterial infections after childbirth.
The most common postpartum infections are
- endometritis (an infection of the inner lining of the uterus)
- wound infections
- urinary tract infections
- mastitis (infection of the breast)
- septic pelvic thrombophlebitis.
What risk factors can contribute to postpartum infections
- lacerations
- Hxt of previous infections
- C-section
- Trauma
- Prolonged rupture of membranes
- Prolonged labor
- Catherization
- Excessive vaginal exams
- Hemorrahage
- Poor general health, nutrition and or hygiene
Deontologic Model.
- The deontologic model determines what is right by applying ethical principles and moral rules.
- does not vary the solution according to individual situations.
***example is the rule, “Life must be maintained at all costs and in all circumstances.” Strictly used, the deontologic model would not consider the quality of life or weigh the use of scarce resources against the likelihood that the life maintained would be near-normal.
Utilitarian Model
- The utilitarian model approaches ethical dilemmas by analyzing the benefits and burdens of any course of action to find one that will result in the greatest amount of good.
- Appropriate actions may vary with the situation when using the utilitarian model.
- concerned more with the consequences of actions than the actions themselves.
- **“The end justifies the means.” If the outcome is positive, the method of arriving at that outcome is less important.
Human Rights Model.
- The belief that each person has human rights is the basis for the human rights model to making ethical decisions.
- The nurse may find personal difficulty in the right of a person to refuse care that the nurse and possibly other care providers believe is best.
- A nurse’s goal is usually to save lives but what if the person’s life is intolerable or care is refused?
Risks and complications of post term infants
- Placental insufficiency
- Some grow to more than 8 lbs placing them at risk for birth injuries or cesarean birth
- decreased amniotic fluid volume (oligohydramnios) due to placental insufficiency
- compression of the umbilical cord may occur.
- When labor begins, poor oxygen reserves may cause fetal compromise.
- fetus may pass meconium as a result of hypoxia before or during labor, increasing the risk of meconium aspiration at delivery
Nursing management for post term infants
- infant is large, the nurse should observe for injury and hypoglycemia.
- The infant with postmaturity syndrome may have an apprehensive look associated with hypoxia
- In cases of asphyxia or meconium aspiration, respiratory support is needed at birth
Lochia Rubia
first 1-3 days after birth
red, mucus, small clots
lochia serosa
days 4-10 after birth
pink-brown, serosanguinous
lochia abla
1-3 weeks
yellow-white, or colorless
nursing considerations critical to remember for lochia post partum
- lochia should be decreasing in amount every day
- it increases in amount or becomes more bright red, a women should rest more
- if a woman increases her bleeding to where it soaks a pad in one hour, even if she is 1day or 4 weeks pp, this needs to be evaluated immediately (could be sign of retained placenta/amniotic sac)
Post partum changes - Cervix and Vagina
- immediately after childbirth the cervix is dilated, edematous and bruised
- by the end of the first week the external os is 1cm in diameter
- the shape of the os is permanently changed
- the vagina and introitus are greatly stretched during childbirht
- the vaginal walls appear edematous and multiple small lacerations may be present, with very few vaginal rugae.
- rugae begin to reappear by 3-4 weeks
- vaginal mucosa becomes atrophic until estrogen production by the ovaries is reestablished
- women may experience dyspareunia
Post partum changes - gastrointestinal
- Constipation is a common problem
- -Bowel tone, motility, pain - Listen for bowel sounds- post cesarean
- -Paralytic ileus
- -Distention - Early ambulation
- High fiber, lots of fluids
- Stool softeners and minimize narcotics
- Abdominal tightening
Post partum changes - urinary system
- Diuresis
- -Up to 3000ml days 2-5 - Uti
- -Due to trauma from birth, catheters, overdistention - Distention
- -Increase in bleeding
- Urinary retention
- -First vaginal delivery
- -Regional anesthesia
- Stress incontinence
- -Resolves with pelvic floor exercises- Kegels
Post partum changes - musculoskeletal
- Muscle fatigue and joint pain 1-2 days or more after birth.
