Exam 3 review Flashcards
(207 cards)
1
Q
What are the four types of heat loss?
A
- Radiation
- Conduction
- Convection
- Evaporation
2
Q
What is radiation heat loss?
A
Heat loss due to heat transfer to cooler surfaces and objects not directly in contact with the body. Think heat lamp
3
Q
What is conduction heat loss?
A
Loss of heat to a cooler surface directly from skin contact.
Baby on moms chest warms; baby on cold table or bed
4
Q
What is convection heat loss?
A
Loss of heat from the warm body to the air (think wind/ac)
5
Q
What is evaporation heat loss?
A
Loss of heat when water on the skin is converted to a vapor.
Think wet baby
6
Q
What are the 3 physiologic adaptations of fetal circulation?
A
- Foramen ovale
- Ductus arteriosus
- Ductus venosus
7
Q
What is the #1 nursing priority in regards to the infant immediately after birth?
A
WARM, dry, stimulate; suction airway
8
Q
A premature infant is classified as an infant born before ___ weeks.
A
37 weeks
9
Q
How is circulation assessed in a newborn?
A
pulse ox/palpate femoral artery
10
Q
where is the pulse ox placed?
A
Right upper extremity; palm of hand
11
Q
What is a complication of supplying oxygen to premature infants?
A
retinopathy and prematurity of lungs
12
Q
The umbilical vein carries ______ blood to the baby in utero.
A
Oxygenated
13
Q
The umbilical arteries carry _____ blood to the placenta in utero.
A
Deoxygenated
14
Q
SGA (small for gestational age) is
A
An infant that is less than 10% of the birth weight.
15
Q
Maternal risk factors for SGA (8)
A
- malnutrition
- HTN
- smoking
- substance abuse
- DM
- cardiac/renal abnormalities
- young maternal age
- hx of small babies
16
Q
SGA infant complications (4)
A
- Congenital aspiration syndrome (meconium)
- Hypoxia
- Hypoglycemia
- Polycythemia (too many RBCs increased rx for clots)
17
Q
LGA (Large for gestational age) is
A
A baby born above 90th percentile
18
Q
Maternal Rx factors for LGA (3)
A
- DM
- Obesity
- hx of big babies
19
Q
LGA infant complications (6)
A
- birth trauma from vag: clavicle fracture depressed skull fracture cephalohematoma - fetal distress - hypoglycemia - hypocalcemia - prolonged labor - hyperbillirubemia
20
Q
IUGR (intrauterine growth restriction) is
A
Advanced gestation with limited fetal growth.
21
Q
Maternal Rx factors for IUGR (7)
A
- multiples
- smoking
- old
- poor nutrition
- substance abuse
- poor prenatal care
- HTN
22
Q
IUGR infant complications (8)
A
- meconium aspiration
- hypoxia
- hypoglycemia
- increased rx for infection
- cerebral palsy
- still born
- poor temp control
- motor/neuro disabilities
23
Q
Contraindications for breastfeeding (4)
A
- HIV/aids
- illicit drug/alcohol use
- TB
- Galactosemia
24
Q
How does an infant receive IgG (given)
A
Passive immunity; passed through fetus via placenta; received last four weeks of pregnancy; premes dont get this and are at increased rx of infection
25
How does an infant receive IgA (acquired)
Passive immunity; acquired through breastfeeding-colostrum; protects infants intestinal mucosa
26
How does an infant receive IgM (made by me/fetus)
Active immunity; cant pass through placenta
| Produced by fetus during 10-15wks gestation
27
What is PPH?
The loss of 500ml of blood vaginally or the loss of 1000ml csec
28
PPH Rx factors (7)
- HTN
- Placenta abruption/previa
- infection
- prolonged labor
- multips (multiple pregnancies=stretched uterus)
- bladder distention
- lrg baby
29
PPH interventions/tx (8)
- RUB FUNDUS
- remove fragments/clots
- uterine tamponade; balloon
- oxytocin
- hemabate
- lay pt flat
- trendelenburg
- check peripads frequently
30
What is a cervical laceration?
The tearing of the vagina during delivery/epis.
