Test One Flashcards
What are the weeks gestation to be considered Term?
Completion of 37th (36+7/7)-42nd weeks gestation
What are the weeks gestation to be considered Late Preterm?
34-36 6/7 weeks gestation
What are the weeks gestation to be considered Preterm?
20-34 6/7 weeks gestation
What are the weeks gestation to be considered Post-Term?
Beyond 42nd + days completed weeks gestation
What is the definition of a viable infant?
an infant who at birth:
weighs at least 500g
or
is >/=24 weeks gestational age
What is the definition of a nonviable fetus?
Delivered fetus which, although living, cannot possibly survive to the point of sustaining life independently, even with support of the best available medical therapy
What are the 3 phases of the first stage of labor?
Latent Phase
Active Phase
Transitional Phase
Latent phase: ____cm dilated
1-3cm
Active Phase: ____cm dilated
4-7cm
Transitional Phase: ___cm dilated
8-10cm
The baby is delivered at _____cm dilated
10cm
Pitocin is synthetic of _____ secreted by ______
oxytocin, secreted by posterior pituitary
Pitocin acts on ______ receptor sites. Binds, then cause ______
myometrial receptor sites, cause uterine contrations
What routes can you give Pitocin?
IM, IVP, IVPB, intranasal
What is methergine used for?
What route is it given?
Prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or subinvolution.
- Directly stimulates uterine and vascular smooth muscle
- IM, PO
What is hemabate used for?
Generic is carboprost
-Treatment of postpartum hemorrhage that has not responded to conventional therapy
-Causes uterine contractions by directly stimulating the myometrium
-Equivalent to Naturally occurring prostaglandin F2
Used to treat uterine atoney unresponsive to oxytocin, methergine or massage
What is Misoprostil used for?
Synthetic Prostaglandin E-1
Used to treat uterine atony unresponsive to oxytocin, massage, or other agents
When is APGAR testing done?
- at 1 minute and 5 minutes of age
- if low, usually keep doing it 10 minutes, 15 min, etc
What does APGAR stand for?
- Activity; muscle tone
- Pulse rate
- Grimace; reflex irritability
- Appearance; skin color
- Respiratory effort
(each letter receives 0, 1, or 2)
If it says the baby is actively crying what is the APGAR?
-Crying but weak?
at least a 6 (2 for resp effort, 2 for muscle tone, and 2 for reflex irritability)
-crying but weak, at least 3 (=resp 1, muscle tone=1, reflex irritability 1)
What does IUGR stand for?
Intrauterine growth restriction (IUGR)
Applied to fetus whose rate of growth does not meet expected norms
What is thermoregulation?
Ability of neonate to produce heat and maintain normal body temperature
- weight is a key factor for thermoregulation
- you need calories to thermoregulate
- Head is the biggest part, can lose a lot of heat through the head
- sweat glands don’t work like adults so they don’t help thermoregulate
What are the factors predisposing newborns to heat loss?
Large surface in relation to body mass
Thin layer of SQ fat
Blood vessels are closer to the skin
Sweat glands
Nonshivering thermogenesis (infants ability to produce heat) is accomplished primarily by metabolism of _____
brown fat
What does brown fat do? Where is it located?
- Promotes rapid metabolism, heat production, , it takes less steps to convert into energy than regular fat
- Located around the neck, axillae, kidneys, trachea and between scapulae. Full-term newborn has greater stores than a preterm infant
- It is rapidly depleted with cold stress
How does acidosis occur in newborns?
CO2 is a byproduct of breaking down fats and carbs
-If a baby is cold it will breakdown fats rapidly leading to high CO2 levels, leading to acidosis
Newborn weight loss of 10% is indication of _________________________________
dehydration and increased risk for hyperbilirubinemia
What is normal blood glucose range for Normal blood glucose for newborns
_______ mg/dl on days 1-2
_______mg/dl by day 3
40 – 60 mg/dl on days 1-2
60 – 70 mg/dl by day 3
What is hypospadias?
penile anomaly, urethral orifice is located below the glans penis along the ventral surface; infant at higher risk for infection,
What is epispadias?
penis anomaly, urethral orifice is located on the dorsal surface of the penis; the coidtion ofen occurs with exstrophy of the bladder
What is hydrocele?
caused by an accumulation of fluid around the testes. It can be transilluminated with light and usually decreases in size without treatment
What is the only immunoglobulin that can pass through the placenta?
IgG
When does the fetus produce IgM?
