Week 1 Content Flashcards
1
Q
- Pregnancy – ____________
- Following Birth – ____________
- Childbirth – ____________
A
- Pregnancy – Antepartum
- Following Birth – Postpartum
- Childbirth – Intrapartum
2
Q
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.
A
Gestational
3
Q
Antepartum: Refers to the period of pregnancy ________________________
A
before the onset of labor.
4
Q
PREGNANCY (ANTEPARTUM) Common Terms
LMP:
A
Last Menstrual Period
5
Q
EDD:
A
Estimated date of delivery. Also abbreviated EDB: (estimated date of
birth).
6
Q
- Preterm: pregnancy that has reached ___ weeks of gestation but before completion of 37 weeks of gestation
A
20
7
Q
- ______ : pregnancy from the beginning of week 38 of gestation to end of week 42 of
gestation
A
Term
8
Q
- Postdate or post-term: pregnancy that goes beyond ____ weeks of gestation
A
42
9
Q
- ________ : 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.
A
Abortion
10
Q
- Viability: Capacity to live ________________; about 22 to 25 weeks gestation are on
the threshold of viability
A
outside the uterus;
11
Q
- 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
A
- 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
12
Q
________ : A woman who is pregnant
Gravidity: Pregnancy
___________ : A woman who has never been pregnant
Primigravida: A woman pregnant for the first time
A
Gravida: A woman who is pregnant
Gravidity: Pregnancy
Nulligravida: A woman who has never been pregnant
Primigravida: A woman pregnant for the first time
13
Q
- _______ : 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
A
- 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
14
Q
Obstetric History
Five digit system
* GTPAL
* ___________________________________
Two digit system
* G – gravida (number of pregnancies)
* P – para (number of pregnancies reaching 20 weeks)
A
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)
15
Q
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 __________
A
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
16
Q
- Placenta: A structure that provides _____________ to and removes ________ from the developing baby and secretes hormones necessary for the pregnancy to continue
A
- Placenta: A structure that provides nourishment to and removes wastes from the developing baby and secretes hormones necessary for the pregnancy to continue
17
Q
- _______ : part of the uterus that is farthest from the cervix, above the openings of the fallopian tubes
A
- Fundus: part of the uterus that is farthest from the cervix, above the openings of the fallopian tubes
18
Q
- _______ : 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.
A
- 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.
19
Q
- ________ : 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.
A
- 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.
20
Q
Terms Related to Labor (Intrapartum)
- _______ : peak, or period of greatest strength, of a uterine contraction.
- ______ : lowest point
A
- Acme: peak, or period of greatest strength, of a uterine contraction.
- Nadir: lowest point
21
Q
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.
A
- 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.
22
Q
Terms Related to Labor (Intrapartum)
- SVD: spontaneous ________ delivery
- VAD: ________ assisted delivery
A
- SVD: spontaneous vaginal delivery
- VAD: vacuum assisted delivery
23
Q
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.
A
- 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.
24
Q
- Dilation: gradual widening of the _______ in the process of labor.
- _________ : the appearance of the fetal scalp or presenting part at the vaginal opening.
A
- 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.
25
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.
26
Preterm infant: * An infant born before the beginning of the ____ week of gestation. Also called a premature infant.
37th
27
Postpartum: refers to the first ________ after childbirth.
6 weeks
28
* _________ : 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.
29
* ________: 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
30
* 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.
31
* _________ 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
32
* 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
33
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
34
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
35
* _________
⚬ 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
36
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
37
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
38
Postpartum Period
⚬ Ovarian function returns
￭ As early as 27 days, mean of ______ weeks – nonlactating
￭ Mean of 6 months - breastfeeding
7 to 9
39
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
40
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
41
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)
42
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
43
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
44
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
45
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
46
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
47
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
48
* _________ 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
49
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
50
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
51
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
52
Normal Newborn Physiologic Adaptations
Nose Breathers
* Reflex to open mouth when nose blocked not present until _______ old
3 weeks
53
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
54
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
55
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
56
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
57
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
58
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”
59
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
60
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
61
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
62
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
63
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
64
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
65
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
66
Identify
Erythema toxicum
67
Identify
Melanocytosis
68
Identify
Vernix
69
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
70
Identify
Desquamation
71
Caput Succedaneum
* An abnormal _____________ under the scalp on top of the skull that may or may not cross the suture lines, depending on the size.