31
Cervial lac rx factors (6)
- forceps
- vaccum
- multiparous
- lrg baby
- oxytocin; speeds up labor
- vag delivery
32
Cervical lac interventions/tx (2)
-surgical repair
-sitz bath/self care
PREVENT INFECTION BIH
33
What is mastitis
Inflam./infection of breast tissue
| MOST COMMONLY CAUSED BY STAPH/STREP; a break in the skin
34
Mastitis s/s (6)
- pain
- chills
- fever
- malaise
- hard, warm, tender upper quadrant
- tachycardia
35
Mastitis rx factors (5)
- poor hand washing/hygiene
- unsupportive bra
- milk stasis
- poor latching/positioning
- poor feeding schedule
36
Mastitis interventions/Tx (6)
"Heat rest, empty breast)
- antibiotics
- good breast support/bra
- local heat
- analgesics
- improved hand washing/hygiene
- breastfeed/nipple care
37
What is HELLP syndrome?
H(hemolysis, which is the breaking down of red blood cells)
EL(elevated liver enzymes)
LP(low platelet count)
38
HELLP s/s (5)
- elevated liver enzymes
- low plt count
- flulike symptoms
- epigastric pain
- hemolysis
39
HELLP rx factors (2)
- severe preeclampsia
| - HTN
40
HELLP syndrome interventions/tx (3 drugs)
IV dexamethasone/betamethasone/mag sulf.
41
What is a puerperal infection?
| s/s (5)
Infections in the uterus during or after pregnancy; common postpartum affecting vagina or cervix
- foul smell
- abnormal discharge
- epigastric/vaginal pain
- fever
- subinvolution
42
Puerperal infection rx factors (4)
- DM
- prolonged labor
- PROM
- invasive procedures; fetal scalp electrode, foley, amniocentesis
43
Puerperal infection inteventions/tx (3)
- antibiotics
- rest
- continue to breastfeed
(nothing in vag)
44
What is PIH?
pregnancy induced HTN
45
PIH s/s (6)
- HTN
- proteinuria
- periorbital edema
- decreased urine output
- visual chngs
- HELLP
46
PIH rx factors (7)
- chronic HTN
- DM
- kidney disease
- hx of preeclampsia
- multiples
- primipara
- obesity
47
PIH interventions/tx (3)
- Treat HTN
- prenatal care
- seizure precautions
truly fixed w delivery
48
What is RDS? & two subtypes
Respiratory distress in newborn
TTN: transient tachypnea of newborn (fluid in lungs doesnt go away)
Meconium aspiration syndrome
49
RDS s/s (4)
- nasal flaring
- SOB
- tachypnea
- grunting
50
RDS rx factors (2)
- prematurity (surfactant underdeveloped)
| - csection
51
RDS interventions (for baby) (5)
- O2 via nc, oxyhood, cpap
- suction
- surfactant
- betamethasone if still in utero
- ABGs,VBGs,CBGs
52
PPH s/s (4ts)
Tone: uterine tone
Trauma: lacerations and uterine rupture
Thromboplastin: bleeding disorders
Tissue: retained tissue/placenta
53
Meds not compatible w breastfeeding
Methotrexate/cancer drugs, antimetabolites
54
What is pyelonephritis?
untreated UTI that travels up to kidneys
55
Pyelonephritis s/s (6)
- chills
- high fever
- flank pain
- N/V
- dec. urine output
- dehydration
56
Pyelonephritis rx factors(4)
- urinary blockage
- catheter
- UTI
- poor hygiene
57
Pyelonephritis tx (2)
IV antibiotics
| fluids
58
What is thrombophlebitis?
blood clot within the vein usually in legs
59
thrombophlebitis s/s (4)
- warm skin
- tenderness
- red skin
- calf pain
60
When does thrombophlebitis most commonly occur?
1st 6 weeks postpartum
61
thrombophlebitis rx (7)
- obesity
- smoking
- HTN
- varicose veins
- DM
- bedrest
- csec
62
Thrombophlebitis tx (4)
- heat
- NSAIDS/blood thinners
- exercise
- compression stockings
63
What are the two types of jaundice/hyperbilirubinemia?
Physiologic & pathologic
64
when does physiologic jaundice occur?
Occurs AFTER 24hrs of birth; usually ok- infant presents normal
65
when does pathologic jaundice occur?
Occurs WITHIN 24hrs of birth; could indicate underlying disease
66
How does pathologic jaundice present>
Newborn looks sick!
| flulike symptoms, anemic, yellow skin, dark urine, pale stool
67
Hyperbillirubinemia/jaundice rx factors (5)
- hematoma
- breastfed baby
- preme
- delayed cord clamping
- incompatible blood typing: Rh - mom Rh + baby, O- mom
68
Hyperbillirubinemia tx (4)
- phototherapy
- provide adequate nutrition
- increase fluids
- blood transfusion
69
What is cold stress?