- Relaxin hormone gradually subsides and joint and cartilage of the pelvis begin to return to prepregnancy positions
-Abdominal wall stretches during pregnancy
–Diastasis recti- may be minimal or extensive
With exercise can return to normal by 6 weeks after birth.
Post partum changes - integuementary
- Gradually changes to the non pregnant state.
- -Melasma “mask of pregnancy”
- -Linea nigra
- -Spider nevi and Palmar Erythema - However Stretch marks only fade
- -Striae gravidarum fade to silvery lines but do not disappear.
Post partum changes - endocrine
-Ovulation and Menstruation
–Ovulation can occur before the first menses.
Sometimes as early as 3 weeks postpartum.
–40%-45% of non nursing mothers resume menstruation within 6 to 8 weeks.
–75% by 12 weeks and all by 6 months.
–Breastfeeding delays the return of menstruation
–If breastfeeding frequently and not using supplements, contraception should be used by 6 months.
when should you do assessments for the post partum patient?
- q 15 min for first hour
- q 30 mins for 2nd hour
- q 4 hours for the first 24 hours
- q 8-12 hours depending on policy and status
Vitals signs after birth of baby - temperature
- may be slightly elevated
- if greater than 100.4 could be sign of infection
Vitals signs after birth of baby - pulse
bradycardia
tachycardia
-could be due to hemorrhage, pain, fatigues, excitement, dehydration, infection
Vitals signs after birth of baby - respirations and BP
-Should be back to normal
- Hypoventilation….
- -Possible as a result of spinal or epidural - BP
- -Varies with maternal position
what is the purpose of critical thinking?
to help nurses make the best clinical judgements
what are the steps to critical thinking?
- recognizing assumptions
- examining biases
- determining the need for closure
- becoming skillful in data management
- acknowledging emotions and environmental factors
Acronym for assessment:
BUBBLE HEP
breasts uterus bowels bladder lochia episiotomy
homan’s
emotions
pain
Acronym for assessment of incisions:
REEDA
redness edema ecchymosis discharge, drainage approximation
Chart Review:
Gravida, Para
Time and type of delivery
Presence and degree of episiotomy/ laceration
Anesthesia, any medications administered
-Medications in the OR and time given
Significant medical/ surgical history
Current medications
Food and drug allergies
Chosen method of infant feeding
Condition of the baby
Laboratory data
Need for Rho (D) immune globulin (RhoGAM)
Need for Rubella, TdAP
Risk for hemorrhage, infection
Vital signs
Skin color
Location and firmness of the fundus
Amount and color of lochia
Perineum- epis, laceration, hemorrhoids
Pain- present? Level of? Location?
IV- Type of fluid, rate of administration and any additives
- Patency of the line
- Condition of the IV site- redness, edema, pain
Urinary output-
- Time and amount of last void
- Presence of catheter
Abdominal incision
-Dressing type, drainage
If anesthesia used, level of feeling and ability to move.
Nursing management post term infants
- Assess for Hypoglycemia (b/c rapid use of glycogen stores)
- Temp - loss of subcutaneous fat can put infant at risk for low temp
- Apgar scores less than 7 are more likely
- Respiratory support incase meconium aspiration
Signs of Dehydration in the Newborn
- Urine output less than 1 mL/kg/hr
- Urine specific gravity greater than 1.01
- Weight loss greater than expected
- Dry skin and mucous membranes
- Sunken anterior fontanel
- Poor tissue turgor
- Blood: elevated sodium, protein, and hematocrit levels
- Hypotension
Why do Preterm infants need higher intakes of sodium ?
because the kidneys do not reabsorb it well.
What happens if a preterm infant receives too much sodium?
- they may be unable to increase sodium excretion adequately and are susceptible to sodium and water overload.
Signs of Overhydration in the Newborn
- Urine output >3 mL/kg/hr
- Urine specific gravity <1.002 Edema Weight gain greater than expected
- Bulging fontanels Blood: decreased sodium, protein, and hematocrit levels
- Moist breath sounds Difficulty breathing
Symptoms of Subinvolution
- Prolonged discharge of lochia
- Irregular or excessive uterine bleeding
- Profuse hemorrhage possible
- Pelvic pain or feelings of pelvic heaviness
- Persistent malaise, fatigue, backache
What medication is used to treat subinvolution and what does it do?
