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Maternity > Exam 2 (5-8) > Flashcards

Exam 2 (5-8) Flashcards

1
Q

Risk Factors in Pregnancy

A
  1. age
  2. parity
  3. lifestyle
  4. low income
  5. existing health conditions
  6. genetics
  7. environment
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2
Q

Age and Pregnancy Risk Factors

A
  • being too young or old
  • young: high BP, anemia, go into labor earlier, STI’s, decreased prenatal care
  • old (over 35): higher risk for C-sections, delivery complications, prolonged labor, infants with genetic disorders
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3
Q

Parity and Pregnancy Risk Factors

A
  • 5 or more pregnancies
  • risk for preterm labor
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4
Q

Lifestyle and Pregnancy Risk Factors

A
  • poor nutrition, vegetarian diet
  • substance use: alcohol or drugs
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5
Q

Low Income and Pregnancy Risk Factors

A
  • no prenatal or inadequate care
  • screen for drugs
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6
Q

Existing Health Conditions and Pregnancy Risk Factors

A
  • diabetes
  • PCOS
  • obesity
  • zika
  • autoimmune diseases: lupus, multiple sclerosis
  • cardiac disease
  • HIV/AIDS
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7
Q

Genetics and Pregnancy Risk Factors

A
  • defective -> chromosomal abnormalities could lead to spontaneous abortion
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8
Q

Pregestational Pregnancies at Risk

A
  • substance abuse
  • diabetes
  • anemia
  • HIV/AIDS
  • heart disease
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9
Q

Gestational Onset Pregnancies at Risk

A
  • hypertensive disorders
  • spontaneous abortions
  • ectopic pregnancies
  • Rh alloimmunization
  • herpes
  • GBS+
  • CMV (herpes)
  • hyperemesis gravidarum
  • gestational trophoblatic disease (multiple tumors)
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10
Q

Substance Abuse During Pregnancy

A
  • 30% of women
  • rates higher in 1st and 2nd trimester
  • universal screening for everyone
  • may be associated with decreased fetal growth restriction, stillbirth, preterm birth, neurological development: hyperactivity, poor cognitive function
  • increased use of medically assisted treatment
  • most at risk: below poverty level, exposed to violence, DV, depression, less than high school education, unmarried, unemployed
  • most common: smoking cannabis in white women
  • frequently misdiagnosed
  • autonomy vs nurse’s obligation
  • fear of losing custody: decrease prenatal care
  • prenatal use: withdrawl syndrome in newborn
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11
Q

Heroin Treatment

A

behavioral therapy mized with pharmacological therapy (MAT) medical assisted therapy
* methadone
* buprenorphine
* naltrexone

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12
Q

Methadone: Heroin Treatment

A
  • most common
  • during pregnancy, brings addicted woman into agencies that promote prenatal care
  • help with withdrawl symptoms
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13
Q

Buprenorphine: Heroin Treatment

A
  • better treatment adherence with fewer side effects and overdoses in comparison to methadone
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14
Q

Naltrexone: Heroin Treatment

A
  • opioid antagonist, non-addictive, may improve compliance if an issue
  • work through same opioid receptior, but safer
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15
Q

Patho of Diabetes

A

diabetes: metabolic disease with hyperglycemia from insulin secretion defects
* makes blood more viscous and causes high BV, cellular dehydration, polyuria, and polydipsia (excessive thirst)
* starts to burn both proteins and fats = ketones and fatty acids which causes weight loss because of breakdown in tissue
* change in vascular circulation with organs

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16
Q

Four Cardinal S/S of Diabetes

A
  1. Polyuria
  2. Polydypsia
  3. Weight Loss
  4. Polyphagia
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17
Q

Polyuria in Diabetes

A

excrete large volumes of urine
* glucose hyperconcentrated = kidney loses ability to pull glucose from water
* osmotic pressure rises, H2O cannot be absorbed back into blood = urination

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18
Q

Polydipsia in Diabetes

A

dehydration in cells, can be from polyuria

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19
Q

Weight Loss in Diabetes

A

breakdown of fats and muscles to make ketones and fatty acids

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20
Q

Polyphagia in Diabetes

A

tissue breakdown = starvation
person may eat excessive amounts of food

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21
Q

Classifications of Diabetes Mellitus

A
  1. Type 1 DM: absolute insulin deficiency
  2. Type 2DM: insulin resistance
  3. Gestational Diabetes: any degree of glucose intolerance
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22
Q

White’s Classification of Diabetes

A

in pregnancy
based on age of diabetes, duration of illness, presence of any organ involved
* eyes and kidneys
* classes A-C: positive pregnancy outcome if glucose controlled
* classes D-T: poor outcome, vascular damage

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23
Q

Influence of Pregnancy of Diabetes on Physiological Changes in 1st Tri.

A

alter insulin requirements
* insulin decreases because increased estrogen and progesterone stimulates pancreas to make more insulin
* this increases peripheral use of glucose
* hypoglycemia with N/V

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24
Q

Influence of Pregnancy of Diabetes on Physiological Changes in 2nd and 3rd Tri.

A

maternal metabolism directed toward supplying adequate nutrition for fetus
* placental hormones: cause insulin resistance
* promote more blood glucose to transfer through placenta
* fetus produces nore glucose when it gets glucose

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25
Q

Influence of Pregnancy of Diabetes on Hormones

A
  • hPL
  • somatotropin (growth hormone)
  • promotes more insulin on bloodstream
  • do not produce sufficient amount of insulin to maintain glucose homeostasis
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26
Q

Other Influences of Pregnancy in Diabetes

A
  • accelerates progress of vascular disease
  • more difficult to control in pregnancy
  • fetus will get bigger since insulin turns into fat
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27
Q

Maternal Risks with Diabetes

A
  • poor glycemic control = miscarriage and big baby (over 4000g)
  • risk for C-section
  • hydramnios: fetal urination, uterine dysfunction, infection
  • hyperglycemia and ketoacidosis
  • high risk for infections
  • worsening retinopathy
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28
Q

Fetal Neonatal Risks with Diabetes

A

produce insulin around 14 wks = growth hormone
* macrosomia: could have birth injury delivering vaginally
* congenital abnormalities
* IUGR: interuterine growth retardation = decreased profusion to placenta with decreased vascularity
* respiratory distress syndrome: inhibit enzymes necessary for surfactant production

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29
Q

Clinical Therapy for Diabetes

A
  • early detection and diagnosis
  • assess risk at 1st visit
  • if low risk: screen at 24-28wks
  • if high: screen asap
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30
Q

Diabetes Levels

A

> 128 mg/dL fasting glucose
200 mg/dL random glucose
6.5% ha1c

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31
Q

Increased Risk for Diabetes

A
  • over 40
  • family history
  • obesity
  • PCOS
  • hypertension
  • glucosuria
  • prior macrosomic, malformed, stillborn
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32
Q

Screening for Gestational Diabetes

A

at 24-28wks
1hr 50g glucose tolerance test

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33
Q

Screening for Diabetes: Negative

A

lower than 140
routine care

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34
Q

Screening for Diabetes: Positive

A

over 140
3hr 100g GTT test
fasting 95
1hr: 180
2hr: 155
3hr: 140
if 2 values exceed these: positive
negaive = 1 value greater

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35
Q

Hemoglobin A1C Control

A

normal: 4-5.9%
hemoglobin will stick to RBC
* levels between 5-6 = fetal malformation rates comparable to those observed in normal pregnancy (2-3%)
* goal for HA1C = 3 months prior to conception
* HA1C concentration = fetal anomaly rate 20-25%

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36
Q

Pregnancy Complications

A
  • Rh factor
  • ABO incompatability
  • ectopic pregnancy
  • HSV
  • GBS+
  • preeclampsia/eclampsia
  • gestational trophoblastic disease
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37
Q

Rh Alloimmunization

A

Rh = inherted protein on surface of RBC (+)
no protein (-)