Illness from the cold; infant cannot maintain body temp
70
Cold stress s/s (5)
- shivering stops
- hypoglycemia
- vasoconstriction
- limp
- lethargic
71
Cold stress rx factors (6)
- HTN
- DM
- cold environment
- IUGR
- Preme
- SGA
72
Cold stress tx (4)
- warm body; blanket, hat, skin to skin
- mo rectal temp
- mo bs
- O2 prn
SLOWLY REWARM
73
What is neonatal hypoglycemia?
Glucose less than 40
| we want 50-150
74
Neonatal hypoglycemia s/s (7)
- SHAKING
- pale skin
- apnea
- poor feeding
- poor body tone
- seizures
- lethargy
75
Neonatal hypoglycemia rx factors
- SGA
- IUGR
- Preme
- LGA
76
Neonatal hypoglycemia tx
- feed regularly
- IM glucagon
- IV dextrose
77
What is neonatal sepsis?
infection of neonate blood
78
Neonatal sepsis s/s (8)
- decrease in wbc
- poor temp control; decreased temp
- poor glycemic control
- tachy or brady
- mottled skin
- poor feeding; abdominal distention
- bleeding probs
- inconsolibility
79
Neonatal sepsis rx factors (2)
- preme
| - maternal UTI/STI
80
Neonatal sepsis tx
IV antibiotics
81
Ortoloni’s maneuver
tests for congenital hip dysplasia; manual procedure performed to rule out the possibility of developmental dysplastic hip; flex hips and knees 90 degrees
82
What is a Pavlik harness?
used to fix congenital hip dysplasia; put the infant in this for 23 1/2hrs a day until resolved to align the hips and joints; keeps hip at 90 degrees.
83
What is Gastrochisis
birth defect of the belly wall. Intestines are found outside the body.
84
what is a cephalohematoma?
rupture of capillaries during birth causes collection of blood on head; DOES NOT CROSS SUTURE LINES; increased rx for jaundice
85
what is Caput succadeum?
swelling or edema occurring in or under he fetal scalp during labor; DOES CROSS SUTURE LINES
86
What is reflex irritability?
This is the grimace response to stimuli
87
what is the Dubowitz exam?
physical/neuromuscular exam to assess for problems
88
What is taking in?
Mother is thinking about her needs and being dependent on the help of others
89
What is taking hold?
Mom is ready to take hold of the situation and care for her baby
90
What is transient tachypnea of the newborn
respiratory distress seen after delivery caused by fluid due to impaired clearance
91
3rd degree laceration
laceration extends through perineal skin
92
4th degree laceration
laceration extends through rectal sphincter
93
What is subinvolution?
failure of a part to return to its normal size after functional enlargement, such as failure of the uterus to return to normal size after pregnancy
94
What is endometritis?
infection of the endometrium/inner lining of uterus
95
what are the 3 newborn screening tests?
1. CHD
2. Newborn screen (metabolic)
3. Hearing
96
What is the CHD screening for?
screens for congenital heart defects; tetralogy of fallow & coarctation of the aorta
97
What is the newborn metabolic screening for?
- PKU
- Maple syrup urine disease
- hypothyridism
- CF
- galactosemia
98
What is a circumcision and why would the parents choose or decline?
Removal of an epithelial layer from the glans penis. May be done for religious reasons, or to be similar to the father; can reduce UTIS
99
circumcision complications
- infection
- obstruction
- hemorrhage
100
what are the methods of circumcision
1. gomco; cut right off
2. mogen; cut right off
3. plastibell; tied and falls off due to lack of circulation
101
Circumcision care (4)
- wipe with wet wash cloth once a day
- keep it clean
- dont pull it off
- keep vaseline on it so the diaper does not rub/irritate
102
What are the two congenital heart defects?
1. Tetralogy of fallow
| 2. Coarcation of aorta
103
How long is breastfeeding recommended for
6 months
104
5 benefits of breastfeeding?
- decreased rx of heart disease, DM, asthma, cancer
- less expensive
- baby gets more nutrients and antibodies
- decreased rx of allergies
- promotes maternal infant attachment
105
Toxoplasmosis is transmitted via
Raw meat or cat liter; crosses placenta
106
Toxoplasmosis is a
parasite
107
How is toxoplasmosis detected?
blood test/serology
| elisa
108
Toxoplasmosis tx
Spiramycin, folinic acid
109
How is hep b transmitted?
Iv drugs or sexual intercourse, can cross the placenta or transmit during delivery; blood
110
How is Hep B detected?
