exam 3- complicated mom and baby Flashcards
(385 cards)
1
Q
what subjective data are you asking mom
then you do what do you get
A
Last mentsutal period
What doing right before dishcagre
How long in care before cramping
Then objective data, list in PRIORITY order: like vs and things
2
Q
High risk pregnancies
what ages under/over
hx of what
what underlying medical conditions
unexplained what
what weights
are they past how long
hx of what
do they have what
A
Under 16(pelvis not grown) and over 35
History of preeclampsia
Underlying medical conditions like cardiovascular disease, HTN, diabetes, sickle cell, pulmonary disorders,
Any unexplained miscarriages or stillborn
Are they underweight or overweight
Are they past 42 weeks
Hx of preterm labor
Do they have cervical incompetence
3
Q
What is the goal? of pregnancy
always what
A
always healthy mom and healthy baby
- want baby in as long as possible as long as its healthy for mom and baby
4
Q
Fetal Movement Count (kick counts) non invasive
what counts as a kick
when are babies most active
when do they slow down
A
all fetal momvemnt is counted as a kick
Babies are more active in third trimsester
Does slow down at 36 weeks due to low space
5
Q
Fetal Movement Count (kick counts) non invasive- When?
around when
mothers feel what
A
Around 18-20 weeks
- mothers feel quickening/fluttering feeling
6
Q
Fetal Movement Count (kick counts) non invasive- How?
give what
do it how
count alll for how long
A
Give a chart,
do It at same time every day, in same position,
count all movements for a full hour
7
Q
Fetal Movement Count (kick counts) non invasive- Mom should become concerned when
how Many in how much time
A
there is less then 10 movements in 3 hours
8
Q
Fetal Movement Count (kick counts) non invasive
After about 20-30 minutes- if you don’t feel anything-
change
drink what
eat what
then if nothing you do what
A
change position,
drink juice/high sugar,
eat a snack
, and if there is no movement you need to be seen because there could be an issue.
9
Q
when are babies the most active
A
Babies tend to be the most active when mom sits down
10
Q
Ultrasonography-noninvaseive
Biparietal diameter-diameter-
measures what
A
measures baby head to foot
11
Q
Ultrasonography-noninvaseive
Doppler umbilical velocimetry-
for what
and is it what
A
blood flow of umbilical cord,
and Is it properly perfusing to placenta/ baby
12
Q
Ultrasonography-noninvaseive
Placental grading for maturity-
is placenta what
and is it
A
is placenta old-past 40/41 week,
and is it functioning
13
Q
Ultrasonography-noninvaseive
Amniotic fluid volume-
tests for what
A
is there proper amount of fluid volume/not enough
14
Q
Ultrasonography-noninvaseive
Nuchal translucency (NTT)-
checks for what
how
A
checks for downs-
checks space behind baby head
15
Q
Ultrasonography-noninvaseive
start having them when
A
Should start having them between 18-22 weeks
16
Q
Ultrasonography-noninvasive
Early on- if mom doesn’t know LMP or if any issue for maturity/knowing how old baby is-
do what
considered what
put where
A
then you will do vaginal ultrasound-
considered nonivnase-
prop into vagina
17
Q
Baseline fetal heart tones
between what
A
between 110-160
18
Q
Variability heart tones
what is it
minimal-
moderate-
marked-
What will the nurse do?
A
difference between the highest and lowest hr
Minimal- 5 beats or less
Moderate-6-25 beats
Marked-greater then 25 bpm
19
Q
Contractions (duration/frequency)
What will the nurse do?- how do you measure
A
measure from the start of the incline to the end of the decline
20
Q
Is it reactive (accelerations?)
are they a good sign
what are they
What will the nurse do?
A
positive sign
Accelerations are short-term rises in the heart rate of at least 15 beats per minute,
lasting at least 15 seconds
21
Q
what do these look like on strip
early decel
late decel
variable decal
accelerations
A
early decel- goes down when contraction goes ip
late decel- goes down after contractions
variable decal- does whatever it wants
accelerations- go up on monitor
22
Q
Early decels
what does it mean
What will the nurse do-m/may need
A
head is compressed
monitor-not too signifiant/ may need to deliver
23
Q
LAte decels
what does it mean
how do you help mom(change / prepare / give)
What will the nurse do?
A
uterine placental problems
change moms positions
prepare for c section
give oxygen 10-15 liters
24
Q
Variable decels
what are they
why do they happen
what will nurse do(r/ give/ may need)
A
variable decals are when the decals dip variably- no real structure to them
cord compression
reposition
give oxygen
may need c section
25
External FHR monitoring
what look like
measures what
- two bands-top(toco) is on moms zyphoid
Bottom is by baby spine and measures fetal heart rate
26
When do you only place internal monitors
also place what as well w this
only place them if membranes have ruptured
also place internal contraction device as well
27
downside to internal monitor
moms cant do what
needs to be what
moms cannot walk around or bounce on labor ball
needs to stay connected to machine
28
Non stress test (NST)--noninvasive-used if mom has
any form of what
what bp
decreased what
any form of diabetes,
HTN,
decreased kick count,
29
Nonstress test
nurses will get what
want how many accelerations
want to see what
nurse will get a 20 minute strip-
want 2 accelerations for baby-
want to see a reactive stress test
30
Non stress test (NST)- if Non reactive-(not good)
need what
may need
dont have time for what
baby goes where
-need to be admitted to hospital-
may need emergent c section-
may not get spinal-
want baby out asap- then baby may need to go to childrens hosital
31
-Non stress test (NST)want positive result for fetal movements-
want what
see what number
want bump and hill in fetal heart tones-
want 15 accelerations
32
-Non stress test (NST)-if nonreasctive
change
drink
eat
change positions
, drink sugary drinks,
eat snacks
33
Non stress test (NST)
keep in mind what
also trying to figure out what
Keep in mind that baby can hear- try to figure out if they are more active when family or dogs or something is around
What is moms diet- is there a lot of caffeine or smoking- is mom on a stimulant of some sort
34
Non stress test (NST)
when do babies sleep
when are they awake
Babies tend to sleep when mom is around and moving-
and awake when she stands still
35
nonreactive stress test requires what
immediate c section
36
Ultrasonography: Biophysical Profile
5 variables to assess
B
A
T
M
N
B-breathing
A-amniotic fluid
T- tone of infant
M-movement of infant
N-non stress test
37
Ultrasonography: Biophysical Profile
what number is ideal
what number requires intervention
what number requires emergent intervention
8-10 is ideal
Less then 8 requires intervention
Less then 6 requires emergent intervention
Like c section
38
Ultrasonography: Biophysical Profile
want baby how
dont want them to look how or how
want baby in fetal position
Don’t want baby to look flacid
Or with free floating extremities with arms
Legs hyperextended out
39
Contraction Stress Test (CST)
used to see if what
Used to see if the baby is “healthy” enough to go through labor
40
what does positive contraction test mean
not able to go through labor, will need to have c/s
41
Contraction Stress Test (CST)
when Mom gets admitted-
get what in her
give what
have what at bedside
get an iv in her-
give small amounts of iv oxytocin to see how baby handles it
have tocolytic at bedside in the case that baby doesn’t tolerate-
42
if baby cannot handle oxytocin -contraction stress test
shows what
then you do what
will need what
If baby doesn’t handle it and has decels on heart rate-
reverse oxytocin with tocolytic
will need c section
43
Contraction Stress Test (CST)
Done on
G d
what bp
p
climbing
any what