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38
Q

Rh - Mother
Rh + baby

A

antibody-antigen response
sensitized mother

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39
Q

No Treatment to Sensitized Mother

A
  • jaundice
  • anemia
  • brain damage
  • heart failure
  • death
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40
Q

Maternal Alloimmunization

A

when woman’s immunse system is sensitized to foreighn erythrocyte surface antigen
stimulates the production of IgG antibodies

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41
Q

Sensitized Woman

A

small amounts of fetal blood cross the placenta
maternal IgM antibodies are produced and RhoGam will not help since she is sensitized

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42
Q

2nd Pregnancy and Sensitized Woman

A

Rh+ child - IgG antibodies produced and cross placenta
risk for hemolysis of fetal RBC

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43
Q

Indirect Coomb’s Test

A

identifies antigen that could cause problems in newborns or mother
possible need for transfusion
positive test = antibodies present, no RhoGam
negative test = no antibodies present

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44
Q

Amniocentesis and Rh Compatability

A

using amniocentesis to test if fetus is Rh + or -

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45
Q

Ultrasound and Hemolytic Anemia

A

faster blood flowing through ultrasound

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46
Q

Other Interventions for Rh Incompatability

A
  • monitoring pregnancy
  • intrauterine transfusions of newborn
  • exchange transfusion of newborn: erythopoietin and iron
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47
Q

Goals of Rh Incompatability

A
  • prevent sensitization
  • treat isoimmune disease in newborn
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48
Q

RhoGam Shot

A

when mom is not sensitized with - titer of + fetus
300mcg Rh immune globulin (RhoGam) IM at 28 wks
repeat dose within 72 hrs with + newborn
also given if any mixing of blood occurs

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49
Q

ABO Incompatibility

A

common and mild type of hemolytic diseases in babies
mom type O and infant type A or B

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50
Q

Maternal Serum Antibodies Crossing the Placenta

A
  • can cause hemolysis of fetal RBC
  • mild anemia
  • hyperbilirubinemia
  • not treated antepartally
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51
Q

Perinatal Infections

A
  • herpes simplex virus
  • GBS
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52
Q

HSV

A

1:6 between ages 14-49 are infected

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53
Q

Fetal Neonatal Risks with HSV

A
  • spontaneous abortion
  • preterm labor
  • intrauterine growth resistance
  • neonatal infection
  • varies with route of birth and presence of lesions
  • c-section of outbreak during labor
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54
Q

Clinical Therapy of HSV

A
  • antiviral after 36wks gestation
  • acyclovir, famciclovir, valacyclovir
  • can reduse the need for a c-section
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55
Q

GBS

A
  • in lower gastrointestinal tracts, urogenital tracts
  • fetal risk: unexpected intrapartum stillbirth
  • clinical therapy guidelines
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56
Q

Hypertensive Disorders

A
  • chronic hypertension
  • chronic hypertension with superimposed preeclampsia
  • preeclampsia/ecclampsia
  • gestational hypertension
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57
Q

Preeclampsia Diagnosis

A
  • BP of over 140/90 with proteinuria
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58
Q

Preeclampsia Diagnosis: Before 20 Weeks

A
  • no stable proteinuria and chronic hypertension
  • new or increased proteins and preeclampsia superimposed on chronic hypertension
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59
Q

Preeclampsia Diagnosis: After 20 Weeks

A
  • proteinuria and preeclampsia
  • no proteinuria and gestational hypertension
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60
Q

Patho of Preeclampsia

A
  • affects 5-10% of women
  • multiorgan disease
  • spiral arteries of uterus do not increase in diameter to promote perfusion to placenta
  • vascular remodeling does not happen and decrease in placental perfusion and hypoxia occur
  • endothelial dysfunction and vasospasm
  • imbalance of vasodialating hormones: prostacyclin and vasoconstricting hormones: thromboxane
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61
Q

Three Characteristics of Preeclampsia

A
  1. vasospasm and decreased organ perfusion
  2. intravascular coagulation
  3. increased permeability and capilary leakage
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62
Q

Vasospasm and Decreased Organ Perfusion: Preeclampsia

A
  • hypertension
  • uteroplacental spasm - intrauterine growth restriction
  • glomerular damage - oliguria (small amounts of urine)
  • cortical brain spasms - CNS problems
  • retinal arteriolar spasms - blurred vision
  • hyperlipidema
  • liver ischemia
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63
Q

Intrautuerine Coagulation: Preeclampsia

A
  • hemolysis of RBC
  • platelet adhesion - low platelet count and DIC (affects clotting)
  • increased VIII antigen
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64
Q

Increased Permeability and Capilary Leakage: Preeclampsia

A
  • decreased serum albumin levels and decreased intravascular volume as fluid with protein
  • increase in blood viscosity
  • proteinuria
  • generalized edema
  • pulmonary edema
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65
Q

Clinical Manifestations and Diagnosis

A

don’t use mild
proteinuria is not an official criteria
BP over 140/90 on two occassions, 4hrs apart after 20wks
low platelets, renal insufficiency, impaired liver function

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66
Q

Risk Factors to Preeclampsia

A
  • first pregnancy
  • materal age below 19 and above 30
  • african american or hispanic
  • low socioeconomic status
  • family history
  • chronic hypertension
  • diabetes
  • lupus
  • multigestation
  • gestational trophoblastic disease
  • fetal hydrops
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67
Q

Nursing Assessment: Worsening Preeclampsia

A
  • increased edema
  • scotomata (vision problems)
  • blurred vision
  • decreased urinary output
  • epigastric pain
  • vomiting
  • bleeding gums
  • persistent/severe headache
  • neurological hyperactivity: deep tendon reflex, clonus (involuntary muscle contractions)
  • pulmonary edema
  • cyanosis
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68
Q

Eclampsia

A
  • seizures or coma
  • multifocal, focal, generalized
  • nursing assessment suring seizure
  • treatment: magnesium sulfate, antihypertensive agents
  • fetal reaction to survive: should reconsider when mom stabilizes
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69
Q

Preeclampsia Treatment

A
  • early detection
  • treat symptoms
  • early treatment: bedrest, regular diet, monitor BP, proteinuria
  • hospitalization if more severe
  • therapeutic goal: diastolic BP between 90-100
  • meds: hydralazine, labetol, oral nifedipine, magnesium sulfate: CNS depressant, seizure prophylaxis, smooth muscle relaxant, safe for fetus
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70
Q

HELLP Syndrome

A

continuation of preeclampsia
H) hemolysis
E) elevated
L) liver enzymes
L) low P) platelet count
* associated with severe preeclampsia
* symptoms: N/V, malaise, epigastric pain

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71
Q

Postpartum and HELLP

A
  • possibility of HELLP
  • eclampsia for 48hrs
  • increased cardiovascular issues in future
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72
Q

Preeclampsia Maternial Consequences

A
  • with eclampsia: 20% maternal mortality rate
  • risk of: abrupto placenta, retinal attachment, cardiac failure, cerebral hemorrhage/stroke
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73
Q

Preeclampsia Fetal Consequences

A
  • fetal growth retardation
  • fetal hypoxia
  • fetal death
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74
Q

Ectopic Pregnancy

A
  • pregnancy outside of uterine cavity (2% of all preg)
  • 95% implant in the fallopian tubes
  • normal cell growth and division
  • pressure from growth causes symptoms
  • will rupture if pressure is too great: maternal death in 1st trimester
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75
Q

Risk Factors to Ectopic Pregnancies

A
  • history of STI’s or PID
  • previous tubal, pelvic, or abdominal surgery
  • endometriosis
  • IVF or other methods of assisted reproduction
  • in utero: Diethylstilbestrol (DES) exposure with abnormalities of reproductive organs
  • use of IUD
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76
Q

Management of Ectopic Pregnancies

A
  • salpingostomy/salpingectomy (removal of conception product/tube)
  • methotrexate
  • monitor blood loss
  • emotional support
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77
Q

Hydatiform Mole (Molar Pregnancy)

