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Maternity > Exam 1 & 2 Decks > Flashcards

Exam 1 & 2 Decks Flashcards

1
Q

Maternal-Newborn Nursing

A

the promotion and maintenance for optimal family health to ensure cycles of optimal child-bearing or child-rearing
family centered

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2
Q

The Basic Unit of Society

A

Family

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3
Q

Types of Families

A

Binuclear (divorsed), nuclear (married), single parent, same sex

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4
Q

Birth Rate

A

number of live births in one year/1000 population

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5
Q

Infant Mortality Rate

A

number of deaths of infants younger than 1 year/1000 live births

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6
Q

Maternal Mortality Rate

A

number of maternal deaths form births and complications of pregnancy, child birth, and puerperium
1st 42 days after termination of pregnancy/100k births

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7
Q

Healthy People 2030

A
  1. reduce maternal mortality rate
  2. reduce rate of infant mortality
  3. reduce rate of preterm births
  4. increase proportion of women delivering live births and having a healthy weight prior to pregnancy
  5. increase proportion of women who are screened for postpartum depression ar postpartum checkup
  6. increase proportion of infants who are breastfed
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8
Q

Nurse Practice Act

A

defines the rules and safe parameters
1. scope of practice
2. standards of care
3. standards for educational programs
4. licensure requirements
5. grounds for disciplinary actons
6. enforced by state board

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9
Q

Scope of Practice

A

range in services and care provided by nurse via state requirements
ex: RN vs NP

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10
Q

Scope of Care

A

promotes consistency and ensures quality nursing care and outcomes
minimum legal acceptance

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11
Q

Evidence-Based Practice

A

based on nursing and research to provide quality, safe client care

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12
Q

State Board of Nursing

A

hospitals have own set of policies for nurses
can limit scope of practice but never expand

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13
Q

Professionsal Negligence/Malpractice

5 Reasons

A
  1. duty
  2. breach of duty
  3. foreseeability
  4. causation
  5. injury or harm
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14
Q

Informed Consent

A

person’s agreement to allow something to happen based on full disclosure ot risks, benefitsm alternatives, and consequences of refusal
failure to claim - claim of battery

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15
Q

HIPAA

A

minimalize exclusion of preexisting conditions, designate rights for those who lose other health coverages, eliminate medical underwriting in group plans including privacy rule

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16
Q

Privacy Rule

A

right of patients to keep personal info from being disclosed

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17
Q

Cultural Competence

A

acknowledging, respecting, and appreciating ethnic, cultural, an linguistic diversity

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18
Q

Encultuation

A

socialization into one’s primary culture as a child

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19
Q

Acculturation

A

culture of minority is gradually displaced by culture of dominant cultural group

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20
Q

Assimulation

A

process by which a person or group’s language or culture resembles those of another group

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21
Q

Ethnocentrism

A

conviction that values and beliefs of ones’ own cultural group are best or only acceptable one

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22
Q

Autonomy

A

respect right to self determination, independent decision making

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23
Q

Fidelity

A

keep promises

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24
Q

Justice

A

fairness

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25
Q

Beneficence

A

positive actions to help

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26
Q

Nonmaleficence

A

avoid causing harm

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27
Q

Veracity

A

truth telling

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28
Q

Paternalism

A

provider makes decisions on diagnosis, therapy, and prognosis

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29
Q

Fundal Massages

A

lower hand underneath in cupped position above pubic synthesis, upper hand at fundus
upper hand rotates while lower hand supports
muscles will contract

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30
Q

Breastfeeding

A

important in 1st hour
removal of colostrum
skin-to-skin and allowing baby to smell milk

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31
Q

Attachment

Breastfeeeding

A

baby uses jaw and tongue to massagae nipple, goes far back into mouth
one hand on breast, one hand on baby’s head
problems with attachement - remove milk early to make supply

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32
Q

Breast Milk

Breastfeeding

A

hand in “C” shape, press back, compress, relax

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33
Q

Calories

Breastfeeding

A

frequent, small feedings
bright yellow stools expected at day 5

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34
Q

C-Section

Breastfeeding

A

placed skin-to-skin in operating room

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35
Q

Small/Early Babies

Breastfeeding

A

below 6lbs or 37 wks
may be sleepy, still offer milk even if it is through hand expression and with a spoon

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36
Q

Shaken Baby Syndrome

A

shake baby back and forth
cause severe vision, behavioral, or developmental problems
convulsions, seizures, loss of consciousness and vision, not breathing, pale, poor feeding, vomiting

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37
Q

Antepartum

A

pregnant women before onset labor

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38
Q

Intrapartum

A

time of labor and childbirth

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39
Q

Postpartum

A

6-8wk time period after delivery of baby and placenta
reproductive system returns to non-pregnant state

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40
Q

Involution

A

pelvic reproductive organs return to approximate pre-pregnancy size, position, and function
takes about 6wks, fastest on day 3-4
risk of hemorrhage

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41
Q

Quick Involution Factors

A

non-complicated L&D process, breastfeeding, early ambulation, complete expulsion of placenta

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42
Q

Slow Involution Factors

A

multiple gestations, c-section, polyhydraminos, retained placenta, full bladder, multiple pregnancies, prolonged labor

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43
Q

Placental Detachment

A

uterus has rapid contractions to vasoconstrict (pinch off) blood vessels as the site of placental attachment - controls bleeding

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44
Q

Protein Catabolism

A

uterine muscle cells decrease in size (6wks)

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45
Q

Exfoliation

A

placental site healing, sloughing off dead tissue in form of lochia

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46
Q

Uterine Atony

A

boggy uterus 1-2hrs after birth

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47
Q

Normal Descent of Uterus

A

1cm / 1 fingerbreadth per day
nonpalpable by day 10-14

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48
Q

Afterpains

Involution

A

intermittent uterine contractions, more uncomfotable in multiparous women
happens during breastfeeding with release of oxytocin

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49
Q

Lochia

A

postpartum uterine discharge classified according to appearances and contents

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50
Q

Lochia Rubra

A

day 1-3
red with small clots
pad saturation in 50 minutes or less - excessive

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51
Q

Lochia Serosa

A

day 3-10
pale pink/brown

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52
Q

Lochia Alba

A

day 10-14
yellow to white

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53
Q

Cervix

Postpartum

A

flabby, thin, protrudes into vagina
closes in 1 wk

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54
Q

Vaginal Walls

Postpartum

A

smooth and swollen, can be ecchymotic (bruised)

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55
Q

Vagina

Postpartum

A

returns to pre-pregnant state
may have edema and small lacerations

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56
Q

Kegels

A

strengthen perineal muscles

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57
Q

Dyspareunia

A

vaginal dryness in painful intercourse because of decreased estrogen

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58
Q

Menstral Flow Postpartum

A

70% return in 9-12wks
7wks for non-nursing mothers
1st cycle - non-ovulatory because of elevated prolactin