* Pressure on the presenting part of the fetal head against the cervix during labor may cause edema of the scalp.
* This diffuse swelling is temporary and will be absorbed within 2-3 days
collection of fluid
72
Cephalohematoma
* A collection of ______ between a skull bone and its periosteum.
* Does not cross the suture line, limited to the surface of the particular bone
* Caused by pressure of the fetal head against the maternal pelvis during prolonged or difficult labor.
⚬ May be apparent at birth but sometimes not seen until 24-48 hours of life as subperiosteal bleeding is slow.
* Firm to touch and may increase in size from 1 to 3 days.
* Resolves in about 2-8 weeks
blood
73
Normal Newborn Care Management Birth Through the First 2 Hours
Basic Principles
⚬ Be prepared
⚬ Calm the infant (and yourself!)
⚬ Review history
⚬ Include parents
⚬ Be gentle
⚬ Quiet & warm environment
⚬ Look & listen frist, then feel, poke, prod, then calm and recover
⚬ Be prepared
⚬ Calm the infant (and yourself!)
⚬ Review history
⚬ Include parents
⚬ Be gentle
⚬ Quiet & warm environment
⚬ Look & listen frist, then feel, poke, prod, then calm and recover
74
* Immediate care after birth
⚬ Apgar scoring and initial assessment
⚬ Caregiver trained in neonatal resuscitation available for all births
* Physical assessment
⚬ General appearance
⚬ Vital signs
⚬ Baseline measurement of physical growth
⚬ Neurologic assessment
* Transitional Period
⚬ TPR, skin color, LOC, muscle tone, activity level eval and documented at least once every 30 minutes until stable for 2 hours.
⚬ Apgar scoring and initial assessment
⚬ Caregiver trained in neonatal resuscitation available for all births
* Physical assessment
⚬ General appearance
⚬ Vital signs
⚬ Baseline measurement of physical growth
⚬ Neurologic assessment
* Transitional Period
⚬ TPR, skin color, LOC, muscle tone, activity level eval and documented at least once every 30 minutes until stable for 2 hours.
75
Gestational age assessment: Newborn classification by gestational age & birth weight
AGA - Appropriate for __________ age
LGA - Large for gestational age: above 90th percentile
SGA - Small for gestational age: below 10th percentile
AGA - Appropriate for gestational age
LGA - Large for gestational age: above 90th percentile
SGA - Small for gestational age: below 10th percentile
76
Apgar scoring
77
Early Care of the Normal Newborn
* Administering vitamin K
⚬ Prevents _________ problems
⚬ Stimulates liver to synthesize clotting factors
* Administering _____ vaccine
* Providing ____ treatment
⚬ Erythromycin ophthalmic ointment
￭ Prevents gonococcal opthalmia neonatorum and chlamydial conjunctivitis
* Administering vitamin K
⚬ Prevents bleeding problems
⚬ Stimulates liver to synthesize clotting factors
* Administering Hep B vaccine
* Providing eye treatment
⚬ Erythromycin ophthalmic ointment
￭ Prevents gonococcal opthalmia neonatorum and chlamydial conjunctivitis
78
Continuing Care of the Normal Newborn
* __________
⚬ Assess all infants for risk factors and signs of hypoglycemia.
⚬ Perform screening test for blood glucose if indicated.
⚬ Maintain safe levels per institutional policies.
* _________
⚬ Assess risk for jaundice.
⚬ Ensure infant is feeding well.
* Blood glucose
⚬ Assess all infants for risk factors and signs of hypoglycemia.
⚬ Perform screening test for blood glucose if indicated.
⚬ Maintain safe levels per institutional policies.
* Bilirubin
⚬ Assess risk for jaundice.
⚬ Ensure infant is feeding well.
79
* Safe sleep (SIDS)
⚬ The American Academy of pediatrics recommends all infants be placed ________ to sleep.
⚬ Avoid overheating.