Methergine to provide sustained uterine contraction
Nursing considerations regarding Subinvolution?
- Tech mothers signs to look for and when to be seen
- Foul odor, increase in heavy bleeding or clots
- Soaking a pad in an hour
- Pelvic pain, malaise, fever
What are risks factors for Subinvolution?
- Grandmultiparus
- Chorioamnionitis
- Retained placental fragments/ amniotic sac
- Polyhydraminos in pregnancy
- Multifetal pregnancy
Treatment for Subinvolution?
- Methergine or cytotec - You want a sustained uterine contraction
- Antimicrobial therapy
The nurse knows what medications and vaccinations can be given postpartum
- Rho D
- Rubella ? Unsure
- Pertussis
- Varicella
What are the 3 puerperal phases?
- taking-in
- taking-hold
- letting-go
What is occurring during the taking-in phase?
- Mother is focused primarily on her own need for fluid, food, and sleep.
- Recaps her birthing experience a lot on the telephone, w/ visitors, social media etc
What is occurring during the taking-hold phase?
- Becoming concerned about managing her own self and responsibility for caring for her baby
- Shifting attention to the baby
- Compares her baby to other babies
- Very teachable at this time
- NURSES SHOULD NOT ASSUME THE MOTHERING ROLE
What is occurring during the letting-go phase?
- Parents relinquish their previous life without children
- Relinquish their fantasy and accept reality (Grieving time)
- Mood changes
- Refocus their relationship with their partners
- Putting children in childcare
Potential complications of a preterm infant
- Respiration
- Thermoregulation
- Hypoglycemia -
- Hyperbilirubinemia
- Feeding difficulties
- Fluid and Electrolyte Balance
- Skin
- Infection
- Nutrition
- Pain
Potential complications of a preterm infant - Skin
Fragile, permeable & easily damaged. Increased exposure to infection from things being taped to skin. Diaper rashes, yeast infections, cradle cap
Potential complications of a preterm infant - Infection - Infection
3-10 times more at risk for infection, sepsis is prevalent, lack adequate passive immunity of IgG from the mother during 3rd trimester, immature immune response
Potential complications of a preterm infant - Pain
Painful procedures, effects of pain can increase intracranial pressure which can increase the risk of intraventricular hemorrhage, stress response can lead to hypoxia, changes in metabolic rate and adverse effects on growth and wound healing
Potential complications of a preterm infant - Nutrition
- Stomachs hold a lot less and they are not able to absorb fats as well. Need more calories to improve growth. Increased risk for hypoglycemia. Decreased ability to suck, swallow and breath, More energy, oxygen, and glucose are used during feedings
Potential complications of a preterm infant - Respiration
Immature lungs, poor cough reflex, narrow respiratory passages, prone to apneic spells
Potential complications of a preterm infant - Thermoregulation
- Heat loss is rapid due to thin skin, little subcutaneous fat, Temp control in brain is immature, calories used for heat production are not available for growth and weight gain
Potential complications of a preterm infant - Fluid and Electrolyte Balance
At risk for fluid loss due to tachypnea, thin skin, use of radiant warmers, immature kidneys
Characteristics of a Post-term baby
- LGA or SGA depending on the efficiency of the placenta
- apprehensive look associated with hypoxia
- Thin w/ loose skin & little subcutaneous fat
- Abundance of hair on head
- Long nails
- Skin can be wrinkled, cracked and peeling w/ little to no vernix
- Nails may be stained yellow green
- Umbilical cord is thin with little Wharton’s jelly
If a post-term infant is large the nurse should assess for _______ and __________.
- Injury
- Hypoglycemia - because of rapid use of glycogen stores
Potential effects of placental insufficiency in a Post-term baby?
- Oligohydramnios and cord compression
- Hypoxia and malnutrition leading to small for gestational age (postmaturity syndrome)
- fetus may pass meconium as a result of hypoxia before or during labor, increasing the risk of meconium aspiration at delivery
Meconium Aspiration occurs most often when ……
Hypoxia causes increased peristalsis of the intestines and relaxation of the anal sphincter before or during labor
Complications related to meconium include
- Obstruction of the airways may be complete or partial
- Atelectasis may result if small airways are completely obstructed
- meconium is irritating to lung tissue and causes an inflammatory reaction and chemical pneumonitis.