A
  • abnormality of placenta from fertilization
  • forms grape-like cysts that fill entire uterus instead of normal placental tissue
  • vast proliferation of trophoblastic tissue associated with loss of preg and can lead to the development of cancer = choriocarcinoma
  • 20% become malignant
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78
Q

2 Types of Molar Pregnancies

A
  1. complete molar preg: ovum with no functioning or missing nucleus or empty egg with normal sperm
  2. partial: some fetal tissue present with normal ovum but two sperm
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79
Q

Increase Incidence of Molar Preg

A
  • women with low protein intake
  • > 35 years old
  • Asian women
  • experienced prior miscarriage
  • undergone ovulation stimulaiton (clomid)
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80
Q

S/S of Molar Preg

A
  • rapid vaginal growth
  • vaginal bleeding
  • N/V
  • hypertension
  • abnormally high hCG levels
  • no fetal heartbear
  • ultrasound: only cysts and no fetus
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81
Q

Management of Molar Preg

A
  • D&C
  • monitor for malignancy through serial hCG levels
  • no preg for 1 year
  • emotional support
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82
Q

Complications of Labor

A
  1. bleeding disorders (PP and PA)
  2. placenta previa
  3. placental abruption
  4. polyhydramnios
  5. oligohydrammios
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83
Q

Placenta Previa

A
  • implantation in lower uterine segment, over or near cervical os (the opening in the cervix at each end of the endocervical canal)
  • may be multifactional uterine scarring predisposes to lower segment implantation
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84
Q

Risk Factors: Placenta Previa

A
  • scarring from previos previa, prior C/S, abortion, multiparity
  • large placenta, multigestation
  • infertility, non-white, low SES, short interpregnancy interval
  • impeded endometrial vascularistriction: >35 years old, diabetes, smoking, cocaine
  • hemorrhage for mom
  • prematurity, malpresentation, IUGR/fetal anemia for fetus
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85
Q

S/S of Placenta Previa

A
  • painless, intermittent bleeding
  • confirmed by ultrasound
  • lower uterine segment not as responsive to oxytocin - use methergine
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86
Q

Nursing Assessment: Placenta Previa

A
  • avoid vaginal exams
  • monitor vitals and SpO2
  • continuous EFM (electronic fetal monitoring)
  • assess for preterm labor, non-stress test
  • BPP (biophysical profile), amniocentesis for lung maturity studies
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87
Q

Active Bleeding in Placenta Previa

A
  • large bore IV access
  • meaure I and O
  • weigh pads
  • CBC, coagulation studies, T and X
  • O2 at 95%
  • anticipate possible c-section birth
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88
Q

Placental Abruption

A
  • premature separation of a normally implanted placenta
  • bleeding may be external or concealed
  • severity depends on degree or separation
  • types: partial or complete
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89
Q

Risk Factors of Placental Abruption

A
  • hypertension
  • seizures
  • blunt trauma to maternal abdomen
  • short umbilical cord
  • previous history of abruption
  • smoking or cocaine use
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90
Q

S/S of Placental Abruption

A
  • sudden onset of intense, sharp abdoment pain
  • uterine irritabilitym tachysystole, increased resting tone
  • vaginal bleeding may or may not be present
  • dark “port wine” stained amniotic fluid
  • fetal heart rate patterns indicative of compromise
  • maternal tachycardia
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91
Q

Management of Placental Abruption

A
  • assess fundal height
  • consider abdominal girth measurements
  • assess for increased pain or tenderness
  • assess for S/S of shick
  • I and O
  • weigh pads
  • provide continuous EFM
  • provide O2 to maintain above 95%
  • anticipate and prepare for emergency delivery
  • observe for DIC, administer blood products
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92
Q

Polyhydraminos

A
  • excessive amniotic fluid, over 2000mL
  • associated with fetal GI abnormalities and maternal diabetes
  • treatment: shortness of breath and pain - amniocentesis
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93
Q

Oligohydramnios

A
  • scanty amniotic fluid, less than 500mL
  • etiology - unknown
  • risks: detal adhesions and malformation
  • treatment: amnioinfusion
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94
Q

Assessment Prenatally

A
  • anticipate what may have compromised fetus in utero
  • maternal and prenatal history: blood type, lab values, GBS/HIV/HepB, diabetes, preeclampsia, smoking/substance abuse, trauma and disorta wiht high glucose levels
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95
Q

Assessment Intrapartum

A

anticipate what will occur in labor
* analgesia/anesthesia, prolonged rupture of membranes, meconium stained amniotic fluid, nuchal cord, use of forceps/vacuun, evidence of fetal distress, precipitous birth

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96
Q

Timing/Frequency of Assessments

A
  • 1st assessment right at 30sec
  • about 85-90% do not need any assistance to life
  • placed skin-to-skin
  • ABC immediately at birth
  • thermoregulation
  • APGAR scoring
  • physical exam of newborn
  • considerations of newborn’s classification
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97
Q

Timing of Newborn Assessment

A
  • admission assessment: 2nd assessment
  • physical exam
  • general measurements
  • gestational age assessment
  • attachment
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98
Q

Ongoing Assessments

A
  • process of adaptation to extrauterine life
  • nutritional status: ability to feed
  • behavioral state/organizational abilities
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99
Q

General Measurements

A
  • weight: avg 2500-400g, 70-75% of body is water weight
  • head circumference: avg 33-35cm, 2cm greater than chest circ
  • chest circ: nipple line
  • abdominal circ
  • length: range of 18-22in (48-52cm)
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100
Q

Birth Weight and Gestational Age Classes

A
  1. LGA (large)
  2. AGA (appropriate)
  3. SGA (small)
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101
Q

Gestational Assessment: New Ballard Scale

A
  • neuromuscular activity
  • physical maturity
  • maturity rating table
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102
Q

Estimating GA

A

first 4hrs after birth
* can preduct at-risk infants and keep alert of problems
* Ballard Tool

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103
Q

Ballard Tool

A
  • each finding given point value: -5 to +5
  • maternal conditions may affect certain components: stress and diabetes
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104
Q

Physical Maturity Characteristics Assessment

A
  • skin
  • lanugo
  • sole (plantar) creases
  • areola and breast bud tissues
  • ear/eye formation
  • genitalia
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105
Q

Skin

A

7 sub-classifications from transparent skin to peeling

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106
Q

Lanugo

A

thin, soft hair usually arounf 24-25wks

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107
Q

Sole Creases

A

full term: deep sole creases down to and including heel as skin loses fluid and dries after birth

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108
Q

Ear Forming and Cartilage

A

more premature: not as thick of cartilage

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109
Q

Eyes

A

fused eyelids premature
see how tight or loose

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110
Q

Male Genitals

A

should have 5-10mL breast buds
term infant: fully descended testes and entire surface of scrotum is covered by rugae

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111
Q

Female Genitals

A

prominent clitoris, labia majora widely separated, labia minora protudes beyond labia majora
LM can be dark in some ethnic groups

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112
Q

Neuromuscularity in Newborn

A
  • posture in supine position
  • square window
  • arm recoil
  • popliteal angle
  • scarf sign
  • heel to ear
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113
Q

Preterm Resting Posture

A

supine, undisturbed, should be more flexed with increased tone but is more flaccid

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114
Q

Full Term Resting Posture

A

increased tone and more flexed

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115
Q

Square Window Sign

A

bending wrist
full term infant will be able to touch hand to wrist

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116
Q

Arm Recoil

A
  • lying in supine: flex both elbows, hold for 5sec, extend arms at baby’s side, and release
  • angle of recoil to which forearm springs back into flexion is noted
  • preterm will not have any arm recoil
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117
Q

Popliteal Angle

A
  • bend knee and push foot towards head
  • mature: little flex and cannot bend over 90 degrees
  • preterm: straight leg and lots of flex
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118
Q

Scarf Sign

A
  • extend infant arm across body
  • mature: bend elbow, not very flexible
  • preterm: straight arm, lots of flexibility
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119
Q

