FINAL EXAM Flashcards

Question

Fetal Reserves

Answer 1

When O2 decreses blood flow is deferred to vital organs. if placental reserves are depleted fetus may not be able to adapt or tolerate decreased O2 during contraction

Answer 2

1. increment = begining 2. Acme = peak 3. decrement = decrease; relaxation the resting tone is critical to return O2 to baby after contraction - <20 mmHg Freq: how often Duration: how long

Answer 3

Must include 1+ regular phasic uterne contraction that increase in freq + intensity + progressive effacement + dilaion. Factors: uterine stretching -- release of prostaglandins Oxytocin release - increase contractility decrease progesterone - inhibits contraction increase prostaglandin Cortoisol release inhibit prog and increase prost placental aging

Answer 4

Process of admin of a drug for purpose of inhibiting uterine contractions. Main goal is to stop labor long enough to get steroids to mature lungs Contradictions: Severe HT or preeclampsia fetal compromise fetal death anomaly incompatible with life lungs are mature Types: Beta-adrenergic agonist Mg Sulfate Ca Channel Blockers --> Nifedipine/Procardia Prostaglandin inhibitors

Answer 5

Beta-adrenergic Agonist Promotion of smooth muscle relaxation IV or SubQ -> RAPID ONSET Side Effects: Maternal + fetal tachy PE Hyperglycemia + hypokalemia hypot Cardiac insufficiency + arrhythmias myocardial ischemia maternal death

Answer 6

Prevents Ca into the myometrial cells --> uterine relax + CNS depressant USED FOR FETAL NEUROPROTECTION NOT TOCOLYSIS SE: maternal flushing, headache, nausea, blurred vision Toxicity Loss of deep tendon reflexes loss of consciousness Respir <7 PE Hypot Cardiac arrhythmias CALCIUM GLUCONATE 1g IV over 3 min

Answer 7

ANTIINFLAM -> powerful prostaglandin synthesis and readily crosses placenta adjunt therapy with other tocolytic therapy -- Mg - oral or rectal Prolongs preg for 48-72hrs could close ductus arterious if admin >32wk, Nectrotizing enterocolitis, hemorrhage + renal failure

Answer 8

Nifedipine - smooth muscle relaxer + potent vasodilator SE: hypot, flushing, headache, tachy, nausea, dizziness, palpitation

Answer 9

Corticosteroids --> stimulate lung maturity Only evidenced based rational for tocolysis Can last 1wk and can be repeated

Answer 10

Stopping contractions Activity restriction + bed rest ---> be aware of DVT and PE Left side to promote perfusion to uterus avoid sex hydration --> dehydration stims pituitary to secrete ADH and Oxytocn treat infection + have patient report abnormal findings vitals monitor FHR and contraction pattern -- if tachy for a prolong period could be infection

Answer 11

Infections of the urinary tract, vagina, or chorioamnionitis (infection of the amniotic sac) * Previous preterm birth * Multifetal pregnancy * Hydramnios (excessive amniotic fluid) * Age below 17 or above 35 * Low socioeconomic status * Smoking * Substance use * Domestic violence * History of multiple miscarriages or abortions * Diabetes mellitus or hypertension * Lack of prenatal care * Recurrent premature dilation of the cervix * Placenta previa or abruptio placentae * Preterm premature rupture of membranes * Short interval between pregnancies * Uterine abnormalities

Answer 12

Abnromal, long and/or difficult labor as related to the passenger, power, passageway or psyche

Answer 13

contractions don't produce progressive dilation, effacement and descent of the presenting part; quantified as the # of contractions in a 10 min window avg over 30 mins Hypotonic: Arrest of descent/dilation need to amniotomy --> AROM Oxytocin augmentation overdistention -- hydaminos + multiparty; must deliver at risk for cord prolapse and infection Tachysystole: ineffective / erratic contraction pattern >5 contractions in 10 min time/ 30 mins with less than 60 s of relaxation --> related to stress + anxiety Ineffective dilation or pushing fetal deoxygentation uterine rupture

Answer 14

rapid labor, is defined as giving birth after less than three hours of regular contractions

Answer 15

abnormal presentation Malposition: - posterior Malpresenation: brow face breech transverse

Answer 16

Cephalopelvic disproportion: fetal head is larger than the maternal pelvic diameter - lack of descent w. strong contractions - prolonged labor Shoulder dystocia --> EMERGENCY! assistance: use forcepts or vacuum (unless <34wks)