gestational diabetes,
HTN,
preeclamspia,
climbing bp,
any underlying cardiac or vascular disease-
44
Amniocentesis
how does it work
will do what
Invasive Fetal Testing
- ultrasound guided needle that is placed via ultrasound-
will aspirate some amniotic fluid from the sac-
45
amniocentesis -Invasive Fetal Testing-
done for what
what time
looks for what
Done for genetic testing
at 14-16 weeks
, looks for down syndrome and other genetic disorders
46
amniocentesis -Invasive Fetal Testing-
ensure what is up to date
when do you not do it
Ensure that coag panel is up to date-
do not do if mom is risk for bleed
47
amniocentesis -Invasive Fetal Testing--Checks for fetal lung development
what is LS ratio
what is diabetic mom goal
what if mom is less then 32 weeks
- LS ratio is 2:1-
diabetic moms goal is 3-1
// if mom is less then 32 weeks then mom may have a reveres ratio where s is greater- not good for feral lung development
48
amniocentesis -Invasive Fetal Testing--This is only done if mom is having problems- like
p l
or really
premature labor,
really HTN
49
amniocentesis -Invasive Fetal Testing- -Only cure for preeclampsia is delivery
why get an amniocentesis if before 32 weeks
If c section before 32 week mark
, get amniocentesis to check if lungs are developed
50
amniocentesis -Invasive Fetal Testing-
-Gestational diabetes may have babies that are large- so may be deceptively healthy-
can have what
why is amniocentesis done
big babies that can have respiratory issues-
amniocentiesis then is performed to check lung development
51
Complications in pregnancy-miscarriage definitions
Threatened
imminent-
risk for one/
one is going to happen at some point
52
what lab is indicative of pregnacny
what means If low
HCG
if low then potential miscarriage
53
Complications in pregnancy- miscarriage definitions
Complete
incomplete-
mothers body completely miscarried
retained part of baby
54
Complications in pregnancy- miscarriage
Missed
and/or recurrent-
missed- when you miscarry without bleeding
reccurent- 2 consecutive miscarriages
55
miscarriage- If mom comes in with bleeding or believes she has a miscarriage-
never do what
just do what
Medically stable mom is needed for stable baby
Complications in pregnancy-
NEVER do vaginal exam-
just take note and look at evidence they bring in like bleeding pad and note it
56
- miscarriage-If mom is bleeding-
put pt where
put in
get
think of what (what hr/bp)
Complications in pregnancy-
lay pt down,
put in iv,
get vitals-
think of hemorrhage shock- find map-tachycarida, hypotension
57
miscarriage
assess what
collect what
Complications in pregnancy-
Assess type of blood, if any clotting,
Collect subjective date- like how it felt when it happened and what they were doing before, how much blood, is there any discharge/odor(infection)
Is there pain that radiates to back-hemorrhage internally
58
Ectopic pregnancy-
is it sustainable with life
what is it
Complications in pregnancy-
non sustainable with life-
it is when implantation of fertilized ovum attaches outside of endometrial lining- usually in fallopian tube
59
Ectopic pregnancy-
who should be suspected to have ectopic pregnancy
Complications in pregnancy-
Any fertile female with lower abd. pain
60
Ectopic pregnancy-
Pt may not even know that they are pregnant
ask what
often when
Complications in pregnancy-
- need to ask when lMP was-
often very early in pregnacny
61
Ectopic pregnancy-
PROBLEM Recognition
p/f
may have some what
Complications in pregnancy-
pain/ fever- might not have any pain,
maybe some bleeding but maybe not
62
Ectopic pregnancy-
Considered life threatening
why
what can happen
leads to what
Complications in pregnancy-
because hypovolemic shock risk is high-
womens fallopian tube can rupture
lead to internal hemorrhage
63
Ectopic pregnancy
-Risks-
previous e
previous what surgery
p I d
implanted
Complications in pregnancy-
previous ectopic,
previous tubal surgery(like endometriosis)
pelvic inflammatory disease
implanted iud
64
Ectopic pregnancy- Treated w (depending on size/location
small ectopic
give what drug
will cause what
get another dose when
Complications in pregnancy-
can give Methotrexate- chemo drug-
will cause patient to miscarry-
pt will get that dose in ER and then another 48-72 hrs after
65
- Ectopic pregnancy
-If its ruptured or larger ectopic-
will need what
how does it work
can they get pregnant still
Complications in pregnancy-
will need to go to OR for laparoscopy-
go in through ab wall and potential removal of fallopian tube-
can still get pregnant-
66
Ectopic pregnancy-Consider
does mom need what
given when
what else
Complications in pregnancy-
- does mother need rogam-figure out blood type-
needs to be given within 72 hrs of miscarriage-
and post op care of abdominal patient
67
Ectopic pregnancy-
When they come in w large ectopic
get what
prep for what
preventing what
Complications in pregnancy-
- Get 2 ivs
prep for surgery,
want to prevent hypovolemic shock
68
Ectopic pregnancy
-What does hypovolemic shock look like-
what hr
what bp
adminster what
Complications in pregnancy-
high hr,
low bp,
administer bloods/fluids depending on coag panel
69
Ectopic pregnancy-
try to figure out what
what lab
number 1 reason for what
Complications in pregnancy-
try to figure out how early on by LMP or ultrasound
Serum HCG level
numb 1 ER visit for women of childbearing age
70
what labs indicate bleeding
low x3
low platelets, h/h
71
Gestational Trophoblastic Disease (Hydatidiform mole)-
was this a pregnancy
what can grow
never was what
Complications in pregnancy-
this is not a pregnancy and was never a pregnancy
- teeth and hair can grow-
never was a fertilized ovum – can grow for years
72
Gestational Trophoblastic Disease (Hydatidiform mole)-
Partial or complete could lead to->
what is that
Complications in pregnancy-
Choriocarcinoma
rapidly metastasizing malignancy( really invasive cancer)
73
Gestational Trophoblastic Disease (Hydatidiform mole)-
needs what after
dont do what
put pt on what
that puts them at risk for what
Complications in pregnancy-
Will need surgery and chemo/radiation after-
do not get pregnant for at least a year,
put pt on some form of birth control for a year
risk for clots
74
- Gestational Trophoblastic Disease (Hydatidiform mole)-
What are s/s? –
large what
potential what
what pain
Complications in pregnancy-
large uterus,
potential vaginal bleeding,
minimal cramping pain,
75
Gestational Trophoblastic Disease (Hydatidiform mole)-
what confirms this
never had what
Complications in pregnancy-
Need ultrasound to confirm
Never had a HR
76
Cervical insufficiency (premature cervical dilation)-
when cervix does what
cervix shouldn't start until when
is baby able to be saved
Complications in pregnancy-
when cervic starts to prematurely open early on in pregnancy-
cervix should not start opening until you are close to delivery
A lot of times baby is unable to be saved
77
Cervical insufficiency (premature cervical dilation)-
If you have had it in past- when you get pregnant again-doctor does what
Complications in pregnancy-
early on the doctor will do cervical cerclage and put stitch in to prevent incometent cervix from happening again
78
Cervical insufficiency (premature cervical dilation)-
what do you do When mom is close to delivery-around 38 weeks-
Complications in pregnancy-
will cut stitch and send mom home
79
Cervical insufficiency (premature cervical dilation)-
educate that what
need what
what restrictions
may need what
Complications in pregnancy-
Educate that any s/s of birth they need to come in
Need to stay hydrated during pregnancy
Lifting restrictions
May need bed rest
80
Cervical insufficiency (premature cervical dilation)-
what is only treatment
Complications in pregnancy-
Cervical cerclage (McDonald procedure)-
