Week 3 Content Flashcards
(92 cards)
1
Q
Postpartum Hemorrhage (PPH)
⚬ Traditionally defined as loss of more than:
￭ _____ ml of blood after vaginal birth
￭ _____ ml after cesarean birth
⚬ Leading cause of maternal morbidity and mortality
⚬ Often unrecognized until mother has profound symptoms
A
⚬ Traditionally defined as loss of more than:
￭ 500 ml of blood after vaginal birth
￭ 1000 ml after cesarean birth
⚬ Leading cause of maternal morbidity and mortality
⚬ Often unrecognized until mother has profound symptoms
2
Q
Postpartum Hemorrhage (PPH)
⚬ Early, acute or primary PPH
￭ ___ hours after birth
⚬ Late or secondary PPH
￭ > 24 hours and up to ___ weeks after birth
⚬ Can sometimes be prevented by careful examination of factors that predispose patient to excessive bleeding
⚬ Classic S/S of shock
￭ May not be present until loss of 30%-40% of blood volume
A
⚬ Early, acute or primary PPH
￭ < 24 hours after birth
⚬ Late or secondary PPH
￭ > 24 hours and up to 12 weeks after birth
⚬ Can sometimes be prevented by careful examination of factors that predispose patient to excessive bleeding
⚬ Classic S/S of shock
￭ May not be present until loss of 30%-40% of blood volume
3
Q
PPH * Etiology and Risk Factors
⚬ Uterine ______
￭ Marked hypotonia of uterus
￭ Leading cause of PPH
￭ Associated with
* High _______
* Polyhydramnios
* Macrosomic fetus
* Obesity
* ________ gestation
A
⚬ Uterine atony
￭ Marked hypotonia of uterus
￭ Leading cause of PPH
￭ Associated with
* High parity
* Polyhydramnios
* Macrosomic fetus
* Obesity
* Multifetal gestation
4
Q
PPH - Etiology and Risk Factors cont’d
⚬ Retained products of conception
￭ Excessive bleeding, ______ uterus
⚬ Placental complications
￭ Nonadherent ______ placenta
￭ Adherent ________ placenta
* Total, partial or focal
⚬ _________ of genital tract
￭ If bleeding despite a firm, contracted uterine fundus
A
⚬ Retained products of conception
￭ Excessive bleeding, boggy uterus
⚬ Placental complications
￭ Nonadherent retained placenta
￭ Adherent retained placenta
* Total, partial or focal
⚬ Lacerations of genital tract
￭ If bleeding despite a firm, contracted uterine fundus
5
Q
PPH - Etiology and Risk Factors cont’d
⚬ ________ of uterus
￭ Fundus collapses into the uterine cavity (inside out) after birth.
￭ Rare but potentially life-threatening
￭ Incomplete, complete or prolapsed
￭ Primary s/s - hemorrhage, shock and pain
⚬ Subinvolution of uterus
￭ Uterine subinvolution is a slowing of the process of involution or __________ of the uterus.
￭ Causes - endometritis, retained placental fragments, pelvic infection, and uterine fibroids may cause uterine subinvolution.
￭ S/s - prolonged lochial discharge, irregular/excessive bleeding, hemorrhage
A
⚬ Inversion of uterus
￭ Fundus collapses into the uterine cavity (inside out) after birth.
￭ Rare but potentially life-threatening
￭ Incomplete, complete or prolapsed
￭ Primary s/s - hemorrhage, shock and pain
⚬ Subinvolution of uterus
￭ Uterine subinvolution is a slowing of the process of involution or shrinking of the uterus.
￭ Causes - endometritis, retained placental fragments, pelvic infection, and uterine fibroids may cause uterine subinvolution.
￭ S/s - prolonged lochial discharge, irregular/excessive bleeding, hemorrhage
6
Q
PPH Interventions
⚬ Identify cause/treat the cause
⚬ Primary Interventions
￭ ________ the fundus
￭ Express _____ in uterus
￭ Eliminate bladder distention
￭ Continuous IV infusion of 10-40 units of ________ with 1L LR or NS
⚬ If no response to oxytocin
￭ Misoprostol (Cytotec)
￭ Methylergonovine (Methergine)
￭ Carboprost (Hemabate)
￭ Dinoprostone (Prostaglandin)
⚬ Blood products
⚬ Oxygen via nonrebreather face mask
A
⚬ Identify cause/treat the cause
⚬ Primary Interventions
￭ Massage the fundus
￭ Express clots in uterus
￭ Eliminate bladder distention
￭ Continuous IV infusion of 10-40 units of oxytocin with 1L LR or NS
⚬ If no response to oxytocin
￭ Misoprostol (Cytotec)
￭ Methylergonovine (Methergine)
￭ Carboprost (Hemabate)
￭ Dinoprostone (Prostaglandin)
⚬ Blood products
⚬ Oxygen via nonrebreather face mask
7
Q
Hemorrhagic (Hypovolemic) Shock
- Results from _______
⚬ Emergency situation in which _________ of organs may become severely compromised, death may occur - Medical management
⚬ Pitocin, Methergine, Hemabate, Miso
⚬ Restore circulating blood volume - Nursing interventions
⚬ Ensure patent airway
⚬ Monitor pulse and blood pressure - Fluid or blood _____________ therapy
A
- Results from hemorrhage
⚬ Emergency situation in which perfusion of organs may become severely compromised, death may occur - Medical management
⚬ Pitocin, Methergine, Hemabate, Miso
⚬ Restore circulating blood volume - Nursing interventions
⚬ Ensure patent airway
⚬ Monitor pulse and blood pressure - Fluid or blood replacement therapy
8
Q
Venous Thromboembolic Disorders (VTE)
- From the formation of a blood ______ or ______ inside blood vessel by inflammation
thrombophlebitis) or patial obstruction of the _______ - Three conditions:
⚬ Superficial venous thrombosis
⚬ Deep venous thrombosis (DVT)
⚬ Pulmonary embolism (PE) - Highest incidence - 3 weeks after birth
⚬ Early __________ !
A
- From the formation of a blood clot or clots inside blood vessel by inflammation
thrombophlebitis) or patial obstruction of the vessel - Three conditions:
⚬ Superficial venous thrombosis
⚬ Deep venous thrombosis (DVT)
⚬ Pulmonary embolism (PE) - Highest incidence - 3 weeks after birth
⚬ Early ambulation!
9
Q
Coagulopathies
- Idiopathic/Immune thrombocytopenic purpura (ITP)
⚬ A blood disorder characterized by a __________ in the number of platelets in the blood.
￭ S/S - easy _________, bleeding gums, and internal bleeding.
⚬ This disease is caused by an immune reaction against one’s own platelets - Von Willebrand disease (VWD)
⚬ The blood does not _____ properly.
￭ Blood contains many proteins that help the blood clot when needed.
￭ One of these proteins is called von Willebrand factor (VWF). - Disseminated intravascular coagulation (DIC)
⚬ A serious disorder in which the proteins that control blood clotting become _________.