Answer 17

Forceps Vacuum risk: succedaneum, hematoma, intracranial hemorrhage

Answer 18

Pitocin - stimulates contractions --> drug med error = injury ; lack of timely recognition Must be medically necessary; preeclampsia, postterm hemorrhage, prom, Contra: transverse lie, scarring, cephalopelvic, previa, herpes, cord prolapse Caution: fetal distress, premature, overdistention want to make sure that cervix is ripe >8 Bishop score SE: increase contraction, resting tone, HR, decrease BP, water intoxication ICP increase, fetal tachy Risk: ftal hypoxia, uterine rupture, abruption, hemorrhage, fetal hyptot

Answer 19

32% and increasing; performed because of factors related to mother: diabetes, CD, preeclampsia, infection, dystocia, herpes fetus: distress, malpresentation, position, anomalies + other Classic: vertical: increased risk of uterine rupture in subsequent pregnancies and labor Transverse: Pfannenstiel's most common Risk: infection, hemorrhage, thrombophlebitis, atelectasis Post Op care: pain respir f(x) I&O Incision bowel f(x) circulation psychological response

Answer 20

Anterior fetal shoulder is behind the pubic bone of the mother Risks: Fetal macrosomia >4000 diabetes obesity previous shoulder dystocia McRoberts Postion: pelvis tilt orienting symphaysis more horizontally to facilitate should delivery

Answer 21

umbilical cord drops down alongside or infornt of the presenting part. This can reduce the circulation to the fetus --> vasoconstriction and resultant fetal hypoxia, which can lead to fetal death or disability if not rapidly diagnosed and managed Care: Trendelenburg or knee-chest. to relieve pressure, elevate part with STERILE gloved hand. IF CORD IS VISIBLE DO NOT TOUCH, cover with warm, sterile, saline soacked gauze and continuously assess FHR

Answer 22

Amniotic fluid escapes into the maternal circulation --> open sinus of the placental site Can be fatal to the mother; amniotic fluid has debris, lanugo, vernix, meconium Signs: dyspnea, chest pain, cyanosis, shock Interventions: delivery, CV and Respir support

Answer 23

* Postpartum Hemorrhage * Complications of breast feeding * Postpartum Infections * Endometritis * UTI * Mastisis * Wound Infection * Thrombophlebitis * Pulmonary Embolism * Postpartum Psychiatric disorders

Answer 24

most common - 2.9% ~ 183% increase - 125,000 affected ONE OF THE ONLY COUNTRIES WHERE MATERNAL DEATH + INJURIES ARE INCREASING * Blood loss >500mL after vag * >1000mL after C/S Early Hemorrhage: first 24hrs after delivery; atony Late: 24hrs - 6wks after; retaining of placental tissue Causes: 1. Tone: uterine atony; overdistention, infarction, rapid labor, placental abnormality, polyhydraminos, fatigue, Pitocin, NSAIDs, anesthetics, Mg Sulfate + placenta at the lower segment of the uterus (doesn’t contract as well) 2. Tissue: retained placenta; commonly with accreta + previa 3. Trauma: damage to the genital tract spontaneously or manipulation/ cerival laceration - forceps DON’T EVER ATTEMPT WITHOUT THE CERVIX BEING FULLY DILATED Thrombin/Clotting: clotting abnormalities; hemophilia, Von Willebrand, HELLP, abruption, DIC or sepsis Hematomas can present as pain or as a change in vital signs disproportionate to the amount of blood loss. Uterine rupture: most common in women who have significant uterine scarring

Answer 25

Risk Factors of PPH * Uterine over-distention - multiple, LGA, polyhydraminos, clots * Previous PPH * Anesthesia or MgSO4 * Additional drugs used to make the uterus relax - nifedipine, terbutaline * Operative birth/ assisstive device - vacuum, forceps * Trauma * Grand multiparity * History of maternal anemia + hemorrhage * Infection * Uterine inversion or rupture * Previa or accreta * Abnormal labor pattern (hypotonia/hypertonic) * Retained placenta * Prolonged labor or fast * Obesity * Oxytocin admin during labor

Answer 26

Signs of impending Hemorrhage * Excessive bleeding >2 pads/30-1hr; 1 pad >15mL * Light headedness, nausea, visual disturbances * Anxiety, pale/ashen, clammy * Elevated HR, respir rate and or same/lower BP; you'll see pulse elevation before BP drop -- change in vital signs is a late sign of hemorrhage =MAP = A MAP of 60 is necessary to perfuse coronary arteries, brain + kidneys; usual = 80-110 * Hematomas - 3-500mL of blood; often feel like they need to have a bowel movement due to the pressure

