Exam 3 Flashcards
(191 cards)
1
Q
what can be tested for with an umbilical cord sample
A
see what drugs and nutrients the mother took in that passed to the baby
2
Q
what can be checked for with a newborn to see if mom was involved in substance abuse
A
umbilical cord
babys urine
meconium (baby waste)
3
Q
how much folic acid is recommended daily prior to conception
A
0.4 mg (400 micrograms)
4
Q
what does folic acid play a role in
A
neural tube defects
5
Q
what are other sources of folic acid that can be recommended
A
green leafy veggies
liver
chicken
turkey
6
Q
what can inadequate weight gain during pregnancy cause
A
preterm labor
intrauterine growth restriction (IGR)
7
Q
how much is recommended for the average women to gain
A
25-35 pounds
8
Q
what does the weight gain in birth account for
A
uterus weight
baby weight
amniotic fluid weight
9
Q
how many calories is recommended to increase during pregnancy from baseline for that woman
A
300 calories
10
Q
how much calcium is recommended daily for pregnant women
A
1,300 mg
11
Q
which fat soluble vitamins are you supposed to take when pregnant
A
A, D, K, E
12
Q
which fat soluble vitamin should you not take too much of and why
A
Vitamin A
can cause congenital anomalies
13
Q
what does B12 assist with in pregnancy
A
helps to form red blood cells
eggs, dairy
14
Q
how much folic acid is recommended for pregnant women
A
0.6 mg
600 micrograms
15
Q
what can Pica be a sign of
A
anemia
16
Q
what is nausea and vomiting called in pregnancy
A
hyperemesis gravidarum
17
Q
what type of foods can help offset nausea
A
sweet or salty foods
18
Q
what medications can be prescirbed for pregnancy N/V
A
Zofran (cheap, causes headaches and constipation)
Diclegis (very expensive, hard to get)
19
Q
what can iron supplements cause
A
constipation
20
Q
what can iron be taken with to increase absorption
A
vitamin C (glass of orange juice)
21
Q
what is Pirosis
A
heartburn
22
Q
what should you recommend to pregnant women with heartburn
A
sit up for 30 min after eating
small frequent meals
23
Q
what are the two main concerns for adolescent pregnancies
A
well balanced diet
adequate weight gain
24
Q
how much protein and water should the pregnant woman ingest per day
A
70g
3L
25
are more or less calories needed in lactation vs. pregnancy
more calories in lactation
26
how many more calories per day should a women ingest during lactation
500 more
27
how many centimeters should the uterus descend each day post partum
1-2 cm
28
what is post partum considered
the interval from childbirth to return of the uterus to non-pregnant state (not pre pregnant-never be same)
29
what is Involution
the shrinking of the uterus
30
what factors promote involution
```
early/frequent ambulation
uterine contractions (2-3 days post partum)
breast feeding (release Oxytocin--cause uterine contractions)
```
31
by what time should the uterus be no longer palpable
2 weeks postpartum
32
what is Subinvolution (Uterine Atony)
failure of the uterus to return to non-pregnant state
33
what can occur if their is no uterine contraction and why
excessive blood loss and hemorrhage
| due to exposed vessels not being constricted
34
what are the factors that slow involution/cause subinvolution
no uterine contractions
full bladder (uterus deviated to left, no space)
multiparius women (increased risk of hemmorhage/uterus is stretched)
prolonged labor (>18 hours)
anastesia/epidural
infection
retained placenta fragments
35
what is Colostrum made up of
nutrients
antibodies
protein
decreased fat
36
how long does mom have to feed baby colostrum
72-96 hours post partum
37
how long can engourgement last
24-48 hours
38
what does a fundal rub do
makes the uterus contract and prevents hemmorhage
39
what should you do before a fundal rub
have mom empty bladder
40
what is the Estimated Blood Loss (EBL) for a vaginal and C-section birth
500mL vaginal
| 1,000mL C-section
41
when does the vagina return to non pregnant size
6-10 weeks post partum
42
what causes delay in secretion of cervical mucosa due to hormones
lactation
43
what is lochia and what is it the result of
vaginal discharge
| result of involution
44
how long should lochia rubra be seen and what color is it