Scarf Sign

A
  • extend infant arm across body
  • mature: bend elbow, not very flexible
  • preterm: straight arm, lots of flexibility
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120
Q

Heel to Ear

A
  • extend foot to ear
  • mature: unable to do this
  • premature: touch foot to ear
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121
Q

General Appearance of Newborn

A

head large for body
tend to stay in flexed position, can hold head up

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122
Q

Pulse Rates

A
  • 110-160
  • sleep can go down to 70
  • crying can go up to 180
  • check apical pulse for 1min
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123
Q

Respiratory Rates

A
  • 30-60 resp/min
  • diaphragmatic but synchronus with abdominal movement
  • count for 1 full minute
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124
Q

BP Rates

A
  • 70/50 and 45/30 at birth
  • 90/60 at day 10
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125
Q

Temperature

A
  • normal range: 97.7-99.4
  • axillary: 97.7-99
  • skin 96.8-97.7
  • rectal 97.8-99
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126
Q

Anterior Fontanelle

A
  • diamond shaped
  • closes in 18mo
  • palpable with 2nd and 3rd finger
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127
Q

Posterior Fontanelle

A
  • triangle shaped, no buldging
  • closes 8-12 wks
  • depression: dehydrated or decreased intracranial pressure
  • bulging: increased intracranial pressure or trauma
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128
Q

Molding

A

baby in vertex positions for vaginal delivery
* pressure on head against cervix
* flat forehead and rises to point at posterior of skull “cone head”

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129
Q

Cephalohematoma

A
  • collection of blood from broken blood vessels that build up under scalp
  • does not cross suture line
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130
Q

Craniosynostasis

A
  • premature fusion of cranial sutures
  • results in growth restriction perpendicular to affected sutures and compensatory overgrowth in unrestricted regions
  • will need surgery
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131
Q

Plagiocephaly

A
  • rapidly growing head attempts to expand and meets type of resistance such as flat surface like crib
  • helmets used to fix aesthetically
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132
Q

Eyes: Physical Assessment

A
  • tearless crying: immature lacrimal ducts
  • peripheral vision: like close up objects
  • can fixate on near objects
  • can perceive faces, shapes, colors
  • blink in response to bright light
  • pupillary reflex present
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133
Q

Ears: Physical Assessment

A
  • soft and plaiable
  • ready recoil
  • pinna parallel with inner and outer canthus
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134
Q

Eye and Ear Variations

A
  • low set ears: chromosomal abnormalities or renal problems
  • abnormal malformations: absent pinna, abnormal folds
  • edema in eyelids from delivery or subconjunctival hemorrhage
  • transient strabismus: cross-eyed
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135
Q

Nose

A
  • small and narrow
  • must breath through nose
  • may sneeze a lot
  • assess for choanal atresia: abstract one nare at a time
  • could have obstruction of posterior nasal passage
136
Q

Mouth

A
  • pink lips, small amounts of saliva
  • intact pallate when placing finger on roof of mouth
  • ankyloglossa (tongue tied) because short frenulum - hard to breastfeed
  • flat phitrum - chromosomal abnormality
  • epstein pearls: keratin containing cysts
137
Q

Chest

A
  • size, shape, symmetry, movement
  • chest: cylindrical measuring around the nipple line
  • breasts: engorged, whitish secretion (witch’s milk)
  • respirations: diaphragmatic, 30-60
  • HR: heard at left nipple, may have murmur in 1st 24 hrs
138
Q

Signs of Distress

A
  • nasal flaring
  • sucking in for air: intercostal, substernal
  • expiratory grunting or sighing
  • seesaw up and down
  • tachypnea: greater than 60
  • central cyanosis
139
Q

Cardiac Variations

A
  • low pitched murmur: blood moving through turbulent part of heart
  • decreased strength or absence of femoral pulses: narrowing aorta can affect it
  • CHD: O2 sat monitors
  • BP assessment if lost lots of volume, pale, no femoral pulse
140
Q

Abdomen

A
  • cylindrical and soft, no distention
  • bowel sounds present by 1hr after birth
  • umbilical cord should be white and gelatinous: 2 arteries and 1 vein
  • 1 artery can lead to renal problems
141
Q

Extremities

A
  • short, flexible, move symmetrically
  • legs: equal in length and symmetrical creases
142
Q

Musculoskeletal Variations

A
  • xiphoid cartilage
  • fractured clavicle: palpate each to see intactness
  • no splinting, heals quickly
143
Q

Variations in Extremities

A
  • gross deformities
  • extra digits or webbing
  • clubfoot
  • hip dislocation
144
Q

Hip Assessment

A

baby in Frank Breech position

145
Q

Barlow Test

A
  • grasp and adduct infant thigh and apply gentle downward pressure
146
Q

Ortolani Test

A
  • finger over greater trochanter and lift thigh to bring femoral head from posterior position toward acetabulum
147
Q

Female Genitalia Variations

A
  • pseudomenstration vs uric acid crystals
  • labia swollen and darker
  • vaginal tags will resolve
148
Q

Hypospadias

A
  • meatus located on ventral surface of glands
  • groove that extends from usual area of meatus internally
149
Q

Epispadias

A

urethral meatus occurs on dorsal surface of penis, undescended testes

150
Q

Cryptorchidism

A
  • if testes cannot be pushed into scrotum manually
151
Q

Phimosis

A
  • uncircumsized
  • foreskin unable to be retracted
152
Q

Hydrocele

A

collection of fluid around testes and scrotum

153
Q

Acrocyanosis

A

bluish discolorization from poor peripheral circulation
* basal motor instability and capilary stasis
* exposed to cold

154
Q

Mottling

A

lacey pattern of dilated blood vessels under leg
* general circulation fluctuations
* can also be from apnea, sepsis, hydrothyroidism

155
Q

Jaundice

A

yellowish skin and mucous membranes
head to toe direction

156
Q

Erythema Toxicum

A

rash 24-48hrs long, normal finding

157
Q

Facial Milia

A

raised white spots on sebaceous glands

158
Q

Vernix Caeosa

A

whote substance protecting baby’s skin and lubricated it
* reabsorbed and may peel

159
Q

Forcept Marks

A

disappear after 1-2 days

160
Q

Telangiectatic Nevi

A

stork bites
pink/red spots on eyelids, nose, and nape of neck

161
Q

Nevus Flammeus

A

port-wine stain
capiliary angioma

162
Q

Mongolian Spots

A

bluish/black, grey/blue
on dorsal area in different darkened skin races
fade gradually and can be mistaken for bruises

163
Q

Moro Reflex

A

arms flare out and fingers form C shape

164
Q

Stepping Reflex

A

able to “walk”
disappears at 2mo

165
Q

Palmar Reflex

A

fingers will grasp your finger

166
Q

Plantar Reflex

A

toes will wrap around your finger

167
Q

Rooting Reflex

A

stroke cheek, will turn head towards

168
Q

Babinski Reflex

A

stroke foot, foot and toes flare out

169
Q

Trunk Incurvation

A

prone position, stroke vertebral column, move buttox in curving motion towards side being stroked

170
Q

Protective Reflexes

A

blink, yawn (overstim), cough/gag, extrusion (tongue pushes out foreign object), sneeze

171
Q

Sleep-Wake States

A
  1. deep sleep
  2. light sleep
  3. drowsiness
  4. quiet alert
  5. active alert
  6. crying
172
Q

Behavioral Response

A

influenced by state of newborn, temperment, and self-regulation

173
Q

Engagement Cues

A

behavior that signals ready to interact with caregiver

174
Q

Disengagement Cues

A

reduction in stimulus

175
Q

Dr. T. Berry Brazelton: Neonatal Behavioral Assessment

A
  1. habituation
  2. orienting response
  3. motor organization
  4. consolability
  5. cuddliness
176
Q

Habituation

A

ability of infant to lessen their response to repeated stimulus

177
Q

Orienting Response

A

respond virtually and auditorally to both animate and inanimate objects
follow with eyes and head, react to voices that are high-pitched