Answer 27

Interventions * Risk assessment * Inspect placenta * Avoid overmanipulating of uterus - don't want to tire out * Active Management: Pitocin @ 3rd stage of labor to promote uterine contraction * If at risk make sure blood match + have IV access * Fundal massage if they begin to hemorrhage to firm up the uterus * Empty bladder to prevent overdistrention Medications: Oxytocin, Cytotec, Methergine, Hemabate Oxytocin: Produces uterine contractions, vassopressive + antidiruetic. SE: water intoxication - ADH like behaviors, NV Conta: none if for PPH 10-49u/500-1000mL >500mL/hr titrated; 10-20mL IM WATCH FOR BLEEDING + TONE Methergine: sustained tetanic uterotonic effect that reduces bleeding and shorten the 3rd stage of labor. SE: HT, Hypot, NV headache Contra: HT, cardiac, preeclampsia .2mg IM up to 5 doses 2-4hrs CHECK BP Before giving don’t give if >140/90 watch bleeding Misoprotol/Cytotec: Synthetic prostaglandin analog. Mixed results for uterine atony but used for reducing risk of GI ulcers by NSAIDs SE: headache, NVD, fever, chills Contra: allergies to prostaglandins 100 - 200mcg tabs -- 600 - 1000mcg rectally or sublingually Monitor bleeding + tone Hemabate: prostaglandin similar to F2-alpha but has a longer duration. Produces myometrial contractions SE: headache, NVD, fever, tachy, HT, fever Contra: Asthma, HT .25mg IM or intrauterine Monitor Caregivers underestimate blood loss by 50% Most woman are healthy can tolerate blood loss - since most patients give birth doral recumbent need a lot of blood loss before the effects are felt.

Answer 28

Puerperal sepsis: any infections of genital canal within 28 days after abortion or birth * occurs within 28 days after and 6 wks, on 2 successive days within the first 10 days postpartum not including the first 24hrs * Commonly in C/S * Leading cause of maternal morbidity + morality worldwide Pathogens: normal vaginal, cervical or bowel organisms - GBS or E.Coli Characterized by * Temperature >100.4 at least 2/10 days post birth * >101 within first 24hrs Common infections: 1. Endometritis 2. Wound infections 3. UTI 4. Mastitis 5. Respir Prevention: 1. Handwashing 2. Perineal hygiene 3. Antibiotic administration 4. Wound management 5. Breast care Risk Factors Preconception * History of previous venous thrombosis, UTI, mastitis, infection * Diabetes * Alcoholism * Drug abuse * Immunosuppression * Anemia * Malnutrition Risk Factors Intrapartum * Prolonged labor * Poor aseptic technique * Birth trauma * C/S * Prolonged ROM * Chorioamnionitis * Bladder catheterization * Internal fetal/uterine pressure monitoring * Vaginal examinations after ruptured membranes * Epidural anesthesia * Retained placental fragments * PPH * Episiotomy + lacerations * Hematomas

Answer 29

- most common cause of postpartum infection * Begins as localized infection but can spread -- outside uterine cavity Higher risk if C/S Symptoms 1. Lower abdominal tenderness + pain 2. >100.4 temp + Chills 3. Foul smelling lochia 4. Tachycardia 5. Subinvolution Treatment * Broad spectrum antibiotic - take cultures * Analgesia * Emotional support Incidence: <3% Vag; 10-50% C/S Interventions: * Monitor vitals q4h * Assess for abdominal pain * Monitor lab values, CBC, blood cultures, sed rate * Antibiotics * Increase fluid intake SEMI FOWLERS + AMBULATION = uterine drainage

Answer 30

* Most commonly at site of incision * Episiotomy + laceration infections occur less often; symptoms 24-48 hrs * Aseptic wound management * Frequent perineal pad changes * Good handwashing Admin antibiotic + analgesics

Answer 31

Engorgement, cracked nipples + blocked ducts are increased risk of mastitis * A sign of engorgement = poor feeding -> good latching best form of prevention of engorgement = warmth/ warming pad and ice after breastfeed, breast massage * Cracked nipples = poor latch, baby should feed on other nipple =lanolin, hydrogeal disks, education on proper latch * Plugged ducts = inadequate removal of milk from underwire bra, clothing baby should feed on other side Mastitis: influenza like symptoms * It can happen any time, most commonly with lactating * Happens in the upper outer quadrant, can be both breasts most commonly unilateral * Caused by S.aureaus, can enter through cracked nipples, engorgement + stasis of milk come before Treatment: antibiotics, continue to breastfeed, warm compress