When are adult levels of IgM reached?
by the end of the 1st trimester
-Signifiant amounts of IgM are produced at birth, and adult levels are reached by 9 months of age
Which immunoglobulin is not produced by the fetus? How to babies get this immuoglobi
IgA, babies can only get it from mom through colostrum which has large amounts of IgA
The infant who is breastfed receives significant passive immunity through ____________
colostrum and breast milk
brown fat production begins at ______ wks and continues for______ wks after birth. It causes an increased demand for ________
26-28 weeks, 3-5 weeks after birth
-glucose and O2
the stomach of a newborn has the capacity of ________ at birth
5-7mL
normal weight loss is _______ in first few days due to ____________
Infants usually return to birth weight by _____days old
4-7%
additional fluids absorbed while in utero
7-10 days old
Euthermic:
Euglycemia:
Euthermic: pertaining to a normal temperature level
Euglycemia: pertaining to a normal blood glucose level
What are some risk factors for neonatal hypoglycemia?
maternal diabetes prematurity SGA IUGR post-maturity LGA cold stress asphyxia or hypoxia maternal intake of terbutaline
What are the 2 ways newborns can have hyperinsulism?
1) Well known consequence of fetal hyperglycemia in neonate born to mothers with poorly controlled diabetes, resolves within one to two days after birth
- fetus is used to high levels of glucose from mom so it makes extra insulin to accommodate, once umbilical cord is clamped (cutting off glucose) baby’s BS falls b/c of fetal hyperinsulism
2) Occurs in infants with birth asphyxia and in infants who are small for gestational age (SGA), may last for several weeks
- Waternal blood is more acidic than fetal blood (due to high BS/ketoacidosis) little gas exchange occurs in the placenta leading to asphyxia and SGA
Baby’s signs of drug withdrawal (NAS) and hypoglycemia are very similar, what are some of these symptoms?
hypoglycemia: Jitteriness, Poor suck, Poor muscle tone, Tachypnea, Dyspnea, Low Temperature, Lethargy, Apnea, Sweating, High-pitched cry, Seizures, coma, Some infants may be asymptomatic
What are some additional signs/symptoms of drug withdrawal (NAS) (different than hypoglycemia)?
baby has shrill cry, tremors, and is irritable
- nasal congestion, sweating, tachypnea, execcesive yawning
What are some nursing considerations with neonatal hypoglycemia?
○ assess blood glucose after feeding
○ prevent cold stress
○ minimize oxygen needs
What is TTN?
transient tachypnea of the newborn
- Retained lung fluid (RLF) or wet lung syndrome or RDS II
- Result of delayed clearing of amniotic fluid during delivery process in term newborns
- Short-term and self-limiting
What are some predisposing factors for TTN?
Term newborn with mature lungs
LGA newborn
Cesarean deliveries
*Precipitous labor and birth (less than 3 hours)
Maternal history of heavy sedation
Polycythemia or other hypervisocity (sluggish blood, hard to get things moving) circulatory disorders
Hypothermia
What are some nursing considerations/treatments with a TTN baby?
TTN Bulb suction, percussion, want them to cry and expel fluids! (comes and goes away), do not feed the baby!
What are the TTN symptoms?
-Onset may be within the first few moments after delivery to within the first few hours
-Rapid respirations soon after birth 60 – 140 / min
-Grunting, flaring, retracting
-Rales audible and or diminished breath sounds
-Excessive oral mucosa
-Requires repeated bulb/wall suctioning
(not going to be able to suck, swallow, and breath during feeding, therefore you DO NOT feed TTN baby)
What can TTN lead to?
can cause hemorrhage, HTN, embolism
What is RDS?
What is a common cause?
- Insufficient pulmonary surfactant
- Alveoli collapse resulting in atelectasis
- More pressure required to open alveoli
- Common cause is cold stress
What are the s/s of RDS?
- Onset at birth, but may occur 6-24 hours after delivery
- Tachypnea > 60 respirations/min
- Grunting, nasal flaring, retracting
- Pallor or cyanosis
- **Rales or diminished breath sounds
- Apnea common
- Atelectasis
What are the complication of RDS?
- **Persistent PDA (patent ductus arteriosis)
- Pneumothorax-from vent or resuscitation
- Hypoglycemia
- Intracranial bleed
- Bronchopulmonary dysplasia: BPD
- Retinopathy
- Necrotizing Enterocolitis (NEC)
What is ABO incompatibility?
- More common than Rh incompatibility but causes less severe problems
- Occurs if fetal blood is A, B, or AB and the mom is O
- Common cause of hyperbilirubinemia
- Can occur with first baby
What is the nursing care for physiologic jaundice?
- Increase fluid intake (to promote excretion), document I&Os
- Thorough physical assessment
- Monitor bilirubin levels
- Parent support and education
- Phototherapy may be used
- If dark skinned must rely on bony prominences and sclera, conjunctival sacs and buccal mucosa
What is pathological jaundice? What can it lead to if untreated?
is that level of serum bilirubin which, if left untreated, can result in sensorineural hearing loss, mild cognitive delays, and kernicterus (bilirubin in the brain leading to bilirubin encephalopathy)
-can cause permanent damage
○ >15 mg/dL at any time
What are the symptoms of Sepsis Neonatorum ?