178
Q

Motor Organization

A

spontaneous body activity in response to internal stimulus (hunger, temp, noisy env)
move arms like a bike, jerky movements

179
Q

Consolability

A

how well they can console themselves or be consoled by others

180
Q

Cuddliness

A

how baby molds into contours of caregiver’s body

181
Q

Daily Newborn Care

A
  1. thermoregulation: cold depletes O2 and glucose
  2. feeding practices: feeding in 1st hr of life
  3. skin/cord care: clean w water and mild soap
  4. prevention of infection: around cord and eye to prevent opthalmia neonatorum
  5. security: ankle bracelets
182
Q

Opthalmic Ointment

A

erythromycin, single dose, 1/4 on lower conjunctival surface

183
Q

Daily Assessments

A
  1. vitals
  2. weight: compare against birth weight, lose 7% if breastfed, 3.5% bottle
  3. overall color
  4. intake and output
  5. umbilical cord
  6. newborn feeding
  7. attachment
184
Q

Preparation for Discharge

A
  • hep b vaccine
  • metabolic screening / PKU
  • hearing screening
  • CHD screening
185
Q

Parental Education

A
  • how to pick up newborn
  • holding and feeding infant
  • changing diaper
  • interpreting newborn cues
  • bathing newborn
  • cord and circumcisions
  • newborn and hearing screening
  • void and stool pattern
  • safety: car seat and shaken baby
  • sleeping positions: sids
186
Q

Circumcision Care

A
  • keeping area clean
  • check for bleeding
  • apply petroleum ointment
187
Q

Signs of Illness

A
  • temp above 100.4 or below 97.7
  • forceful or frequent vomiting
  • difference in awaking baby
  • cyanosis with or without feeding
  • increasing jaundice
  • breathing differently, absense of breathing longer than 20 sec
  • inconsolable infant / high-pitched cry
  • discharge / bleeding from cord, circumcision, any opening
  • no wet diapers for 18-24 hrs
  • develop eye drainage
188
Q

Care of Newborn at Delivery

A

85-90% do not need assistance
others: need NRP - neonatal resuscitation program

189
Q

N) Neonatal

A

provide warmth, clear airway, dry, stimulate
rapid assessment: breathing, muscle tone, color
wet when born, put on mom with blankets, keep warm

190
Q

R) Resuscitation

A

assess breathing
provide effective ventilations

191
Q

P) Program

A

assess heart rate
provide effective ventilations or chest compressions

192
Q

Targeted Pre-Ductal SpO2 After Birth

A
  1. 1 minute: 60-65%
  2. 2 min: 65-70%
  3. 3 min: 70-75%
  4. 4 min: 75-80%
  5. 5 min: 80-85%
  6. 10 min: 85-90%
193
Q

Thermoregulation

A

balance of heat loss and heat protection
* hypothermia: common because of decrease subcutaneous fat, blood vessels close to surface of skin

194
Q

4 Types of Heat Loss Mechanisms

A
  1. evaporation
  2. convection
  3. conduction
  4. radiation
195
Q

Convection

A

air flowing by skin and carrying away body heat with it
* air currents

196
Q

Radiation

A

transfer of heat between 2 objects that are not in contact with each other
* indirect source, cool window warm baby

197
Q

Evaporation

A

moisture on body lost to the environment
* H2O/vapor, baby born wet and needs to be dried

198
Q

Conduction

A

loss of hear from body surface to cool surface and in contact
* cold scale and warm baby

199
Q

Neutral Thermal Environment

A

maintenance of thermal balance
* babies maintain this through non-shivering thermogenesis by using the metabolism of brown fat instead of shivering

200
Q

Temperature Regulation

A

increased muscle activity, acrocyanosis, increased cellular metabilic activity, increased O2
* can create respiratory distress because temperature is dropping and less adipose tissue
* large body surface in relation to mass

201
Q

Transition of Respiratory System into Extrauterine Life

A
  • 6-12 hours after birth
  • exchange of O2 and CO2
  • maintenance of acid/base balance
  • in utero: received O2 via placenta thru cord and 10% of CO is profusing
202
Q

3 Needs of Respiratory System Once Born

A
  1. air replacing fluid
  2. onset of breathing
  3. increasesd pulmonary blood flow
203
Q

Inflation of Breathing Mechanisms

A
  • systemic vascular resistance increases
  • pulmonary vascular resistance decreases
  • all increases profusion of lungs
204
Q

Air Replaces Fluid: Absorption

A

rest of fluid absorbed by blood vessels in lymphatics

205
Q

Initial Inflation of Lungs

A

mechanical stimulation in utero: breathing amniotic fluid to promote growth and differentiation of lungs
* first breath: decrease in secretion into pulmonary fluid and reabsorb

206
Q

Surfactant and Alveolar Stability

A

surfactant needed
* 6th-7th month: cells develop lecithin so thin walls of alveoli do not collapse after each breath
* surface tension pulls on film of fluid in alveoli and lecithin is a surface acting agent that reduces surface tension of fluid by reducing muscular effor needed to draw air into lungs
* increases compliance

207
Q

The First Breath

A

hardest thing for neonate to do
* requires pressure 10-15x that of later breaths
* inflating all alveoli
* 40% of air remains as residual because of surfactant

208
Q

4 Initiations of Breathing

A

occur in respitory center in medulla
1. mechanical
2. sensory
3. thermal
4. chemical

209
Q

Mechanical Initiation of Breathing

A

compression of fetal chest as it moves through birth canal
* chest recoild and creates negative intrathoracic pressure
* passive inspiration of air = replacement of fluid with air

210
Q

Sensory Initiation of Breathing

A

tactile, visual, auditory

211
Q

Thermal Initiation of Breathing

A

change in temperature signals respiratory system

212
Q

Chemical Initiation of Breathing

A
  • mild hypercapnia: increasing CO2 levels
  • hypoxia: low O2 levels
  • acidosis: low pH
  • all stimulate respiratory system via peripheral chemoreceptors
  • prostaglandins suppress respirations and drop with clamping cord
213
Q

Increase in Pulmonary Blood

A

blood flow increases to lungs
* 10% of cardiac output perfuses pulmonary vasculature with replacement of fluid by air in lungs
* pressure shift: increased vascular resistance now decreases and leads to increased perfusion
* gas exchange can now occur at the level of capilaries

214
Q

Characteristics of Newborn Respiration

A
  • normal rate: 30-60 breaths/min
  • shallow and diaphragmatic with brief pauses (5-15sec)
  • apnea: over 20sec and may have skin or HR changes
  • nose breathers since reflex to open mouth not there
  • use of intercostal muscles, grunting, flaring indicates distress
215
Q

Neonatal Circulatory System

A

1 cord vein: O2 and blood
2 cord arteries: deox blood
* systemic vascular resistance increases, pulmonary artery pressure decreases and when cord is clamped: placental circulation lost
* closure of fetal shunts: foramen ovale, ductus arteriosus, ductus venosus

216
Q

Characteristics of Cardiac Function

A

right ventricle stronger in cardiac workload (2/3 of work)
* 4pt BP pressure different in arms and legs

217
Q

APGAR Scores

A

assessed at 1 and 5 minutes, indicates extrauterine transition
* 7-10 = minimal no difference
* 4-6 = moderate difference
* 0-3 severe distress

218
Q

APGAR: 0 Points

A

Activity: absent muscle tone
Pulse: absent
Grimace: flaccid reflexes
Appearance: blue, pale
Respiration: absent

219
Q

APGAR: 1 Point

A

Activity: arms and legs flexed
Pulse: below 100 bpm
Grimace: some flex
Appearance: body pink, extremities blue
Respiration: slow and irregular

220
Q

APGAR: 2 Points

A

Activity: active
Pulse: over 100 bpm
Grimace: active - sneezing, coughing, pulling away
Appearance: pink
Respiration: crying