- lung injury promotes the growth of bacteria.
a late preterm infant is defined as ____
infants born between 34 0/7 and 36 6/7 weeks gestation
a preterm infants is defined as __
born before the beginning of the 38th week of gestation
SGA is defined as __
those infants who fall below the tenth percentile in size on growth charts
LGA is defined as _
infants who are above the 90th percentile for gestational age on intrauterine growth charts
What are some signs that may be expected in infections of pp women?
- fever
- tachycardia
- pain
- unusual amount, color, or odor or lochia
- examine wounds for redness, edema, tenderness, discharge or pulling apart of incisions
risk factors for postpartum depression
- depression during pregnancy or previous PPD
- first pregnancy
- hormonal fluctuation that follow childbirth
- medical problems during pregnancy
- personal or family hx of depression, mental illness, or alcoholism
- marital dysfunction
- anger about pregnancy
- single status
- young maternal age
- feelings of isolation
- fatigue
- financial worries
- child care stress
- multifetal pregnancy
- chronic factors
- unwanted or unplanned pregnancy
symptoms of postpartum affective disorders:
- apathy
- lack of interest or energy
- anorexia
- sleeplessness
- verbalizations of failure, sadness, loneliness, anxiety, vague confusion
in postpartum affective disorders nurses must assess for ___
- cryings
- sleeplessness
- poor personal hygiene
- inability to follow directions or concentrate
nursing interventions for pp affective disorders_
- providing anticipatory guidance
- demonstrating caring
- helping the mother verbalize feelings
- enhancing sensitivity to infant cues
- helping family members
- providing help
- discussing options and resources
name some measures taken to prevent mastitis:
- positioning infant correctly and avoiding nipple trauma and milk stasis
- mother should breastfeed every 2-3 hours
- avoid continuous pressure on breasts from tight bras or infant carriers.
A post term infant is described as an infant born after ?
born after the 42 week of gestation
IUGR
due to decrease in cell production related to chronic malnutrition. can be symmetric or asymmetric
Risks for LGA
- maternal diabetes
- multiparity
- previous macrosomic baby
- prolonged pregnancy
Things LGA babies are at risk for
cesarian birth, operative vaginal delivery, shoulder dystocia, breech presentation, cephalopelvic disproportion, hypoglycemia, hyperbilirubinemia
Management of infants born to diabetic and GDM mothers
Q 18
- Assess for signs of complications, trauma, and congenital anomalies at delivery and during the early hours after birth.
- Respiratory problems may be apparent at birth or may develop later.
- Assess newborn for hypoglycemia -(jitteriness, tremors or diaphoresis)
- Cold stress, which increases the need for oxygen and glucose, could increase respiratory problems and exacerbate hypoglycemia.
- Infants with polycythemia need adequate hydration to prevent sluggish blood flow to vital organs and ischemia.
- Hypocalcemia may be suspected if tremors continue and the blood glucose concentration is normal.
-
nurses are expected to perform in accordance with _____, ___, and ____. Doing so provides the best prevention of, or defense against, malpractice claims
nurse practice acts, standards of care, agency policies
nurses can help defend malpractice claims by following guidelines for ___, ____, and _____ and by maintaining their levels of expertise.
informed consent, refusal of care, and documentation
to give informed consent, the patient must be __, ____, _____, and _____
competent, receive full information, understand that information, and consent voluntarily
What happens with insulin release in early pregnancy?
Insulin release in response to serum glucose levels accelerate which can result in hypoglycemia
What occurs during the second half of pregnancy that creates maternal resistance to insulin?
- placental hormones rise, particularly estrogen, progesterone, and human placental lactogen (hPL) which create resistance to insulin in maternal cells
Why does insulin resistance occur during the 2nd half of pregnancy?
- to allow an abundant supply of glucose to be available for the fetus
Effects of Diabetes in the Postpartum Period
- The need for additional insulin falls during the postpartum period.
