Week 1 Content Flashcards
- Pregnancy – ____________
- Following Birth – ____________
- Childbirth – ____________
- Pregnancy – Antepartum
- Following Birth – Postpartum
- Childbirth – Intrapartum
PREGNANCY (ANTEPARTUM) Common Terms
__________ age: Prenatal age of the developing baby (measured in weeks and days).
Calculated from the 1st day of the woman’s last menstrual period.
Gestational
Antepartum: Refers to the period of pregnancy ________________________
before the onset of labor.
PREGNANCY (ANTEPARTUM) Common Terms
LMP:
Last Menstrual Period
EDD:
Estimated date of delivery. Also abbreviated EDB: (estimated date of
birth).
- Preterm: pregnancy that has reached ___ weeks of gestation but before completion of 37 weeks of gestation
20
- ______ : pregnancy from the beginning of week 38 of gestation to end of week 42 of
gestation
Term
- Postdate or post-term: pregnancy that goes beyond ____ weeks of gestation
42
- ________ : a spontaneous or elective termination of pregnancy before the 20th week of gestation, based on the date of the last menstrual period. Spontaneous abortion is frequently called miscarriage.
Abortion
- Viability: Capacity to live ________________; about 22 to 25 weeks gestation are on
the threshold of viability
outside the uterus;
- Late preterm: Pregnancy that reached between 34 weeks 0 days & 36 weeks 6 days gestation
- Early term: Pregnancy that reached between 37 weeks 0 days & 38 weeks 6 days gestation
- Full term: Pregnancy that reached between __ weeks 0 days and 40 weeks 6 days
- Late term: Pregnancy that reached between 41 weeks 0 days and 41 weeks 6 days
- Late preterm: Pregnancy that reached between 34 weeks 0 days & 36 weeks 6 days gestation
- Early term: Pregnancy that reached between 37 weeks 0 days & 38 weeks 6 days gestation
- Full term: Pregnancy that reached between 39 weeks 0 days and 40 weeks 6 days
- Late term: Pregnancy that reached between 41 weeks 0 days and 41 weeks 6 days
________ : A woman who is pregnant
Gravidity: Pregnancy
___________ : A woman who has never been pregnant
Primigravida: A woman pregnant for the first time
Gravida: A woman who is pregnant
Gravidity: Pregnancy
Nulligravida: A woman who has never been pregnant
Primigravida: A woman pregnant for the first time
- _______ : Number of pregnancies in which fetus or fetuses have reached viability, not number of fetuses (e.g., twins) born. Whether the fetus is born alive or stillborn (a fetus who shows no signs of life at birth) after viability is reached does not affect parity
- Nullipara: Woman who has not completed a pregnancy with a fetus or fetuses who
have reached the stage of fetal viability - Primipara: Woman who has completed one pregnancy with a fetus or fetuses who
have reached the stage of fetal viability - Multipara: Woman who has completed two or more pregnancies to the stage of fetal viability
- *fetal viability may be considered ____ weeks in this context
- Parity: Number of pregnancies in which fetus or fetuses have reached viability, not number of fetuses (e.g., twins) born. Whether the fetus is born alive or stillborn (a fetus who shows no signs of life at birth) after viability is reached does not affect parity
- Nullipara: Woman who has not completed a pregnancy with a fetus or fetuses who
have reached the stage of fetal viability - Primipara: Woman who has completed one pregnancy with a fetus or fetuses who
have reached the stage of fetal viability - Multipara: Woman who has completed two or more pregnancies to the stage of fetal
viability - *fetal viability may be considered 20 weeks in this context
Obstetric History
Five digit system
* GTPAL
* ___________________________________
Two digit system
* G – gravida (number of pregnancies)
* P – para (number of pregnancies reaching 20 weeks)
Five digit system
* GTPAL
* Gravida, Term, Preterm, Abortions, Living children
Two digit system
* G – gravida (number of pregnancies)
* P – para (number of pregnancies reaching 20 weeks)
GTPAL
G = Gravida: the _______ of pregnancies, including this one
T = Term: the number of pregnancies that ended in _______ births (37 weeks 0 days and beyond; including early, full, late term, or postterm births)
P = Preterm: the number of pregnancies that ended in _________ birth (between 20 weeks 0 days and 36 weeks 6 days gestation)
A = Abortion: the number of pregnancies that ended in ____________ (spontaneous abortion) or elective termination (therapeutic abortion) before 20 weeks or less than 500 g at birth