⚬ Not to sleep in a bed or couch with adults
* Plagiocephaly (Tummy Time)
⚬ Supervised periods of lying prone each day
supine
80
⚬ Breast milk provides sufficient fat, protein & fluids
￭ Human milk contains all the _________ required for infant nutrition, except vitamin D is somewhat low
vitamins
81
Vitamins D and K
￭ Breastfed babies should be exposed to __________ for 30 min/week wearing only a diaper, or for 2 hours/week fully clothed to help prevent rickets
* Rickets is the softening and weakening of _______ in children, usually because of an extreme and prolonged vitamin D deficiency.
￭ To prevent hemorrhagic problems in the newborn, an injection for Vitamin K is routinely given at birth.
￭ Breastfed babies should be exposed to sunlight for 30 min/week wearing only a diaper, or for 2 hours/week fully clothed to help prevent rickets
* Rickets is the softening and weakening of bones in children, usually because of an extreme and prolonged vitamin D deficiency.
￭ To prevent hemorrhagic problems in the newborn, an injection for Vitamin K is routinely given at birth.
82
After 6 months, breastfed babies need iron supplementation
￭ All formulat fed and breastfed infants weaned before 6 months should receive an ___________ formula until 12 months of age
iron fortified
83
The American Academy of Pediatrics (AAP) recommends that infants be breastfed exclusively for the first ___ months of life and that breastfeeding continues for at least 12 months (if able).
⚬ If weaned before 12 months, infants should receive iron-fortified infant formula
⚬ In the United States, approximately 60% of infants are breastfed at birth; but
fewer than 25% are still breastfeeding at 6 months of age.
6
84
* Benefits of Breastfeeding
⚬ Human milk is designed for human infants and is nutritionally superior to any
alternative
⚬ Bacteriologically safe and fresh
⚬ __________ in breast milk more easily absorbed than those in formula
Nutrients
85
Breastfeeding
lower incidence of _________, respiratory infections, otitis media, SIDS, and allergic &
digestive diseases
⚬ Mothers experience less postpartum ________, faster involution, delayed return of ovulation and less risk of ovarian cancer and premenopausal breast cancer
lower incidence of diarrhea, respiratory infections, otitis media, SIDS, and allergic &
digestive diseases
⚬ Mothers experience less postpartum bleeding, faster involution, delayed return of ovulation and less risk of ovarian cancer and premenopausal breast cancer
86
Anatomy and Physiology of Lactation
⚬ Uniqueness of human milk
￭ Contains antimicrobial factors (__________)
* IgA (most abundant)
* IgG, IgM, IgD, & IgE
￭ Colostrum: more concentrated than mature milk and extremely rich in immunoglobulins
* Higher concentrations of protein and minerals but less fat than mature milk
￭ Composition of mature milk changes during each feeding
* Important to breastfeed infant long enough to supply balanced feeding
antibodies
87
Estrogen and progesterone levels decrease after delivery, which triggers the
release of _________ from the anterior pituitary
prolactin
88
Stages of Human Milk
⚬ _________ : present at first postpartum day; thick and yellow
⚬ ___________ milk: present 2-5 days-2 weeks postpartum; not as yellow as colostrum
⚬ ________ milk: present after transitional milk; whiter & thinner than transitional milk
⚬ Foremilk: immediate milk received in feeding; part-skim and part-whole milk; satisfies infan’ts initial thirst
⚬ Hindmilk: later milk received in feeding; let down usually takes 20 minutes of suckling; higher in fat content (4x higher than foremilk); satisfies hunger and promotes infant weight gain
⚬ Colostrum: present at first postpartum day; thick and yellow
⚬ Transitional milk: present 2-5 days-2 weeks postpartum; not as yellow as colostrum
⚬ Mature milk: present after transitional milk; whiter & thinner than transitional milk
⚬ Foremilk: immediate milk received in feeding; part-skim and part-whole milk; satisfies infan’ts initial thirst