bright red
| seen first, 3-4 days after
45
what color is lochia serosa and how long can it be seen
pink/brown
| 22-27 days
46
what color is lochia alba and how long can it be seen
white
| up to 6 weeks
47
what should you always assess when it comes to lochia
color
odor
amount
48
when is lochia considered heavy
saturated peri pad within 1 hour
49
what is an episiotomy and when should it heal
a purposeful cut of the perineum to allow baby to come through (2-3 weeks for it to heal)
50
what degree can a perineal laceration go up to
4th degree
51
what is considered a 4th degree laceration of the perineum
perineum to the anus is ripped
52
what are concerns with perineal lacerations
infection
| comfort
53
what can be done for perineal lacerations from the nurse
```
ice to perineum
high fiber diet
stool softeners
encourage urination
ease the fear of voiding
sitz bath
```
54
what are some indications that a c-section is needed
```
large baby
distressed baby (HR drops)
```
55
what does post partum care consist of for a woman with a c-section
```
bed rest for 12 hours
blood clot/DVT watch
incision site
infection
STILL HAVE TO DO FUNDAL RUBS
```
56
what will happen in the respiratory system post partum and when will this occur by
diaphragm will move down
| 6 weeks post partum
57
when will cardiac volume/output go back to normal after birth
2-6 weeks post partum
58
when will BP go back to baseline
~1 week
59
how long do clotting factors stay elevated and what is the mom at risk for because of it
6 weeks
| blood clots
60
what can occur to womens hair post partum
become more coarse and fall out due to hormones
61
is it normal to see elevated WBC count after birth
yes
62
if mom tests Rubella Equivical post partum, what does this mean
she needs the MMR vaccine
63
what should be avoid after the MMR
getting pregnant for 28 days
64
can MMR transfer through breast milk
No
65
when will the mom receive Rogam during pregnancy
if mom has Negative blood type
66
when is Rogam given post partum
if baby is a positive blood type
67
when is rogam not needed
if the baby is also negative
68
diuresis (increased frequency) occurs for how many days post partum
2-3 days
69
what can cause urine retention after birth
fear to void
| decreased sensation to void (catheter, anasthesia)
70
if the bladder is full, what happens to the uterus and what can this cause
uterus displaced to the left
| bleeding (decreased uterine contraction) and increase risk for UTI
71
what hormones decrease after delivery of the placenta
progesterone
| estrogen
72
how early can menstrual cycle w/ ovulation occur
28 days post partum
73
when can menses be delayed in post partum women
later in women who breast feed (up to a few years) because of increased progesterone
74
what is normal for the first 3-4 menses after birth
for them to be heavier
75
what can cause an increase in appetite after birth
lactation
76
what is the headache called due to an epidural
Spinal Headache
77
what causes a spinal headache
leakage of spinal fluid from epidural
78
how is a spinal headache diagnosed
if woman lays flat, headache disappears
79
what is the biggest piece of education to give parents about neborn
how to keep them safe
80
what are the pieces of education to keep a newborn safe
VARIFY EVERYONE
SOCIAL MEDIA
SECURITY TAG ON BABY
(abduction)
81
how long is post partum considered to last
6 weeks
82
what can a uterus displaced to the right mean
placenta fragments
| holding onto a clot
83
how far above the umbilicus should the uterus be 2-3 hours post birth
about 1 cm or less
84
does a gush of blood after a woman stands mean a hemmorhage
no
| blood just pooled in uterus and is exiting
85
what can be done to encourage attatchment
Rooming In
| keeping the baby in close proximity to parents
86
how is bonding encouraged
skin-to-skin
87
what does skin-to-skin help the baby maintain
temperature
| respirations
88
what is mutuality
newborn does something, causes parent to react
| baby cries, mom picks it up
89
what is aquaintance developed through
eye contact
touching
talking to the baby
90
what is claiming
identifying with the newborn
| "baby has my eyes, my nose, etc."