L = Living: the number of children currently __________
G = Gravida: the number of pregnancies, including this one
T = Term: the number of pregnancies that ended in term births (37 weeks 0 days and beyond; including early, full, late term, or postterm births)
P = Preterm: the number of pregnancies that ended in preterm birth (between 20 weeks 0 days and 36 weeks 6 days gestation)
A = Abortion: the number of pregnancies that ended in miscarriage (spontaneous abortion) or elective termination (therapeutic abortion) before 20 weeks or less than 500 g at birth
L = Living: the number of children currently living
- Placenta: A structure that provides _____________ to and removes ________ from the developing baby and secretes hormones necessary for the pregnancy to continue
- Placenta: A structure that provides nourishment to and removes wastes from the developing baby and secretes hormones necessary for the pregnancy to continue
- _______ : part of the uterus that is farthest from the cervix, above the openings of the fallopian tubes
- Fundus: part of the uterus that is farthest from the cervix, above the openings of the fallopian tubes
- _______ : A developing baby from 9 weeks after conception until birth. In everyday practice this term is often used to describe a developing baby during pregnancy, regardless of age.
- Fetus: A developing baby from 9 weeks after conception until birth. In everyday practice this term is often used to describe a developing baby during pregnancy, regardless of age.
- ________ : space at the intersection of sutures connecting fetal or infant skull bones.
- _________ : narrow areas of flexible tissue that connect the fetal skull bones, permitting slight movement during labor.
- Fontanel: space at the intersection of sutures connecting fetal or infant skull bones.
- Sutures: narrow areas of flexible tissue that connect the fetal skull bones, permitting slight movement during labor.
Terms Related to Labor (Intrapartum)
- _______ : peak, or period of greatest strength, of a uterine contraction.
- ______ : lowest point
- Acme: peak, or period of greatest strength, of a uterine contraction.
- Nadir: lowest point
Terms Related to Labor (Intrapartum)
- FHR: ____________
- __________ birth: surgical birth of the fetus through an incision in the abdominal wall and uterus.
- _________ labor: onset of labor after 20 weeks and before the beginning of the 37th week of gestation.
- FHR: fetal heart rate
- Cesarean birth: surgical birth of the fetus through an incision in the abdominal wall and uterus.
- Preterm labor: onset of labor after 20 weeks and before the beginning of the 37th week of gestation.
Terms Related to Labor (Intrapartum)
- SVD: spontaneous ________ delivery
- VAD: ________ assisted delivery
- SVD: spontaneous vaginal delivery
- VAD: vacuum assisted delivery
Terms Related to Labor (Intrapartum)
- __________ : cervical thinning.
- Station: measurement of fetal descent in relation to the ischial spines of the maternal pelvis.
- ___________ : fetal part that first enters the pelvic inlet; also, the presenting part.
- Effacement: cervical thinning.
- Station: measurement of fetal descent in relation to the ischial spines of the maternal pelvis.
- Presentation: fetal part that first enters the pelvic inlet; also, the presenting part.
- Dilation: gradual widening of the _______ in the process of labor.
- _________ : the appearance of the fetal scalp or presenting part at the vaginal opening.
- Dilation: gradual widening of the cervix in the process of labor.
- Crowning: the appearance of the fetal scalp or presenting part at the vaginal opening.
Jaundice: * Yellow discoloration of the skin and sclera caused by excessive _________
in the blood; also called icterus.
_______ : * Unusable component of hemolyzed (broken down) erythrocytes.
Jaundice: * Yellow discoloration of the skin and sclera caused by excessive bilirubin
in the blood; also called icterus.
Bilirubin: * Unusable component of hemolyzed (broken down) erythrocytes.
Preterm infant: * An infant born before the beginning of the ____ week of gestation. Also called a premature infant.
37th
Postpartum: refers to the first ________ after childbirth.
6 weeks
- _________ : secretion of milk from the breasts; also describes the time when a child is breastfed.
- _____________ : swelling of the breasts resulting from increased blood flow, edema, and the presence of milk.