⚬ It can affect people recovering from complications from pregnancy and delivery - Preeclampsia, postpartum hemorrhage
A
- Idiopathic/Immune thrombocytopenic purpura (ITP)
⚬ A blood disorder characterized by a decrease in the number of platelets in the blood.
￭ S/S - easy bruising, bleeding gums, and internal bleeding.
⚬ This disease is caused by an immune reaction against one’s own platelets - Von Willebrand disease (VWD)
⚬ The blood does not clot properly.
￭ Blood contains many proteins that help the blood clot when needed.
￭ One of these proteins is called von Willebrand factor (VWF). - Disseminated intravascular coagulation (DIC)
⚬ A serious disorder in which the proteins that control blood clotting become overactive.
⚬ It can affect people recovering from complications from pregnancy and delivery - Preeclampsia, postpartum hemorrhage
10
Q
Postpartum Infections
- A puerperal infection - clinical infection of the ________ tract
⚬ Occurs within ___ days after miscarriage, induced abortion or birth.
⚬ Presence of fever (38 C, 100.4 F) or more on two successive days of first 10 postpartum days
￭ Not including first 24 hrs after birth - Endometritis
- Wound infections
- Urinary tract infections
- Mastitis
A
- A puerperal infection - clinical infection of the genital tract
⚬ Occurs within 28 days after miscarriage, induced abortion or birth.
⚬ Presence of fever (38 C, 100.4 F) or more on two successive days of first 10 postpartum days
￭ Not including first 24 hrs after birth - Endometritis
- Wound infections
- Urinary tract infections
- Mastitis
11
Q
Postpartum Psychiatric Disorders
- Mental health disorders in postpartum period have implications for mother, newborn, and entire family
⚬ Interfere with _________ to newborn and family integration
⚬ May threaten _____ and well-being of mother, newborn, and other children - Mood disorders
⚬ ____% of women experience a mild depression or “baby blues”
￭ Symptoms resolved within a few days to 2 weeks
⚬ 10% to 15% of women experience more serious depression
⚬ Paternal postpartum depression
A
- Mental health disorders in postpartum period have implications for mother, newborn, and entire family
⚬ Interfere with attachment to newborn and family integration
⚬ May threaten safety and well-being of mother, newborn, and other children - Mood disorders
⚬ 80% of women experience a mild depression or “baby blues”
￭ Symptoms resolved within a few days to 2 weeks
⚬ 10% to 15% of women experience more serious depression
⚬ Paternal postpartum depression
12
Q
Postpartum Psychologic Disorders cont’d
- Postpartum depression (PDD) without psychotic features
⚬ PPD - an intense and pervasive _________ with severe and labile mood swings
￭ Onset - within first few ______ after birth
⚬ Medical management
￭ Antidepressants, anxiolytic agents, mood stabilizers and electroconvulsive therapy
￭ Psychotherapy focuses fears and concerns of new responsibilities and roles; monitoring for suicidal or homicidal thoughts - Cognitive-behavioral therapy (CBT
- Interpersonal psychotherapy
A
- Postpartum depression (PDD) without psychotic features
⚬ PPD - an intense and pervasive sadness with severe and labile mood swings
￭ Onset - within first few months after birth
⚬ Medical management
￭ Antidepressants, anxiolytic agents, mood stabilizers and electroconvulsive therapy
￭ Psychotherapy focuses fears and concerns of new responsibilities and roles; monitoring for suicidal or homicidal thoughts - Cognitive-behavioral therapy (CBT
- Interpersonal psychotherapy
13
Q
Postpartum depression with psychotic features
⚬ Postpartum psychosis: syndrome characterized by depression, delusions, and thoughts of __________ either infant or herself
￭ Onsent - first _____ weeks after birth
⚬ Psychiatric emergency; may require psychiatric hospitalization
⚬ Associated with bipolar (or manic-depressive) disorder
A
⚬ Postpartum psychosis: syndrome characterized by depression, delusions, and thoughts of harming either infant or herself
￭ Onsent - first 2 to 4 weeks after birth
⚬ Psychiatric emergency; may require psychiatric hospitalization
⚬ Associated with bipolar (or manic-depressive) disorder
14
Q
Postpartum Psychologic Disorders cont’d
- Care Management
⚬ Screening for postpartum depression and anxiety
￭ ___________ Postnatal Depression Screen (EPDS)
⚬ Nursing care on the postpartum unit, the home and the community
⚬ Referrals
⚬ Providing safety
⚬ Psychiatric ___________
⚬ Psychotropic __________
⚬ Other treatments for postpartum depression
A
- Care Management
⚬ Screening for postpartum depression and anxiety
￭ Edinburgh Postnatal Depression Screen (EPDS)
⚬ Nursing care on the postpartum unit, the home and the community
⚬ Referrals
⚬ Providing safety
⚬ Psychiatric hospitalization
⚬ Psychotropic medications
⚬ Other treatments for postpartum depression
15
Q
Edinburg Scale
Score __ or more Flag
A
13
16
Q
- Anxiety disorders
⚬ Symptoms of anxiety that impair _________
⚬ Generalized anxiety disorder (GAD)
⚬ Panic disorder
⚬ Obsessive-compulsive disorder (OCD)
⚬ Post-traumatic stress disorder (PTSD)
⚬ Social anxiety phobia
A
⚬ Symptoms of anxiety that impair functioning
⚬ Generalized anxiety disorder (GAS)
⚬ Panic disorder
⚬ Obsessive-compulsive disorder (OCD)
⚬ Post-traumatic stress disorder (PTSD)
⚬ Social anxiety phobia
17
Q
Maternal Death
- Caused by variety of complications, may be sudden and unexpected
- Care
⚬ Context and implications of maternal and/or fetal death on remaining family members
⚬ __________ beliefs/customs
⚬ __________ protocols
￭ Hospital chaplain, social worker, obstetrician, perinatologist, nurse
￭ __________ by medical staff to address emotional toll on staff
⚬ Offer empathy and compassion
A
- Caused by variety of complications, may be sudden and unexpected
- Care
⚬ Context and implications of maternal and/or fetal death on remaining family members
⚬ Cultural beliefs/customs
⚬ Hospital protocols
￭ Hospital chaplain, social worker, obstetrician, perinatologist, nurse
￭ Debriefing by medical staff to address emotional toll on staff
⚬ Offer empathy and compassion
18
Q
High-Risk Neonate
- A newborn, regardless of gestational age or birth weight, has greater-than-average chance of __________ or ___________ due to conditions or circumstances associated with birth and
adjustments following birth - Classification
⚬ Birthweight
⚬ Gestational age
⚬ Predominant pathophysiologic status
A
- A newborn, regardless of gestational age or birth weight, has greater-than-average chance of morbidity or mortality due to conditions or circumstances associated with birth and
adjustments following birth - Classification
⚬ Birthweight
⚬ Gestational age
⚬ Predominant pathophysiologic status
19
Q
Acquired and Congenital Problems
- Conditions or circumstances superimposed on normal course of events associated with