81
- Placenta Previa-
when placenta is where
Complications in pregnancy-
when the placenta covers part of cervical os(opening)
82
Placenta Previa-
s/s
Complications in pregnancy-
Painless bleeding- small old blood
83
Placenta Previa-
unable to do what
placenta shifting means what
possible what treatment
Complications in pregnancy-
Unable to have vaginal delivery
Placenta can shift during pregnancy- so may shift out of previa, or may shift into
Possible C/S if the placenta continues to cover the cervical opening
84
Placenta Previa- if bleeding need to come to hospital-
risk for what
risk for needing what else
Complications in pregnancy-
risk for hemrohage-
risk for needing post delivery hysterectomy if bleeding isnt under control
85
Placenta Previa
-If mom is before 37 weeks and is having bleeding or ruptured membrane
get them where
give what
why does that help
Complications in pregnancy-
- admit to hospital
give steroids
to develop baby lungs before delivery
86
Placenta Previa- what confirms this
Complications in pregnancy-
Ultrasound can confirm this
87
Placenta Previa-If they come in as a known previa and bleeding
put where
get what
worry about what
put what in
give what
ultimately need what
Complications in pregnancy-
- lay down,
get vials,
worry about shock-
put IV,
give iv fluids, blood producs-
will need c section
88
Placenta Previa- If early on identiefied-
mom may need what
limit what
Complications in pregnancy-
bedrest through whole pregnancy
limit activity
89
abruption placentae)-
what is it
Complications in pregnancy-
Premature separation of the placenta
placenta is being ripped from uterine wall as a complication of trauma or accident
90
abruption placentae)-
what pain
what bleed
Complications in pregnancy-
Sharp, stabbing pain
bright red active bleeding
91
abruption placentae)-
need what emergency
get what
lay where
v
what products
Complications in pregnancy-
Emergency C/S stat!-
get large bore iv,
lay down,
vitals,
0- blood products
92
abruption placentae)-
baby isn't getting what
Complications in pregnancy-
Baby isn’t getting blood/oxygen
93
abruption placentae)- If function of placenta is altered- like in previa and abruption-
how does baby look
Complications in pregnancy-
baby may be smaller
94
abruption placentae)-
Complete tear
baby isn't what
emergent what
dont have time for what
do what to mom instead
Complications in pregnancy-
baby isn’t getting any oxygen- and will die soon-
emergency c section
don’t have time for a spinal-
put mom to sleep and intubate and get to nicu
95
abruption placentae)- In small tear-
admitted where
give what x2
ultrasound how often
constant what
what ivs
worried about what
Complications in pregnancy-
admitted to hospital-
give steroids and bedrest-
get ultrasounds every few hrs,
constant vitals
large bore ivs,
worried about hypovolemic shock and DIC
96
preterm labor
labor when
Complications in pregnancy-
Labor occurring between 20-36 weeks
97
preterm labor
Risks
addicted to what
g d
what diseases
s c
Complications in pregnancy-
- addicted to narcotics,
gestational diabetics
, cardiac, renal liver diseases,
sickle cell
98
preterm labor
are they in pain
may have what
might have some what
Complications in pregnancy-
Sometimes pt not in a lot of pain- like in Braxton hicks that are tolerable but wont go away
Might have some drainage- might not
Might have some dialation/ no dialation
99
preterm labor
Terbutaline does what
what drug also may help
Complications in pregnancy-
Terbutaline- iv push to stop contractions
Magnesium Sulfate
100
preterm labor
Corticosteroid – betamethasone
does what
given when
Complications in pregnancy-
– develops lungs-
given in 2 doses 48 hrs apart
101
preterm labor-If terbutaline works- to stop contractions
put where
lay on what side
give what
no what
avoid what
no what
decrease what
Complications in pregnancy-
put on bed rest-
lay on left side,
give fluids
, no lifting
, avoid breast and nipple stimulation
, no leg/foot massage,
decrease stress
102
Preterm rupture of Membranes (PROM)
Rupture of membrane occurs when
Complications in pregnancy-
occurring before the end of week 37 gestation
103
Preterm rupture of Membranes (PROM)
To diagnose:
Complications in pregnancy-
Nitrazine paper test-
will turn blue – test anywhere you get disacharge
104
Preterm rupture of Membranes (PROM)
To diagnose:
Ferning (microscope)-
if NPT is what
what means positive pregnancy
Complications in pregnancy-
if NPT is purple-
if present then it is positive for membranes
105
Preterm rupture of Membranes (PROM)
want to deliver how fast
prevents what
Complications in pregnancy-
Want to deliver within 24 hrs
to prevent Chorioamnionitis – infection of the membranes
106
Preterm rupture of Membranes (PROM)
keep where
give what x2
what team
Complications in pregnancy-
Keep in hospital-
give steroids, antibiotics,
nicu team if really early on
107
Preterm rupture of Membranes (PROM)-If mom comes in-
do what w her words
the earlier what
Complications in pregnancy-
believe her until you can prove that it isn’t happening-
the earlier you can intervention the earlier you can save baby
108
-Hypertensive Disorders in Pregnancy
what is cure
how do babies present
Complications in pregnancy-
Only cure is delivery
Babies will be smaller
109
Hypertensive Disorders in Pregnancy-Preeclampsia
happens from what
affects what
- happens from vasoconstriction from hypertension
that affects placenta and has systemic effects on mom
110
Hypertensive Disorders in Pregnancy
what's rising
worry when
Bp may be slowly rising-
will worry when bp is around 140/80 or map around 100-110
111
Hypertensive Disorders in Pregnancy-Risk factors-
what age
underlying
increased maternal age,
underlying cardio disorder
112
Hypertensive Disorders in Pregnancy- perform detailed assessment:
check urine for what
what in eyes
h
what pain
check urine for protein,
floaters/spots in eyes,
headaches
, left sided abdominal pain
113
Pre eclampsia no severe features
what bp
what proteinuria
how much wt gain
mild what
140/90-bp
Proteinuria 1+
Wt. gain 2 lb/week
Mild edema
114
Pre eclampsia w/ severe features
what bp
what Proteinuria
o
what is affected
160/110
Proteinuria 3+
Oliguria
Renal function affected
CNS, lungs, liver, heart or thrombocytopenia
115
Eclampsia-s/s
s
c
Seizure /
Coma
116
Pre eclampsia no severe features
where
what med
what position
monitor how often
At home
Low dose ASA
Bedrest, lateral recumbent
Monitor weekly
117
Pre eclampsia no severe features
diet
watch for what
Diet- decrease sodium,
Watch for dvt/stroke
118
Pre eclampsia w/ severe features
over 37 weeks do what
under 37 weeks do what
over 37 weeks = deliver baby
under 37 weeks = hold off and give steroids
119
Pre eclampsia w/ severe feature
b
restrict who
what precaitions
bedrest
restrict visitors-
seizure precautions
120
Pre eclampsia w/ severe features
needs to be under 0 stress to do what
prevent stroke/ heart attack
121
Pre eclampsia w/ severe features
VS how often
L
daily what
24 hr what
VS q 4 h,
Labs,
daily weights,
foley, 24 h urine- w urometer bag
122
Pre eclampsia w/ severe features
what every4 hr
F
B
N
FHT,
BPP- ultrasound
NST
123
Pre eclampsia w/ severe features
Diet
high
low
high protein,
mod. Na
124
Severe pre eclpamisa
keep what at bedside
give them what
intubation kit
give them 02
125
Pre eclampsia w/ severe features
Meds
H
L
M s
hydralazine,
labetalol- beta blocker
Mag. sulfate
126
Eclampsia
montior what
give what for seruizure x2
give what
F
Airway!
Mag. Sulfate or diazepam- for seizure
O2
FHT
127
what is immediate treatment for eclampsia
Delivery baby- immediately
128
Magnesium sulfate
given to who
go back to what state
Given to e clampsia-
can go back to pre-eclampsic state(uncontrolled HTN)
129
Magnesium sulfate-What does the nurse assess?