- Lactation: secretion of milk from the breasts; also describes the time when a child is breastfed.
- Engorgement: swelling of the breasts resulting from increased blood flow, edema, and the presence of milk.
- ________: breast fluid secreted during pregnancy and immediately after childbirth.
- Episiotomy: surgical incision of the perineum to enlarge the vaginal opening.
- _______: acronym for redness, ecchymosis, edema, discharge, and approximation. Useful for assessing wound healing or the presence of inflammation or infection.
- Colostrum: breast fluid secreted during pregnancy and immediately after childbirth.
- Episiotomy: surgical incision of the perineum to enlarge the vaginal opening.
- REEDA: acronym for redness, ecchymosis, edema, discharge, and approximation. Useful for assessing wound healing or the presence of inflammation or infection
- Uterine ______: decreased uterine muscle contraction; a primary cause of excessive bleeding.
- Lochia ______: reddish or red-brown vaginal discharge that occurs immediately after childbirth; composed mostly of blood.
- Lochia ________: pink or brown-tinged vaginal discharge that follows lochia rubra; composed largely of serous exudate, blood, and leukocytes.
- Lochia _____: white, cream-colored, or light yellow vaginal discharge that follows lochia serosa.
- Uterine atony: decreased uterine muscle contraction; a primary cause of excessive bleeding.
- Lochia rubra: reddish or red-brown vaginal discharge that occurs immediately after childbirth; composed mostly of blood.
- Lochia serosa: pink or brown-tinged vaginal discharge that follows lochia rubra; composed largely of serous exudate, blood, and leukocytes.
- Lochia alba: white, cream-colored, or light yellow vaginal discharge that follows lochia serosa.
- _________ fluid - a liquid produced by the fetal membranes and the fetus. It surrounds the fetus throughout pregnancy, protecting it from trauma and temperature variations, providing freedom of fetal movements, and helping maintain the fetal oxygen supply
- _________ sac - a thin-walled bag that contains the fetus and amniotic fluid during pregnancy
- Amniotic fluid - a liquid produced by the fetal membranes and the fetus. It surrounds the fetus throughout pregnancy, protecting it from trauma and temperature variations, providing freedom of fetal movements, and helping maintain the fetal oxygen supply
- Amniotic sac - a thin-walled bag that contains the fetus and amniotic fluid during pregnancy
- ROM – __________ of membranes
- SROM – Spontaneous rupture of membranes
- AROM – Artificial rupture of membranes
- PROM - Premature rupture of the membranes: spontaneous rupture of the membranes before the onset of labor. The gestation may be term, preterm, or
postterm. - PPROM – Preterm premature rupture of the membrane
- AMA – __________ maternal age
- HRM – High Risk Maternity
- ROM – Rupture of membranes
- SROM – Spontaneous rupture of membranes
- AROM – Artificial rupture of membranes
- PROM - Premature rupture of the membranes: spontaneous rupture of the membranes before the onset of labor. The gestation may be term, preterm, or
postterm. - PPROM – Preterm premature rupture of the membrane
- AMA – Advanced maternal age
- HRM – High Risk Maternity
Fourth Stage of Labor
- First 1 to 2 hours after birth
⚬ _____________ is recommended to begin - Assessment
- Post anesthesia recovery:
⚬ Regardless of obstetric status, no woman should be discharged from recovery area until completely _____________________
⚬ Transfer from recovery area to postpartum
- First 1 to 2 hours after birth
⚬ Breastfeeding is recommended to begin - Assessment
- Post anesthesia recovery:
⚬ Regardless of obstetric status, no woman should be discharged from recovery area until completely recovered from anesthesia
⚬ Transfer from recovery area to postpartum
Postpartum Period
- The interval between birth and return of reproductive organs to their non-pregnant state
- Puerperium or fourth stage of pregnancy
- Traditionally _________ - varies among women
- “Fourth trimester”
⚬ sometimes considered the first three months after pregnancy.