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59
Q

Cardiac Output and Blood Volume

A

increase - hypervolemia
CO returns after 12wks of delivery

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60
Q

Diuresis

A

urinate a lot because of decrease in aldosterone and Na retention

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61
Q

Diaphoresis

A

sweating a lot

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62
Q

Fibrinogen

A

protein responsible for blood clotting - must monitor for blood clots after birth

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63
Q

Walking and Urinating Postpartum

A

critical, bladder tone diminished
decrease UTI susceptibility

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64
Q

Neurological Effects Postpartum

A

lack of feeling in legs
dizziness and headache
disconfort and fatigue
symptoms of carpal tunnel syndrome

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65
Q

Endocine Effects Postpartum

A

sharp decrease in estrogen and progesterone, lactation begins
estrogen = prolactin inhibiting hormone

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66
Q

Musculoskeletal Effects Postpartum

A

relaxin hormone relaxes pelvic ligaments and joints within pregnancy
joints may feel altered
abdomen wall - weakened and maybe separated (diastasis recti)

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67
Q

Gastrointestinal Effects Postpartum

A

very hungry and thirsty
bowel tone - sluggish
go on high fiber diet or use laxatives

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68
Q

Integumentary Effects Postpartum

A

melanocyte decreases
cholasma and linea nigra gradually fades
striae fades to silvery lines
spider nevi and palmar erythema disappear

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69
Q

Immune System Effects Postpartum

A

Rubella, Rhogam, Coombs test

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70
Q

Rh Factors with Rh- mom and Rh+ baby

A

Coombs test - negative = mom is not sensitized to it
300mcg of RhoGam in first 72 hours after delivery

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71
Q

Why it is necessary to give mom RhoGam shot

A

prevent maternal antibody production from Rh+ antigens
if blood mixes = cause problems in future pregnancies

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72
Q

Rubella Vaccine

A

administer to nonimmune mother
safe for nursing mothers
avoid pregnancy for 1 month
never want to give it to pregnant mom since it is a live vaccine

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73
Q

Lactation

A

synthesis, release, and ejection of milk through ductal system
inhibitory with high levels of progesterone and estrogen

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74
Q

Colostrum

A

rich in nutrients, protein, antibodies, immune cells

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75
Q

Traditional Milk

A

2-5 days after delivery
rich in fat and protein

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76
Q

Mature Milk

A

10-15 days after delivery

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77
Q

Let Down Reflex

A

milk ejected though ductile system through neurohormonal reflexes
infant sucking = stimulates oxytocin from posterior pituitary
milk ejection = stimulates prolactin from anterior pituitary

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78
Q

Breastfeeding Benefits for Baby

A

antibodies, increases intellecual development

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79
Q

Breastfeeding for Mom

A

involution, decrease hemorrhage, increase expenditure of calories, decrease risk of osteoporosis, breast cancer, ovarian cancer, increse attachement

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80
Q

Common Breastfeeding Positions

A

football, lying down, cradling, across lap

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81
Q

Rubin’s Restorative Phases

A

Taking in
Taking hold
Letting go

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82
Q

Taking In

Rubin’s Restorative Phases

A

dependent, absorbing experiences of labor, need rest, comfort, and nutrition

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83
Q

Taking Hold

Rubin’s Restorative Phases

A

independent, attend to infant’s needs, want to learn about how to care for child

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84
Q

Letting Go

Rubin’s Restorative Phases

A

interdependent, redefine new role

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85
Q

Positive Attachement

A

touching, holding, kissing, cuddling, talking, singing, “en face” position

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86
Q

Malattachment

A

refusing to look at infant, no touch, no holding, no naming, negative comments, refusing to respond to infant cues

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87
Q

Malattachment Interventions

A

rooming in, skin-to-skin in en face position, providing praise and support

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88
Q

Baby Blues

A

3-5 days after delivery
80% of women
changes in hormones can make mom feel sad, irritable, and confused

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89
Q

Postpartum Assessment

A

determine physiological needs: vitals
intrapartum history
need for immunizations
educational/cultural/religious/language/DV

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90
Q

Vital Signs

A

elevated temp (100.4) in first 24 hrs
postpartum shivers common
pulse: 60-100, may see slight bradycardia from the increased CO in preg
if tachycardic: may be infection
BP should be normal

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91
Q

Orthostatic Hypotension

A

BP decreases after lying down for long period and standing rapidly

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92
Q

C-Section Assessment

A

stool softeners, early ambulation, incision: REEDA

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93
Q

REEDA

C-Section Assessment

A

redness, edema, ecchymosis, discharge, approximation

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94
Q

Pulmonary Infections Postpartum

A

use of narcotics and immobility

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95
Q

Postpartum Focused Assessment (BUBBLE HEB)

A

breasts, uterus, bladder, bowels, locia/lacerations, episotomy
hemmorhoids, emotions, bonding

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96
Q

Intimate Partner Violence

A

pattern of coercive control, imbalance of power
hostile, demanding, answering for patient

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97
Q

Types of Abuse

A

emotional/psychological, verbal, physical, sexual, financial, spiritual

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98
Q

Violence Against Women Statistics

A

1/4 women in US will be in abusive relationship
battering is the most common form of injury
1/3 attempt suicide
1/3 of ER visits are DV related

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99
Q

Cycles of Violence

A

tension building
explosion
honeymoon

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100
Q

Tension Building

Cycle of Violence

A

abuser is critical and bully
victim feels some control, but walking on eggshells

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101
Q

Explosion

Cycle of Violence

A

physical or emotional violence
victim feels helpless

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102
Q

Honeymoon

Cycles of Violence

A

apologetic abuser, very romantic

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103
Q

Batterers

A

90-95% men
personal entitlement, charming, angry, very attentive to victim in hospital

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104
Q

Screening for DV

A

private space, non-judgemental
direct and indirect questions

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105
Q

Newborns’ and Mothers’ Health Perception Act (NMHPA)

Preparing for Discharge

A

minimum federal standards for health plan coverage and minimum stay
48hrs for uncomplicated vaginal birth
96hrs for uncomplicated C-section

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106
Q

Criteria for Discharge - Mother

A
  1. stable vitals
  2. right lochia
  3. firm fundus
  4. adequate urine output
  5. surgical wounds healing
  6. ambulates with minimul discomfort
  7. adequate pain control
  8. family support
  9. Rh status known
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107
Q