H
L
F
i
Headache,
lethargic,
flushing,
irritable,
130
Magnesium sulfate- check for toxicity
B
U
R
P
B- BP
U-urine output- decreased
R- decreased respirations
P-platella reflexes
131
Magnesium sulfate
watch how
check bp how often
what checks
Wathc pt closely- 1/1 ratio
Check bp every 15
Reflex checks
132
Magnesium sulfate
want what in
may be on what
Want urometer in
May be on capnograpghy
133
what is 5-7
what is 10+
what is 12-15
what is 25+
magnesium levels
Therapeutic: 5-7 mEq/L
Loss of deep tendon reflexes: 10 mEq/L
Respiratory failure: 12-15 mEq/L
Cardiac arrest: 25 mEq/L
134
antidote for magnesium toxicity
calcium gluconate
135
Hellp syndrome
H
E
L
L
P
Hemolysis- breakdown of RBC
Elevated
liver enzymes- liver damage
low
platelet count- risk for bleeds
136
Hellp syndrome
d/t what
is prognosis good
risk for what
D/T elevated BP
High maternal and infant mortality rate
risk for stroke/ hemmorrhage
137
Hellp syndrome
high levels cause what
mom may need what
High levels of bilirubin causes liver to fail
Mom may need liver transplant
138
Hellp syndrome-mom will be
J
what pain
what bp
risk for what
jaundaices,
abdominal pain,
HTN,
risk for clot and bleed
139
Hellp syndrome treatment
what blood product
iv what
ultimately need what
FFP,
IV dextrose,
infant delivery
140
Hellp syndrome-Nusring considerations
watching for what-(h)
put in large what
Hemorrhage,
Large bore iv
141
Hellp syndrome
Controlling bp-
m
h
b
mag,
hydralazine,
beta blockers,
142
Hellp syndrome
lots of what
Lots of blood products and heparin
143
Complications in pregnancy-Multiple Pregnancy
what are identical
what are non identical
Monozygotic (Identical)
Dizygotic (Non identical)
144
Complications in pregnancy-Multiple Pregnancy
what is a mono mono twin
will need what
- share a umbilical cord and same amniotic sac-
will need c section
145
complications in pregnancy-Oligohydramnios
what is it
will require what
< 500 ml of amniotic fluid
( will require an Amnioinfusion during labor – will help baby by allowing to slide through canal)
146
complications in pregnancy-Oligohydramnios
etiology
u o
what issues
what insuffinceny
what type of pregnancies
uretheral obstruction
kidney issues
placental insufficiently
late pregnancies
147
complications in pregnancy-Oligohydramnios
complications
can cause what restriction
what complications
cause intrauterine growth restriction,
birth complications
148
Polyhydramnios
how much amniotic fluid
what is normal amount
2000 ml-
normal amount if 700-1000
149
Polyhydramnios tx
a
treat what
amnioreduction
treat underlying cause
150
Polyhydramnios complications
f m
what prolapse
what birth
fetal malposition
umbilical cord prolapse
premature birth
151
what causes Polyhydramnios
f a
m c
i
fetal abnomalties
maternal conditions
idophathic
152
Isoimmunization (Rh Incompatibility)-rhogam
give when what mom
Complications in pregnancy-
Rh negative
153
Isoimmunization (Rh Incompatibility)-rhogam
if not given can cause what
Complications in pregnancy-
Hemolytic disease of the newborn
(Erythroblastosis fetalis)- fatal for infant
154
Isoimmunization (Rh Incompatibility)-rhogam
first dose when
next one when
Complications in pregnancy-
Give first dose around 28 weeks,
next one 72 hrs postpartum
155
Isoimmunization (Rh Incompatibility)-rhogam
If mom has any bleeding issues/ any chance of miscarriage then do you give rhogam
Complications in pregnancy-
If mom has any bleeding issues/ any chance of miscarriage then still give rhogam
156
Complications in Pregnancy: pre-existing
Cardiac disease
Hypertensive vascular disease
Thromboembolic disease- DVT
Anemia (Sickle-cell anemia)
UTI
Glycosuria
Respiratory disorders
GI disorders
Endocrine disorders- Diabetes
157
: pre-existing- impact of diabetes
uncontrolled diabetes can
lead to
p b
p
Complications in pregnancy-
lead to birth defects
preterm birth
preeclampsia
158
pre-existing- impact of hypertension
increases risk of
p
p b
low what
Complications in pregnancy-
preeclamspia
premature birth
low birth weight
159
pre-existing- impact of heart disease
h f
what during pregnancy
Complications in pregnancy-
heart failure
aarythmias during pregnancy
160
Complications in pregnancy-pre-existing- gestational diabetes
what is goal during pregnancy
control blood glucose
161
Complications in Pregnancy: pre-existing-
gestational diabetes
Complications at risk for:
LGA what is it
LGA-large gestation age baby-big baby
162
Complications in Pregnancy: pre-existing-
gestational diabetes
Complications at risk for: Hydramnios
what is it
- too much amniotic fluid
163
Complications in Pregnancy: pre-existing-
gestational diabetes
Complications at risk for:CPD / Shoulder dystocia - what happens
baby is too big for mom pelvis
164
Complications in Pregnancy: pre-existing-
gestational diabetes
Complications at risk for:
Risk of what after birth
Risk of hypoglycemia in infants after birth
165
Complications in Pregnancy: pre-existing- gestational diabetes
What mothers are at risk for developing gestational diabetes- ?
p o s
what diabetes
o
polysustic ovarian syndrome
, type 2 diabetes,
obese,
166
Complications in Pregnancy: pre-existing- gestational diabetes
how do you get diagnosed
Around 26 weeks-
1 hr glucose test, sit for 1 hr and draw blood- if blood sugar is over 130- failure
then 3 hr glucose test if fail- draw blood
167
teaching for gestational diabetics
diet x2-no
what drug
watch what continuously
no carbs/ sugars
metformin
watch sugars constantly
168
Hypotonic contractions-
what is it
cannot do what
what doesn't work
Complications in Labor: Force
not enough contraction-
cannot do vaginal delivery-
cervix will not dilate
169
Hypotonic contractions-
try what med
if that doesn't work then get what
- may try oxytocin-
if oxytocin doenst work need c section
170
Hypertonic uterine contractions-
how many contractions
not enough what
no what
Complications in Labor: Force
too many-
not enough rebound time-
no rest period-
171
what is goal in hypertonic contractions
if cant do that, then do what
try to slow labor down
- if cant –then c section
172
Uncoordinated contractions-
what looks like
cervix doesn't do what
Complications in Labor: Force
all over place-
cervix will not dialate-
173
Uncoordinated contractions-
try what
if that dosnert work then what
try oxytocin
- if baby doesn’t normalize then c section
174
Precipitous Labor:
what is it
lasts less than 3 hours & results in a rapid birth
175
Precipitous Labor:
Maternal Risks:
L
p h
Lacerations
Postpartum hemorrhage
176
Precipitous Labor: Fetal Effects:
H
c t
P
Hypoxia
Cerebral trauma
Pneumothorax
177
Precipitous Labor: Hx of precipitous labor:
what do you do
Close monitoring during last few weeks of pregnancy
178
Precipitous Labor:
Assessment
r d
intense what
Rapid dilation
Intense uterine contractions
179
induction of high risk pregnancy- why induce
problems w what
what readiness
Complications in pregnancy-
problems with fetal maturity
cervical readiness
180
complications in Labor: induction of high risk pregnancy
why give dinoprostone, Misoprostol-
Will ripen cervix
gets ready for oxytocin to work
181
complications in Labor: induction of high risk pregnancy
give oxytocin in what
cant give this until what
does what
oxytocin (in LR)
– cant start until cervix is ripened
induces labor
182
Amniotomy
what is it
risk of what
check what after
complications in Labor: induction of high risk pregnancy
Artifical rupture of membrane
Risk of cord prolapse
Check FHR right away after!
183
Cesarian-
keep what
avoid what
gradually do what
watch for what
complications in Labor: induction of high risk pregnancy
keep incision dry/clean
avoid lifting
gradually increase activity
watch for infection
184
Why do c section-
if mom not doing what
if what comes back
what placenta
active what
baby measures how
if mom not dilating,
diagnostics came back saying its not healthy for mom and baby
, malfunctioning placenta
, active genital herpes,
baby measuring large
185
when do you only do cesarian
Benefits of delivery have to outweigh risks of continuing pregnancy
186
Oxytocin (Pitocin)
Risks
h
what bp
what urine output
complications in Labor: induction of high risk pregnancy
: hyperstim,
hypotension,
decreased urine output
187
Oxytocin (Pitocin)
Any sign of fetal distress or hyperstim, what should the nurse do?
complications in Labor: induction of high risk pregnancy
Ready for c section
188
Oxytocin (Pitocin)
how fast of administration
complications in Labor: induction of high risk pregnancy
Titrates medication- start slow
189
Oxytocin (Pitocin)
May get a consent right away in the case that what
what do you do
needs what
complications in Labor: induction of high risk pregnancy
baby/mom doesn’t tolerate
automatically stop oxytocin
needs emergency c section
190
Oxytocin (Pitocin) -Hyperstim
what are they
complications in Labor: induction of high risk pregnancy
- frequent contractions that you don’t get rebound off of
191
Oxytocin (Pitocin)
need what
to measure what
complications in Labor: induction of high risk pregnancy
Need a urometer or hat in toilet
measure output
192
Oxytocin (Pitocin)
what do With decels-
mom on what side
put on what
give what
complications in Labor: induction of high risk pregnancy
put mom on left side,
put on oxygen,
give fluid bolus
193
Failure to progress
when what stop happening
labor how long
maxed out on what
complications in Labor: Force
- when cervix stops dilating,
labor longer then 24 hours,
maxed out on Pitocin
194
Failure to progress
what do you need to do
Complications in Labor: Force-
c section
195
Failure to progress-Prolonged descent or arrest of descent-
baby not doing what
Complications in Labor: Force-
baby is no longer coming down pelvis
196
Failure to progress
What is this most often attributed to?