⚬ Hindmilk: later milk received in feeding; let down usually takes 20 minutes of suckling; higher in fat content (4x higher than foremilk); satisfies hunger and promotes infant weight gain
89
Inspect breast for previous surgery, augmentation (can breastfeed as long as the ___________ haven’t been removed), mastectomy (nurse from remaining breast)
milk ducts
90
LATCH score
*
latch, audible swallowing, type of nipple, comfort, hold
91
* Maternal Nutrition
⚬ Drink liquids daily when thirsty
￭ Preferably water, avoid sugar laden drinks
￭ Milk great, if tolerated
⚬ Breastfeeding mothers need an additional ____ kcal daily
⚬ Need ______ as part of balanced diet
⚬ Drink liquids daily when thirsty
￭ Preferably water, avoid sugar laden drinks
￭ Milk great, if tolerated
⚬ Breastfeeding mothers need an additional 500 kcal daily
⚬ Need calcium as part of balanced diet
92
* _______ - the ability to take nourishment from breast or bottle
Feeding
93
Term newborns are born with reflexes that facilitate feeding:
￭ ________ , sucking and swallowing
⚬ Physiological signs that newborn is ready to feed:
￭ Vital sign stable, unlabored respirations, nares patent, no cyanosis
⚬ Active ______ sounds
⚬ No abdominal ___________
￭ Rooting, sucking and swallowing
⚬ Physiological signs that newborn is ready to feed:
￭ Vital sign stable, unlabored respirations, nares patent, no cyanosis
⚬ Active bowel sounds
⚬ No abdominal distention
94
Newborn feeding - Cues
⚬ Hand-to-______ or hand-to-hand movements
⚬ ______ motions
⚬ Rooting
⚬ Mouthing
⚬ Hand-to-mouth or hand-to-hand movements
⚬ Sucking motions
⚬ Rooting
⚬ Mouthing
95
Bottle Feeding
￭ Ready to feed, concentrated formula, powdered formula
⚬ Store formula in refrigerator and use within ____ hours
⚬ Heating is optional; it should be at least room temperature
￭ DO NOT __________
⚬ Most newborns eat 2-4 oz on demand
⚬ Burp baby
￭ Ready to feed, concentrated formula, powdered formula
⚬ Store formula in refrigerator and use within 48 hours
⚬ Heating is optional; it should be at least room temperature
￭ DO NOT microwave
⚬ Most newborns eat 2-4 oz on demand
⚬ Burp baby
96
Methods of heat loss [newborn]
⚬ Conduction
⚬ Convection
⚬ Radiation
⚬ Evaporation
97
Acrocyanosis is
blue hands/feet on a newborn
98
* FICA: Spirituality Assessment Tool
* F: ______ and belief: Do you consider yourself religious?
* I: Importance: Importance of _________?
* C: ____________: Are you part of a spiritual community?
* A: Address in care: How would you like me to ________ these issues?
* F: Faith and belief: Do you consider yourself religious?
* I: Importance: Importance of spirituality?
* C: Community: Are you part of a spiritual community?
* A: Address in care: How would you like me to address these issues?
99
The woman's family members are present when the home care maternal-child nurse arrives for a postpartum and newborn visit. What should the nursAe do?
A. Observe the family members interactions with the newborn and one another.
B. Ask the woman to meet with her and the baby alone.
C. Do a brief assessment on all family members present.
D. Reschedule the visit for another time so that the mother and infant can be
assessed private
A. Observe the family members interactions with the newborn and one another.
100
Why is the patient's family important to the maternity nurse?
A. They pay the bills.
B. The nurse will know which family member to avoid.
C. The nurse will know which mothers will really care for their children.
D. The family culture and structure will influence nursing care decisions
D. The family culture and structure will influence nursing care decisions
101
The two primary functions of the ovaries are to:
A. Normal female development and sex hormone release.
B. Ovulation and internal pelvic support.
C. Sexual response and ovulation.
D. Ovulation and hormone production.
D. Ovulation and hormone production.
102
Which statement would indicate that the client requires additional instruction about breast self-examination?