HbsAg antigen blood test
111
Hep B tx
Baby will be given immune globulin if mom is a carries after birth then vaccine
112
Rubella is a
virus
113
How is rubella transmitted
Mother who isn’t vaccinated; saliva or resp droplets
114
How is rubella detected?
Blood test; titer test
115
How is rubella treated
PREVENTION IS KEY
| vaccine given 1-3 months after pregnancy
116
GBS is
bacterial/viral
117
GBS is transmitted
to baby in birth
118
How is GBS detected
Vaginal or rectal culture during 35-37 wks; blood test
119
How is GBS tx
Use antibiotics prophylaxis, autoimmune meds, plasma exchange
120
What is CMV?
Cytomealovirus
121
CMV is transmitted via
Body fluids; Saliva, urine, breast milk, sexual intercourse
122
How is CMV detected
fluorescent antibody,complement fixation test
123
How is CMV tx
isolate infant, tx symptoms
124
What is HSV?
herpes simplex virus
125
How is HSV transmitted
Can be through sex or vaginal birth; BODY FLUIDS
126
How is HSV detected?
Serology blood test, cultures, pap smear
127
HSV tx
Viral therapy after 36 wks; acyclovir
128
What does APGAR assess?
- Appearance; skin color
- Pulse
- Grimace; reflex irritability
- Activity; muscle tone
- Respirations
129
What is the perfect APGAR score?
10
130
What is the most common APGAR score and why?
9; acrocyanosis
131
Normal infant appearance
Pink, crying, fussy
132
Abnormal infant appearance
blue, silent, limp
133
When should the infants cord be cut?
cut when done pulsing but mom still contracting; not immediately but not too late
134
what is the infant at risk for if the cord cutting is delayed?
increased risk of jaundice
135
how is an infants glucose assessed?
heel stick on side of foot to avoid hitting a nerve
136
In utero the placenta belongs
partly to mom and partly to baby
137
what is the purpose of the foramen ovale in utero?
Separates R & L atria; allows blood to go from R atria to L atria due to high pressure and resistance in lungs.
138
Neonate lungs (in utero)
High pressure; higher on R side
| Lungs and liver are not used
139
Ductus arteriosis in utero
allows blood to travel from pulmonanry artery to aorta and then the rest of the body.
140
The pulmonary artery has ____ pressure due to _____ resistance in lungs forcing blood into the aorta.
high pressure, high resistance
141
the umbilical artery brings blood back from the aorta to the _____.
placenta
142
After birth the placenta is
removed from fetal circ.
143
What happens to the ductus venosus after birth?
it closes
144
How does the ductus venosus close?
umbilical cord cut-->whartons jelly contracts around vessels when temp falls-->low resistance to high resistance-->blood in umbilical vein and ductus venosus starts clotting off & blood flow is decreased.
145
After birth what do the lungs do?
take in air; first breath pushes fluid out of lungs,O2 lvls increase
146
What happens to the ductus arteriosus after birth?
It closes
147
Ductus arteriosus closing patho
Muscles constrict during 1st few hrs of life-->body sense increase of O2 in blood-->prostaglandins produced by placenta are no longer present-->DA closes
148
prostaglandin production keeps the ________ open
ductus arteriosus
149
why should moms not take NSAIDS during pregnancy
they are prostaglandin inhibitors; can affect fetal circ.
150
What does oxytocin/pitocin do pp
treats PPH; makes uterus contract
151
Oxytocin need to know
- administer IV/IM
| - H2O intoxication- no IV bolus
152
What does methylergonovine/methergine do?
Assists in the delivery of the placenta and assists in controlling/preventing PPH.
153
Methylergonovine/methergine need to know
Contraindicated for HTN/preeclampsia pts.
NEVER ADMIN TO NEWBORN
Monitor BP, fundal height, lochia
Do not smoke during administration
154
Carboprost, Tromethamine/hemabate is used pp for
Treats/prevents postpartum hemorrhage, reduces blood loss secondary atony
155
Carboprost, Tromethamine/hemabate need to know
```
Contraindicated for asthma patients.
Max dose 12mg
Max duration of use 48hrs
Admin in large muscle
Mo. Uterine status; bleeding
Delay breastfeeding for 24hrs following administration
```
156
Misoprostol/cytotec is used pp for
to prevent/control pph
157
Misoprostol/cytotec need to know
Do not give pitocin less than 4 hrs after administration
| Administer only when FHR and uterine activity can be continuously monitored
158
What is mag sulfate used for pp
pre-eclampsia/eclampsia
159
Mag sulfate need to know
Administer IM into gluteal site, teach patient about their condition and what the drug is being used for, assess for magnesium toxicity- antidote sodium gluconate.