○ often subtle and non specific ○ apnea or tachycardia ○ temperature instability-hypothermia (hypothermic means CANNOT contain a temperature) ○ pallor, cyanosis ○ irritable, hypotonic, lethargic ○ disinterest in feeding, poor suck
What is the nursing care for Sepsis Neonatorum?
- Prevention: Hand washing !!
- Early Identification of risk factors
- Thorough assessment, and timely notification of HCP
- Maintain thermoregulation
- Provide supportive respiratory care
- **Maintain hydration and euglycemia
- Administer Rx per provider and monitor for signs of response
- Emotional support & accurate, realistic information to parents
What are the cons to bottle feeding?
May confuse newborn while learning to feed
Use different muscles
How often should you breastfeed a newborn? How long on each side?
- About 8 – 12 times per 24 hours for the first month
- About 15 – 20 minutes per side
When is “hind milk” obtained? What is the benefit of hind milk?
Feed on one breast until it softens to assure “hind milk” is obtained
- higher fat content to make them full
- foremilk is higher in lactose (sugar)
Supplementation: AAP does not recommend unless medically indicated
Examples:
- Hypoglycemia
- LBW
- Dehydration
- **Inborn errors of metabolism
- Maternal conditions or Rx
How do you store and reuse/reheat breast milk?
Can store breast milk in refrigerator or freezer for later use
Never microwave
Assessments associated with labor:
heart and lungs, vitals, determine position/presentation/locate fetal heart sounds, FHR pattern, dilation, contractions, test urine and amniotic membrane and fluid, assess for infection, HTN, and diabetes
Interventions associated with labor:
hygiene, nutrient and fluid intake, elimination, ambulation and positioning, supportive care, emergency interventions, reduce anxiety comfort measures, encourage voiding, keep pt and family informed
What are the assessments associated with birth?
BP, uterine activity, bearing down effort, FHT, vaginal sow, cervical dilation complete, strong contractions ever 2-3 minutes lasting 60-90 seconds, increase in bloody show, mother feels urge to bear down
What are the interventions associated with birth?
Top 3 to promote fetal oxygenation: change positions, give O2, IV fluids
-promote effective pushing, fetal oxygenation, support mom and family, assess every 5 minutes, monitor maternal vitals and HR, privacy, encouragement and raise, keep pt informed, positioning
What are the assessments associated with post-partum care?
Vital signs: recovery q15 x4, q 30 x2, once during 3rd hour, q 4-8 until discharge
- Bubble Heavn
- Heart and Lungs
- Anesthesia regression
What are the interventions associated with post-partum care?
-Prevent complications, educate patients, prevent infection, excessive bleeding, bladder distention, maintenance of uterine tone, promote rest, comfort, ambulation, nutrition, bonding, and breastfeeding
When does the first stage of labor begin and end?
begins with onset of labor and ends with complete dilation (10cm)
What are the interventions in the fist stage of labor?
teach about what to expect, implement relaxation techniques, promote comfort, encourage voiding
When does the second stage of labor begin and end?
How long it is?
Begins with full dilation (10cm) ends with delivery of baby
-(primip – 2 hrs; multip – mins to 1.5 hrs)
What are the s/s of second stage labor?
perineal bulging/ stretching/ pain , pass flatus/ stool, crowning, diaphoresis
§ psychosocial – less irritable, cooperative, focused on pushing, modesty unimportant, exhaustion building
What are the interventions in the 2nd stage of labor
monitor pt/fetus, positioning for pushing, promote partner involvement and encouragement between contractions, rest between pushes, comfort measures, prepare for neonate (O2, warmer, suction, etc.)
When does the 3rd stage of labor begin and end?
What is the potential complication?
From the time of the birth of the baby until the placenta is expelled
-Retained placenta (leading to hemorrhage)
What are the signs of placental separation?
uterus changes to globe shape, painful contractions begin, sudden gush of dark red blood, lengthening of umbilical cord, feeling of fullness in vagina or urge to push
What are the interventions associated with the 3rd stage of labor?
instruct w/pushing to deliver placenta, baby-friendly activities, administer analgesics as prescribed and oxytocics once placenta is expulsed to stimulate uterine contraction and prevent hemorrhage, comfort measures (clean perineal area, ice pack)
Which 3 hormones are responsible for continued uterine contraction to close uterine vessels and prevent hemorrhage?
Oxytocin
Eronovines
Prostaglandins
When is the 4th stage of labor? What are the main goals in this stage?