A. Yellow discharge from my nipple is normal if I’m having my period.
B. I should check my breasts at the same time each month, like after my period.
C. I should also feel in my armpit area while performing my breast examination.
D. I should check each breast in a set way, such as in a circular motion
A. Yellow discharge from my nipple is normal if I’m having my period.
103
Uterine atony
* "hypotonia of uterus"
* Is the leading cause of early ____
PPH
104
__________ : interval between birth and the return of organs to their
normal, nonpregnant state
Postpartum
105
Involution: Return of __________ to nonpregnant state after birth
* Subinvolution: "delayed return of the enlarged uterus to nonpregnant size and
function
uterus
106
* End of 3rd stage of labor (after placenta is delivered): fundus is midline, at or ____
below umbilicus
2 cm
107
6th Day Postpartum: fundus halfway between ________ and symphysis pubis
umbilicus
108
* Fundus 2 Weeks Postpartum: should not be __________ abdominally
palpable
109
* Fundus ___ Weeks Postpartum: returned to nonpregnant location and size
6
110
Postpartum hemostasis is achieved by compression of intramyometrial blood vessels – you want uterine contractions postpartum
* ___________ : release by the pituitary gland, strengthens and coordinate these uterine contractions
* Pitocin: (exogenous oxytocin) is usually administered IV or IM immediately after expulsion of the placenta
* Breastfeeding: increases release of __________
* Oxytocin: release by the pituitary gland, strengthens and coordinate these uterine contractions
* Pitocin: (exogenous oxytocin) is usually administered IV or IM immediately after expulsion of the placenta
* Breastfeeding: increases release of oxytocin
111
* Afterpains: breastfeeding and oxytocin/Pitocin __________ afterpains
increase
112
* _____ pregnancies & births = firmer fundus and better uterine tone, less cramping
Less
113
POSTPARTUM LOCHIA
* First __ hours should be about that of a heavy menstrual period and then steadily
decrease
2
114
POSTPARTUM LOCHIA
** Foul odor indicated ____________ **
infection
115
Important Labs: after birth
H&H can drop
____ can be high (up to 30,000 during labor)
WBC
116
Colostrum: early milk that is thick _________ (transitions to mature milk 72-96
hours PP)
yellow
117
* Engorgement: increase in blood and lymphatic fluid as milk production increases (___________)
congestion
118
Breastfeeding support: frequent feedings/pumping, warm/hot water
* Non-breastfeeding support: binders or well fitted bras, ice packs, mild analgesics **cabbage leaves have also been found to help decrease milk production**
Breastfeeding support: frequent feedings/pumping, warm/hot water
* Non-breastfeeding support: binders or well fitted bras, ice packs, mild analgesics **cabbage leaves have also been found to help decrease milk production**
119
* ___________ of areolae and linea nigra may not regress completely
Hyperpigmentation
120
Striae gravidarum (stretch marks) on the breast, abdomen, hips, and thighs may _____ but usually do not disappear completely
fade
121
* Blood sugar is _______ in postpartum period
lower
122
PREVENTION OF PP HEMORRHAGE
Maintain Good Uterine Tone
* _____________________ – reduces risk for hemorrhage by causing uterus to contract and applies
pressure to the "wound" inside the uterus where the placenta was attached.
Massage the Fundus
123
PREVENTION OF PP HEMORRHAGE
Prevent Bladder Distension
* Encourage frequent __________ to prevent bladder distention that can lead to excessive bleeding (interference with uterine contractions).
* Maintain foley until feeling regained after anesthesia (epidural causes legs to go numb!)
voiding
124
* Hypotension is a _____ sign of postpartum hemorrhage
LATE
125
**Bladder distension makes uterus displaced up and to the ______**
right
126
NEWBORN Stage 1: First period of reactivity (BIRTH - 30 min)
Heart rate increases rapidly to 160-180 bpm gradually falls after 30 minutes or to baseline 120-160bpm
Respirations are __________ : 60 to 80/min
Fine crackles present on auscultation
Audible grunting, nasal flaring, and retractions of the chest also can be present (GFR) - Should cease within the first ______
Infant is alert and may have spontaneous startles, tremors, crying, and head movement from side to side
Bowel sounds audible
Heart rate increases rapidly to 160-180 bpm gradually falls after 30 minutes or to baseline 120-160bpm
Respirations are irregular: 60 to 80/min
Fine crackles present on auscultation
Audible grunting, nasal flaring, and retractions of the chest also can be present (GFR) - Should cease within the first hour
Infant is alert and may have spontaneous startles, tremors, crying, and head movement from side to side
Bowel sounds audible
127
Newborn Stage 2 : Period of decreased responsiveness (60-100 mins)
Infant is ____
Respirations are rapid (up to 60breaths/min) & shallow but unlabored
Bowel sounds are audible & peristaltic waves may be noted over the rounded abdomen
Infant is pink
Respirations are rapid (up to 60breaths/min) & shallow but unlabored
Bowel sounds are audible & peristaltic waves may be noted over the rounded abdomen
128
Newborn stage 3: Second PERIOD OF REACTIVITY (2-8 hours & lasts from 10 mins to several hours)
Brief periods of tachycardia & tachypnea occur associated with increased ___________
Changes in skin color
Mucus production
____________ (1st stool) is commonly passed at this time
Brief periods of tachycardia & tachypnea occur associated with increased muscle tone
Changes in skin color
Mucus production
Meconium (1st stool) is commonly passed at this time
129
Newborn Respiratory Patterns
______ breathers
Shallow & _________ respirations (count for a full 1 minute)
Chest & abdomen rises simultaneously
Short periods of _______ (<15 seconds)
Observe for blue lips – apneic periods >____ seconds = abnormal
Rate – irregular is normal
__________ is normal
Nose breathers
Shallow & irregular respirations (count for a full 1 minute)
Chest & abdomen rises simultaneously
Short periods of apnea (<15 seconds)
Observe for blue lips – apneic periods >20 seconds = abnormal
Rate – irregular is normal
Crackles is normal
130
How does heat loss occur in newborns?