- Breastfeeding is encouraged to help lower the amount of insulin needed in women with types 1 and 2 diabetes mellitus.
- The woman with gestational diabetes mellitus (GDM) usually needs no insulin after birth but the greater risk for later development of type 2 diabetes should be emphasized with teaching before discharge.
Maternal Effects of Pre-Existing Diabetes TYPE 1
- Increased risk for hypertension, urinary tract infections, and ketosis.
Increased Maternal risks due to Diabetes Mellitus on Pregnancy
- Hypertension; preeclampsia
- Urinary tract infections
- Ketoacidosis (risk for mother and fetus) - Uncontrolled hyperglycemia or infection; most common in women with type 1 diabetes
- Labor dystocia; cesarean birth; uterine atony with hemorrhage after birth
- Hydramnios secondary to fetal osmotic diuresis caused by hyperglycemia; uterus is overstretched
- Birth injury to maternal tissues (hematoma, lacerations) - Fetal macrosomia causing difficult birth
In which trimester is it most important to manage blood glucose levels for diabetic mothers?
First Trimester
*Maternal hyperglycemia during organ formation in first trimester can cause congenital anomalies
Adverse effects of Diabetes on Fetus and neonate
- Hypoglycemia
- Polycythemia
- Hyperbilirubinemia
- Hypocalcemia
- Respiratory distress syndrome - Excess insulin retards cortisol production which is necessary for th esynthesis of surfactant
Insulin is considered a ______ hormone, thus Fetal hyperglycemia stimulating production of insulin to metabolize carbohydrates; excess nutrients transported to fetus can also cause increased growth
growth hormone
Vascular impairment in a Diabetic mother can cause what in the fetus?
- Polycythemia
- IUGR
- Perinatal death
What causes Hypoglycemia in a neonate?
Neonatal hyperinsulinemia after birth when maternal glucose is no longer available (but insulin production remains high)
What dictates the inappropriate growth of an infant of a diabetic mother?
- Vascular impairment =IUGR
- NO vascular impairment= - the infant is likely to be large if maternal glucose levels remain too high
How can Fetal hyperinsulinemia cause Respiratory distress?
- hyperinsulinemia retards cortisol production, which is necessary for the synthesis of surfactant
Glucose Challenge Test.
- A GCT is administered between 24 and 28 weeks of gestation, often to both low- and high-risk antepartum patients.
- . Fasting is not necessary for a GCT, and the woman is not required to follow any pretest dietary instructions.
- STEPS: The woman should ingest 50 g of oral glucose solution. A blood sample is taken 1 hour later. If the blood
glucose concentration is 140 mg/dL or greater, a 3-hour oral glucose tolerance test is recommended.
Oral Glucose Challenge Test.
*is more likely to be used for diagnosis following abnormally high GCT results
OGTT is the gold standard for diagnosing diabetes, but it is a more complex test.
- The woman must fast from midnight on the day of the test. After a fasting plasma glucose level is determined, the
woman should ingest 100 g of oral glucose solution. Plasma glucose levels are then determined at 1, 2, and 3
hours.
Intrapartum management of women with heart disease
- Careful management of IV fluid administration is essential to prevent fluid overload.
- The woman should be positioned on her side, with her head and shoulders elevated.
- Oxygen is administered to increase blood oxygen saturation and is monitored with pulse oximetry.
- Bonnie says Epidural is recommended - Discomfort should be reduced to a minimum
- The environment is kept as quiet and calming as possible to decrease anxiety, which can cause tachycardia
- Maternal signs of cardiac decompensation (tachycardia, rapid respirations, moist rales, and exhaustion) should be reported immediately to the physician.
- Vaginal birth is recommended for a woman with heart disease unless there are specific indications for a cesarean birth.
- Vacuum extraction or outlet forceps are often used to minimize maternal pushing and use of the Valsalva maneuver and to limit prolonged labor, which can add to the hemodynamic stress for the woman with cardiac disease.
- The fourth stage of labor is associated with special risks. After delivery of the placenta, about 500 mL of blood is returned to the intravascular volume. To minimize the risks of overloading the heart, abrupt positional changes should be avoided.
- the uterus should not be massaged to expedite separation of the placenta.