6 weeks
- _________
⚬ Post birth uterine discharge
* Days 1-3: lochia rubra (dark red)
* Days 4-10: lochia serosa (brownish red or pink)
* About 10-14 days after birth: lochia alba (yellowish white)
Present up to 4-8 weeks after birth
⚬ Assessment
* Amount, type, and odor
Lochia
Blood loss after birth is assessed by the extent of perineal pad saturation as (left
to right)
- scant (<2.5 cm),
- light (<___ cm),
- moderate (>10 cm)
- heavy (one pad saturated within 2 hours).
Best Practice: Weigh on scale
- scant (<2.5 cm),
- light (<10 cm),
- moderate (>10 cm)
- heavy (one pad saturated within 2 hours).
Best Practice: Weigh on scale
Postpartum Period
- Endocrine System
⚬ Placenta ■ Rapid decrease in _______ and progesterone levels after expulsion of the placenta is responsible for triggering anatomic and physiologic changes in
puerperium (postpartum period) ■ Decrease estrogen = diuresis of excess extracellular fluid
⚬ Pituitary ■ _______ increase
- Endocrine System
⚬ Placenta ■ Rapid decrease in estrogen and progesterone levels after expulsion of the placenta is responsible for triggering anatomic and physiologic changes in
puerperium (postpartum period) ■ Decrease estrogen = diuresis of excess extracellular fluid
⚬ Pituitary ■ Prolactin increase
Postpartum Period
⚬ Ovarian function returns
■ As early as 27 days, mean of ______ weeks – nonlactating
■ Mean of 6 months - breastfeeding
7 to 9
Postpartum Period - Gastrointestinal System
⚬ Appetite
⚬ ___________
■ Decreased food and fluid intake during labor, reduced muscle and bowel tone, fear of pain during defecation, opioids
⚬ Appetite
⚬ Constipation
■ Decreased food and fluid intake during labor, reduced muscle and bowel tone, fear of pain during defecation, opioids
Postpartum Period - Cardiovascular
⚬ Cardiac Output and Vital Signs
⚬ Delivery blood loss, offset by increase in volume during pregnancy
■ Vaginal 300-500 mL
■ Cesarean 500-1000 mL
⚬ Hematocrit ■ Decreases for 3-4 days, non-pregnant level by 8 weeks
⚬ White Blood Cell Count ■ During pregnancy 5,000-10,000 mm3, after labor and delivery _______ mm3
⚬ Coagulation ■ Clotting factors and fibrinogen ________ , vessel damage, and immobility predispose woman to thromboembolism
⚬ Varicosities
⚬ Cardiac Output and Vital Signs
⚬ Delivery blood loss, offset by increase in volume during pregnancy
■ Vaginal 300-500 mL
■ Cesarean 500-1000 mL
⚬ Hematocrit ■ Decreases for 3-4 days, non-pregnant level by 8 weeks
⚬ White Blood Cell Count ■ During pregnancy 5,000-10,000 mm3, after labor and delivery 30,000 mm3
⚬ Coagulation ■ Clotting factors and fibrinogen increased, vessel damage, and immobility predispose woman to thromboembolism
⚬ Varicosities
Postpartum Period * Abdomen
⚬ Still-pregnant appearance
⚬ Return almost to prepregnancy state _______
⚬ Joints stabilized – 6 to 8 weeks (increase in shoe size)
⚬ Still-pregnant appearance
⚬ Return almost to prepregnancy state 6 weeks
⚬ Joints stabilized – 6 to 8 weeks (increase in shoe size)
Postpartum Period * Immune
⚬ Mildly ___________ during pregnancy, gradually returns to pre-pregnant
⚬ Rebound can trigger flare up of _________ conditions
⚬ Mildly suppressed during pregnancy, gradually returns to pre-pregnant
⚬ Rebound can trigger flare up of autoimmune conditions
Postpartum Period Nursing Considerations
- Prevention of Infection/Complications
⚬ _________ Massage
⚬ ________ (Intact, Laceration, episiotomy)
■ Squeeze bottles, Ice, Tucks, Spray (Dermaplast), Sitz bath