L
C D
Complications in Labor: Force-
LGA (big baby),
cephlopelic disproportionate(baby head to big)
197
Umbilical cord prolapse
what happens
what stops happening
Complications in Labor: Passenger-
-cord comes around baby head-
baby will stop perfusing
198
Umbilical cord prolapse
how do you help this
do not do what- do what
Complications in Labor: Passenger-
Get sterile gloves and lift babies head off of umbilical cord-
do not get off bed - scream to get help
199
Umbilical cord prolapse
needs what
do what to mom
Complications in Labor: Passenger-
– needs c section
Intubate mom and get baby out asap
200
umbilical cord prolapse others
what position
give what
and what med
knee to chest or trendelenberg
02 10 l mask
tocolytic to reduce uterine activity
201
Cephalopelvic Disproportion (CPD)-
what happens
what do if you know about it beforehand
Complications in Labor: Fetal position, presentation, size
pelvis is too small for baby to fit through-
if know about it beforehand can get c section
202
Complications if didn’t know about CPD beforehand-
s d
what fracture
P
shoulder dystocia,
clavical fracture,
pneumothroax
203
-External cephalic version
if baby presents how
will try to do what
Complications in Labor: Fetal position, presentation, size
If baby is breached-
will try to feel externally and move baby to correct position
204
External cephalic version
this is done where
needs what
guided
constant what
Complications in Labor: Passage-
Done in OR- very painful,
needs iv,
ultrasound guided,
constant fetal heart tones
205
External cephalic version
how long in gestation
monitor what during
Complications in Labor: Passage-
34-38 weeks gestation
Monitor FHR during
206
External cephalic version
high risk of complications-
any signs of what
do what
Complications in Labor: Passage-
any sings of placenta burst
will do emergent c section
207
Vacuum extraction/ Forceps birth
happens when
or if what
Complications in Labor: Passage -
Happens if having hard time pushing,
or if epidural is causing you to not feel anything
208
Vacuum extraction/ Forceps birth
Watch for
v a
h
t d
Complications in Labor: Passage -
vaginal aspirations,
hemorrhage,
tissue damage
209
Vacuum extraction/ Forceps birth
mom at risk for what
baby will have some what
Complications in Labor: Passage -
Mom risk for bleeding,
baby will have some head deformity(should even out in a few weeks)
210
What is the greatest risk to the mother after giving birth?-
what is last chance treatment
bleeding/ hemorrhage
last chance is getting uterus out of mom
211
Lochia –what look like
rubra- what looks like+ how long
serosa- what looks like+ how long
alba- what looks like+ how long
Lochia rubra-redneded pieces-1-3 days
Lochia serosa-pink -7-14 days
Lochia alba-white/gray-10-14 days-up tp 6 weeks
212
what does Abnormal lochia look like
never be what
never have what
means a possible what
no sex how long
–never be absence
or never should have foul oder-
possible infection
for 6 weeks-no sex
213
Needs a focused assement, especially on pelvis postpartum
L
what does what
weight what
dont want mom to do what
Lochia –what look like
What does discharge look like/how much
Weight the peripads
Don’t want mom to flush after feeling gush of fluid
214
Check uterus every few minutes for first few hours-
measure what
measure to make sure it is slowly shrinking down back to 0
215
what are you pushing on after birth
watch for what
Push on the softball feeling-
as you push watch for any discharge that may be coming out
216
why do you want mom to move around after postpartum
Want mom to move around because you don’t want blood to pool
217
risk factors for uterine atony- uterus doesn't contract enough after childbirth causing blood loss
what baby
retained what
o
L L
LGA baby,
retained placenta,
oxytocin,
long labor
218
complications in postpartum
T- lack of what
also known as
4 t's
lack of tone-
boggy uterus/ uterine atony
219
complications in postpartum
T- trauma-any what
4 t's
any lacerations
220
complications in postpartum
T-retained what
4 t's
T- retained tissue/placenta
221
complications in postpartum
T- thrombin-what issues
4 t's
- clotting factor or coagulation issues
222
uterine atony
uterus does what
leads to what
if all else fails->
uterus doesn't contract after childbirth
leads to hemorrhage
if all else fails, needs hysterectomy
223
Uterine Atony
Deep fundal massage-
what do you do
assess what
What are the PRIORITY actions by the nurse? Bleed-
will hurt, but will help- be very forceful to try and get uterus to clamp down-
assess what kind of drainage is coming out
224
uterine atony-
oxytocin in iv fluids-how does it work
What are the PRIORITY actions by the nurse? Bleed
aids in contracting of uterus
225
uterine atony
what to bed
give what
empty what
if cant get uterus out, need what
elevate foot of bed
give 02
empty bladder
if cant get uterus out, need hysterectomy
226
If mom is stable and just a little bit of drainage-
have mom do what
helps what
What are the PRIORITY actions by the nurse? Bleed
can have mom breastfeed because it will
help cause uterus to clamp down
227
Also just normal shock from hypovolemia-
lots of what
what products
what can stop bleeding
What are the PRIORITY actions by the nurse? Bleed
Lots of big iv,
blood products,
Methylergometrine can stop bleeding.
228
what pain
what urge
what in catheter
could mean internal hemorrhage
back pain
urge to poop
blood in catheter
229
What are the PRIORITY actions by the nurse? Bleed
is you cant reverse shock- can go into what
last chance is what
If cant reverse can go into DIC
Last choice is OR and getting hysterectomy
230
Who is at risk? for postpartum infections
D
unstable what
compromise what
what type of birth
– diabetics,
unstable blood glucose,
compromised immune system,
traumatic birth
231
Endometritis- uterus/// Perineum infection
s/s
what temp
what from incision
o
what hr
maybe-
Puerperal infections
increased body temp,
increased drainage from incision,
odor,
tahycardia,
maybe lethargic-
232
Endometritis- uterus/// Perineum infection
may need what
watch for what
Watch for s/s of sepsis
May need PICC line
233
Puerperal infections-Peritonitis- need to return to hospital immediately
signs of this
what abdomen
what pain
rigid like abdomen
belly pain
234
Puerperal infections
Mastitis
infection where
s/s-(p/c/t)
can they breastfeed
- breast tissue-
will have pain, chills , temp
yes, can breastfeed
235
Puerperal infections
UTI- why can it happen x2
can happen from the birth iteself-
or foley placed-
236
Puerperal infections
Urinary retention-
happens from what
retention can happen from the spinal epidural
237
Postpartal depression-Who is at risk?
lack
hx
-lack of support,
hx of depression ,
238
Postpartal depression
last longer then what
can moms control this
Longer than 1-10 days
Moms cannot control this- cannot just “get over”- need help
239
how may moms look in postpartum depression
when do they come into hospital
Moms may be sleeping too much/not enough
need to come in if they have suicidal ideation
240
teach postpartum depression to who
when will ob check
teach support person about watching/reporting
ob checks at week 6
241
Postpartal psychosis-medical crisis
overwhelmingly what
non
Overwhelmingly sad
Non sleeping
242
Postpartal psychosis-medical crisis
what state
lose what
will have what
Heightened manic state
Lost contact w/ reality
Will have hallucinations/ delusions
243
Postpartal psychosis-medical crisis
what is needed
they may do what
never do what
Crisis intervention needed!-
may harm infant-
never leave her alone or alone w baby
244
breastfeeding jaundice
breastmilk jaundice
Pathologic Jaundice
Breastfeeding Jaundice- (caused by poor feeding practices)
BreastMIlK Jaundice -caused by milk composition.
Pathologic Jaundice- signs WITHIN 24hrs of life.-normal
245
treating jaunduice
what therapy
how much skin
want a lot
light therapy with eye protection
as much skin exposed as possible
want baby to eat and have as much bowel movements as possible-gets rid of bilirubin
246
How do you know a fetus is a risk?
prenatal hx->
what status
exposure to what
what conditions
is mom considered what
what of pregnancies
lower socialeconomical status may put baby at risk because they may not have access to healthy foods/ not get prenatal care/
exposure to toxic chemicals or any sorts of drugs,
preexisting conditions,
is mom considered a geriatric pregnancy,
amount and number of pregnancies
247
what is Apgar
activity
pulse
grimace
appearance
respiration
248
what Apgar score do you want
what if less then that
want 7-10
if less then 7 then you need interventions
249
when's Apgar done
x2
at 1 minute
at 5 minutes
250
Lower the weight and degree of prematurity =
_increased_ incidence of mortality and morbidity
251
If baby is born to mother who has overdoses-
cant do what
who can you give It to
cannot give noloxone
- can give to mom if she is overdose.