Criteria for Discharge - Newborn

A
  1. stable vitals for 12 hrs
  2. passed urine and stool spontaneously
  3. 2 successful feeds
  4. no abnormalities upon physical exam
  5. no bleeding and circumcision for 2hrs
  6. jaundice is managed
  7. Hep B administered or appointment made
  8. appointment with PCP
  9. congenital cardiac heart defect screening
  10. hearing screening
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108
Q

SIDS

A

sudden death in 1st year of life
most occur 2-4 months old

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109
Q

Triple Risk Model

SIDS

A

vulnerable infant, critical development period, stressors

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110
Q

Safe to Sleep

A

firm mattress, no soft objects in crib, no smoking, right temperature, sleeping close but not with, in supine position

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111
Q

Ovulation

A

egg is released from ovary and uterus thickens

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112
Q

Ovary

A

contains oocytes in a folicle

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113
Q

GnRh

A

gonadotropin-releasing hormone
released from hypothalamus to stimulate FSH and LH

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114
Q

Anterior Pituirary Hormones

A

FSH and LH

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115
Q

Ovarian Hormones

A

estrogen and progesterone

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116
Q

FSH and LH in Ovary

A

promote folicle growth and oocyte maturation, estrogen production, primes endothelium to thicken

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117
Q

Rise of Estrogen on LH

A

surge of LH secretion, also surges progesterone to increase

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118
Q

Rise of LH Effect

A

trigger ovulation and a formation of a corpus luteum

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119
Q

Corpus Luteum

A

yellow hormone-secreting body in the female reproductive system
secretes estrogen and progesterone
maintains endothelium if pregnancy occurs

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120
Q

Effects of Progesterone and Estrogen on FSH and LH

A

progesterone and estrogen inhibit FSH and LH

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121
Q

Uterine Cycle

A

menstural phase
proliferate phase
secretory phase
ischemic phase

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122
Q

Menstural Phase

Uterine Cycle

A

3-6 days, starts on first day of flow
uterus sheds
progesterone and estrogen are low

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123
Q

Proliferate Phase

Uterine Cycle

A

end of menses to ovulation (day 14)
influenced by outside factors and hypothalamus changes: stress, diet, sleep
high in estrogen, stimulating endometrium to fill with blood
increase in cervical mucus, thin and less acidic

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124
Q

Secretory Phase

Uterine Cycle

A

after ovulation
progesterone increases, endometrium swells to prepare for a fertilized ovum, estrogen decreases
if fertilization does not occur, estrogen and progesterone decrease, vasoconstriction

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125
Q

Ischemic Phase

Uterine Cycle

A

blood supply to the endothelium sloughs and blood escapes with tissues and mucus
does not happen if fertilization occurs
estrogen and progesterone decrease

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126
Q

Ovarian Phase

A

follicular phase
luteal phase

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127
Q

Follicular Phase

Ovarian Cycle

A

with menstrual and proliferate phase
developing viable follicles for ovulation
estrogen is secreted by follicles and surges to the end of this phase - leads to positive feedback on LH leading to luteal phase

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128
Q

Luteal Phase

Ovarian Cycle

A

with secretory an ischemic phase
ovum released from follicle - follicle turns into corpus luteum
LH and FSH decrease, progesterone and estrogen increase to prepare uterine lining

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129
Q

Conception

A

union of sperm and ovum
sperm: 48-72hrs
ova: 12-24hrs

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130
Q

Fertilization

A

sperm penetrates outer layer of ovum
develops embryo
72hr critical time
occurs in ampulla of fallopian tube

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131
Q

3 Factors of Fertilization

A

ability of egg and sperm to mature
ability of sperm to reach ovum
ability of sperm to penetrate ovum

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132
Q

Estrogen and Fallopian Tubes

A

increases contractility
have peristalis and cilia

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133
Q

Capacitation

A

sperm penetrating ovum
sperm has to stay in genital tract for 4-6 hours to fertilize because of this

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134
Q

Ovum Once Penetrated

A

outer later changes to prevent other sperm from attaching
if more than one do, embryonic death
tail detaches, head largens, 2 nuclei move and fuse

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135
Q

Zygote

A

fertilized ovum with unique genetic material
secretes HCG

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136
Q

Zygote and Placenta Secrete

A

hCG

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137
Q

Function of hCG

A

maintain corpus luteum to secrete progesterone

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138
Q

Pre-Embryonic Period

A

begins with fertilization
rapid cell division
zygote implants in upper posterior part of uterus (lining is thickest and best blood supply)
becomes blastocyst

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139
Q

Embryonic Period

A

rapid organ formation
susceptible to teratogens
3 germ layers
embryonic membranes: chorion and amnion
umbillical cord and placental development

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140
Q

Chorion

A

outermost layer closest to uterine lining

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141
Q

Amnion

A

smooth membraine that lines fluid-filled space
fills with amniotic fluid
prevent umbillical cord compression

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142
Q

Amniotic Cavity

A

cusion, movement, temperature, protection

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143
Q

Umbilical Cord

A

2 arteries with deoxygenated blood from fetus to placenta
1 vein supplying O2 and nutrients
Wharton’s Jelly to insulate and protect

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144
Q

Placental Functions

A

transport and exchange: serves as lungs, GI, liver, passive immunity
hormone secretion: hCG, estrogen, progesterone, hPL

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145
Q

First Trimester: Fetus

Conception to 12wks

A

face more human
reflexes
spontaneous movement
heartbeat
45g, 3 1/2in
susceptible to teratogens
sex distinguished

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146
Q

Second Trimester: Fetus

13wks-26wks

A

very active
lanugo present (hair)
vernix caseosa coats skin (white biofilm)
brown fat forms
lungs form with alveoli and surfactant
eyes open and are sensitive to light
700-800g, 10in

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147
Q

Third Trimester: Fetus

27wks-Birth

A

increase in subcutaneous fat
bones are soft and flexible
increase in muscles
respiratory and circulatory systems are functioning
lanugo and vernix may disappear
maternal antibodies transferrred
head down position

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148
Q

Estrogen

A

secreted in ovaries then placenta
increases uterine growth
increases support of breast development
increases uterine blood flow
prevents further follicular development during pregnancy
relaxes pelvic ligaments

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149
Q

Progesterone

A

secreted in corpus luteum then placenta
relaxes smooth muscles
reduces gastric motility
relaxes blood vessel walls
supports and maintains uterine lining for implantation of developing embryo
decreases prostaglandin production

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150
Q

hCG

A

secreted from placental cells
prevents involution of corpus luteum
peak at 9-10wks

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151
Q

Relaxin

A

secreted in corpus luteum and small amounts in placenta
decreases uterine contractility
relaxes connective tissues

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152
Q

hPL

A

secretes in placenta
makes glucose available for fetus
growth promoting and lactogenic

