TEST 4 - ash Flashcards
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
What are risks factors for Subinvolution?
- Grandmultiparus
- Chorioamnionitis
- Retained placental fragments/ amniotic sac
- Polyhydraminos in pregnancy
- Multifetal pregnancy
If a post-term infant is large the nurse should assess for _______ and __________.
- Injury
- Hypoglycemia - because of rapid use of glycogen stores
Regarding Late-onset GBS, what patients are neurologic consequences are more likely in
- infants who survive meningeal infections
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
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.
Potential complications of a preterm infant - Respiration
Immature lungs, poor cough reflex, narrow respiratory passages, prone to apneic spells
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
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.
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
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
Acronym for assessment:
BUBBLE HEP
breasts uterus bowels bladder lochia episiotomy
homan’s
emotions
pain
Vitals signs after birth of baby - temperature
- may be slightly elevated
- if greater than 100.4 could be sign of infection
Why does insulin resistance occur during the 2nd half of pregnancy?
- to allow an abundant supply of glucose to be available for the fetus
Asymmetric growth restriction is caused by complications such as preeclampsia that begin in the ____ Trimester and interfere with uteroplacental function
3rd
Meconium Aspiration occurs most often when ……
Hypoxia causes increased peristalsis of the intestines and relaxation of the anal sphincter before or during labor
symptoms of postpartum affective disorders:
- apathy
- lack of interest or energy
- anorexia
- sleeplessness
- verbalizations of failure, sadness, loneliness, anxiety, vague confusion
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
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.
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
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
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 medication is used to treat subinvolution and what does it do?
Methergine to provide sustained uterine contraction
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