252
what happens if you give naloxone to baby
end up w
p e
c a
s
pulmonary edema,
cardiac arrest,
seizures-
253
babies born to narcotic addicted mothers look how
what apgar score
what appearance
have low apgar scores
flacid appearcne--
254
If baby starts to aspirate-
do what first
why
assess and see how they do before putting down a tube or deep suctioning them-
this is because if they have mecomium in the lungs, we may make it worse, as opposed to if we just allowed it to happen
255
Risk factors for mecomium-
mom has what tones
p labor
d labor
p labor
any what
I I
t
uses what
if mom has nonreasoning fetal heart tones,
premature labor,
difficult labor,
prolonged labor,
any intrapartum bleeding
, intrauterine infections ,
twins,
actively using narcotics
256
Care of the newborn at risk for Asphyxia-Red Flags:
nonressuring
diffucult
fetal scalp what
significant what
Nonreassuring fetal heart pattern
Difficult birth, prolonged labor
Fetal scalp acidosis (pH < 7.2)
Significant intrapartum bleeding
257
Care of the newborn at risk for Asphyxia-Red Flags:
maternal what
pre
c h d
Maternal infection/sepsis
Prematurity, SGA
Congenital heart disease
258
Care of the newborn at risk for Asphyxia-Red Flags:
what abnormality
infant of what
what use in pregnancy
Structural abnormality
Infant of multiple pregnancy
Narcotic use in pregnancy
259
Resuscitation of baby- how do you stimulate baby
Stimulation by rubbing newborns back w/ dry, warm, sterile towel
260
Resuscitation of baby
infants head where
no what
Infant’s head in sniffing position;
no hyperextension
261
Resuscitation of baby- suction only where
Suction (mucus, blood, meconium) only in mouth
262
Resuscitation of baby- use of what inflates lungs
Use of positive pressure to inflate lungs
263
Resuscitation of baby- what helps to not overinflate lungs
Use bag and mask w/ manometer
264
Resuscitation of baby
how fast chest compressions
do you give supplemental 02
Chest compressions 100 per minute
Supplemental 02 not utilized right away unless central cyanosis & Sp02 low (Too much 02 can cause long-term adverse effects)
265
Resuscitation of baby
may need what
if you do that- then also give them what
helps w what
Endotracheal intubation
If you need to intubate the baby- give surfactant through ET tube
to develop lungs
266
Resuscitation of baby Medications
: EPI
267
Resuscitation of baby
always check what
for what
give what
Also check glucose-
hypoglycemia can also show up as unrepsosive baby-
give dextrose
268
Resuscitation of baby- when do it
what Apgar score
what appearance
not doing what
not doing what
Apgar less then 7,
flaccid appearance,
not crying,
not breathing,
269
Fluid & Electrolyte balance
what can develop after resuscitation
consider what then after
Hypoglycemia can develop in all infants after resuscitation!
Consideration for D10 Solution IV
270
Fluid & Electrolyte balance
what urine output
how weigh output
Urine output should be equal to or higher 2 ml/kg/hr
Measure diapers to weigh output
271
Fluid & Electrolyte balance
closely monitor what
consider what x2
Fluids = monitor closely to avoid overload
Consider isotonic fluids, dopamine
272
Radiation
what is it
examples
Regulating Temperature- prevent cold stress=prevent cardiac arrest
transfer of body heat to a cooler solid object NOT in contact with baby
heat from baby moving to an open window
273
Convection
Regulating Temperature- prevent cold stress=prevent cardiac arrest
-flow of heat from body surface to cooler surrounding air-
air conditioner /open window
274
Conduction
Regulating Temperature- prevent cold stress=prevent cardiac arrest
-transfer of heat to solid object in contact with baby-
cold stethoscope on skin
275
Evaporation
Regulating Temperature- prevent cold stress=prevent cardiac arrest
loss of heat through conversion of a liquid to a vapor
amniotic fluid evaporation when born
276
what happens when babies shiver
need to give what
shiver- use up more energy and become hypoglycemic-
give dextrose
277
how to keep babies warm
warm b
dont do what right away
warm r
what on them
watch what
warm blankets
, don’t bathe right away
, warm room
, hat on them,
watch temp
278
why are premature babies at risk for cold stress
what age is that developed
also does what
they dont have brown fat
developed at 36 weeks
helps store glucose
279
Nutritional Intake
ensure what before feedings
why
Ensure the newborn is stable before attempting feedings
Sucking is hard work for a preterm!
280
Nutritional Intake-May need what if possible
what feeding
via what
gavage or gastric feedings w/ breast milk
via NG or gastric tube
281
Nutritional Intake-may need
what regulation
what iv
what type of feedings
Glucose regulation,
dextrose IV
,ng tube synringe feedings
282
Nutritional Intake- why might it be hard for babies- dont have enough what
May not have enough surfacnat in lungs to do adequate breathing while they are trying to eat.
283
s/s of distress while feeding
c
struggling to do what
cyanosis,
struggling to breathe while eating,
284
Preterm Infant
preterm = how early
what is late preterm
what is early preterm
Born before the end of 37 weeks gestation
Late preterm = 34 – 37 weeks
Early preterm = 24 – 34 weeks
285
preterm infant- Health problems are associated with immaturity of body systems-
what is number 1 priority
give what pre birth
number 1 priority is immature lung development
- give some steroids pre birth to help develop some lung development
286
Preterm Infant Assessment
head appears how
what skin
what present
L
no what on hands/feet
what eyes
what ears
immature what
Head appears larger
Rudy skin w/ no subcutaneous fat
Acrocyanosis present
Lanugo- body hair
No sole creases on hands/feet
Small eyes
Larger ears, cartilage is not formed
Immature CNS
287
SGA (Small for gestational age) Infant Risks:
mom has what
what BP
s
I
T
O
Birth weight is 10th percentile on the intrauterine growth curve
- mom has preeclampsia,
HTN,
smoker
IUGR (Intrauterine growth restriction)
Twins,
Oligohydramnios- low amniotic fluid
288
SGA (Small for gestational age) Infant
look how- but what
what eyes
Normal but small organs / appearance
Wide eyed
289
SGA (Small for gestational age) Infant
risk for what x2
hypoglycemia
infections
290
IUGR (Intrauterine growth restriction)
failed to do what
caused by what
Failed to grow at the expected rate,
Caused by stress on the infant in utero
291
IUGR (Intrauterine growth restriction)
muscles look how
what respirations
what eyes
s
Muscles appear wasted away
Gasping respirations,
wide eyed,
spastic
292
IUGR (Intrauterine growth restriction)
deliver when
why
Can deliver at 31-32 weeks,
will grow better outside of mom-
no more room inside of mom
293
LGA (Large for gestational age) Infant
baby is what
but also what
baby is huge
but also deceptively healthy
294
LGA (Large for gestational age) Infant
Monitor for:
h
p
what difficulties
Hypoglycemia- drops quickly after birth
Polycythemia
Breathing difficulties
295
LGA (Large for gestational age) Infant-Priority
what fracture
what difficulty
- clavicle/humorous fracture,
breathing difficulties d/t not enough surfactant,
296
LGA (Large for gestational age) Infant
born to who
may have what
Born to diabetic mothers
May have congenial abnormalities
297
LGA (Large for gestational age) Infant-Polycythemia-
appear how
needs what
this can cause what
then appear how
inc red blood cells, so will appear pink and healthy-
need to be able to break these down
, this can then cause anemia,
and can appear jaundiced
298
LGA (Large for gestational age) Infant
can alter what
may not get what
Can alter pulse ox readings-
may not be able to find 02 dropping right away
299
LGA (Large for gestational age) Infant-Signs that they are struggling with breathing-
g
c
n f
what in chest
grunting,
cyanosis,
flaring,
retractions in chest,
300
Post Term Infant-
extends past how long
how do they present
extends past 42 weeks
could present as either SGA, AGA, or LGA depending on placenta
301
Characteristics of post maturity syndrome-High risk for morbidity & mortality due to poor placental function ->
h
a
h
m a
hypoxia
Asphyxia
Hypoglycemia
Meconium aspiration
302
Characteristics of post maturity syndrome-High risk for morbidity & mortality due to poor placental function ->
p
what abnormalties
s
what stress
Polycythemia
Congenital anomalies
Seizures
Cold stress
303
Respiratory Distress Syndrome (RDS) in newborn-Assessment
c
what rr
what respirations
n f
significant what
a
what temp
: cyanosis,
tachypnea,
grunting respirations,
nasal flaring,
significant retractions,
apnea
low body temperature
304
Respiratory Distress Syndrome (RDS) in newborn-Causes:
most common cause->
m a s
s
what transition
p
Preterm (most often) from not enough surfactant
Meconium aspiration syndrome
Sepsis
Slow to transition to mom
Pneumonia
305
Respiratory Distress Syndrome (RDS) in newborn
notice when
what type of breathers
Can notice during eating.