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153
Q

Prolactin

A

secreted in the anterior pituitary
promotes development of breasts and supports lactation
lactation inhibits estrogen

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154
Q

Melanocyte Stimulating Hormone

A

secreted in anterior pituitary
produces hyperpigmentation

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155
Q

Oxytocin

A

secreted in posterior pituitarty
stimulates uterine contractions
stimulates milk ejection reflex

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156
Q

Aldosterone

A

secreted in the adrenals
conserves Na and maintains fluid balance

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157
Q

Cortisol

A

secreted in adrenals
active in metabolism of glucose and fats
may help prevent rejection of pregnancy because of anti-inflammatory effect

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158
Q

Thyroxine

A

secreted in thyroid
stimulates basal metabolic rate

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159
Q

FSH

A

secreted in anterior pituitary
initiates maturation of ovum and suppressed during pregnancy

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160
Q

LH

A

secreted in the anterior pituitary
stimulates ovulation of mature ovum in non-pregnant state

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161
Q

Prostaglandins

A

secreted in cell membrane
stimulates smooth muscle contractility
influences onset of normal labor with oxytocin
promotes cervical ripening

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162
Q

Fundal Height at the 12th, 20th, and 36th Week

A

palpated just above the pubic symphysis
level of umbilicus
at xiphoid process

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163
Q

McDonald’s Rule

A

fundal height = gestational age between 22wks and 34wks

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164
Q

Heger’s Sign

Uterus Changes

A

softening of lower part of uterus

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165
Q

Braxton Hicks Contractions

A

irregular and intermittent contractions about 4mo into pregnancy

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166
Q

Goodell’s Sign

A

softening of the cervix

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167
Q

Chadwick’s Sign

A

increased vascularituy to cervix and vagina - turns purple

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168
Q

Leukorrhea

A

vaginal secretions that are white and thick
ph down to 4/5

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169
Q

Breasts in Pregnancy

A

tingling/tenderness
increased vascularity
areola darkens, Montgomery tubercles enlarge

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170
Q

Blood Volume in Pregnancy

A

increases 1500mL

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171
Q

RBC in Pregnancy

A

increase 20-30% for increased iron

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172
Q

Coagulation in Pregnancy

A

increased fibrinogen, clot easier

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173
Q

WBC in Pregnancy

A

increase 45-50%

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174
Q

BP in 2nd Trimester

A

goes down because of systemic vascular resistance

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175
Q

Hemorrhoids in Pregnancy

A

enlargement of uterus puts pressure on pelvic and femoral vessels, interferes with venous blood return

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176
Q

Supine Hypotensive Sign

A

lying supine allows fetus to put pressure on vena cava - reduces blood flow to right atrium
feeling of faintness, BP lowers

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177
Q

Respiratory System in Pregnancy

A

more need for O2, stable rate
estrogen relaxes ligaments for better chest expansion
may see epitaxis (nosebleeds)

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178
Q

GI and Pregnancy

A

N/V from increased hCG
cardiac sphincter tone and gastric motility decreases leading to acid reflux
constipation because decreased gastric motility and increased water absorption
gallstones from increased cholesterol in bile
ptyalism and PICA

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179
Q

Renals and Pregnancy

A

ureters: hyperplasia and hypertrophy
urine rate low - leads to UTIs
increased urinary frequency
nocturia

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180
Q

Musculoskeletals and Pregnancy

A

cartilage loosens
lordosis
carpal tunnel syndrome: edema in perpheral nerves

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181
Q

Endocrines and Pregnancy

A

basal metabolic rate increases
thyroid increases
pancreas increases insulin

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182
Q

Skin and Pregnancy

A

warm and flushed from increased circulation
stretch marks: striae gravidarum
hyperpigmentation
melasma/cholasma: on face

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183
Q

Hair and Pregnancy

A

hair is in a resting phase
fewer hairs fall out

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184
Q

Hyperemesis Gravidarum

A

excessive vomiting
risk of dehydration, electrolyte balance

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185
Q

Gestational Diabetes

A

glucose intolerance or not secreting enough insulin

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186
Q

Maternal Role Attachment

A

interaction and development process occurring overtime where mother becomes attached to infant, acquires competence in care-taking tasks in role, express pleasure and gratification in role

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187
Q

First Trimester

Psychologial Adaptation

A

acceptance of pregnancy
“I am pregnant”
not a good time to teach about L&D

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188
Q

Second Trimester

Psychological Adaptation

A

differentiation
focus shift on baby, perceived as seperate
“I am going to have a baby”
better to teach now

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189
Q

Third Trimester

Psychological Adaptation

A

nesting
ambivalence returns, anxious
“I am going to be a mom”
really teach about L&D

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190
Q

Presumptive Signs of Pregnancy

A

subjective
N/V, breast changes, fatigue, amenorrhea (no period)

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191
Q

Probable Signs of Pregnancy

A

objective
serum lab test, positive pregnancy test, Chadwick’s Sign, Goodell’s Sign, Hegar’s Sign, fetal outlline by examiner, ballottment

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192
Q

Positive Signs of Pregnancy

A

diagnostic
fetal heart audible, fetal movement palpable, visualization

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193
Q

Determining Due Date

A

add 280 days to 1st day of last period

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194
Q

Nagele’s Rule

A

1st day of last period, subtract 3 months, add 7 days

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195
Q

Ultrasound to Determine Due Date

A

crown rump length
biparietal diameter
femer length

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196
Q

Crown Rump Length

A

7-13wks
length of the embryo or fetus from the top of its head to bottom of torso
little biological variability during this time - most accurate

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197
Q

Biparietal Diameter

A

> 13 diameter
measures the head

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198
Q

Femer Length

A

> 13wks

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199
Q

Gravida

A

number of times someone has been pregnant

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200
Q

Nulligravida

A

never been pregnant

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201
Q

Primigravida

A

first pregnancy

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202
Q

Multigravida

A

2nd or more pregnancies

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203
Q

Para

A

number of deliveries after 20wks
twins/triplets: 1 para

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204
Q

Nullipara

A

no pregnancies at viable time

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205
Q

Primipara

A

first pregnancy to viable term

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206
Q

Multipara

A

two or more pregnancies to viable term

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207
Q

Post-Term Birth

A

after 42wks

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208
Q

Preterm Birth

A

after 20wks and before 37

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209
Q

Term

A

38-42wks

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210
Q

Viability of Fetus

A

22-24wks
500g

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211
Q

1st Prenatal Visit

A
  • medical history of family
  • past medical history of mother
  • gynecological history
  • past OB history
  • social history
  • exposes to infection/teratogens
  • nutritional status
  • immunization record
  • illnesses
  • risk factors
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212
Q