221
Q

Phase 1 Transition Phase

A

period of reactivity: 1-2 hrs
* bonding, head to toe assessments, breastfeeding, increased motor activity, minimal bowel sounds, saliva

222
Q

Phase 2 Transition Phase

A

sleep period: 1-4 hrs
* deep sleep to stabilize HR and RR

223
Q

Phase 3 Transition Phase

A

second period of reactivity: 2-8 hrs
* breastfeeding, lots of mucus, meconium

224
Q

Nursing Care During Transition

A
  • review of prenatal birth info
  • initial rapid assessment
  • newborns’ adaptation to extrauterine life
  • vital signs per protocol
  • assessment of blood glucose if needed
  • weight and measurement
225
Q

Difficult Transitions: Maternal Conditions

A
  • increased age
  • diabetes
  • hypertension
  • substance use
  • prior history of stillborn
  • fetal demise
226
Q

Difficult Transitions: Fetal Conditions

A
  • prematurity/postmaturity
  • congenital abnormailities of cardiac system
227
Q

Difficult Transitions: Antepartum Conditions

A
  • placental abnormalities (previa, poly/oligohydraminos)
  • breech
  • infections
  • asphyxia in utero
  • narcotics close to delivery time (decrease RR of fetus)
228
Q

Difficult Transitions: Delivery Complications

A
  • assistive devices
  • C-section
229
Q

Difficult Transitions: Neonatal Difficulties

A
  • lack of respiratory effors: neurologically depressed, impaired muscle function
  • mucus blockages
  • respiratory distress from impaired cardiac/lung functioning
230
Q

Blood Volume of Newborn

A

80-90mL/kg of body weight
* dependent on cord clamping, could be 100

231
Q

Delaying Cord Clamping

A

enhances pulmonary profusion
* increases iron stores
* risk of jaundice due to high number of RBC and organ damage from the viscosity of blood

232
Q

Erythropoietin Saturation in Fetus

A

increases due to 50% saturation of fetal blood
* decreases production after birth
* resumes response to low hemoglobin = jaundice
* RBC lifespan 33% less than adult
* leukocytosis = normal and increase in WBC

233
Q

Gastrointestinal Adaptations

A
  • stomach: size of marble
  • 36-38 wks: adequate intestinal and pancreatic enzymes
  • proteins require more digestion but absorn and digest fats less efficiently
234
Q

Colostrum and the Stomach

A

correlate with the maturity of enzymes - amylase and lipase lacking of ar birth
* decreased fat, increased antibody and protein in colostrum

235
Q

Swallowing

A

experience it in utero
* gastric emptying in utero: swallow vernix

236
Q

Air and the Stomach

A

enters immediately after birth
* hits small intestine 2-12 hrs
* hear bowel sounds hr after birth
* meconium 8-24 hrs

237
Q

Weight Loss

A

1st 3-4 days
* colostrum acts as a laxative
* 3.5% formula fed
* 7% breastfed
* regained by day 10

238
Q

Urinary Adaptations

A
  • at risk for fluid shifts because kidneys are immature
  • glomerular filtration rate low
  • limited capacity to concentate urine
  • void in the 1st 24 hrs - uric acid crystals
239
Q

Water and Newborns

A

cannot reabsorb water to maintain vital organ functioning
* risk for over and dehydration

240
Q

Hepatic Adaptations

A

liver takes up 40% of abdominal cavity
iron storage, bilirubin conjucation, coagulation of blood

241
Q

Iron Storage: Hepatic Adaptations

A

mom’s iron intake lasts for 5-6 months

242
Q

Glucose: Hepatic Adaptations

A

diffuses across the placenta, not insulin, fetus makes own
* cuts off at birth, rapidly utilize from stress of delivery
* goes to glycogen if depleted - liver needs to be able to do this
* no greater than 40 mg/dL

243
Q

Jaundice

A

normal biological response
refers ot the increased yellow pigment in tissues from high levels of bilirubin

244
Q

Bilirubin

A

product of fetal RBC destruction
* heme: iron
* globin: protein

245
Q

Unconjucated Bilirubin

A

indirect bilirubin from the heme
* fat soluble and unable to be excreted
* crosses the placenta

246
Q

Conjucated Bilirubin

A

direct bilirubin

247
Q

Total Bilirubin

A

total of unconjugated and conjugated
* 2-3 mL/dL then 5-6mL/dL in 3-5 days

248
Q

RBC in Newborn

A

hemolysis occurs as lungs oxygenate newborn

249
Q

Hyperbilirubinemia: A Breakdown

A
  • bili enzymatically converted in liver, water soluble bili excreted in the urine
  • glucantranferase: responsible for urine/stool color
  • enzyme is lacking since liver immature, this impairs liver’s ability to conjugate bili and excrete it
  • creates excessive amounts of bili in the blood, risk to cross the blood-brain barrier
250
Q

Normal Intestinal Flora and Bili

A

reduces conjugated bili to urobilinogen
* excreted in the kidneys and stercobilinogen and excreted in the feces
* requires adequate calories and hydration
* delay in feeds causes reabsorption

251
Q

Transcutaneous Bilirubin

A
  • done prior to discharge
  • non-invasive measurement using light to measure bili in blood
  • if suspicious: draw blood
252
Q

Bilirubin Levels

A

high-risk
high-intermediate
low-intermediate
low-risk

253
Q

Why Newborns are Prone to Bili

A
  • accerated destruction of RBC
  • blood type or Rh incompatibility
  • bruising from instruments, cephalohematoma
  • decreased hepatic function
  • decreased albumin levels
  • drugs that interfere with conjugated bili: indomethacin, sulfa drugs, salicylates
  • maternal enzymes in breastmilk inhibit conjugation
254
Q

BF and Jaundice

A
  • early onset, decreased intake of BM
  • BF infants have more bili
  • peaks 2-4 days
  • associated with poor feeding
255
Q

Meconium and Jaundice

A

leads to dehydration and delay in passing this
* mec has conjugated bili and if not passed in a timely manner, reabsorbs and transported to liver
* enterohepatic circulation

256
Q

BM and Jaundice

A
  • related to milk composition, rare
  • late onset = 2-3 wks
  • newborns are healthy
  • treatment: monitor serum bili levels
  • may stop BF for 12-24 hrs and if bili levels drop = BMJ
  • genetic component
257
Q

Passive Immunologic Adaptations: IgG

A

IgG crosses placenta
* 3rd trimester
* begin immunizations at 2 months because of low levels of antibodies and immature WBC
* more vulnerable infections
* Hep B: given at birth

258
Q

Passive Immunologic Adaptations: IgA

A

in colostrum
* protects against GI and respiratory infections

259
Q

Neurologic Functioning

A
  • lots of neuro development in postpartum period
  • time of high risk to intellectual development
  • brain: one quarter size of adult brain
  • myelination of nerve fibers incomplete
260
Q

Nutrition Across Lifespan

A
  • need lots of nutrients
  • most vulnerable to poor nutrition during periods of rapid growth - unborn and 1st yr of life
261
Q

Healthy People 2020

A

BF = unequalled way of providing ideal food for healthy growth and devlopment of infants
* 81.9% of mom’s initiate BF in early postpartum period
* 25.5% exclusively BF at 6 months
* 34% continue at 1 year
* 25.4% of BF infants receive formula before 2 day and want to go down to 14.2%
* 2.9% birth in places with recommended BF care and want to go down to 8.1%

262
Q

Breastfeeding and Other Foods

A
  • 1 mil infants die because given food too early and not breast fed
  • rooming in with unrestricted BF
  • no food or drink than BM unless medically necessary
263
Q

Contraindications to BF

A
  1. HIV
  2. Active Untreated TB
  3. Human T-cell leukemia virus type 1
  4. exposure to toxic chemicals
  5. use of illegal drugs
  6. children with metabolic disorders / allergies (galactosemia)
  7. some meds given to mom = antimetabolites and therapeutic radiopharmaceuticalas
264
Q