birth and adjustment to extrauterine existence
⚬ Birth ________
⚬ Maternal _________ abuse
⚬ inf______
⚬ _________ anomalies
A
- Conditions or circumstances superimposed on normal course of events associated with
birth and adjustment to extrauterine existence
⚬ Birth trauma
⚬ Maternal substance abuse
⚬ Infection
⚬ Congenital anomalies
20
Q
Birth Injury
- Injury sustained during labor and birth
- Birth injuries may be avoidable
⚬ Ultrasonography allows antepartum dx that may be treated in utero/shortly after birth:
⚬ Macrosomia, hydrocephalus, and unusual presentations - Elective ________ birth chosen for some pregnancies to prevent birth injury
- Small % of significant birth injuries are __________ despite skilled & competent obstetric care
⚬ Especially with difficult or prolonged labor
⚬ When the infant is in an _________ presentation - Some injuries cannot be anticipated until circumstances are encountered during childbirth
A
- Injury sustained during labor and birth
- Birth injuries may be avoidable
⚬ Ultrasonography allows antepartum dx that may be treated in utero/shortly after birth:
⚬ Macrosomia, hydrocephalus, and unusual presentations - Elective cesarean birth chosen for some pregnancies to prevent birth injury
- Small % of significant birth injuries are unavoidable despite skilled & competent obstetric care
⚬ Especially with difficult or prolonged labor
⚬ When the infant is in an abnormal presentation - Some injuries cannot be anticipated until circumstances are encountered during childbirth
21
Q
Birth Injury con’t
⚬ Skeletal injuries
￭ ________ fracture
* Gentle handling, containment of limb against chest
￭ _________ dystocia
⚬ Peripheral nervous system injuries
￭ Erb-Duchenne paralysis (Erb palsy)
* Brachial plexus injury due to stretching or pulling (shoulder-head)
* Paralysis of extremity, arm limp
⚬ Tx – passive ROM, positioning of affected arm, avoid stress on muscles
⚬ 3 - 6 months to resolve
A
⚬ Skeletal injuries
￭ Clavicle fracture
* Gentle handling, containment of limb against chest
￭ Shoulder dystocia
⚬ Peripheral nervous system injuries
￭ Erb-Duchenne paralysis (Erb palsy)
* Brachial plexus injury due to stretching or pulling (shoulder-head)
* Paralysis of extremity, arm limp
⚬ Tx – passive ROM, positioning of affected arm, avoid stress on muscles
⚬ 3 - 6 months to resolve
22
Q
Birth Injury con’t
￭ Facial nerve paralysis
* Due to pressure on ___________ during birth
* Usually resolves hours to _____
* Assist w/ feeding techniques, possible gavage feeding, lactation consultant, eye care
⚬ Neurologic injuries
￭ Hypoxic-Ischemic Brain Injury
* Seizures, hypotonia, poor suck/swallow, apneic episodes
⚬ Treat symptoms, supportive care
A
￭ Facial nerve paralysis
* Due to pressure on facial nerve (CN VII) during birth
* Usually resolves hours to days
* Assist w/ feeding techniques, possible gavage feeding, lactation consultant, eye care
⚬ Neurologic injuries
￭ Hypoxic-Ischemic Brain Injury
* Seizures, hypotonia, poor suck/swallow, apneic episodes
⚬ Treat symptoms, supportive care
23
Q
Neonatal Infections
- ________
⚬ Significant cause of morbidity and mortality
⚬ Patterns of transmission
￭ Early onset or congenital - Within 72 hours after birth from direct contact with organisms from maternal GI or GU
- More rapid
- ________ is major cause of death
￭ Late onset – maternal or nosocomial - Approx. 7 to 30 days of age from hospital or community
- Bacterial infections
⚬ Group B streptococcus
⚬ Escherichia coli
⚬ Klebsiella
⚬ Pseudomonas
A
- Sepsis
⚬ Significant cause of morbidity and mortality
⚬ Patterns of transmission
￭ Early onset or congenital - Within 72 hours after birth from direct contact with organisms from maternal GI or GU
- More rapid
- GBS is major cause of death
￭ Late onset – maternal or nosocomial - Approx. 7 to 30 days of age from hospital or community
- Bacterial infections
⚬ Group B streptococcus
⚬ Escherichia coli
⚬ Klebsiella
⚬ Pseudomonas
24
Q
Neonatal Infections cont’d
- Fungal infections
⚬ Candidiasis
⚬ Thrush - Viral infections
⚬ Perinatally acquired
⚬ May occur in the NICU - Septicemia
⚬ Pneumonia
⚬ Bacterial meningitis
A
- Fungal infections
⚬ Candidiasis
⚬ Thrush - Viral infections
⚬ Perinatally acquired
⚬ May occur in the NICU - Septicemia
⚬ Pneumonia
⚬ Bacterial meningitis
25
Neonatal Infections
* Lab studies
⚬ Cultures, CSF, urine
⚬ CBC
￭ Immature to total neutrophil ratio (I/T ratio)
* If the IT ratio is greater than .2, there are more immature than mature neutrophils in the blood stream
* Normal value can r/o sepsis
* Treatment
⚬ Specific to organism - antiviral, antibiotic or antifungal
⚬ Breast milk encouraged
* Prevention – ____________
* Lab studies
⚬ Cultures, CSF, urine
⚬ CBC
￭ Immature to total neutrophil ratio (I/T ratio)
* If the IT ratio is greater than .2, there are more immature than mature neutrophils in the blood stream
* Normal value can r/o sepsis
* Treatment
⚬ Specific to organism - antiviral, antibiotic or antifungal
⚬ Breast milk encouraged
* Prevention – hand washing
26
Neonatal Infections * Intervention
⚬ Nursing responsibility to minimize infection
⚬ Effective _______________
⚬ Standard precautions
⚬ Cleaning of equipment
⚬ Replacement of used equipment
⚬ Appropriate disposal of linens and diapers
⚬ Avoid overcrowding
⚬ Guidelines for _______
⚬ Nursing responsibility to minimize infection
⚬ Effective handwashing
⚬ Standard precautions
⚬ Cleaning of equipment
⚬ Replacement of used equipment
⚬ Appropriate disposal of linens and diapers
⚬ Avoid overcrowding
⚬ Guidelines for visitation
27
Neonatal Infections
* Perinatally acquired infections – TORCH
⚬ Toxoplasmosis
⚬ Other
￭ Gonorrhea, hepatitis B, syphilis, varicella zoster, West Nile virus,parvovirus B19, and HIV, parvovirus B19, and HIV
⚬ Rubella
⚬ Cytomegalovirus (CMV)
⚬ Herpes simplex
⚬ Toxoplasmosis
⚬ Other
￭ Gonorrhea, hepatitis B, syphilis, varicella zoster, West Nile virus,parvovirus B19, and HIV, parvovirus B19, and HIV
⚬ Rubella
⚬ Cytomegalovirus (CMV)
⚬ Herpes simplex
28
Drug-Exposed Infants
* Recreational drug use
⚬ Marijuana, cocaine, hallucinogens, methamphetamine, inhalants, heroin
* _________
⚬ Most used substance during pregnancy
⚬ Low birth weight
* Alcohol
⚬ ______ alcohol syndrome (FAS)
⚬ Alcohol-related birth defects (ARBD)
* Prescription opioids
⚬ Neonatal abstinence syndrome (NAS) - next slide
* Recreational drug use
⚬ Marijuana, cocaine, hallucinogens, methamphetamine, inhalants, heroin
* Tobacco
⚬ Most used substance during pregnancy
⚬ Low birth weight
* Alcohol
⚬ Fetal alcohol syndrome (FAS)
⚬ Alcohol-related birth defects (ARBD)
* Prescription opioids
⚬ Neonatal abstinence syndrome (NAS) - next slide
29
Drug-Exposed Infants cont’d
* Neonatal Abstinence Syndrome (NAS)
⚬ A term used to describe a set of behaviors exhibited by the infant who was exposed to ______________ in utero