1st Prenatal Exam

A
  • full physical and pelvic exam
  • auscultation of FHR
  • Labs for blood type and Rh status, HIV, rubella, syphilis, CBC, Hep B, pap smear, urinalysis, STIs, TB
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213
Q

Return Visits

A

every 4 weeks until 28wk
every 2 weeks until 36wk
every week until delivery

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214
Q

Weight Gain and Energy Needs

A

extra 300cal every day
need lots of energy

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215
Q

Weight Gain Chart

A

Thin >18.5 – 28 -40 lbs
Avg 18.5 – 24.9 – 25-35lbs
Heavy 25-29.9 – 15-25lbs
Obese >30 – 11-20lbs

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216
Q

Nutritional Needs

A

folic acid, iron, vitamin D for bone growth, avoiding listerosis

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217
Q

Listerosis

A

food-borne illness from bacteria
avoiding raw fish, meat, lunch meats, unpasteurized milks, fewer than 200mg of coffee daily

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218
Q

Nurse’s Role in Prenatal Check-Ups

A
  • knowledge of tests
  • meanings of results of test
  • how procedure works
  • what to prepare for prior to test
  • what to do before and after test
  • risks/complications
  • when tests are performed
  • client education
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219
Q

Ultrasound

A

tissue imaging using high frequency sound waves deflected by organs and return as echos

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220
Q

First Trimester and Ultrasounds

A
  • determine viability
  • estimate gestational age
  • determine cause of vaginal bleeding
  • help visualize for CVS
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221
Q

Second Trimester and Ultrasounds

A

detect polyhydramnios/oligo (too much amniotic fluid)
help visualize for amniocentesis

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222
Q

Third Trimester and Ultrasounds

A
  • determine placental insufficiencies
  • determine intrauterine growth restrictions
  • detect congenital abnormalities
  • part of biophysical profile
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223
Q

CVS

A

diagnose for fetal chromosomal abnormalities
sampling chorionic villi of the placenta around 10-12wks

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224
Q

Alpha Fetal Protein Screen

A

screening for neural tube defects (spina bifida) around 16-18wks

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225
Q

Amniocentesis

A

screens amniotic fluid from sac for genetic analysis and fetal lung maturity at 15-20wks
meaures lecithin and sphingomyelin: surfactants in proper pulmonary function, ratio 2:1 for proper lung maturity
severe diabetes can skew test

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226
Q

Non Stress Test

A

reactive=good
watching for accelerations in response to fetal movement
shows good and intact CNS and good oxygenation
2 or more accelerations in 20 minutes
15 bpm above baseline lasting 15 seconds

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227
Q

Non-Reactive Stress Test

A

not good
fetus may be asleep - eat glucose or use vibrations
may be from hypoxia, asphyxia, drug use, congenital heart abnormalities

228
Q

Contraction Stress Test

A

see if fetus can tolerate labor
looking for decelerations in fetal heart rate
no decels = negative test

229
Q

Biophysical Profile

A

used to evaluate the well being of a fetus
uses ultrasounds and FHR monitoring
2 points given to each component
less points = may need c-section
* fetal breathing movements
* gross body movements
* reactive FHR
* qualitative amniotic fluid

230
Q

Risk Factors in Pregnancy

A
  1. age
  2. parity
  3. lifestyle
  4. low income
  5. existing health conditions
  6. genetics
  7. environment
231
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
232
Q

Parity and Pregnancy Risk Factors

A
  • 5 or more pregnancies
  • risk for preterm labor
233
Q

Lifestyle and Pregnancy Risk Factors

A
  • poor nutrition, vegetarian diet
  • substance use: alcohol or drugs
234
Q

Low Income and Pregnancy Risk Factors

A
  • no prenatal or inadequate care
  • screen for drugs
235
Q

Existing Health Conditions and Pregnancy Risk Factors

A
  • diabetes
  • PCOS
  • obesity
  • zika
  • autoimmune diseases: lupus, multiple sclerosis
  • cardiac disease
  • HIV/AIDS
236
Q

Genetics and Pregnancy Risk Factors

A
  • defective -> chromosomal abnormalities could lead to spontaneous abortion
237
Q

Pregestational Pregnancies at Risk

A
  • substance abuse
  • diabetes
  • anemia
  • HIV/AIDS
  • heart disease
238
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)
239
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
240
Q

Heroin Treatment

A

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

241
Q

Methadone: Heroin Treatment

A
  • most common
  • during pregnancy, brings addicted woman into agencies that promote prenatal care
  • help with withdrawl symptoms
242
Q

Buprenorphine: Heroin Treatment

A
  • better treatment adherence with fewer side effects and overdoses in comparison to methadone
243
Q

Naltrexone: Heroin Treatment

A
  • opioid antagonist, non-addictive, may improve compliance if an issue
  • work through same opioid receptior, but safer
244
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

245
Q

Four Cardinal S/S of Diabetes

A
  1. Polyuria
  2. Polydypsia
  3. Weight Loss
  4. Polyphagia
246
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

247
Q

Polydipsia in Diabetes

A

dehydration in cells, can be from polyuria

248
Q

Weight Loss in Diabetes

A

breakdown of fats and muscles to make ketones and fatty acids

249
Q

Polyphagia in Diabetes

A

tissue breakdown = starvation
person may eat excessive amounts of food

250
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
251
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

252
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

253
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

254
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
255
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
256
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
257
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

258
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
259
Q

Diabetes Levels

A

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

260
Q

Increased Risk for Diabetes

A
  • over 40
  • family history
  • obesity
  • PCOS
  • hypertension
  • glucosuria
  • prior macrosomic, malformed, stillborn
261
Q

Screening for Gestational Diabetes

A

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

262
Q

Screening for Diabetes: Negative

A

lower than 140
routine care

263
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

264
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%

265
Q

Pregnancy Complications

A
  • Rh factor
  • ABO incompatability
  • ectopic pregnancy
  • HSV
  • GBS+
  • preeclampsia/eclampsia
  • gestational trophoblastic disease
266
Q

Rh Alloimmunization

A

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

267
Q

Rh - Mother
Rh + baby

A

antibody-antigen response
sensitized mother

268
Q

No Treatment to Sensitized Mother

A
  • jaundice
  • anemia
  • brain damage
  • heart failure
  • death
269
Q

Maternal Alloimmunization

A

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

270
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

271
Q

2nd Pregnancy and Sensitized Woman

A

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

272
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

273
Q

Amniocentesis and Rh Compatability

A

using amniocentesis to test if fetus is Rh + or -

274
Q

Ultrasound and Hemolytic Anemia

A

faster blood flowing through ultrasound

275
Q

Other Interventions for Rh Incompatability

A
  • monitoring pregnancy
  • intrauterine transfusions of newborn
  • exchange transfusion of newborn: erythopoietin and iron
276
Q