- Careful assessment for signs of circulatory overload, such as a bounding pulse, distended neck and peripheral veins, and moist rales in the lungs, is performed throughout labor and the postpartum period.
Signs of Intrauterine Drug Exposure* Relating to Feeding
- Exaggerated rooting reflex
- Excessive sucking
- Uncoordinated sucking and swallowing
- Frequent regurgitation or vomiting
- Diarrhea
- Weight loss
Signs of Intrauterine Drug Exposure* - Other Signs
- Hypertension
- Fever
- Diaphoresis
- Excoriation
- Mottling
Optimal identification of the GBS carrier status is obtained by vaginal and rectal culture between___-___ weeks of gestation.
35-37 weeks of gestation (BONNIE SAYS 34 - 36)
Nursing management of GBS positive women
- Penicillin is the first-line agent for antibiotic treatment of the infected woman during birth.
- Cephazolin is the alternative for the patient with non–life-threatening penicillin allergy.
- Clindamycin is used for the woman at high risk for anaphylaxis.
What is Neonatal Abstinence Syndrome (NAS),
a disorder in which infants exposed to maternal drugs before birth demonstrate signs of drug withdrawal.
Signs of drug exposure usually begin during the first ___-__ hours after birth but may not occur for up to 4 weeks depending on the specific drug, the dose, and the times of the mother’s last use.
24 to 72
(Didn’t know how to put important stuff into a question) Infants with NAS may be irritable and have hyperactive muscle tone and a high-pitched cry. Although they have tremors, the blood glucose level is normal. Infants appear hungry and suck vigorously on their fists but have poor coordination of suck and swallow. Frequent regurgitation, vomiting, and diarrhea are common. Infants are restless, and their excessive activity coupled with poor feeding ability results in . Seizures may occur.
- Irritability
- Jitteriness, tremors, seizures
- Muscular rigidity, increased muscle tone
- Restless, excessive activity
- Exaggerated Moro reflex
- Prolonged high-pitched cry
- Difficult to console
- Poor sleeping patterns
- Yawning
- failure to gain weight
Nursing management of SGA infants
- assess for hypoglycemia, especially in asymmetric, growth-restricted infants. The brain of the infant is normal and needs large amounts of glucose, but the liver is small and has inadequate stores of glycogen.
- Caloric needs are greater than for a normal infant, making early and more frequent feedings important.
- Temperature regulation and respiratory support are additional nursing concerns.
- Observation for jaundice is important in infants with polycythemia because a large amount of bilirubin may be released when the red blood cells break down.
Uterine involution
Immediately after birth: U/2 6-12 hours after birth: @U Subsequent involution :1 fb (cm) per day Day 7: ½ way between umbilicus and symphysis pubis Non palpable by : 14th day (into pelvis) Pre pregnant size by 5-6 weeks.
Nursing Focus of the immediate post partum patient
- Provide adequate care for safety and comfort
- Prepare for anticipatory guidance for expected change
- Provide patient education for care of self and infant
- Identify physical and emotional changes for normalcy and potential deviations
If the growth restriction is asymmetric, the head circumference and length are _________, but the abdominal circumference and weight are _____.
Normal
Low
The nurse knows how to manage the various interventions for a postpartum patient
- get patient to walk
- assist pt w/ breastfeeding
- good pericare
- emptying bladder frequently
Characteristics of late preterm infants
- look like full-term infants, yet physiologically immature.
- at risk for respiratory disorders, problems with temp maintenance, hypoglycemia, hyperbilirubinemia, feeding difficulties, acidosis, and infection.
- have immature suck and swallow reflexes, have shorter awake periods, and may fall asleep during feedings
Hemoglobin and Hematocrit values
Hgb - 10 (infusions start at 8.5)
Hematocrit - 35-46
Mothers with diabetes whose blood sugar is not in control in the 1st trimester are are higher risk for
- pre-clampsia
- polyhydraminos
- risk of prom
- risk of macrosomia
What vaccine should pregnant women receive with EACH pregnancy?
Tetanus, Diphtheria, Pertussis. Recommended during every pregnancy. Prevents whooping cough which is deadly to baby. Vaccine is given to everybody around baby.