Growth in Neonatal Period

A

most rapid
* rate tapers off at 2nd half of 1st year

265
Q

Birth Weight Trends

A
  • doubles by 4-6 months and triples by one year
  • 4-6 oz per week for first 5-6 months
  • meet inital birth weight at day 10-14
266
Q

Nutritional Requirements

A

calories: 100-120 calories
* proteins for cell growth: whey and casein
* carbs for energy
* fat for brain and CNS
* fluids 100-150 mL/kg/day
* iron: reserves depleted 5-6 months
* vitamin D and K

267
Q

Metabolic Screening

A

PKU test
* newborn genetic screening aimed at early detection of genetic diseases that can result in severe health problems not symptomatic at birth
* blood sample heel stick and administer on paper

268
Q

Preterm Infant Characteristics

A
  • larger proportion of warer
  • little subcu fat
  • poorly calcified bones
  • incomplete nerve and muscle development
  • suck reflex week (usually present at 32-34 weeks)
  • limited ability for digestion, absorption, and renal function
  • immature liver lacking development in metabolic enzyme system or adequate iron stores
  • feeding tubes and supplements for calories
269
Q

Colostrum

A
  • comes in 16 weeks gestation
  • high density, thick, gel-like
  • yellow in color from high beta keratin
  • high in proteins, fat soluble vitamins a and e, minerals than mature milk
  • coats gut to prevent adherence of pathogens and promote gut closure
  • easy to digest, maternal antibodies
270
Q

BM Transition

A
  • decrease in immunoglobulins and protein
  • high in lactose and fat
  • longer you breastfeed, higher the fat concentration
271
Q

BF Assessment

A
  • alignment, areolar grasp, compression, audible swallowing
  • let down reflex
  • nipple condition
  • maternal comfort during feeding
  • infant’s weight and output
272
Q

Infant Stomach

A
  • day 1: 5-7mL
  • day 3: 0.75-1oz
  • day 7: 1.5-2oz
273
Q

Signd of Effective BF

A
  • nursing 8 times or more in 24 hrs
  • mom hears infant swallowing
  • number of wet diapers increases
  • infant’s stools lighten
274
Q

Formula Fed Infants

A
  • can cause harm to GI tracts
  • gut is sterile and immature with tight junctions of GI mucosa not mature
  • pathogens enter with open junctions
  • necrotizing endocolitis
  • interfere with flora and pH of gut
275
Q

Formula Prep

A
  • powder or liquid concentrate, ready to feed
  • discard if offered to infant or unfridgerated after 1 hr
  • water can make intoxication and decreased electrolyte status
276
Q

Baby Bottle Syndrome

A
  • hold them during feeding and rotate sides
  • do not prop bottle - risk for aspiration and formation of dental problems over time
277
Q

Newborn at Risk

A

greater than average chance of morbidity (illness) or mortality because of conditions present at birth or stress of birth

278
Q

High Risk Period

A

encompasses human growth and development from age of viability up to 28 days after birth

279
Q

Common Problems that Appear with NB

A
  • gestational age and birth weight problems
  • drug exposure
  • congenital abnormalities
  • hypothermia
  • hypoglycemia
  • TTN
  • MAS
  • PPHN
  • sepsis
  • hyperbili
280
Q

Anticipation of NB

A
  • what may have compromised fetus in utero maternal medical and prenatal history
  • what occurred in labor
281
Q

Conditions Present at Birth

A
  • IUGR
  • SGA
  • LGA
  • diabetic mother
  • preterm baby
  • CHD
  • inborn error of metabolism
  • substance abuse
282
Q

Classification According to Size

A
  • preterm
  • full term
  • late preterm
  • postterm
283
Q

IUGR

A
  • deveiation and restriction in expected fetal growth pattern
  • multiple adverse conditions may cause cong. abnormalities
  • pathologic: do not get enough nutrients and O2
284
Q

SGA

A

below 10th precentile
* physically and neurologically mature but smaller
* may be premature, full term, post term
* fetal growth problems

285
Q

IUGR Fetal Factors

A
  • affect genetic growth potential
  • chromosomal abnormalities
  • heart disease/hemolytic
  • IU infection
  • TORCH
  • malformations
  • multiple gestations
286
Q

TORCH

A

toxoplasomosis
rubella
cytomegalovirus
herpes

287
Q

IUGR Maternal Factors

A
  • hypertension
  • age
  • drugs/smoking
  • anemia/sickle cell
  • cardiac/renal/vasc disese
  • asthma
  • multiple gestations
  • no prenatal care/low SES
  • grand multiparity
288
Q

IUGR Placental Factors

A

inadequate delivery of nutrients
* previa
* abruption
* abnormal venous connection
* drugs that decrease blood flow
* diabetes
* chorioamnionitis
* small placenta

289
Q

IUGR Environmental Factors

A
  • high altitude
  • X-ray exposure
290
Q

Patterns of IUGR

A

depends on timing
* symmetrical and asymmetrical

291
Q

Symmetrical IUGR

A

weight, length, head circ. plot similarly on growth curve and all organ systems small, normally happens in 1st trimester
* poor long term prognosis
* chromosomal abnormailties
* teratogenic effects / TORCH
* may not grow as big as their counterparts

292
Q

Asymmetrical IUGR

A

disproportion reduction in size of all structures and organs, happens later in preg 2nd/3rd
* from either maternal or placental conditions that occur later in pregnancy and impede on placental blood flow
* preeclampsia, placental infarcts, maternal malnut.
* head size spaired but overall weight and organ sizes decrease
* better prognosis

293
Q

IUGR Risks

A
  • labor intolerance related to placental insufficiency and inadequate nutritional O2 reserves
  • mec aspiration from asphyxia
  • hypoglycemia: heat loss
  • hypocalcemia down 7.5mg/dL
  • jittery, tetany, seizures
294
Q

Assessment Findings: IUGR

A
  • large head
  • long nails
  • large anterior font
  • decreased wharton’s kelly
  • thin extremities and trunk
  • loose skin and decreased subq fat
  • dry, flaky/mec stained skin
  • hypothermia, polycythemia
295
Q

SGA Risk Factors

A
  • maternal diabetes
  • multiparity
  • previoud macrosomic baby
  • prolonged preg
  • hypertension
  • cardiac disease
  • renal disease
296
Q

LGA Outcomes

A
  • C-section
  • operative vag delivery
  • shoulder dystocia
  • breech
  • birth trauma
  • cephalopelvic disproportion
  • hypoglycemia
  • hyperbili
297
Q

LGA Assessment

A
  • fractured clavicles
  • brachial nerve damage
  • facial nerve damage
  • fepressed skull fractures
  • cephalohematoma
  • intracranial hemorr
  • asphyxia
298
Q

SGA Assessments

A
  • head large for body
  • wasted apperance of extremities
  • deceased subq fat
  • decreased amount of breast tissue
  • scaphoid abdomen
  • wide skull sutures
  • poor muscle tone
  • loose and dry skin
  • thin umb cord
299
Q

SGA Complications

A
  • hypoxia
  • little room to tolerate L and D
  • organ dysfunction
  • hypoglycemia
  • hypothermia
  • polycythmia: response to chronic hypoxia, bone marrow stimulation to increase production of RBC
300
Q

SGA Complication Factors

A
  • congenital malormations
  • IU infection - TORCH
  • hypoxia: cog diff, learning dis.
301
Q

SGA Interventions

A
  • monitor O2, color, RR
  • monitor temp over 97.6, hold bath
  • free from hypoglycemia
  • monitor hypocalcemia
  • weigh daily - maybe need to increase caloric intake
  • monitor feeding intolerance - may have had placental insuf.
302
Q

LGA

A

bw over 90%
birth trauma: cephalopelvic disproportion
macrosomia
C-sections
hypoglycemia
polycythemia

303
Q

Infant of Diabetic Mother

A
  • hypoglycemia/calcemia/mag
  • hyperbili
  • birth trauma
  • polycythemia
  • RDS
  • congen malfor
  • low musc tone
  • hypoxic: ischemic encephalopathy
  • periventricular leukomalacia
  • poor feeding
304
Q