Goals of Rh Incompatability

A
  • prevent sensitization
  • treat isoimmune disease in newborn
277
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

278
Q

ABO Incompatibility

A

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

279
Q

Maternal Serum Antibodies Crossing the Placenta

A
  • can cause hemolysis of fetal RBC
  • mild anemia
  • hyperbilirubinemia
  • not treated antepartally
280
Q

Perinatal Infections

A
  • herpes simplex virus
  • GBS
281
Q

HSV

A

1:6 between ages 14-49 are infected

282
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
283
Q

Clinical Therapy of HSV

A
  • antiviral after 36wks gestation
  • acyclovir, famciclovir, valacyclovir
  • can reduse the need for a c-section
284
Q

GBS

A
  • in lower gastrointestinal tracts, urogenital tracts
  • fetal risk: unexpected intrapartum stillbirth
  • clinical therapy guidelines
285
Q

Hypertensive Disorders

A
  • chronic hypertension
  • chronic hypertension with superimposed preeclampsia
  • preeclampsia/ecclampsia
  • gestational hypertension
286
Q

Preeclampsia Diagnosis

A
  • BP of over 140/90 with proteinuria
287
Q

Preeclampsia Diagnosis: Before 20 Weeks

A
  • no stable proteinuria and chronic hypertension
  • new or increased proteins and preeclampsia superimposed on chronic hypertension
288
Q

Preeclampsia Diagnosis: After 20 Weeks

A
  • proteinuria and preeclampsia
  • no proteinuria and gestational hypertension
289
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
290
Q

Three Characteristics of Preeclampsia

A
  1. vasospasm and decreased organ perfusion
  2. intravascular coagulation
  3. increased permeability and capilary leakage
291
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
292
Q

Intrautuerine Coagulation: Preeclampsia

A
  • hemolysis of RBC
  • platelet adhesion - low platelet count and DIC (affects clotting)
  • increased VIII antigen
293
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
294
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

295
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
296
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
297
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
298
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
299
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

300
Q

Postpartum and HELLP

A
  • possibility of HELLP
  • eclampsia for 48hrs
  • increased cardiovascular issues in future
301
Q

Preeclampsia Maternial Consequences

A
  • with eclampsia: 20% maternal mortality rate
  • risk of: abrupto placenta, retinal attachment, cardiac failure, cerebral hemorrhage/stroke
302
Q

Preeclampsia Fetal Consequences

A
  • fetal growth retardation
  • fetal hypoxia
  • fetal death
303
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
304
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
305
Q

Management of Ectopic Pregnancies

A
  • salpingostomy/salpingectomy (removal of conception product/tube)
  • methotrexate
  • monitor blood loss
  • emotional support
306
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
307
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
308
Q

Increase Incidence of Molar Preg

A
  • women with low protein intake
  • > 35 years old
  • Asian women
  • experienced prior miscarriage
  • undergone ovulation stimulaiton (clomid)
309
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
310
Q

Management of Molar Preg

A
  • D&C
  • monitor for malignancy through serial hCG levels
  • no preg for 1 year
  • emotional support
311
Q

Complications of Labor

A
  1. bleeding disorders (PP and PA)
  2. placenta previa
  3. placental abruption
  4. polyhydramnios
  5. oligohydrammios
312
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
313
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
314
Q

S/S of Placenta Previa

A
  • painless, intermittent bleeding
  • confirmed by ultrasound
  • lower uterine segment not as responsive to oxytocin - use methergine
315
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
316
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
317
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
318
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
319
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
320
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
321
Q

Polyhydraminos

A
  • excessive amniotic fluid, over 2000mL
  • associated with fetal GI abnormalities and maternal diabetes
  • treatment: shortness of breath and pain - amniocentesis
322
Q

Oligohydramnios

A
  • scanty amniotic fluid, less than 500mL
  • etiology - unknown
  • risks: detal adhesions and malformation
  • treatment: amnioinfusion
323
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
324
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

325
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
326
Q

Timing of Newborn Assessment

A
  • admission assessment: 2nd assessment
  • physical exam
  • general measurements
  • gestational age assessment
  • attachment
327
Q

Ongoing Assessments

A
  • process of adaptation to extrauterine life
  • nutritional status: ability to feed
  • behavioral state/organizational abilities
328
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)
329
Q

Birth Weight and Gestational Age Classes

A
  1. LGA (large)
  2. AGA (appropriate)
  3. SGA (small)
330
Q

Gestational Assessment: New Ballard Scale

A
  • neuromuscular activity
  • physical maturity
  • maturity rating table
331
Q

Estimating GA

A

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

332
Q

Ballard Tool

A
  • each finding given point value: -5 to +5
  • maternal conditions may affect certain components: stress and diabetes
333
Q

Physical Maturity Characteristics Assessment

A
  • skin
  • lanugo
  • sole (plantar) creases
  • areola and breast bud tissues
  • ear/eye formation
  • genitalia
334
Q

Skin

A

7 sub-classifications from transparent skin to peeling

335
Q

Lanugo

A

thin, soft hair usually arounf 24-25wks

336
Q

Sole Creases

A

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

337
Q

Ear Forming and Cartilage

A

more premature: not as thick of cartilage

338
Q

Eyes

A

fused eyelids premature
see how tight or loose

339
Q

Male Genitals

A

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

340
Q

Female Genitals

A

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

341
Q

Neuromuscularity in Newborn

A
  • posture in supine position
  • square window
  • arm recoil
  • popliteal angle
  • scarf sign
  • heel to ear
342
Q

Preterm Resting Posture

A

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

343
Q

Full Term Resting Posture

A

increased tone and more flexed

344
Q

Square Window Sign

A

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

345
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
346
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
347
Q

Scarf Sign

A
  • extend infant arm across body
  • mature: bend elbow, not very flexible
  • preterm: straight arm, lots of flexibility
348
Q

Scarf Sign

A
  • extend infant arm across body
  • mature: bend elbow, not very flexible
  • preterm: straight arm, lots of flexibility
349
Q

Heel to Ear

A
  • extend foot to ear
  • mature: unable to do this
  • premature: touch foot to ear
350
Q

General Appearance of Newborn

A

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

351
Q

Pulse Rates

A
  • 110-160
  • sleep can go down to 70
  • crying can go up to 180
  • check apical pulse for 1min
352
Q

Respiratory Rates

A
  • 30-60 resp/min
  • diaphragmatic but synchronus with abdominal movement
  • count for 1 full minute
353
Q