160
What is rhogam used for pp
This drug is administered postpartum if mom and baby have different blood types, more specifically if baby is positive for Rh cells. This drug prevents the body from attacking the Rh positive fetus or antigens in the body when pregnant, a final dose is given postpartum.
161
What is erythromycin opthalmic ointment used for?
To prevent any infections being transmitted to the newborn following delivery.
162
Erythromycin ophthalmic ointment need to know
STATE MANDATED
Coat each eye in a thin line of ointment, assess for diarrhea and ensure adequate fluid intake if diarrhea occurs. Know s/s of possible infection.
Wash hands immediately after
Do not irrigate eyes
163
Vitamin K Phytonadione pp is used for
Newborns are commonly born vitamin K deficient; vitamin K is important as it plays the role of a major clotting factor. Since newborns don’t have this on their own it is important to give them this vaccine to enhance clotting and decrease any risks of bleeding.
164
Vitamin K need to know
Given IM vastus lateralis; one time dose one hr after birth, monitor for bleeding and bruising.
If mom was on coags during pregnancy an additional dose should be given
Administer before circumcision
165
Hep B vaccine pp is used to
To prevent the newborn from contracting hep B from birth or others.
166
Hep B vaccine need to know
Administer within 24hrs but no later than 7 days old. Drug should be clear and slightly amber. IM injection.
Delay administration if pt has active infection
167
How should the fundus decrease following delivery?
1 centimeter per day; after delivery, should be under umbilicus
168
if the fundus is left or right what does it indicate?
full bladder
169
If the fundus is boggy the nurse should
massage it until it is firm
170
When using phototherapy on an infant what should the infant be wearing?
eye goggles and genital covering; mo hydration
171
Breastmilk comes in ____ colostrum comes in _____
2-5 days, right away
172
If the mom is not planning to breastfeed the mom can prevent by
- wear a well fitted bra; binder
- cold compress
- dont stimulate nipples; no shower water
173
the more preterm an infant is the more ___ they have
lanugo
174
in a preterm male the ___ have not descended
testes
175
if the fundus is firm but the patient is still bleeding this can indicate
retained fragments
176
baby blues are ___ and last about ____ weeks
normal, first 1 to 2 weeks
| due to fluctuating hormones
177
postpatum depression is ____ and occurs ____ weeks
abnormal, 3 to 4 weeks
178
postpartum psychosis
voices telling u to kill baby
179
How do you know baby is latching well?
baby has more areola, audible swallowing
180
mom will express ___ if latching is wrong
pain
181
breast care
clean after breastfeeding no soap; just water and dry
182
Do not warm formula in the ____
Microwave
183
bottle fed feces
sticky; strong odor
184
breast fed feces
liquidy yellow green; smells sweet
185
Increased sweating after delivery is ___
normal; body trying to get rid of extra fluid
186
what birth control delays breastmilk production
depo
187
breastfeeding babies should be fed every
2-3hrs
188
Pill is
estrogen/progesterone
189
mini pill is
progesterone
190
depo is
progesterone
191
nuvaring is
estrogen/progesterone
192
red brick dust is caused by
uric acid crystals in the urine
193
normal newborn resp
30-60
194
normal newborn hr
120-160
195
normal newborn temp
97.8-99
196
what is the blink reflex
newborn reflex stimulated by flash of light- response is blinking
197
pupillary reflex
pupils should constrict
198
moro/startle reflex
response to sudden movement/loud noise should have symmetric extension of extremities
199
rooting reflex
stroke infants cheek should attempt to feed
200
palmar/plantar grasp
fingers and toes grasp
201
stepping reflex
when baby is held upright one foot should step
202
babinski reflex
fanning and extension of all toes when heel is stroked upward
203
babys head should be 1-2cm greater than
chest circumfrence
204
pp moms can have a temp of ___ and be okay, ___is concerning
100.4, 100.6
205
BUBBLEHE
```
Breasts; size, shape, engorgement
Uterus; firm or boggy?
Bladder; tender or distended?
Bowel movement?
Lochia; amount, odor, color, clots
Episiotomy; location, stiches, edema, redness
Homans sign; positive?
Emotional status; bonding?
```
206
What does a positive homans sign mean?
DVT
207
newborn weight loss in the first 3-4 days
5-10%= normal