__________ – loss of heat to cooler surface
__________ – lose heat to cooler ambient air
__________ – when amniotic fluid evaporates from the skin
__________ – when the newborn is near cool objects, walls, tables, cabinets, without actually being in contact with them
Conduction – loss of heat to cooler surface
Convection – lose heat to cooler ambient air
Evaporation– when amniotic fluid evaporates from the skin
Radiation – when the newborn is near cool objects, walls, tables, cabinets, without actually being in contact with them
131
Conduction – loss of heat to _________ surface
cooler
132
Convection – lose heat to cooler __________
ambient air
133
Evaporation– when __________ evaporates from the skin
amniotic fluid
134
Radiation – when the newborn is _____________ , walls, tables, cabinets, without actually being in contact with them
near cool objects
135
Hyperbilirubinemia (Neonatal Jaundice) - presence of unconjugated bilirubin released with the breakdown of RBCs because of immature _______
Occurs in as many as ____% newborns, more severe in preterm
Physiologic (non-pathologic) jaundice – appears 2-3days afterbirth (>24 hours)
Pathologic – occurs <24hrs after birth
Hyperbilirubinemia (Neonatal Jaundice) - presence of unconjugated bilirubin released with the breakdown of RBCs because of immature liver
Occurs in as many as 60% newborns, more severe in preterm
Physiologic (non-pathologic) jaundice – appears 2-3days afterbirth (>24 hours)
Pathologic – occurs <24hrs after birth
136
Hyperbilirubinemia (Neonatal Jaundice) Management
______________ *** eyes must be covered
Phototherapy
137
First pee and poo-
should be within 24 hours of birth
138
Newborn Vital signs
Temperature: Able to maintain stable body temperature of ____°F to 98.6°F (36.1°C to 37°C) in normal room environment.
97
139
Newborn Heartbeat: Normally _________ beats per minute. It may be much slower when an infant sleeps.
110 to 160
140
Newborn Breathing rate: Normally ______ breaths per minute.
30 to 60
141
Newborn Blood pressure: Normally an upper number (systolic) between 60 and 80, and a lower number (diastolic) between 30 and 45.
142
Newborn Oxygen saturation: Normally _______ on room air.
Blood Sugar: > ___
Newborn Oxygen saturation: Normally 95% to 100% on room air.