Answer 32

straight cath > indwelling = avoid CAUTI * Frequent cervical exam in labor * Anesthesia can cause urinary retention = stasis * GU injury * C/S * Atonic bladder + urethra post delivery Lower UTI * Dysuria * Urgency + Frequency * Suprapubic pain * Low grade fever * Hematuria * Cloudy + smelly urine Upper UTI * Pyelonnephritis * Develops 3-4 days * Chills + fever * Costovertebral angle tenderness * Nausea + vomiting Symptoms + Treatment * Burning + pain urination * Lower adnominal pain * Low grade fever * Flank pain * Proteinuria, hematuria, bacteriuria nitrates + WBC Assess vitals Q4H >fluids + I&O Antibiotics, antipyretics, antispasmodics, antiemetics Rest

Answer 33

formation of blood clots inside blood vessel 1. Superficial thrombosis: involves the veins of the superficial saphenous system 2. Deep thrombosis: lower extremities 3. PE: complication of DVT Causes: venostasis + hypercoagulation Declining due to early ambulation Risks: >fibrinogen, hx of DVT, increased parity, obesity, >35, immobility, C/S, tissue trauma, blood other than O, dehydration

Answer 34

Assess for hot, red painful, edematous areas of lower extremities + groin >100 temp HOMAN CONTRA BECAUSE YOU CAN DISLODGE CLOT Treatment: analgesics rest + elevation superficial DVT: heparin + coumadin PE SS: dyspnea, sweating, pallor, chest pain, cyanosis, confusion, tachypnea, cough, temp, sense of impending death Treatment: elevate head of bed, O2 8-10L, clot busters

Answer 35

* Have implications for mother, newborn + family, can interfere with the attachment + integration, can threaten the safety/ well being Postpartum Depression - 10 -20%; first 3 mo - 1 yr * Intense, pervasive sadness * Labile mood swings * Intense fear, anger, anxiety * Unable to care for self or infant * Irritability --> violent outburst * Rejection of infant * Obsessive thoughts Treatment: Edinburgh Scale, Postpartum depression scale * Depression responds best to a combo psychotherapy, medication, social support Postpartum Psychosis - rare but immediately needs to be treated, psychiatric emergency * Depression, delusion, bizarre + irrational behavior, thoughts of harming self + infant * Predictors = hx of bipolar or postpartum psychosis * Risk of homicide + suicide is high Antipsychotics + mood stabilizers = lithium

Answer 36

Alcohol - most common Abnormalities in brain and neuron development LBW Prematurity Fetal alcohol syndrome Leading cause of mental retardation Cocaine maternal cardiac events Abruption of Placenta** Fetal effects = vasocon + neuroexcitation Opioids Withdrawal - NAS *should not immediately give narcan as infant will immediately go into withdrawal Tobacco Decreased fertility Increased risk of miscarriage Placenta Previa IUGR long term cognitive function + risk of brain damage

Answer 37

The primary concern for any woman with this disorder is controlling the balance between insulin and blood glucose levels to prevent hyperglycemia or hypoglycemia. Women with gestational diabetes are at an increased risk of complications during pregnancy and delivery. Gestational: If glucose cant get into the cell Note signs of hyperglycemia (confusion, increased thirst, frequent urination, changes in visual acuity) or hypoglycemia (dizziness; tremors; lethargy; excessive sweating, pale, cool, moist skin).

Answer 38

Severe NV that causes dehydration, electrolyte imbalance + acid/base imbalance, starvation ketosis + weight loss. -hypokalemia + natremia - decrease urea Peaks @ 9-20wks Cause: increase of HCG, prog, + E, h.pylori, ambivalence towards preg. Findings: ● Vomiting that may be prolonged, frequent, and severe ● Weight loss, acetonuria, and ketosis ● Signs and symptoms of dehydration including: ● Lightheadedness, dizziness, faintness, tachycardia, or inability to keep food/fluids down for more than 12 hours ● Dry mucous membranes ● Poor skin turgor ● Malaise ● Low blood pressure Management: IV Hydration B6 or vitamin B6 plus doxylamine Laboratory studies to monitor kidney and liver function Correction of ketosis and vitamin deficiency should be strongly considered. Dextrose and vitamins, especially thiamine, should be included in the therapy when prolonged vomiting is present