* Importance of maternal screening
* Early identification
* No PNC a red flag
⚬ Neonatal Behavioral Assessment Scale (NBAS)
⚬ Nursing care
￭ Feeding ad lib
￭ Swaddling, holding, reducing stimuli
￭ Individualized developmental care
* Neonatal Abstinence Syndrome (NAS)
⚬ A term used to describe a set of behaviors exhibited by the infant who was exposed to chemical substances in utero
* Importance of maternal screening
* Early identification
* No PNC a red flag
⚬ Neonatal Behavioral Assessment Scale (NBAS)
⚬ Nursing care
￭ Feeding ad lib
￭ Swaddling, holding, reducing stimuli
￭ Individualized developmental care
30
Hemolytic Disorders
* Hemolytic disease occurs when blood groups of mother and newborn are ___________ - blood incompatibility
⚬ Rh incompatibility
⚬ ABO incompatibility
⚬ Other hemolytic disorders
* Occur when maternal _________ are present naturally or form in response to antigen from fetal blood crossing placenta and entering maternal circulation
* Hemolytic disease occurs when blood groups of mother and newborn are different - blood incompatibility
⚬ Rh incompatibility
⚬ ABO incompatibility
⚬ Other hemolytic disorders
* Occur when maternal antibodies are present naturally or form in response to antigen from fetal blood crossing placenta and entering maternal circulation
31
Hemolytic Disorders
* Rh incompatibility (isoimmunization)
⚬ Only Rh-___ offspring of Rh-negative mother is at risk
⚬ If fetus is Rh positive & mother Rh negative, mother forms ________ against fetal blood cells
* Rh incompatibility (isoimmunization)
⚬ Only Rh-positive offspring of Rh-negative mother is at risk
⚬ If fetus is Rh positive & mother Rh negative, mother forms antibodies against fetal blood cells
32
Hemolytic Disorders
* ABO incompatibility
⚬ Occurs if fetal blood type is A, B, or AB, and maternal type is ___
⚬ Incompatibility arises because naturally occurring anti-A and anti-B __________ are transferred across placenta to fetus
⚬ Exchange transfusions required occasionally
* Other hemolytic disorders
⚬ Other metabolic and inherited conditions that increase hemolysis and may cause jaundice in infant
* ABO incompatibility
⚬ Occurs if fetal blood type is A, B, or AB, and maternal type is O
⚬ Incompatibility arises because naturally occurring anti-A and anti-B antibodies are transferred across placenta to fetus
⚬ Exchange transfusions required occasionally
* Other hemolytic disorders
⚬ Other metabolic and inherited conditions that increase hemolysis and may cause jaundice in infant
33
Hemolytic Disorders * Prevention/Treatment
⚬ Administration of _____, human gamma globulin
⚬ Intrauterine transfusions
⚬ Exchange transfusions
⚬ Treatment of __________
⚬ Administration of RhIG, human gamma globulin
⚬ Intrauterine transfusions
⚬ Exchange transfusions
⚬ Treatment of jaundice
34
Infants of Diabetic Mothers
* Increases risk for fetal and neonatal complications contributes to perinatal mortality
* Characteristic appearance
⚬ Macrosomia
⚬ Increased risk for birth injuries
⚬ Increase in congenital anomalies
* Fetal effect
⚬ ________ distress syndrome (RDS)
⚬ ___________ity
⚬ Hypoglycemia, hypocalcemia, hypomagnesemia
⚬ Cardiomyopathy
⚬ Hyperbilirubinemia, polycythemia
* Increases risk for fetal and neonatal complications contributes to perinatal mortality
* Characteristic appearance
⚬ Macrosomia
⚬ Increased risk for birth injuries
⚬ Increase in congenital anomalies
* Fetal effect
⚬ Respiratory distress syndrome (RDS)
⚬ Prematurity
⚬ Hypoglycemia, hypocalcemia, hypomagnesemia
⚬ Cardiomyopathy
⚬ Hyperbilirubinemia, polycythemia
35
Infants of Diabetic Mothers cont’d
* Nursing responsibilities
⚬ Early identification
⚬ Follow-up with complications
⚬ Monitoring ___________ levels
⚬ Ensuring early and adequate ________
⚬ Supporting parents
* Nursing responsibilities
⚬ Early identification
⚬ Follow-up with complications
⚬ Monitoring blood glucose levels
⚬ Ensuring early and adequate feeding
⚬ Supporting parents
36
Congenital Anomalies
* Reported to occur in __% of births worldwide - WHO
* Rate is higher in fetuses that are aborted
* Leading cause of death in infants under one year of age
* Major congenital anomalies that cause serious problems
⚬ Congenital _______ disease
⚬ Abdominal wall defects
⚬ NTDs
⚬ Cleft lip or palate
⚬ Clubfoot
⚬ Developmental dysplasia of the hip (DDH)
* Improved methods for detecting and preventing
* Reported to occur in 6% of births worldwide - WHO
* Rate is higher in fetuses that are aborted
* Leading cause of death in infants under one year of age
* Major congenital anomalies that cause serious problems
⚬ Congenital heart disease
⚬ Abdominal wall defects
⚬ NTDs
⚬ Cleft lip or palate
⚬ Clubfoot
⚬ Developmental dysplasia of the hip (DDH)
* Improved methods for detecting and preventing
37
Preterm and Postterm Infants
* Infants who are born considerably before term and survive are particularly susceptible to development of __________ related to preterm birth
⚬ Necrotizing __________
￭ Acute inflammatory disease of the bowel
￭ Damage to mucosal lining of bowel wall with diminished blood supply to the cells
⚬ Growth failure
⚬ Bronchopulmonary dysplasia
￭ Immature alveoli/respiratory tract or _________damage from lung disease or prolonged exposure to mechanical ventilation
⚬ Intraventricular and periventricular hemorrhage
⚬ Retinopathy of prematurity
￭ Severe vascular constriction with hypoxemia
* Infants who are born considerably before term and survive are particularly susceptible to development of sequelae related to preterm birth
⚬ Necrotizing enterocolitis
￭ Acute inflammatory disease of the bowel
￭ Damage to mucosal lining of bowel wall with diminished blood supply to the cells
⚬ Growth failure
⚬ Bronchopulmonary dysplasia
￭ Immature alveoli/respiratory tract or alveolar damage from lung disease or prolonged exposure to mechanical ventilation
⚬ Intraventricular and periventricular hemorrhage
⚬ Retinopathy of prematurity
￭ Severe vascular constriction with hypoxemia
38
* Preterm Infants
⚬ Organ systems are _________and lack adequate physiologic reserves to function in extrauterine environment
⚬ Potential problems and needs of preterm infant weighing 2000 g differ from those of term, postterm, or postmature infant of equal weight
⚬ Varying opinions exist about practical and ethical dimensions of resuscitation of extremely low–birth-weight infants, 1000 g
⚬ Organ systems are immature and lack adequate physiologic reserves to function in extrauterine environment
⚬ Potential problems and needs of preterm infant weighing 2000 g differ from those of term, postterm, or postmature infant of equal weight
⚬ Varying opinions exist about practical and ethical dimensions of resuscitation of extremely low–birth-weight infants, 1000 g
39
* Specific problems of infants born prematurely:
⚬ _________ problems.