Obligate nose breathers.
306
Respiratory Distress Syndrome (RDS)--Will require treatemnt
immediate what
possible what
maybe needs what
what med
- immediate assessment,
possible surfactant,
maybe needs intubation,
needs antibiotics
307
Transient Tachypnea of the Newborn
due to what
occurs more in what
why not in vaginal
Illnesses that occur in newborns at risk:
Due to inability to clear airway of secretions
Occurs more often in cesarean born infants
In vaginal birth, the contractions will squeeze out secretions, don’t get that in c section
308
Transient Tachypnea of the Newborn
s/s
what type of respirations
c
g
r
what rr
Illnesses that occur in newborns at risk:
labored respirations
cyanosis
grunting
retractions
tachypnea
diffulcty feeding
309
Transient Tachypnea of the Newborn
how treated x2
happens how quick post delivery
Illnesses that occur in newborns at risk:
Can be treated quickly by suctioning, possible oxygen
48-72 hours post delivery
310
Transient Tachypnea of the Newborn
What is the difference between RDS and this?
RDS why
transient why
Illnesses that occur in newborns at risk
RDS happens as a lack of surfactant,
transient can happen in near term from stress of not being able to clear secretions
311
Meconium Aspiration Syndrome
how does it happen
what does it lead to
Illnesses that occur in newborns at risk:
Due to relaxation of anal sphincter usually secondary to asphyxia expelling meconium stool meconium-stained amniotic fluid which is then inhaled by fetus
respiratory problems including pneumonia
312
Meconium Aspiration Syndrome
may require what
what is red flag
Illnesses that occur in newborns at risk:
May require mechanical ventilation
Red flag is if meconium is present at birth
313
Meconium Aspiration Syndrome
Treatment:
what to baby
do you suction/what kind
possible what
Illnesses that occur in newborns at risk:
: assess baby,
hold off on suctioning if possible, can do bulb suction.
Possible antibiotocs for aspitration pnemononia
314
Hemolytic Disease of the Newborn (Hyperbilirubinemia)
what is it
Illnesses that occur in newborns at risk:
Early jaundice (within first 24 hours) is most often caused by ABO incompatibility or Rh Incompatibility (rare now because of rhogam)
315
Hemolytic Disease of the Newborn (Hyperbilirubinemia)
Treatment
Illnesses that occur in newborns at risk:
Dependent on blood levels not cause
316
Hemolytic Disease of the Newborn (Hyperbilirubinemia)-
What can happen if not treated?
Illnesses that occur in newborns at risk:
Kernicterus (permanent brain damage) and severe anemia which can
erythroblastosis fetalis
hydrops fetalis (fluid on the heart or other organs)
death
317
Hemolytic Disease of the Newborn (Hyperbilirubinemia)
watch for what as well
Illnesses that occur in newborns at risk:
Also, watch for hypoglycemia in these infants!
318
Hemolytic Disease of the Newborn (Hyperbilirubinemia)
when is jaundice a concern
Illnesses that occur in newborns at risk:
Jaundice is a concern when it extends past nipple line, starts from head and goes down
319
Hemolytic Disease of the Newborn (Hyperbilirubinemia)
when is late jaundice
Is this a bad thing
Illnesses that occur in newborns at risk:
Late jaundice (24-72 hrs after)
may be normal from RBC being destroyed
320
Hemolytic Disease of the Newborn (Hyperbilirubinemia)
Labs-Total serum bilirubin level
what is normal
what is dangerous in term infant
what is dangerous in preterm
Illnesses that occur in newborns at risk:
normal is 0-3 mg/100ml
Term infant w/ bilirubin above 20 mg/dL is dangerous!
Preterm infant w/ bilirubin above 12 mg/dL is dangerous!
321
how do you check labs in newborn
x2
Check w a heel stick poke ( side of heel)
also umbilical cord
322
Hemolytic Disease of the Newborn (Hyperbilirubinemia)- Treatment-
what is initial treatment
p
what transfusion
Illnesses that occur in newborns at risk:
Early feeding is initial treatment
Phototherapy
Exchange transfusion
323
Hemolytic Disease of the Newborn (Hyperbilirubinemia)- Treatment:
what med
also want to prevent what
Illnesses that occur in newborns at risk:
Medications erythropoietin
Prevent dehydration
324
what is greatest risk factor in Hyperbilirubinemia
what happens if they are hydrated
Dehydration is greatest risk factor-
increased probability that it will become worse-
if pt is hydrated, it will flush bilirubin out of body
325
-Hemolytic Disease of the Newborn (Hyperbilirubinemia)-
Billi blanket-
-how long leave the baby under there for
-can become what
-how do you dress them x2
Illnesses that occur in newborns at risk:
do not leave under blanket for longer then they need to be,
can become hyperthermic
Do not put them under w anything more then a diaper and eye patches
326
Hemolytic Disease of the Newborn (Hyperbilirubinemia)
always have what on them in photo therapy
Illnesses that occur in newborns at risk:
Always have a pulse ox and a temp sticker on them
327
Hemolytic Disease of the Newborn (Hyperbilirubinemia)
what does mild jaundice get
what does severe jaundice get
Illnesses that occur in newborns at risk:
Mild jaundice goes home w billiblanket
Severe jaundice gets photo therapy light box and that’s done in hospital
328
Hemolytic Disease of the Newborn (Hyperbilirubinemia)
severe jaundice can also get what
waste goes through where
Illnesses that occur in newborns at risk:
Severe can also get donor blood
waste goes through umbilical vein
329
Illnesses that occur in newborns at risk:
Anemia
normal to have for how long
Normal to have physiologic anemia for 6-12 weeks
330
Illnesses that occur in newborns at risk: - polycythemia
increased what
hyper what
what blood flow to tissues
Increased blood volume and hematocrit
hyper viscosity (thickness) of the blood
↓ blood to tissues
331
Illnesses that occur in newborns at risk: - polycythemia
what h/h
Hct over 65-70% (normal 49-61%)
Hgb over 22 g/dl (normal 14-20g/dl)
332
Illnesses that occur in newborns at risk: - polycythemia
most common in :
I
full term infants w what
what transfusion
chronic what
what abnormalities
IUGR,
full-term infants with delayed cord clamping,
maternal-fetal & twin-to-twin transfusions,
chronic intrauterine hypoxia
, chromosomal anomalies
333
polycythemia
increased risk for what
decreased what
Illnesses that occur in newborns at risk: -
Increased risk for DVT/ Pe
decreased blood to tissues
334
Etiology->
Illnesses that occur in newborns at risk: Necrotizing Enterocolitis (NEC)
: Unknown but can result from poor perfusion in the gut
335
Necrotizing Enterocolitis (NEC)- whose at risk
what infants
f f
s
what type of milk
Illnesses that occur in newborns at risk:
Preterm infants /
formula feed /
SGA
animal milk
336
Necrotizing Enterocolitis (NEC)-Manifestations
what intolerance
what diarrhea
L
A
what hr
what abdomen
what temp
Illnesses that occur in newborns at risk:
Feeding intolerance-spit up
Bloody diarrhea (occult blood)
Lethargy
Apnea
bradycardia
Super distended abdomen
increased temperature
337
Necrotizing Enterocolitis (NEC)Interventions
frequent what
asucaltae what
may need what
Illnesses that occur in newborns at risk:
Frequent vitals including temp
Auscultate bowel sounds
May need gastric tube
338
Necrotizing Enterocolitis (NEC) Interventions
stop what
strict what
watch what
what med
Illnesses that occur in newborns at risk:
Stop oral feeds
Strict NPO
Watch skin integrity
Antibiotics right away
339
what is only chance of survival in necrotizing enterocolitis
OR is the only chance of survival
340
Group B strep infection-
can cause what:
N b
I
s
Newborn at risk from maternal infections
can cause newborn blindness,
infection,
sepsis,
341
Newborn at risk from maternal infections-