91
what can help with early contact from the nurse
promoting skin-to-skin contact
dimming the lights
post pone babys eye cream so baby can see mom
92
what is Biorhythmicity
baby is in tune with moms natural rhythm
| *promotes bonding
93
what is entrainment
baby responds to speech, turns head to look
94
how longs is the process of transitioning to parenthood
about 3 weeks
95
what occurs in the Taking In phase and how long is it
first 24 hours
| mom is excited, wants to talk about her experience
96
what occurs in the Taking Hold phase and how long is it
mom is focused on ONLY babies needs
| 2-3 days (can last up to 3 weeks)
97
what occurs in the Letting Go phase
move forward as a unit
| mom is learning how to balance her needs, babies needs, rest of family needs
98
how long is the First Period of Reactivity
30 minutes
99
what occurs in the First Period of Reactivity
HR: 160-180
Grunting/Nasal Flaring
Spontaneous Cry/Startle Response
100
what can grunting and nasal flaring mean in other situtations
respiratory distress
101
how long is the Second Period of Reactivity
2-8 hours
102
what occurs in the Second Period of Reactivity
meconium is passed
103
how long does a baby have to pass meconium before it is of concern
24 hours
104
how long is the Neonatal Period
birth-28 days
105
what are 6 important things that the babies does in the Neonatal Period
```
Establishing/Maintaining Respirations
Experiencing circulatory changes
Ingesting and digesting nutrients
Eliminating and regulating weight
Learning to regulate temperature
Establishing relationships
```
106
how long is passive immunity sufficient for the newborn
3 months
107
why do babies often experience GERD and vomiting
immature/sterile GI system at birth
108
how much weight do babies typically lose in first 24 hours and what is this mostly due to
10%
| loss of extracellular fluid
109
if a parent voices concern over babies urine being pink, what should you say
this is normal
| Brick Dust Urine
110
when should first void occur
within 24 hours
111
what is normal for female babies to experience with their reproductive system
vaginal discharge
blood/spotting
edema to labia
vernix on genitalia (cheese-like)
112
what is normal for male babies to experience with their reproductive system
two testes palpable
| Hydrocele
113
what is Hydrocele
accumulation of fluid in scrotum, resolves itself
114
what should you check the penis for
Hydrocele
Epispasdias
Hypospadias
115
what is Epispasdias
urethra on dorsal side of penis
116
what is Hypospadias
when urethra is found on ventrical space of the penis
117
what are signs that a babies hips are dislocated
uneven leg lengths
uneven butt folds
uneven thigh creases
uneven knee placement
118
Ortolani's Manuver (Test) is when
femoral head moves in and out of the asitablum
119
how can hip dysplasia (dislocated) be helped
double diaper
pelvic harness
surgery
120
how does jaundice occur
RBC's are broken down--->hemoglobin is released--->hemoglobin further broken down---->Billirubin builds (lab for jaundice)
121
what are the two types of Bilirubin
Unconjugated/Indirect
| Conjugated/Direct
122
unconjugated/indirect (fat soluble) can what in the body
can cross the blood brain barrier and cause neurotoxicity (Kernicterus)
123
conjugated/direct (water soluble) is excreted through
excrete waste
| feed baby, poops/pees it out
124
when is the peak of Physiologic Jaundice
2-4 days
125
what is pathologic jaundice caused by
maternal newborn blood type incompatibility
126
what are signs and symptoms of jaundice to teach parents
starts in sclera
works it's way down body
lethargy, not wanting to eat
127
what are some treatments for jaundice
keep baby near window
feed plenty
Phototherapy
128
what should you monitor during Phototherapy
```
hydration status
monitor temperature
I's and O's
protective goggles
diaper
```
129
normal HR for baby
120-160
low as 80 at rest
little irregularity is normal
130
what are s/s of cardiac issues in baby
```
persistent tachycardia (>160 bpm)
persistent bradycardia (<100)
```
131
what are some causes of persistent tachycardia
anemia
hypovolemia
sepsis
hyperthermia
132
what are some causes of persistent bradycardia
heart block
| hypovolemia
133
what CBC values are typically elevated at birth
```
RBC's= due to fetal circulation/oxygen exchange
WBC's= 24,000 on first day, 12,000 by day two
```
134
why is there a decrease in clotting factors in baby
immature live/GI system
| not able to synthesize Vitamin K
135
what are the things that initiate breathing in a newborn
uterine contractions
passage through alveoli
cutting of the cord
136
how does passing through the birth canal initiate breathing
sqeezed through=baby cries and expands alveoli
137
how do uterine contractions initiate breathing
decrease in uterine/placenta flow activates receptors in newborn aorta/carotid
138
what is cold stress
baby gets cold, oxygen drops
139