BP Rates

A
  • 70/50 and 45/30 at birth
  • 90/60 at day 10
354
Q

Temperature

A
  • normal range: 97.7-99.4
  • axillary: 97.7-99
  • skin 96.8-97.7
  • rectal 97.8-99
355
Q

Anterior Fontanelle

A
  • diamond shaped
  • closes in 18mo
  • palpable with 2nd and 3rd finger
356
Q

Posterior Fontanelle

A
  • triangle shaped, no buldging
  • closes 8-12 wks
  • depression: dehydrated or decreased intracranial pressure
  • bulging: increased intracranial pressure or trauma
357
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”

358
Q

Cephalohematoma

A
  • collection of blood from broken blood vessels that build up under scalp
  • does not cross suture line
359
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
360
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
361
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
362
Q

Ears: Physical Assessment

A
  • soft and plaiable
  • ready recoil
  • pinna parallel with inner and outer canthus
363
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
364
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
365
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
366
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
367
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
368
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
369
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
370
Q

Extremities

A
  • short, flexible, move symmetrically
  • legs: equal in length and symmetrical creases
371
Q

Musculoskeletal Variations

A
  • xiphoid cartilage
  • fractured clavicle: palpate each to see intactness
  • no splinting, heals quickly
372
Q

Variations in Extremities

A
  • gross deformities
  • extra digits or webbing
  • clubfoot
  • hip dislocation
373
Q

Hip Assessment

A

baby in Frank Breech position

374
Q

Barlow Test

A
  • grasp and adduct infant thigh and apply gentle downward pressure
375
Q

Ortolani Test

A
  • finger over greater trochanter and lift thigh to bring femoral head from posterior position toward acetabulum
376
Q

Female Genitalia Variations

A
  • pseudomenstration vs uric acid crystals
  • labia swollen and darker
  • vaginal tags will resolve
377
Q

Hypospadias

A
  • meatus located on ventral surface of glands
  • groove that extends from usual area of meatus internally
378
Q

Epispadias

A

urethral meatus occurs on dorsal surface of penis, undescended testes

379
Q

Cryptorchidism

A
  • if testes cannot be pushed into scrotum manually
380
Q

Phimosis

A
  • uncircumsized
  • foreskin unable to be retracted
381
Q

Hydrocele

A

collection of fluid around testes and scrotum

382
Q

Acrocyanosis

A

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

383
Q

Mottling

A

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

384
Q

Jaundice

A

yellowish skin and mucous membranes
head to toe direction

385
Q

Erythema Toxicum

A

rash 24-48hrs long, normal finding

386
Q

Facial Milia

A

raised white spots on sebaceous glands

387
Q

Vernix Caeosa

A

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

388
Q

Forcept Marks

A

disappear after 1-2 days

389
Q

Telangiectatic Nevi

A

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

390
Q

Nevus Flammeus

A

port-wine stain
capiliary angioma

391
Q

Mongolian Spots

A

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

392
Q

Moro Reflex

A

arms flare out and fingers form C shape

393
Q

Stepping Reflex

A

able to “walk”
disappears at 2mo

394
Q

Palmar Reflex

A

fingers will grasp your finger

395
Q

Plantar Reflex

A

toes will wrap around your finger

396
Q

Rooting Reflex

A

stroke cheek, will turn head towards

397
Q

Babinski Reflex

A

stroke foot, foot and toes flare out

398
Q

Trunk Incurvation

A

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

399
Q

Protective Reflexes

A

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

400
Q

Sleep-Wake States

A
  1. deep sleep
  2. light sleep
  3. drowsiness
  4. quiet alert
  5. active alert
  6. crying
401
Q

Behavioral Response

A

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

402
Q

Engagement Cues

A

behavior that signals ready to interact with caregiver

403
Q

Disengagement Cues

A

reduction in stimulus

404
Q

Dr. T. Berry Brazelton: Neonatal Behavioral Assessment

A
  1. habituation
  2. orienting response
  3. motor organization
  4. consolability
  5. cuddliness
405
Q

Habituation

A

ability of infant to lessen their response to repeated stimulus

406
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

407
Q

Motor Organization

A

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

408
Q

Consolability

A

how well they can console themselves or be consoled by others

409
Q

Cuddliness

A

how baby molds into contours of caregiver’s body

410
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
411
Q

Opthalmic Ointment

A

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

412
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
413
Q

Preparation for Discharge

A
  • hep b vaccine
  • metabolic screening / PKU
  • hearing screening
  • CHD screening
414
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
415
Q

Circumcision Care

A
  • keeping area clean
  • check for bleeding
  • apply petroleum ointment
416
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
417
Q

Care of Newborn at Delivery

A

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

418
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

419
Q

R) Resuscitation

A

assess breathing
provide effective ventilations

420
Q

P) Program

A

assess heart rate
provide effective ventilations or chest compressions

421
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%
422
Q

Thermoregulation

A

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

423
Q

4 Types of Heat Loss Mechanisms

A
  1. evaporation
  2. convection
  3. conduction
  4. radiation
424
Q

Convection

A

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

425
Q

Radiation

A

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

426
Q

Evaporation

A

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

427
Q

Conduction

A

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

428
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

429
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

430
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
431
Q

3 Needs of Respiratory System Once Born

A
  1. air replacing fluid
  2. onset of breathing
  3. increasesd pulmonary blood flow
432
Q

Inflation of Breathing Mechanisms

A
  • systemic vascular resistance increases
  • pulmonary vascular resistance decreases
  • all increases profusion of lungs
433
Q

Air Replaces Fluid: Absorption

A

rest of fluid absorbed by blood vessels in lymphatics

434
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

435
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

436
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

437
Q

4 Initiations of Breathing

A

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

438
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

439
Q

Sensory Initiation of Breathing

A

tactile, visual, auditory

440
Q

Thermal Initiation of Breathing

A

change in temperature signals respiratory system

441
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
442
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

443
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
444
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

445
Q

Characteristics of Cardiac Function

A

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

446
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

447
Q

APGAR: 0 Points

A

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

448
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

449
Q

APGAR: 2 Points

A

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

450
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

451
Q

Phase 2 Transition Phase

A

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

452
Q

Phase 3 Transition Phase

A

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

453
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
454
Q

Difficult Transitions: Maternal Conditions

A
  • increased age
  • diabetes
  • hypertension
  • substance use
  • prior history of stillborn
  • fetal demise
455
Q

Difficult Transitions: Fetal Conditions

A
  • prematurity/postmaturity
  • congenital abnormailities of cardiac system
456
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)
457
Q

Difficult Transitions: Delivery Complications

A
  • assistive devices
  • C-section
458
Q

Difficult Transitions: Neonatal Difficulties

A
  • lack of respiratory effors: neurologically depressed, impaired muscle function
  • mucus blockages
  • respiratory distress from impaired cardiac/lung functioning
459
Q