Ophthalmia Neonatorum-
blindness from what
blindness from chlamydia ghonneora
342
Newborn at risk from maternal infections-
Hepatitis B virus –
when does this happen
how prevent this
post delivery-
vaccine for this
343
Newborn at risk from maternal infections-
Herpes infection –
what do you get if active herpes
if baby gets it-then what
give what med
if active herpes mom needs c section
no nursery if baby gets it
give antivirals- acyclovir
344
HIV infection
-moms get what
what special c section
Newborn at risk from maternal infections
moms receive screening for HIV to test, and work to prevent infection-
bloodless c sections- cauterize every bleed with every cut
345
Newborns wont always show an elevated temp as a sign of infection->
L
won't do what
wont what as much
will be Q/L
Newborn at risk from maternal infections
may be lethargic
, wont eat,
wont cry as much,
will be quiet and limp
346
Diabetes mellitus
Large infant- pathophyscioology
increased what
Newborn at risk from maternal illnesses:
: ↑ glucose to infant =
↑ production of insulin
=↑ utilization of glucose (↑ storage of glucose)=
fat baby\
347
Diabetes mellitus
what helps to manage risks in newborn
Newborn at risk from maternal illnesses:
Prenatal management helps decrease risks to newborn
348
Diabetes mellitus
After delivery:
monitoring what
risk for what
early what
Newborn at risk from maternal illnesses:
Monitoring blood glucose levels:
at risk for hypoglycemia
early feedings
349
Diabetes mellitus-Assess for complications (LGA)-
what fracture
risk for what
Newborn at risk from maternal illnesses:
humerus/clavical fracture,
risk for pneumpthorax
350
Diabetes mellitus
what blood glucose number
Newborn at risk from maternal illnesses:
Want a blood glucose of at least 60 on a stick
normal is 40+
351
Diabetes mellitus- s/s of hypoglycemia- If babies are
t
j
p
what cry
need to get what
Newborn at risk from maternal illnesses:
tired,
jittery,
pale
weak cry,
first thing is get a blood glucose
352
Diabetes mellitus
If you cant control their glucose with feeding- do what
Newborn at risk from maternal illnesses:
transfer and get d10 infusion
353
Newborn at risk from maternal illnesses: Drug-dependent mother
s/s
extremely what
not what
t
y
s
what cry
Extremely irritable,
not sleeping,
tremors
, yawning,
sneezing,
high pitched cry
354
Newborn at risk from maternal illnesses: Drug-dependent mother
want to do what
what type of room
give what
Want to Swaddle,
low stimulation in room,
pacifier
355
Medications to control withdrawal symptoms-
give them what
monitor w what
Newborn at risk from maternal illnesses: Drug-dependent mother
give them morphine as well
ciwa-
356
Nutritional support in this
can you give them narcan
Newborn at risk from maternal illnesses: Drug-dependent mother
may not want to eat/eat all time
no narcan
357
Fetal alcohol spectrum disorder (FASD): how present
I
m
c p
what lip
failure
what iq
what damage
Newborn at risk from maternal illnesses: Fetal Alcohol Exposure
IUGR,
microcephaly,
cerebral palsy,
short palpebral fissure and thin upper lip,
failure to thrive,
impact on IQ,
CNS damage as evidenced by impulsivity, cognitive impairments, speech & language abnormalities
358
Cleft lip/palate
risk x2
Newborn care of child w/ physical or developmental challenge: GI complications
Malnutrition risk
Aspiration/pneumonia Risk
359
Cleft lip
D isues
s c issues
Dental issues
Speech clarity issues
360
cleft lip may have
complications from what
may need what d/t what
Surgical complications
Emotional support/facial deformity
361
Cleft lip
what can help decrease aspiration
may need what
may wait for what
There is some direct fit bottles that help decrease risk of aspiration
May need g tube
May wait for sugery
362
cleft lip/palalte
monitor w
monitor t
monitor r
gentle what post op
monitor wt
monitor temp
monitor resp
gentle suctioning post op
363
Omphalocele
Gastroschisis
what is difference
Internal organs are born externally but in a sac
Gastroschisis- not in a sac
364
what do you do in omphalocele/ gastroschsis
what right away
Want to cover these right away with sterile dressing/bag
Surgery right away
365
high risk for infection in omphalcole/ gastroschisis
place what
give them what
place ng tube in kids
give them antibiotics
366
omphalacele and gastroschsis
assess what- what if necessary
feed baby w what
what for warmth
what as much as possible
assess repository effort- cap/ bipap/ ventilator or intubation if necessary
feed baby w tpn
incubator for warmth
bond as much as possible
367
Tracheoesophageal Fistula (Esophageal Atresia)
milk can go where
resulting in what
Newborn care of child w/ physical or developmental challenge: GI complications
During feedings milk can fill the blind pouch of the upper esophagus and then overflow into the trachea, or fistula can allow milk enter the trachea resulting in aspiration
368
Tracheoesophageal Fistula (Esophageal Atresia)
what happens in this
Newborn care of child w/ physical or developmental challenge: GI complications
Upper and lower part of esophagus don’t meet up properly
369
Tracheoesophageal Fistula (Esophageal Atresia)
always watching for what
if they have this-> need what right away
Newborn care of child w/ physical or developmental challenge: GI complications
Always watch first feeds to make sure they can tolerate-
if they have any assessment findings that they have this then they need surgery right away
370
Spina Bifida
what happens in this
Newborn care of child w/ physical or developmental challenge: Neuro tube defects
Congenital condition in which the spinal cord does not develop properly due to incomplete closure of the neural tube
371
Spina Bifida
will be born how
lay them how after birth
Newborn care of child w/ physical or developmental challenge: Neuro tube defects
Born via c section-
lay them prone w butt in the air
372
Spina Bifida
risk factors
how prevent this
Newborn care of child w/ physical or developmental challenge: Neuro tube defects
Risk factors is lack of folic acid
want prenatal vitamins
373
Spina Bifida
how repair this
Newborn care of child w/ physical or developmental challenge: Neuro tube defects
Surgical repair
374
risk for what x3 in spina bifida
I
M
altered what
Infection Risk
Malnutrition
Altered Cerebral Perfusion
375
Care of the Family with birth of a high risk newborn
GREIF
Anticipatory grief
Acknowledgement of maternal failure
Resumption of process of relating to infant
Understanding special needs and growth patterns
376
vaginal delivery- stage 1
L-what cms--keep what
Awhat cms-what may happen
Twhat cms-wait until when
latent-0-3 cm- keep active
active-4-7- may rupture membranes
transition-8-10-wiat until 10 to push
377
stage 2 vagianl
do what/prevent what
assess
allow what
massage area to perevent tearing
assess pt
allow mom to push baby out
378
stage 3 vagianl
stage 4 vagianl
3- getting placenta out
4- mom time w baby
379
methotrexate
why used
methotrexate- chemo to treat ectopic
380
betamethasone
rhogam
metoclopromide
what used for
B- steroid used to develop baby lungs
R- used to prevent blood crossing in rh- mom to rh+ baby
M- treats n/v
381
Dinoprostone
oxytocin
tocolytic
terbutaline
what used for
D- ripens cervix
O- allows cervix to contract
toco- reverses oxy, allows uterus to slow
T-slows contractions
382
tocolytic meds exmaples
t
I
n
terbutaline
indomethacin
nifedipine
383
magnesium sulfate
calcium glutinate
MS- prevent seizures in preeclampsia
CG- reversal for magnesium toxicity
384
normal baby vitals
temp
hr
rr
bp
type of respirations
97.6-98.2
120-160
rr-40-60
80/40
irregular reputations
385
how to calculate due date
count back 3 months
add one week and boom