⚬ _________ difficulties.
⚬ Cerebral Palsy.
⚬ Developmental delay.
⚬ _________ problems.
⚬ _________ impairment.
⚬ Breathing problems.
⚬ Feeding difficulties.
⚬ Cerebral Palsy.
⚬ Developmental delay.
⚬ Vision problems.
⚬ Hearing impairment.
40
* Late-preterm Infants
⚬ Born between ___ weeks and 36 weeks and 6 days of gestation
⚬ Referred to as late ________ rather than near term
⚬ Higher risk for problems related to:
￭ __________function
* Surfactant
￭ Thermoregulation
￭ Hypoglycemia
￭ Hyperbilirubinemia
￭ Feeding problems
￭ Neurodevelopmental problems
￭ Infection/sepsis
⚬ Born between 34 weeks and 36 weeks and 6 days of gestation
⚬ Referred to as late preterm rather than near term
⚬ Higher risk for problems related to:
￭ Respiratory function
* Surfactant
￭ Thermoregulation
￭ Hypoglycemia
￭ Hyperbilirubinemia
￭ Feeding problems
￭ Neurodevelopmental problems
￭ Infection/sepsis
41
Preterm and Postterm Infants cont’d
⚬ _________ aspiration syndrome
￭ Appears in 10% to 15% of all births
￭ Primarily in term and postterm births probably due to mature gut.
⚬ Persistent _________ hypertension of the newborn - failure of the normal circulatory transition that occurs after birth.
￭ Combined findings of pulmonary hypertension, right-to-left shunting, and a structurally normal heart
⚬ Meconium aspiration syndrome
￭ Appears in 10% to 15% of all births
￭ Primarily in term and postterm births probably due to mature gut.
⚬ Persistent pulmonary hypertension of the newborn - failure of the normal circulatory transition that occurs after birth.
￭ Combined findings of pulmonary hypertension, right-to-left shunting, and a structurally normal heart
42
Preterm and Postterm Infants cont’d
* Postterm Infants
⚬ Born after 42 weeks of gestation
￭ Postterm or postmature regardless of birth weight
⚬ ___________ syndrome - progressive placental dysfunction
⚬ Significant increase in fetal and neonatal _________ compared to those born at term
* Postterm Infants
⚬ Born after 42 weeks of gestation
￭ Postterm or postmature regardless of birth weight
⚬ Dysmaturity syndrome - progressive placental dysfunction
⚬ Significant increase in fetal and neonatal mortality compared to those born at term
43
Other Problems Related to Gestation
* Small for gestational age (SGA <10%) and intrauterine growth restriction (IUGR)
⚬ Perinatal __________
⚬ Hypoglycemia
⚬ Hyperglycemia
⚬ _______ loss
* Small for gestational age (SGA <10%) and intrauterine growth restriction (IUGR)
⚬ Perinatal asphyxia
⚬ Hypoglycemia
⚬ Hyperglycemia
⚬ Heat loss
44
Other Problems Related to Gestation – cont’d
Large-for-gestational age (LGA>90th%) or macrosomia (weighing more than 4000 g at birth)
* Greater risk for __________
* Higher incidence of __________
* Asphyxia
* Congenital anomalies
Large-for-gestational age (LGA>90th%) or macrosomia (weighing more than 4000 g at birth)
* Greater risk for morbidity
* Higher incidence of birth trauma
* Asphyxia
* Congenital anomalies
45
Care of the High-Risk Newborn - Nursing care
⚬ Assessment
￭ Respiratory function
￭ Cardiovascular function
￭ Body temperature
￭ Central nervous system function
￭ Nutrition status
￭ Renal function
￭ Hematologic status
￭ Infection prevention
⚬ Assessment
￭ Respiratory function
￭ Cardiovascular function
￭ Body temperature
￭ Central nervous system function
￭ Nutrition status
￭ Renal function
￭ Hematologic status
￭ Infection prevention
46
Care of the High-Risk Newborn cont’d ⚬ Interventions
￭ Physical care
￭ Maintain body _________
* Care of the hypothermic infant
* _________ should occur over a period of hours
￭ Transition to the isolette or incubator.
￭ Physical care
￭ Maintain body temperature
* Care of the hypothermic infant
* Warming should occur over a period of hours
￭ Transition to the isolette or incubator.