Blood Volume of Newborn

A

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

460
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

461
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

462
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
463
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

464
Q

Swallowing

A

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

465
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

466
Q

Weight Loss

A

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

467
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
468
Q

Water and Newborns

A

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

469
Q

Hepatic Adaptations

A

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

470
Q

Iron Storage: Hepatic Adaptations

A

mom’s iron intake lasts for 5-6 months

471
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

472
Q

Jaundice

A

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

473
Q

Bilirubin

A

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

474
Q

Unconjucated Bilirubin

A

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

475
Q

Conjucated Bilirubin

A

direct bilirubin

476
Q

Total Bilirubin

A

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

477
Q

RBC in Newborn

A

hemolysis occurs as lungs oxygenate newborn

478
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
479
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

480
Q

Transcutaneous Bilirubin

A
  • done prior to discharge
  • non-invasive measurement using light to measure bili in blood
  • if suspicious: draw blood
481
Q

Bilirubin Levels

A

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

482
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
483
Q

BF and Jaundice

A
  • early onset, decreased intake of BM
  • BF infants have more bili
  • peaks 2-4 days
  • associated with poor feeding
484
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

485
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
486
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

487
Q

Passive Immunologic Adaptations: IgA

A

in colostrum
* protects against GI and respiratory infections

488
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
489
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
490
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%

491
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
492
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
493
Q

Growth in Neonatal Period

A

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

494
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
495
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

496
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

497
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
498
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
499
Q

BM Transition

A
  • decrease in immunoglobulins and protein
  • high in lactose and fat
  • longer you breastfeed, higher the fat concentration
500
Q

BF Assessment

A
  • alignment, areolar grasp, compression, audible swallowing
  • let down reflex
  • nipple condition
  • maternal comfort during feeding
  • infant’s weight and output
501
Q

Infant Stomach

A
  • day 1: 5-7mL
  • day 3: 0.75-1oz
  • day 7: 1.5-2oz
502
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
503
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
504
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
505
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
506
Q

Newborn at Risk

A

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

507
Q

High Risk Period

A

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

508
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
509
Q

Anticipation of NB

A
  • what may have compromised fetus in utero maternal medical and prenatal history
  • what occurred in labor
510
Q

Conditions Present at Birth

A
  • IUGR
  • SGA
  • LGA
  • diabetic mother
  • preterm baby
  • CHD
  • inborn error of metabolism
  • substance abuse
511
Q

Classification According to Size

A
  • preterm
  • full term
  • late preterm
  • postterm
512
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
513
Q

SGA

A

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

514
Q

IUGR Fetal Factors

A
  • affect genetic growth potential
  • chromosomal abnormalities
  • heart disease/hemolytic
  • IU infection
  • TORCH
  • malformations
  • multiple gestations
515
Q

TORCH

A

toxoplasomosis
rubella
cytomegalovirus
herpes

516
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
517
Q

IUGR Placental Factors

A

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

518
Q

IUGR Environmental Factors

A
  • high altitude
  • X-ray exposure
519
Q

Patterns of IUGR

A

depends on timing
* symmetrical and asymmetrical

520
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

521
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

522
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
523
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
524
Q

SGA Risk Factors

A
  • maternal diabetes
  • multiparity
  • previoud macrosomic baby
  • prolonged preg
  • hypertension
  • cardiac disease
  • renal disease
525
Q

LGA Outcomes

A
  • C-section
  • operative vag delivery
  • shoulder dystocia
  • breech
  • birth trauma
  • cephalopelvic disproportion
  • hypoglycemia
  • hyperbili
526
Q

LGA Assessment

A
  • fractured clavicles
  • brachial nerve damage
  • facial nerve damage
  • fepressed skull fractures
  • cephalohematoma
  • intracranial hemorr
  • asphyxia
527
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
528
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
529
Q

SGA Complication Factors

A
  • congenital malormations
  • IU infection - TORCH
  • hypoxia: cog diff, learning dis.
530
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.
531
Q

LGA

A

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

532
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
533
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
534
Q

PTN Risk Factors

A
  • ancephaly
  • 1st preg
  • history of postterm preg
  • grand multipar
535
Q

PTN Complications

A
  • mec aspiration
  • fetal hypoxia: cord comp
  • neuro conditions: seizures from fetal asphyxia in labor
  • birth trauma
536
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
537
Q

Preterm Newborn Class

A
  • Very: less than 32 wks
  • Premat: 32-34 wks
  • Late: 34-37 wks
538
Q

Preterm Newborn Weights

A
  • LBW: < 2500
  • VLBW < 1500
  • ELBW < 1000
539
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
540
Q

Preterm Risk Factors

A

nonmodifiable and modifiable

541
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
542
Q

Inborn Errors of Metabolism

A
  • hereditary disorders, enzyme defects, block met pathway and toxins can accumulate
  • afefct organ and energy fxn and production
543
Q

Sub. Abusing Mother

A
  • tobacco
  • alcohol
  • drugs
544
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
545
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
546
Q

Nursing Interventions: Sub Abuse Infants

A
  • reduce withdrawl symp
  • monitor pulse, resp, temp, small freq feedings
  • admin meds as ordered
  • swaddling
547
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

548
Q

Birth Related Stress

A
  • cold
  • hypogly
  • hyperbili
  • infection
  • RDS
  • TTN
  • MAS
  • PPHN
549
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
550
Q

Cold Clinical Intervention

A
  • rewarm w skin to skin, heat lamos, swaddling
  • monitor gluc levels
  • monitor O2
551
Q

Newborn With Hypoglycemia

A

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

552
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
553
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
554
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

555
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
556
Q

Phototherapy Nursing Care

A
  • assessments: feedings, BM status
  • warmth
  • eyepatches, cover genitals
  • positioning q2h
557
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
558
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
559
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
560
Q

Assess for Sepsis

A
  • resp
  • temp
  • cardovasc
  • neuro
  • gastro
  • skin
  • metabolic
  • immature total neutrophil ratio >0.2 suggests infection
561
Q

Nursing Interventions for Reducing Sepsis

A
  • hand hygene
  • blood cultures, CBCD, urine culture
  • supportive care: reso, cardio, fluid/electrolytes, hypogly, acidosis
562
Q

RDS Summary

A
  • hyaline mem disease
  • primary absence/def of pul surfantant
  • indicated failure to synth adequate surfactant
  • lec/spin ratio 2:1
563
Q

RDS Assessment

A
  • grunting, flaring, retracting, tachypnea, skin color gray or dusky
  • hypoxemia
  • acidosis from sustained hypoxemia
564
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
565
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
566
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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