⚬ Excessive bleeding - Signs and Symptoms of Complications
⚬ Infection ■ Uterine ■ Perineum ■ Breasts
⚬ Bleeding
⚬ DVT’s
⚬ Depression ■ Hormonal changes ■ Sleep disturbances
- Prevention of Infection/Complications
⚬ Fundal Massage
⚬ Pericare (Intact, Laceration, episiotomy)
■ Squeeze bottles, Ice, Tucks, Spray (Dermaplast), Sitz bath
⚬ Excessive bleeding - Signs and Symptoms of Complications
⚬ Infection ■ Uterine ■ Perineum ■ Breasts
⚬ Bleeding
⚬ DVT’s
⚬ Depression ■ Hormonal changes ■ Sleep disturbances
Postpartum Period Nursing Considerations
Promotion of
⚬ Normal bladder function
⚬ Normal bowel function
⚬ Comfort
⚬ Rest
⚬ Breastfeeding/Lactation suppression
⚬ Normal bladder function
⚬ Normal bowel function
⚬ Comfort
⚬ Rest
⚬ Breastfeeding/Lactation suppression
Postpartum Period Assessment
BUBBLEHEE —
- Vital signs * Heart/Lungs * Breasts * Fundus * Abdomen/Incision * Bladder elimination * Lochia * Perineum * Homan’s sign – no * Lower extremities ⚬ Edema/deep tendon reflexes
Breasts
uterus
bowel
bladder
lochia
epiostomy
Hemorrhoids
edema
emotional state
Postpartum Period Care Management Psychosocial Needs
- Effect of the birth experience
- Maternal self-image
- Adaptation to parenthood and parent-infant interactions
- Family structure and functioning
- Impact of cultural diversity
- Discharge Teaching
- Effect of the birth experience
- Maternal self-image
- Adaptation to parenthood and parent-infant interactions
- Family structure and functioning
- Impact of cultural diversity
- Discharge Teaching
Postpartum Period - Attachment, Bonding, & Acquaintance
- Parents
⚬ Process - this is not instant but rather occurs over time
■ Attachment ■ Bonding
■ Does not require _________ contact with the newborn. Mothers who are seperated from infant often worry. - Siblings
⚬ Reactions manifested in _________ changes
⚬ Involvement in planning and care
⚬ Acquaintance process
- Parents
⚬ Process - this is not instant but rather occurs over time
■ Attachment ■ Bonding
■ Does not require immediate contact with the newborn. Mothers who are seperated from infant often worry. - Siblings
⚬ Reactions manifested in behavioral changes
⚬ Involvement in planning and care
⚬ Acquaintance process
- _________ vaccination
⚬ If the woman is not immune, vaccination is recommended - __________ vaccination
- Tetanus-diphtheria-acellular pertussis (______)
- Rh Isoimmunization
⚬ Rh immune globulin should be given within 72 hours for R-negative women who deliver an Rhpositive infant
- Rubella vaccination
⚬ If the woman is not immune, vaccination is recommended - Varicella vaccination
- Tetanus-diphtheria-acellular pertussis (Tdap)
- Rh Isoimmunization
⚬ Rh immune globulin should be given within 72 hours for R-negative women who deliver an Rhpositive infant
Postpartum Period Discharge Teaching
- Signs of complications
⚬ Fever
⚬ Change in lochia
⚬ Pain at incision/laceration site
⚬ Reddened/tender area of breast
⚬ Calf pain/tenderness/redness
⚬ S/S of UTI
⚬ Headache, Blurred Vision, Epigastric Pain
⚬ Fever
⚬ Change in lochia
⚬ Pain at incision/laceration site
⚬ Reddened/tender area of breast
⚬ Calf pain/tenderness/redness
⚬ S/S of UTI
⚬ Headache, Blurred Vision, Epigastric Pain
Normal Newborn Transition to Extrauterine Life
- First Stage = First period of reactivity
⚬ Up to _________ after birth
⚬ Infant alert with spontaneous startles, crying, head movement - Second Stage = Period of decreased responsiveness
⚬ Lasts 60 to 100 minutes
⚬ Respirations are rapid and shallow