47
Care of the High-Risk Newborn cont’d - Interventions cont’d
￭ Oxygen therapy
* Mechanical ventilation
* Plastic hood
* Nasal cannula
* Continuous positive airway pressure (CPAP)
￭ Oxygen therapy
* Mechanical ventilation
* Plastic hood
* Nasal cannula
* Continuous positive airway pressure (CPAP)
48
Care of the High-Risk Newborn cont’d ⚬ Interventions cont’d
￭ NRP
￭ __________ replacement therapy
￭ Additional therapies
* Inhaled __________ (iNO)
* Extracorporeal membrane
oxygenation therapy - ECMO
￭ Weaning from respiratory assistance
￭ NRP
￭ Surfactant replacement therapy
￭ Additional therapies
* Inhaled nitric oxide (iNO)
* Extracorporeal membrane
oxygenation therapy - ECMO
￭ Weaning from respiratory assistance
49
Care of the High-Risk Newborn cont’d - Interventions cont’d
⚬ Nutritional care
￭ Types of nourishment
￭ Hydration
￭ Elimination patterns
￭ Oral feeding
￭ Gavage feeding
￭ Gastrostomy tube feeding
￭ Advancing infant feedings to breast/bottle
￭ Nonnutritive sucking - pacifiers
⚬ Nutritional care
￭ Types of nourishment
￭ Hydration
￭ Elimination patterns
￭ Oral feeding
￭ Gavage feeding
￭ Gastrostomy tube feeding
￭ Advancing infant feedings to breast/bottle
￭ Nonnutritive sucking - pacifiers
50
Care of the High-Risk Newborn cont’d
⚬ _____ care
⚬ Environmental concerns
￭ Noise is generated by equipment, monitors, alarms, staff
￭ _______ level has been correlated with incidence of intracranial hemorrhage
￭ NICUs should establish day-night lighting
￭ Undisturbed sleep for 50 minutes
⚬ Skin care
⚬ Environmental concerns
￭ Noise is generated by equipment, monitors, alarms, staff
￭ Noise level has been correlated with incidence of intracranial hemorrhage
￭ NICUs should establish day-night lighting
￭ Undisturbed sleep for 50 minutes
51
Care of the High-Risk Newborn cont’d
⚬ Developmental outcome
￭ Inappropriate stimulation
￭ Containment or facilitated tucking
￭ Skin-to-skin (_________ care)
￭ Co-bedding of multiples
￭ Approach behaviors
⚬ Developmental outcome
￭ Inappropriate stimulation
￭ Containment or facilitated tucking
￭ Skin-to-skin (kangaroo care)
￭ Co-bedding of multiples
￭ Approach behaviors
52
Growth and Development Potential
* Difficult to predict
* The lower the birthweight, the greater the likelihood of _________
* Milestones are corrected for gestational age until ___ years of age
* Effective discharge plan
* Difficult to predict
* The lower the birthweight, the greater the likelihood of sequelae
* Milestones are corrected for gestational age until 3 years of age
* Effective discharge plan
53
Parental Adaptation to Preterm Infant
* Parental tasks
⚬ Must accomplish several psychologic tasks before effective parenting can evolve
* Parental responses
⚬ Progress through stages as they interact with their infants
* Parental maladaptation
⚬ Incidence of physical and emotional _______ is increased
* Parental tasks
⚬ Must accomplish several psychologic tasks before effective parenting can evolve
* Parental responses
⚬ Progress through stages as they interact with their infants
* Parental maladaptation
⚬ Incidence of physical and emotional abuse is increased
54
Support of Parents of a High Risk Neonate
* Help them “____” the infant rather than focus on the equipment
* Explain normal characteristics for an infant of that gestational age
* Express feelings about pregnancy, labor, and birth
* Assess the parent’s perceptions of the infant and determine level of involvement
* Help them “see” the infant rather than focus on the equipment
* Explain normal characteristics for an infant of that gestational age
* Express feelings about pregnancy, labor, and birth
* Assess the parent’s perceptions of the infant and determine level of involvement
55
Parent Education [high risk neonate]
* Cardiopulmonary resuscitation (CPR)
⚬ Increased risk for _____
* Discharge planning
⚬ Durable medical equipment
⚬ All immunizations and newborn screening should be complete prior to discharge
* Transport to and from a Regional Center
⚬ Infants may need to be transferred back to a community hospital
* Cardiopulmonary resuscitation (CPR)
⚬ Increased risk for SIDS
* Discharge planning
⚬ Durable medical equipment
⚬ All immunizations and newborn screening should be complete prior to discharge
* Transport to and from a Regional Center
⚬ Infants may need to be transferred back to a community hospital
56
Neonatal Loss
* Losses of what was hoped for, dreamed about, and/or planned
⚬ Fetal demise
* Any perception of loss of control during the birthing experience
⚬ Preterm labor or cesarean birth
* Birth of child with a defect or illness
* Infertility
* Cluster of painful responses
* Overlapping phases in grief process
⚬ Acute distress
⚬ Intense grief
⚬ Reorganization
* Losses of what was hoped for, dreamed about, and/or planned
⚬ Fetal demise
* Any perception of loss of control during the birthing experience
⚬ Preterm labor or cesarean birth
* Birth of child with a defect or illness
* Infertility
* Cluster of painful responses
* Overlapping phases in grief process
⚬ Acute distress
⚬ Intense grief
⚬ Reorganization
57
Family Aspects of Grief
* Grandparents
⚬ __________ guilt because they feel the death is out of order
* Siblings
⚬ Younger children may be __________
⚬ Will follow cues of the parents for how to respond
⚬ Older children may be frightened by the event
⚬ Teens feel awkward
* Grandparents
⚬ Survivor guilt because they feel the death is out of order
* Siblings
⚬ Younger children may be confused
⚬ Will follow cues of the parents for how to respond
⚬ Older children may be frightened by the event
⚬ Teens feel awkward
58
Care Management
* Nurse prepares the parents for an inevitable death, provide end-of-life care, and facilitate the grieving process after an expected or unexpected death.
⚬ Help actualize the _______
⚬ Help the parents with _______making
⚬ Help the bereaved acknowledge and express their _______
⚬ Normalize the _______ process and facilitate coping
⚬ Meet the physical needs of the postpartum bereaved mother
* Nurse prepares the parents for an inevitable death, provide end-of-life care, and facilitate the grieving process after an expected or unexpected death.
⚬ Help actualize the loss
⚬ Help the parents with decision making
⚬ Help the bereaved acknowledge and express their feelings
⚬ Normalize the grief process and facilitate coping
⚬ Meet the physical needs of the postpartum bereaved mother
59
Death - * Nursing interventions
⚬ Assist the bereaved in communicating with, supporting, and getting support from the family
⚬ Create __________ for the parents to take home
⚬ Be concerned about the __________ and spiritual needs of the parents
⚬ Provide sensitive care at and after discharge
⚬ Provide __________ care
⚬ Assist the bereaved in communicating with, supporting, and getting support from the family
⚬ Create mementos for the parents to take home
⚬ Be concerned about the cultural and spiritual needs of the parents
⚬ Provide sensitive care at and after discharge
⚬ Provide postmortem care
60
EARLY PPH: < ____ HOURS
LATE PPH: > 24 HOURS (and up to ___ weeks!)
EARLY PPH: < 24 HOURS
LATE PPH: > 24 HOURS (and up to 12 weeks!)