what is the process of cold stress
baby gets cold---> increased O2 consumption ---> increased RR ---> vasoconstriction ---> decreased O2 uptake ---> decreased O2 to tissues
140
transition to breathing starts as soon as
umbilical cord is clamped
141
what are s/s of respiratory distress
retractions (sucking in at rib cage)
stridor
episodes of apnea
acrocyanosis (blueish/purple discoloration of feet and hands)
central cyanosis (bluesih/purple discoloration around the mouth and chest)
142
caput succedaneum
edema on the head, not controlled to one half
143
cephalhematoma
blood between skull and skin
does not cross suture line (well defined)
*risk of Jaundice when it reabsorbs
144
mongolian spots
look like bruises
145
Nevi (stork bites)
flat and pinkish red in color
146
Erythema Toxicum is also known as
newborn rash
no lotion
can get it up to month after birth
147
Rooting/Sucking
poke cheek, turn and suck on whatever it is
148
Babinski's
done on the foot, stroke heel lateral aspex
big toe flex, others fan out
disappear 1-2 years
*lasts longer can mean neurologic damage*
149
Palmer's Grasp
grasp object
150
Plantar Grasp
curl toes around object
151
Moro's Reflex (startle)
baby has sensation of falling, brings arms in, spreads out
disappears around 4 months
*lasts longer can mean neurologic damage
152
what is Non-Shivering Thermogenesis
baby trying to keep warm, metabolism of brown fat
153
why is newborn at risk for heat loss
thin skin
| vessels close to the surface
154
what does an APGAR score tell us
how the baby is transitioning to extrauterine life
155
when is the APGAR test performed
1 minute and 5 minutes
156
if APGAR is under 7, what do we do
reassess every 5 minutes until above 7
157
APGAR for HR
```
>100 = +2
<100 = +1
absent = 0
```
158
APGAR for RR
strong cry = +2
weak cry = +1
absent = 0
159
APGAR for Muscle Tone
well flexed = +2
some flexion = +1
flacid/floppy = 0
160
APGAR for Irritability
crying/whaling = +2
small grimace = +1
absent = 0
161
APGAR for color
all pink = +2
pink core/pale extremities = +1
pale/blue = 0
162
APGAR scores meaning
```
0-3 = SEVERE
4-6 = MODERATE
7-10 = MINIMAL
```
163
what is the first priority when baby comes out
establish RR
164
what can you do to induce respirations/increase APGAR score
```
dry the baby
tactile stimulation
skin to skin
cap on the head
bulb suction from MOUTH THEN NOSE (aspiration risk)
```
165
vital signs of newborn how to
check axillary temp
HR (1 minute)
RR (1 minute)
O2 Sat (not super reliable at first)
166
where should O2 Sat be taken on newborn always
Preductal (right hand/wrist)
167
within 10 minutes what is normal O2 Sat for newborn
85-95
168
when does the anterior fontanel (soft) close
18 months
169
when the umbilical cord is cut, what should you look for
how many vessels in it (should be 3)
170
what are the three standard meds newborns get at birth
Erythromyocin (eye cream)
Vitamin K
Hepatitis B (must have consent)
171
what is needed if parents refuse Hep B Vaccine for baby
declination form
172
what is needed if parents refuse Erythromyocin or Vitamin K
Against Medical Advice Form
173
what can be assessed for s/s of pain in newborn
change in HR, BP, RR, O2 Sat
crying
not eating/sleeping
174
what is considered Hypoglycemia in a baby
<45
175
when is hypoglycemia common in babies
big/small babies
maternal diabetes
cold stress/RR distress
176
where to take newborn BGL
heel stick
lateral aspect (spongey)
warm up heel first
177
when is a metabolic screen performed on newborns
25 hours and 10-14 days old
| assess for genetic diseases
178
CCHD (Critical Congenital Heart Defect) Test looks at what
O2 Saturation
179
CCHD is done as long as
baby is on room air
| before discharge
180
what is done in CCHD
```
Preductal Saturation (right hand)
Postductal Saturation (either foot)
done at same time
```
181
what is criteria for newborn to pass CCHD
>95%
| both within 3% of each other
182
education for circumcision
keep gauze pad and ointment over it
| must void before discharge
183
what causes lactogenesis
decrease in progesterone, prolactin prepares breasts for milk
184
what hormone is essential for lactation
Oxytocin
185
what does Oxytocin cause in lactation
Milk Ejection
| Let Down
186
Benefits of breast feeding immune support
```
IGA
IGD
IGE
IGG
IGM
```
187
other benefits of breast feeding
reduce respiratory/GI infections
decrease chance of breast/ovarian cancer
beneficial to environment (no bottles)
188
what are the contraindications of breast feeding
baby has Galactosemia (Cant process protein in milk)
| Mom has active TB or HIV
189
what is recommended for breast feeding
exclusively breast milk for 6 months
| breast feed until 2 years
190
whats the education for formula feeding
prep formula
don't prop bottle
burp baby after 15mL (if spitting up during, burp more)
191
when should complementary feeding begin
6 months
| *wait 3-5 days before introducing new foods