Post Term Newborn

A
  • after 42 wks
  • post maturity syndrome
  • risk for asphyxia and mec passage
  • polycythemia/hypoglycemia/hypothermia
  • decreased amn fluid
  • risk for cord compression and thicker mec stained amn fluid
  • risk for morb/mort
  • decreased placental fxn from altered O2 and nutrient transport
  • increase hypoxia and hypoglycemia
305
Q

PTN Risk Factors

A
  • ancephaly
  • 1st preg
  • history of postterm preg
  • grand multipar
306
Q

PTN Complications

A
  • mec aspiration
  • fetal hypoxia: cord comp
  • neuro conditions: seizures from fetal asphyxia in labor
  • birth trauma
307
Q

PTN Findings

A
  • dry, cracked, peeling skin
  • lack of vernix
  • profuse hair
  • long fingernails
  • thin wasted appearance
  • mec staining (green/yellow)
  • hypogly
  • poor feeding
308
Q

Preterm Newborn Class

A
  • Very: less than 32 wks
  • Premat: 32-34 wks
  • Late: 34-37 wks
309
Q

Preterm Newborn Weights

A
  • LBW: < 2500
  • VLBW < 1500
  • ELBW < 1000
310
Q

Preterm Findings

A
  • decreased tone and posture
  • skin transparent and red
  • decreased subq
  • lanugo
  • creases not on foot or limited
  • eyelids fused and open 26-30 wks
  • overriding sutures
  • pinna: soft and folded
  • weak cry
  • testes not desc
  • immature suck
  • apnea and bradycardia
  • anemia
311
Q

Preterm Risk Factors

A

nonmodifiable and modifiable

312
Q

CHD

A
  • screening
  • pulse ox to detect diminished O2 delivery
  • find mitrial stenosis, hypoplastic left heart, coarctation of aorta, patent dictus arteriosus, transposition of great vessels
313
Q

Inborn Errors of Metabolism

A
  • hereditary disorders, enzyme defects, block met pathway and toxins can accumulate
  • afefct organ and energy fxn and production
314
Q

Sub. Abusing Mother

A
  • tobacco
  • alcohol
  • drugs
315
Q

FAS

A
  • phenotypic features: growth restriction, CNS abnormalities, facial dysmorphology
  • long term behavioral and cognitive disab
  • reduce environmental stim
  • extra time to feed
  • reinforce parenting
316
Q

Newborn Withdrawl Syndrome

A
  • hyperactivity
  • increased musc tone/exaggerateed reflexes
  • tremors
  • sneezing, hiccuping, yawning, short unquiet sleep
  • fever
  • tachyplea, excessive secretions
  • vigorous suck
  • vom, drooling, dia
  • sensitive gag reflex
  • poor feeding
  • stuffy nose, yawning, flushing, sweatung
  • sudden pallor
  • excoriated buttocks, knees, elbows
  • facial structures
  • pressure-point abrasions
317
Q

Nursing Interventions: Sub Abuse Infants

A
  • reduce withdrawl symp
  • monitor pulse, resp, temp, small freq feedings
  • admin meds as ordered
  • swaddling
318
Q

Eat Sleep Console

A

Finnegan Symptom Prioritization
* newborn inability to take in age-appropriate vol of food, sleep more than one hour after feeding, or be consoled within ten mins

319
Q

Birth Related Stress

A
  • cold
  • hypogly
  • hyperbili
  • infection
  • RDS
  • TTN
  • MAS
  • PPHN
320
Q

Cold Stress

A
  • heat loss that newborn compensates for
  • increased met rate
  • decreased surfactant production and hypoxemia
  • increased consumption of glucose and hypogly
  • met acid increases risk for jaundice
321
Q

Cold Clinical Intervention

A
  • rewarm w skin to skin, heat lamos, swaddling
  • monitor gluc levels
  • monitor O2
322
Q

Newborn With Hypoglycemia

A

want glucose over 40 mg/dL
* jittery
* tachypnea
* diaphoresis
* hypotonia
* lethargy
* apnea
* temp instability

323
Q

Physiological Jaundice

A
  • common after first 24 hours
  • increased bili from polycythemia and short life span of FRBC
  • decreased uptake of bili by liver
  • decreased enzyme activity and ability conjugate bili
  • decreased ability to excrete bili
  • increased enterohepatic circ
  • breastfeeding
324
Q

Pathological Jaundice

A
  • in 1st 24 hrs of life
  • total serum level above 12 in term
  • total 15 in preterm
  • serum bili increase more than 5 mg per day
  • conj bili: more than 2
  • jaundice lasting 1 wk term
325
Q

Bili Encephalopathy

A

unconj bili in excess that binds to albumin and crosses BBB
* cause neurotoxicity
* lethargy, irritability
* arching of neck and trunk (retrocollis and opisthonos)
* kernicterus: movement disorfer, athetoid form of CP, deafness, seizure, coma, limited upward gaze

326
Q

Interventions with High Bili

A
  • phototherapy
  • exchange transfusion if newborn has active hemolysis, unconj bili level of 14, weighs less than 2500 and less tha. 24 hrs old
327
Q

Phototherapy Nursing Care

A
  • assessments: feedings, BM status
  • warmth
  • eyepatches, cover genitals
  • positioning q2h
328
Q

Newborns with Infection

A
  • anticipate sepsis neonatorum
  • immature immune system
  • vertical transmission: transplacental, ascending (prolonged ROM), intrapartal
  • horizontal: nosocomial infec, transmitted from hospital equiptment or staff
329
Q

Risk Factors for Neonatal Inf: Maternal

A
  • poor prenatal nut
  • low SES
  • Hx STI
  • prolonged ROM: 12 hrs
  • GBS
  • chorioamnionitis
  • maternal temp in labor
  • premature labor
  • diff labor
  • fetal scalp electrode use
  • invasive procedures
  • UTI
330
Q

Risk Factors for Neonatal Inf: Neonate

A
  • prematurity
  • LBW
  • diff delivery
  • birth asphyxia
  • mec staining
  • cong abnor
  • male
  • multi gest
  • invasive procedure
  • length of stay
  • humidifcaion in incubator or vent
  • broad spectrum antibiotics
331
Q

Assess for Sepsis

A
  • resp
  • temp
  • cardovasc
  • neuro
  • gastro
  • skin
  • metabolic
  • immature total neutrophil ratio >0.2 suggests infection
332
Q

Nursing Interventions for Reducing Sepsis

A
  • hand hygene
  • blood cultures, CBCD, urine culture
  • supportive care: reso, cardio, fluid/electrolytes, hypogly, acidosis
333
Q

RDS Summary

A
  • hyaline mem disease
  • primary absence/def of pul surfantant
  • indicated failure to synth adequate surfactant
  • lec/spin ratio 2:1
334
Q

RDS Assessment

A
  • grunting, flaring, retracting, tachypnea, skin color gray or dusky
  • hypoxemia
  • acidosis from sustained hypoxemia
335
Q

RDS Management

A
  • pulse ox
  • cardiac monitoring
  • exogenous surfactant replacement
  • O2 therapy by mask, hoord, cannula
  • CPAP
  • mech vent
  • extracorporeal mem ox therapy (ECMO) if vent not working
336
Q

Transient Tachypnea of Newborn (TTN)

A
  • failure to clear lung fluid, mucus, debris
  • exhibit signs of distress shortly after birth
  • expiratory grunting and nasal flaring
  • subcostal retractions
  • slight cyanosis
  • maintain adequate resp, nut, hydration
337
Q

Meconium Aspiration Syndrome (MAS)

A
  • mechanical obstruction of airways
  • chem pneum
  • vasocon of pul vessels
  • inactivation of natural surfactant
  • assess for complications related to MAS
  • mantain adequate resp, nut, hydration

Maternity (5 decks)

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