61
PPH
VAGINAL: ≥ _____ ML BLOOD LOSS
C-SECTION: ≥ _____ ML BLOOD LOSS
VAGINAL: ≥ 500 ML BLOOD LOSS
C-SECTION: ≥ 1000 ML BLOOD LOSS
62
POST-PARTUM RISK FOR PPH
Uterine _______: High parity, hydramnios, macrosomic fetus, multifetal gestation
__________ of Genital Tract: less common; vaginal canal or cervix
__________ Placenta:
--- Nonadherent: floating, can easily be scraped out
--- Adherent: stuck to wall, won’t shed on its own (see next slide)
__________ of Uterus: uterus inside out and external to vagina, manually put back + abx
__________ of Uterus: only partially shrinks, risk for spontaneous bleed
Uterine Atony: High parity, hydramnios, macrosomic fetus, multifetal gestation
Lacerations of Genital Tract: less common; vaginal canal or cervix
Retained Placenta:
--- Nonadherent: floating, can easily be scraped out
--- Adherent: stuck to wall, won’t shed on its own (see next slide)
Inversion of Uterus: uterus inside out and external to vagina, manually put back + abx
Subinvolution of Uterus: only partially shrinks, risk for spontaneous bleed
63
POSTPARTUM INFECTION
Endometritis: perform _____ at appropriate times/intervals
Wound Infections: ____________
UTI: encourage ______ and frequent voiding
Mastitis: ____________
Thrombophlebitis: SCDs, ambulation, ankle pumps
Endometritis: perform SVEs at appropriate times/intervals
Wound Infections: handwashing
UTI: encourage fluids and frequent voiding
Mastitis: handwashing
Thrombophlebitis: SCDs, ambulation, ankle pumps
64
COAGULOPATHIES
idiopathic or immune thrombocytopenic purpura: abnormally low __________
platelets
65
COAGULOPATHIES
von Willebrand disease (vWD): low levels of ___________
clotting proteins
66
COAGULOPATHIES
disseminated intravascular coagulopathy (DIC): body's _____________ goes haywire due to infection or trauma
clotting system
67
EFFECTS OF MEDICATIONS ON UTERUS (tocolytics)
Some anesthetics may increase risk of uterine atony
- Halothane: inhaled general anesthetic
Other common medications that cause uterine atony
-Magnesium sulfate: used for preeclampsia
-Nifedipine: used for BP and angina
-Terbutaline: bronchodilator (asthma, bronchitis etc.)
Some anesthetics may increase risk of uterine atony
- Halothane: inhaled general anesthetic
Other common medications that cause uterine atony
-Magnesium sulfate: used for preeclampsia
-Nifedipine: used for BP and angina
-Terbutaline: bronchodilator (asthma, bronchitis etc.)
68
MEDICATION FOR HEMORRHAGE (uterotonics)
Oxytocin (___________): IV
Methergine: IM/PO - Contraindicated for HTN (___________)
Hemabate (carboprost): IM
- Synthetic prostaglandin
- Contraindicated: _________, HTN
Misoprostol: Oral, Vaginal, Rectal
Oxytocin (Pitocin): IV
Methergine: IM/PO - Contraindicated for HTN (preeclampsia)
Hemabate (carboprost): IM
- Synthetic prostaglandin
- Contraindicated: asthma, HTN
Misoprostol: Oral, Vaginal, Rectal
69
OTHER POSTPARTUM MEDICATIONS
Ibuprofen (Motrin)
Norco (Acetaminophen/hydrocodone)
Vicodin (Acetaminophen/hydrocodone)
Percocet (Oxycodone/Acetaminophen)
Tucks (Witch Hazel)
Dermoplast
Lansinoh Pure Lonolin
Hydrocortisone Cream (Hemorrhoid Cream)
Colace (Docusate Sodium)
Ibuprofen (Motrin)
Norco (Acetaminophen/hydrocodone)
Vicodin (Acetaminophen/hydrocodone)
Percocet (Oxycodone/Acetaminophen)
Tucks (Witch Hazel)
Dermoplast
Lansinoh Pure Lonolin
Hydrocortisone Cream (Hemorrhoid Cream)
Colace (Docusate Sodium)
70
OTHER CONSIDERATIONS
Value of Rubella Immunity: Rubella can cause severe __________ and even death
RhoGAM: Rh- mom w/ Rh+ baby needs w/I ___ hours PP
Value of Rubella Immunity: Rubella can cause severe birth defects and even death
RhoGAM: Rh- mom w/ Rh+ baby needs w/I 72 hours PP
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NEWBORN VITAL SIGNS
Temperature: Able to maintain stable body temperature of 97.7°F to 98.9°F (36.5°C to 37.2°C) in normal room environment.
Heartbeat: Normally ___________ beats per minute. It may be much slower when an infant sleeps.
Breathing rate: Normally _________ breaths per minute. (shallow / irregular)
Temperature: Able to maintain stable body temperature of 97.7°F to 98.9°F (36.5°C to 37.2°C) in normal room environment.
Heartbeat: Normally 120 to 160 beats per minute. It may be much slower when an infant sleeps.
Breathing rate: Normally 30 to 60 breaths per minute. (shallow / irregular)
72
NEWBORN VITAL SIGNS
Blood pressure: Normally an upper number (systolic) between _____, and a lower number (diastolic) between ______.
Oxygen saturation: Normally ________% on room air.
Blood Sugar: > ___
Blood pressure: Normally an upper number (systolic) between 60 and 80, and a lower number (diastolic) between 40 and 50.
Oxygen saturation: Normally 95% to 100% on room air.
Blood Sugar: > 45
73
Large for Gestational Age (LGA) > ___kg at birth
-Greater risk for morbidity, higher incidence of birth ________, deficient supply of __________ (asphyxia), congenital abnormalities.
Small for Gestational Age (SGA) - intrauterine growth restriction
-Perinatal asphyxia, hypoglycemia, ______ loss
`Large for Gestational Age (LGA) > 4kg at birth
-Greater risk for morbidity, higher incidence of birth trauma, deficient supply of oxygen (asphyxia), congenital abnormalities.