Blood Sugar: > 45
143
Caput succedaneum: _________ area of the scalp, bruising usually accompanied - crosses suture lines
edematous
144
Cephalhematoma: collection of blood between _________ & periosteum
Caused by pressure of fetal head against maternal _________during prolonged or difficult labor
Risk for ___________
Cephalhematoma: collection of blood between skull bone & periosteum
Caused by pressure of fetal head against maternal pelvis during prolonged or difficult labor
Risk for jaundice
145
35 weeks of gestation the skin is covered by ________ caseosa (cheese like white substance) that is fused with the epidermis and serves as a protective covering
vernix
146
- Sweat glands, ______: small, white sebaceous glands noticeable on the newborn face
Milia
147
Mongolian Spots: bluish black areas of pigmentation on ______ & ________
-Usually fade over months to years
- Needs to be well documented so abuse is not suspected
Mongolian Spots: bluish black areas of pigmentation on back & buttocks
-Usually fade over months to years
- Needs to be well documented so abuse is not suspected
148
______ : salmon patches, telangiectatic nevi, ‘stork bites’ or ‘angel kisses’ are the result of superficial capillary defect occur in up to 80% of newborns
- No clinical significance & require no tx
Nevi
149
Erythema toxicum: ‘baby ______’ transient rash because of the inflammatory response
acne
150
Acrocyanosis = _________________
blue extremities
151
APGAR categories
HR
resp effort
Muscle tone
reflex irritability
color
152
Newborn meds
Erythromycin ointment – prevention of __________ infection
Vitamin K (Aquamephyton) Injections – prevention of vitamin K dependent _____________ disease of the newborn
--Given within 1-2hrs after birth
--Newborn at risk first week of life due to immature liver and sterile GI tract
Hepatitis B Vaccine
Erythromycin ointment – prevention of gonorrheal infection
Vitamin K (Aquamephyton) Injections – prevention of vitamin K dependent hemorrhagic disease of the newborn
--Given within 1-2hrs after birth
--Newborn at risk first week of life due to immature liver and sterile GI tract
Hepatitis B Vaccine
153
4th stage of labor
Bladder distention is problematic because:
A full bladder can displace the ________, preventing it from contracting properly.
This increases the risk of ________________________
It may also cause discomfort or urinary retention.
A full bladder can displace the uterus, preventing it from contracting properly.
This increases the risk of postpartum hemorrhage.
It may also cause discomfort or urinary retention.
154
4th stage of labor -
recovery stage
* First 1 to 2 hours after birth
155
What do nurses observe? – Vitals and Physical signs during 4th stage of labor (recovery)
Vital Signs:
Blood pressure
Heart rate
Temperature
Fundus: Location, firmness, and consistency.
A firm fundus is essential to prevent PPH.
Lochia (vaginal discharge): Amount, color, and odor (heavy bleeding, clots, or foul odor could indicate complications).
Neonatal Monitoring:
Respiration and heart rate.
Temperature and glucose stability.
Vital Signs:
Blood pressure
Heart rate
Temperature
Fundus: Location, firmness, and consistency.
A firm fundus is essential to prevent PPH.
Lochia (vaginal discharge): Amount, color, and odor (heavy bleeding, clots, or foul odor could indicate complications).
Neonatal Monitoring:
Respiration and heart rate.
Temperature and glucose stability.
156
Delivery Anesthesia & recovery time
Epidural/Spinal Anesthesia:
May cause ____________ and delayed return of bladder sensation, contributing to urinary retention.
Prolonged immobility can delay ____________ and increase fall risk.
May cause hypotension and delayed return of bladder sensation, contributing to urinary retention.
Prolonged immobility can delay ambulation and increase fall risk.
157
The return of the uterus to a nonpregnant state after birth is called ____________
involution
158
Heart rate is ____________ immediately after birth and can remain elevated for the first hour before decreasing gradually over the next 48 hours.
increased [mother]
159
Blood pressure shows a transient __________ of approximately 5% during the first few days after birth, returning to prepregnancy levels over weeks or months.
increase
160
Immediately after birth, excessive ____________ can occur if the bladder becomes distended because it pushes the uterus up and to the side and prevents it from contracting firmly
bleeding
161
Benefits of breastfeeding for the mom include
the convenience
decreases ___________
promotes ______________
may lower risk of _________ and other disease.
the convenience
decreases bleeding
promotes weight loss
may lower risk of cancer and other disease.
162
The _______ score is a standardized tool used to assess breastfeeding effectiveness and support interventions when needed.
Each category is scored on a scale from 0 to 2 (higher scores indicate more effective breastfeeding), with a total possible score of ___
The LATCH score is a standardized tool used to assess breastfeeding effectiveness and support interventions when needed.
Each category is scored on a scale from 0 to 2 (higher scores indicate more effective breastfeeding), with a total possible score of 10
163
Breast engorgement management
discomfort may be reduced by applying __________ or ___________ (or both) to the breasts and wearing a well-fitted support bra.