⚬ Sleeps or has a marked decrease in motor activity - Third Stage = Second period of reactivity
⚬ Lasts from 10 minutes to several hours
⚬ Occurs between 2 and 8 hours after birth
⚬ Tachycardia, tachypnea occur
⚬ Meconium passed
⚬ Increased muscle tone, changes in skin color, and mucus production
- First Stage = First period of reactivity
⚬ Up to 30 minutes after birth
⚬ Infant alert with spontaneous startles, crying, head movement - Second Stage = Period of decreased responsiveness
⚬ Lasts 60 to 100 minutes
⚬ Respirations are rapid and shallow
⚬ Sleeps or has a marked decrease in motor activity - Third Stage = Second period of reactivity
⚬ Lasts from 10 minutes to several hours
⚬ Occurs between 2 and 8 hours after birth
⚬ Tachycardia, tachypnea occur
⚬ Meconium passed
⚬ Increased muscle tone, changes in skin color, and mucus production
Normal Newborn Physiologic Adaptations
Significance of Surfactant
* A phospholipid and protein secreted in the lining of the alveoli onto the alveolar surface
* Significant increase at approximately 34 weeks gestation
* Maintains alveolar stability, allowing alveoli to remain _____
* Enables the establishment of functional residual capacity
open
Normal Newborn Physiologic Adaptations
Nose Breathers
* Reflex to open mouth when nose blocked not present until _______ old
3 weeks
Normal Newborn Physiologic Adaptations
Expected Findings
* Shallow and ______ breaths
* Short periods of ______ (< 20 seconds)
* Chest and abdomen rise simultaneously with inspiration
- Shallow and irregular breaths
- Short periods of apnea (< 20 seconds)
- Chest and abdomen rise simultaneously with inspiration
Newborn- Signs of respiratory distress
- Expiratory Grunting, persistent nasal Flaring, Retractions
⚬ GFR - Seesaw or paradoxic respirations
- Increased use of intercostal muscles
- Tachypnea = > 60 breaths/min at rest
- Central cyanosis = hypoxemia
- Expiratory Grunting, persistent nasal Flaring, Retractions
⚬ GFR - Seesaw or paradoxic respirations
- Increased use of intercostal muscles
- Tachypnea = > 60 breaths/min at rest
- Central cyanosis = hypoxemia
Normal Newborn Cardiovascular system
- Expected Findings - NURSES MUST BE AWARE OF THESE!
⚬ Heart Rate
■ Full minute, irregular in 1st hours
■ Re eval >160 bpm or < 110 bpm
⚬ PMI - point of maximal impulse
⚬ Murmurs
⚬ Blood pressure, MAP matches gestational age
⚬ Pink coloration
- Signs of risk for cardiovascular problems
⚬ Persistent tachycardia/bradycardia, pallor, cyanosis
⚬ Heart Rate
■ Full minute, irregular in 1st hours
■ Re eval >160 bpm or < 110 bpm
⚬ PMI - point of maximal impulse
⚬ Murmurs
⚬ Blood pressure, MAP matches gestational age
⚬ Pink coloration
- Signs of risk for cardiovascular problems
⚬ Persistent tachycardia/bradycardia, pallor, cyanosis
Normal Newborn Hematologic system
- Lab Values
⚬ RBC’s and Hemoglobin higher than adult, because fetal circulation is less efficient
at oxygen exchange than the lungs.
■ Hgb for newborn: 14-24 g/dl at birth; 12-20 g/dl at first 2 weeks
■ Hct for newborn: 51%-56% at birth; 39%-59% by 8 weeks
⚬ WBC’s: 9,000-30,000/mm3
■ 18,000/mm3 normal at birth
■ Increases to 24,000 mm3 first day of life
■ Stabilizes at 12,000 mm3 during neonatal period
■ Immature leukocyte function inhibits ability to destroy pathogens; more vulnerable to infection
⚬ Platelets: 150,000-300,000/mm3
- Lab Values
⚬ RBC’s and Hemoglobin higher than adult, because fetal circulation is less efficient
at oxygen exchange than the lungs.