2 hours following delivery of placenta
-maternal vital sign stabilization and hemodynamic stability
What are the interventions associated with the 4th stage of labor?
Maternal assessment - Vital Signs, heart and lungs, BUBBLE HEAVN
§ Interventions – assess vitals, fundus and lochia q 15 min for 1st hour, prevent excessive blood loss, facilitate bonding, encourage voiding
What are the side effects for Pitocin?
water intoxication, n/v
What are the contraindications and side effects for Methergine?
Contraindications: HTN, cardiac disease
Side effects: HTN, n/v, headache
Nursing considerations: check BP and don’t give if >140/90; monitor vaginal bleeding and uterine tone
What are the contraindications and side effects for Hemabate?
Contraindication: asthma, HTN
Side effects: headache, n/v/d, fever, tachycardia, HTN
What are the contraindications and side effects of Misoprostil?
Contraindication: hx allergy to prostaglandins
Side effects: headache, n/v/d
What are some ways to maximize support and promotes the physiologic and psychosocial adaptation during the 3rd and 4th stage of labor?
Understand principles of hypothermia and metabolic processes
Psychosocial: assess psychological hx, emotional status, reaction to labor and birth, interaction w/baby and rest of family, culture, self concept and body image, support system
o Nurse teaches, encourages, and supports mother
o Plan includes promotion of parenting skills and family member adjustment
Physiological: focus on preventing complications through assessment and patient education
o Major areas of focus
§ Prevention of infection, excessive bleeding, bladder distension
§ Maintenance of uterine tone
§ Promotion of rest, comfort, ambulation, exercise, nutrition, normal bladder and bowel patterns
§ Breastfeeding promotion and support
List some appropriate preventative and restorative nursing strategies for care of the postpartum client
Assess fundus and lochia, check for vaginal, vulvar hematomas or unrepaired lesions, encourage voiding (prevent bladder distention), monitor vitals to prevent hypovolemic shock, ensure rest (fatigue can lead to pp depression), reduce anxiety, encourage early ambulation, BUBBLE HEAVN, encourage breastfeeding and bonding, Report saturation of OB-Pad in 2 hours or less, sitz bath and ice packs for comfort, assess for thrombophlebitis, REEDA, nutrition, prenatal vitamins, iron and pain meds
What are some attachment intervention the nurse can implement with family members?
provide opportunity for parents to hold, touch, examine baby immediately after birth, encourage parents to hold infant close, incorporate parents in infant care, provide privacy, help with breastfeeding
What are the benefits to the golden hour?
skin-to-skin contact that promotes attachment, encourage breastfeeding and improved thermoregulation
What are some signs of attachment?
- Newborn: Visual tracking, Pleasant face, Grasping with hands, Quiets when held, Enjoys feeding, Extremities relaxed, Cooing or vocalizations
- Parental: Touching, En face (20 cm apart form fact to fact), Eye contact, Naming, Claiming, Smiling, Vocalized to baby, Shows pride
Previous vaginal deliveries can influence the ________
second stage of labor (usually happens quicker if mom has had previous vaginal delivery)
Who are at risk for Rh incompatibility?
What happens if untreated?
How is it prevented?
Only Rh – positive offspring of Rh-negative mother is at risk
If fetus is Rh Positive and mother is negative, mother forms antibodies against fetal blood cells
-results in marked fetal hemolytic anemia, fetal bilirubin can increase, fetus makes large amounts of immature RBCs to replace those hemolyzed and lead to hydrops fetalis
-Prevented with Rhogam
SGA:
What are the complications?
Small for Gestational Age, below 10 % for GA (may also be IUGR)
-Hypoglycemia, Temperature instability, Neurologic deficiencies, Learning disabilities, Intolerance to stress of labor (hypoxia), Fetal asphyxia, Meconium passage, Polycythemia, Malnutrition, learning disabilities later on
LGA:
What are the complications?
above 90% for GA ○ Prolonged labor or failure to descend ○ Assisted or operative deliveries ○ Shoulder dystocia ○ Birth Trauma ○ Meconium ○ Hypoglycemia ○ CNS injury
What are some nursing considerations for LGA?
● Early identification of risk factors or signs of problems
● Promote safe, atraumatic birth
● Close monitoring and support of Respiratory transition
● Close monitoring of glucose status
● Monitor for s/s polycythemia and dehydration
Transition from fetal to neonatal circulation involves closure of which 3 shunts?
■ Foramen Ovale
■ Ductus arteriosus
■ Ductus venosus
What does vitamin K activate?
Coagulation factors (II, VII, IX, X)
What are the fetal/neonate urinary adaptations?
- Urine is present in bladder at the time of birth
- Renal system is initially unable to concentrate urine
- Kidneys are fully functional at birth, but immature