Antiinflammatory medications such as ibuprofen can help
breastfeeding mothers can feed frequently and use hand expression or a breast pump to reduce engorgement and promote comfort
Formula-feeding mothers with engorged breasts should not express breast milk as it can stimulate milk production and worsen engorgement.
discomfort may be reduced by applying ice packs or cabbage leaves (or both) to the breasts and wearing a well-fitted support bra.
Antiinflammatory medications such as ibuprofen can help
breastfeeding mothers can feed frequently and use hand expression or a breast pump to reduce engorgement and promote comfort
Formula-feeding mothers with engorged breasts should not express breast milk as it can stimulate milk production and worsen engorgement.
164
If a pregnant individual contracts rubella, it can lead to Congenital Rubella Syndrome (CRS) in the fetus, which may include:
____________________________
Miscarriage or stillbirth.
Severe birth defects
165
Rh Isoimmunization – what does the Rh-negative mom need? Why is it
important?
If RH-Negative, Rh Immune Globulin (__________) is given to prevent the formation of anti-Rh antibodies
Without RhIG, an Rh-negative mother may develop antibodies if exposed to Rh-positive fetal blood. These antibodies can _______________ in subsequent pregnancies.
If RH-Negative, Rh Immune Globulin (RhoGAM) is given to prevent the formation of anti-Rh antibodies
Without RhIG, an Rh-negative mother may develop antibodies if exposed to Rh-positive fetal blood. These antibodies can attack the fetus in subsequent pregnancies.
166
Convection is the flow of heat from the body surface to cooler ambient air
Prevention - Newborns in open bassinets are __________ to protect them from the cold. A _____ may be worn to decrease heat loss from the infant’s head.
Newborns in open bassinets are wrapped to protect them from the cold. A cap may be worn to decrease heat loss from the infant’s head.
167
Radiation is the loss of heat from the body surface to a cooler solid surface in relative proximity.
Prevention: bassinets and examining tables are placed away from ____________, and care is taken to avoid direct air drafts.
outside windows
168
Evaporation is the loss of heat that occurs when a liquid is converted to a vapor.
Prevention: completely ____ the newborn after birth or with bathing
dry
169
Conduction is the loss of heat from the body surface to cooler surfaces in direct contact.
Prevention: During initial assessment, the newborn is placed on a ____________ bed under a radiant _________
-scales used for weighing the newborn should have a protective ________
Prevention: During initial assessment, the newborn is placed on a prewarmed bed under a radiant warmer
-scales used for weighing the newborn should have a protective cover
170
Moro Reflex (_________ Reflex)
What It Is: The baby extends their arms and legs outward when startled (e.g., by a loud noise or a sudden movement) and then quickly brings them back toward the body.
Startle
171
Rooting Reflex
What It Is: When the infant’s cheek or mouth is stroked, they turn their head toward the touch and ____________ , as if searching for the breast or bottle.
open their mouth
172
Breastfed babies typically eat every 2 to 3 hours. This equates to about 8-12 feedings per day in the first few weeks.
Formula-fed babies generally eat every 3 to 4 hours, resulting in 6-8 feedings per day.
Breastfed babies typically eat every 2 to 3 hours. This equates to about 8-12 feedings per day in the first few weeks.
Formula-fed babies generally eat every 3 to 4 hours, resulting in 6-8 feedings per day.
173
After the first week, most babies urinate ____ times per day.
6-8
174
Jaundice is common in newborn babies because babies have a high number of _______________ in their blood, which are broken down and replaced frequently. A newborn baby's ______ is not fully developed, so it's less effective at processing the bilirubin and removing it from the blood.
Jaundice is common in newborn babies because babies have a high number of red blood cells in their blood, which are broken down and replaced frequently. A newborn baby's liver is not fully developed, so it's less effective at processing the bilirubin and removing it from the blood.
175
Breastfeeding- benefits to baby
It is easily digested and has many nutrients. Breastfeeding also protects babies against health issues like GI problems, allergies, and infections.
It is easily digested and has many nutrients. Breastfeeding also protects babies against health issues like GI problems, allergies, and infections.
176
￭ Colostrum: more concentrated than mature milk and extremely rich in ____________
immunoglobulins