■ Hgb for newborn: 14-24 g/dl at birth; 12-20 g/dl at first 2 weeks
■ Hct for newborn: 51%-56% at birth; 39%-59% by 8 weeks
⚬ WBC’s: 9,000-30,000/mm3
■ 18,000/mm3 normal at birth
■ Increases to 24,000 mm3 first day of life
■ Stabilizes at 12,000 mm3 during neonatal period
■ Immature leukocyte function inhibits ability to destroy pathogens; more vulnerable to infection
⚬ Platelets: 150,000-300,000/mm3
Newborns tolerate a narrower range of environmental temperatures and are extremely ___________ to both under and overheating
- Expected Findings:
⚬ 36.5-37.2 (97.7-98.9) axillary
⚬ Balance achieved between heat loss and heat generation - Methods of heat loss
⚬ Conduction
⚬ Convection
⚬ Radiation
⚬ Evaporation
- Expected Findings:
⚬ 36.5-37.2 (97.7-98.9) axillary
⚬ Balance achieved between heat loss and heat generation - Methods of heat loss
⚬ Conduction
⚬ Convection
⚬ Radiation
⚬ Evaporation
Newborn characteristics leading to heat loss
⚬ Thin layer __________ fat
⚬ Limited stores of glucose, glycogen, ____
⚬ Blood vessels close to the surface
⚬ Large surface-to-body ratio
⚬ Shivering rarely operable
⚬ Limited voluntary activity or ability to change posture
⚬ Unable to communicate: “too hot”, “too cold”
⚬ Thin layer subcutaneous fat
⚬ Limited stores of glucose, glycogen, fat
⚬ Blood vessels close to the surface
⚬ Large surface-to-body ratio
⚬ Shivering rarely operable
⚬ Limited voluntary activity or ability to change posture
⚬ Unable to communicate: “too hot”, “too cold”
Renal system - Newborn
⚬ Day 1-2 = 2-6 wet diapers/day
⚬ After day 4 = 6-8 wet diapers/day
⚬ Average # of diapers = # of days old
⚬ Day 1-2 = 2-6 wet diapers/day
⚬ After day 4 = 6-8 wet diapers/day
⚬ Average # of diapers = # of days old
Nursing Alert
- An infant who has not voided by ________ should be assessed for adequacy of fluid
intake, bladder distention, restlessness, and symptoms of pain. The pediatrician or
neonatal nurse practitioner should be notified.
24 hours
Newborns
- Stools
⚬ Progress from thick, greenish black meconium to loose, greenish brown
transitional stools to milk stools
⚬ Stools of breastfed infants are frequent, seedy, and ________-colored.
mustard
Hyperbilirubinemia (Neonatal Jaundice)
⚬ Occurs in as many as __% of newborns, more severe in preterm
⚬ One of the most common reasons for pedi-readmits to the hospital
⚬ Physiologic Jaundice
■ Occurs after the first 24 hours of life as a result of hemolysis of red
blood cells and immaturity of the liver
* Typically 2-3 days after birth
⚬ Occurs in as many as 60% of newborns, more severe in preterm
⚬ One of the most common reasons for pedi-readmits to the hospital
⚬ Physiologic Jaundice
■ Occurs after the first 24 hours of life as a result of hemolysis of red
blood cells and immaturity of the liver
* Typically 2-3 days after birth
Hyperbilirubinemia (Neonatal Jaundice)
⚬ Caused by presence unconjugated bilirubin released with the breakdown of _____
■ Increased fetal RBC’s with a shortened life span
■ Liver immaturity
⚬ Concern
■ Acute bilirubin encephalopathy: neuroligcal dysfunction associated with elevated levels of bilirubin
■ Kernicterus is a type of brain damage that can result from high levels of bilirubin in a baby’s blood.
RBC’s
East Asians have inherently higher _________ levels at birth than caucasians. The potential for unneccessary treatment makes jaundice a problem of public health and clinical significance.
bilirubin
Newborns- immune system
⚬ Immature Immune System
■ ________________ to organisms make the newborn vulnerable to infection
■ Immature leukocyte function
* Immunoglobulins contribute possive immunity
⚬ IgG crosses the placenta in utero and provides a newborn with passive immunity.
⚬ IGA does not cross the placenta but is present in colostrum
⚬ IgM does not cross the placenta
■ If elevated in newborn, may indicate intrauterine infection (TORCH)
- So, WASH, WASH, WASH the hands
Lack of exposure
Identify
Erythema toxicum
Identify
Melanocytosis
Identify
Vernix
Lanugo is soft, fine ______ covering a fetus while inside the uterus. It helps protect the fetus and keeps it warm while during development. Some newborns have lanugo covering their bodies at birth, especially if they’re born prematurely.
hair
Identify
Desquamation