Small for Gestational Age (SGA) - intrauterine growth restriction
-Perinatal asphyxia, hypoglycemia, heat loss
74
Premature Babies & Developmental Milestones
-If baby is 8 weeks early, they have ___ more weeks to hit their developmental milestones
-Milestones are corrected for gestational age until 3 years (after __________, they have to see a specialist if they still have any physiological or developmental issues or delays)
-If baby is 8 weeks early, they have 8 more weeks to hit their developmental milestones
-Milestones are corrected for gestational age until 3 years (after 3 years they have to see a specialist if they still have any physiological or developmental issues or delays)
75
Complications - Late Preterm (34-36 6/7 weeks)
thermoregulation problems
hypo________
hyper___________
sepsis
r____________ problems
thermoregulation problems
hypoglycemia
hyperbilirubinemia
sepsis
respiratory problems
76
Complications - Post-term (> 40 weeks)
_______________________ syndrome
persistent pulmonary HTN: failure of the normal circulatory transition that occurs after birth
meconium aspiration syndrome
persistent pulmonary HTN: failure of the normal circulatory transition that occurs after birth
77
RESPIRATORY CONCERNS
Lung maturity is a concern for preterm newborns
- Without surfactant you can’t keep your lungs __________
Surfactant Replacement Therapy (extrauterine)
Betamethasone: steroid therapy to help develop lungs, if premature birth is expected (intrauterine)
Interventions:
Neonatal Resuscitation Program (NRP)
Oxygen Therapy: mechanical ventilation, plastic hood, nasal cannula, CPAP
ECMO (most invasive) -- oxygenates the body while bypassing the lungs
Lung maturity is a concern for preterm newborns
- Without surfactant you can’t keep your lungs inflated
Surfactant Replacement Therapy (extrauterine)
Betamethasone: steroid therapy to help develop lungs, if premature birth is expected (intrauterine)
Interventions:
Neonatal Resuscitation Program (NRP)
Oxygen Therapy: mechanical ventilation, plastic hood, nasal cannula, CPAP
ECMO (most invasive) -- oxygenates the body while bypassing the lungs
78
Oxygen Therapy: for newborns
Mechanical ventilation
Plastic hood
Nasal cannula
CPAP (continuous positive air pressure)
Mechanical ventilation
Plastic hood
Nasal cannula
CPAP (continuous positive air pressure)
79
Caput succedaneum: edematous area of the scalp, bruising usually accompanied - ________ suture lines
Cephalhematoma: collection of ______ between skull bone & periosteum, risk for __________
Caput succedaneum: edematous area of the scalp, bruising usually accompanied - crosses suture lines
Cephalhematoma: collection of blood between skull bone & periosteum, risk for jaundice
80
HYPERBILIRUBINEMIA
Build up of bilirubin in the blood d/t the newborns ________ _________
Jaundice → Kernicterus
Tx: ____________
Risk Factors:
“Late Pretermer” (34-36 and 6/7 weeks)
Rh incompatibility – causes significant hemolysis
ABO incompatibility – causes significant hemolysis
Prematurity
Sepsis
Maternal Diabetes or Intrauterine Infections
Cephalohematoma
Build up of bilirubin in the blood d/t the newborns immature liver
Jaundice → Kernicterus
Tx: Phototherapy
Risk Factors:
“Late Pretermer” (34-36 and 6/7 weeks)
Rh incompatibility – causes significant hemolysis
ABO incompatibility – causes significant hemolysis
Prematurity
Sepsis
Maternal Diabetes or Intrauterine Infections
Cephalohematoma
81
DIABETIC MOTHER: RISK TO NEWBORN
Hypoglycemia - ________, low temp
Congenital abnormalities
_________________ & polycythemia (increased RBC)
Hypocalcemia & Hypomagnesemia
Macrosomia → Increased Risk of Birth ________
Respiratory Distress Syndrome – not enough ___________ produced
Hypoglycemia - jittery, low temp
Congenital abnormalities
Hyperbilirubinemia & polycythemia (increased RBC)
Hypocalcemia & Hypomagnesemia
Macrosomia → Increased Risk of Birth Trauma
Respiratory Distress Syndrome – not enough surfactant produced
82
PARENT EDUCATION
Safety
“Back to Sleep” - don't let baby's to sleep on their ______ ; SIDS
CPR - First Aid
Carseat – rear facing in the back seat
Feeding
Amount/type/frequency
Gavage (NG) - if baby is tired and can't finish the amount.
Diapers
____ wet diapers/day → hydration status
Skin Integrity (not too tight, rash, etc)
Importance of follow-up appointments
Always contact doctor if there is something concerning
Safety
“Back to Sleep” - don't let baby's to sleep on their stomach; SIDS
CPR - First Aid
Carseat – rear facing in the back seat
Feeding
Amount/type/frequency
Gavage (NG) - if baby is tired and can't finish the amount.
Diapers
6-8 wet diapers/day → hydration status
Skin Integrity (not too tight, rash, etc)
Importance of follow-up appointments
Always contact doctor if there is something concerning
83
The perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage (PPH) is most likely caused by:
Cervical lacerations
Subinvolution of the placental site
Coagulation disorders
Defective vascularity of the decidua
B) Subinvolution of the placental site
Rationale: Late PPH may be the result of subinvolution of the uterus, pelvic infection, or retained placental fragments. Late PPH is not typically a result of defective vascularity of the decidua, cervical lacerations, or coagulation disorders.
84
What infection is contracted mostly by first-time mothers who are breastfeeding?
Endometritis
Wound Infection
Thrombophlebitis
Mastitis
D) Mastitis
Rationale: Mastitis is infection in a breast, usually confined to a milk duct. Most women who suffer this are primiparas who are breastfeeding.
85
A woman experienced a miscarriage at 10 weeks of gestation and had a dilation and curettage (D&C). She states that she is just fine and wants to go home as soon as possible. While you are assessing her responses to her loss, she tells you that she had purchased some baby things and had picked out a name. On the basis of your assessment of her responses, what nursing intervention would you use first?
Ready her for discharge
Notify pastoral care to offer her a blessing
Ask her what name she had picked out for baby
Ask her whether she would like to see what was obtained from her D&C
Ask her what name she had picked out for baby
Rationale: One way of actualizing the loss is to allow parents to name the infant. The nurse should follow this clients cues and inquire about naming the infant. The client is looking for an opportunity to express her feelings of loss. The nurse should take this opportunity to offer support by allowing the woman to talk about her feelings. Furthermore, one way of actualizing the loss is to allow parents to name the infant. The nurse should follow this clients cues and inquire about naming the infant. Although it may be therapeutic to offer religious support, the nurse should take this opportunity to offer support by allowing the woman to talk about her feelings. Furthermore, one way of actualizing the loss is to allow parents to name the infant. Asking the woman whether she would like to see what was obtained from her D&C is completely inappropriate.
86
A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A cesarean section is performed for failure to progress. The fetal heart rate (FHR) before birth is 180 beats/min with limited variability. At birth the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic. On the basis of the maternal history, the cause of this newborns distress is most likely to be:
Hypoglycemia
Phrenic nerve injury
Respiratory distress syndrome
Sepsis
D) Sepsis
Rationale: The prolonged rupture of membranes and the tachypnea (before and after birth) both suggest sepsis. An FHR of 180 beats/min is also indicative. This infant is at high risk for sepsis.
87
A premature infant with respiratory distress syndrome receives artificial surfactant. How would the nurse explain surfactant therapy to the parents?
Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide.
The drug keeps your baby from requiring too much sedation
Surfactant is used to reduce episodes of periodic apnea
Your baby needs this medication to fight a possible respiratory tract infection
Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide.
Rationale: Surfactant can be administered as an adjunct to oxygen and ventilation therapy. With administration of artificial surfactant, respiratory compliance is improved until the infant can generate enough surfactant on his or her own. Surfactant has no bearing on the sedation needs of the infant. Surfactant is used to improve respiratory compliance, including the exchange of oxygen and carbon dioxide. The goal of surfactant therapy in an infant with respiratory distress syndrome (RDS) is to stimulate production of surfactant in the type 2 cells of the alveoli. The clinical presentation of RDS and neonatal pneumonia may be similar. The infant may be started on broad-spectrum antibiotics to treat infection.
88
Bladder distention can increase the risk of ___________.
hemorrhage
89
Homan's sign (check for _____________ ).
deep vein thrombosis
90
Rh Isoimmunization: Rh- mothers need _______ to prevent complications in future pregnancies.
RhoGAM
91
Methergine (IM/PO): Cannot be given to women with _______
high BP.
92
How long do we allow prematures to catch up for developmental stages?
Example: If they are born 8 weeks early, they have ___ more weeks to meet the developmental milestones
8