Answer 39

hydatidiform mole is a benign proliferating growth of the trophoblast in which the chorionic villi develop into edematous, cystic, vascular transparent vesicles that hang in grapelike clusters without a viable fetus. hydatidiform moles are benign, but they sometimes become cancerous. Having one or more of the following risk factors increases the risk that a hydatidiform mole will become cancer. Partial: may have some fetal tissue Complete: no fetal tissue Risk <20 yrs >35 yrs Previous molar preg Risk for woman increased risk of choriocarcinoma Assessment: bleeding + uterine enlargement (big for gestational age) Anemia NV Ultrasound to diagnose Treatment: immediate evacuation with aspiration + suction Nursing actions no preg for 1 yr, monitor for malignancy

Answer 40

Hypertension is identified as systolic pressure 140 mm Hg or greater or diastolic pressure 90 mm Hg or greater. Hypertensive disorders of pregnancy are the most common complication of pregnancy, affecting 10 percent of pregnant women, and are the second leading cause of maternal death and a significant contributor to neonatal morbidity and mortality. ● Preeclampsia is a multisystem hypertensive disease unique to pregnancy, with hypertension accompanied by proteinuria after the 20th week of gestation. Eclampsia is the onset of convulsions or seizures that cannot be attributed to other causes in a woman with preeclampsia. ●Chronic hypertension with superimposed preeclampsia includes the following scenarios: Women with hypertension only in early gestation who develop proteinuria after 20 weeks of gestation. Women with hypertension and proteinuria before 20 weeks who develop a sudden exacerbation of hypertension, ● Gestational hypertension: Systolic BP ≥ 140/90 for the first time after 20 weeks, without other signs and systemic finding of preeclampsia ● Chronic hypertension: Hypertension (BP ≥ 140/90) before conception. High blood pressure known to predate conception or detected before 20 weeks of gestation Treatment: ● Magnesium sulfate, a central nervous system depressant, has been proven to help reduce seizure activity without documentation of long-term adverse effects to the woman and fetus. ● Antihypert ● Assess CNS changes, visual, reflexes Risks for Woman ● Cerebral edema/hemorrhage/stroke ● Disseminated intravascular coagulation (DIC) ● Pulmonary edema ● Congestive heart failure ● Maternal sequelae resulting from organ damage include renal failure, HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), thrombocytopenia and disseminated intravascular coagulation, pulmonary edema, and eclampsia (seizures), hepatic failure ● Abruptio placenta ● Women with a history of preeclampsia have a 1.5 to 2 times higher risk of developing heart disease later in life ● obesity ● Chronic HT, kidney disease, lupus, diabetes Fetal Risk: ● Fetal/neonatal morbidity and mortality are consequences of intrauterine growth restriction (IUGR), prematurity, and placental abruption. ● Fetal intolerance to labor because of decrease placental perfusion ● Stillbirth

Answer 41

Increases the demand for cardiac output Demand on the heart increases -- 50% Signs cardiac issues are worsening Progressive generalized edema Crackles at bases of lungs Rapid, weak irregular pulse (100 bpm or higher) Difficulty catching breath Cough Increased fatigue Care: EKG + FHR Anticoag: warfarin + heparin O2 + Pulse Ox Pain management Make sure placenta is properly perfused AVOID FLUID OVERLOAD NO METHERGINE

Answer 42

Methadone: Most common in pregnancy Buprenorphione: less side effects than methadone Naltrexone: opioid antagonist

Answer 43

Type1 : body isnt making insulin - body attacks destroys insulin producing cells. Autoimmunity of beta cells of the pancreas resulting in absolute insulin deficiency and is managed with insulin. About 5%-10% of patients diagnosed with diabetes are type I Type 2: body is producing enough insulin but not properly produced overweight can't stop insulin production. fat deposits on cell can't open. Characterized by insulin resistance and inadequate insulin production. This is the most prevalent form of diabetes and is linked to increased rates of obesity and sedentary lifestyle. It is managed primarily with diet and exercise; the addition of oral antihyperglycemic or insulin may be indicated if hyperglycemia continues. - glucose can't get into cells + trys to get rid of extra w. kidney Challenge to manage because of HPL P HgH Corticotropin-releasing hormone Shift energy source from ketone -> free fatty acid Treatment: Euglycemic control minimize complication prevent prematurity -> keep the lowest possible glycosylated hemoglobin w/o going into hypoglycemia Cardinal Signs Polyuria Polydipsia Weight Loss Polyphagia Changes of insulin during pregancy 1st Tri: decreases 2nd-3rd: rises HPL + Somatropin - hormones from the placenta create insulin resistance

Answer 44

Macrosomia -- BIG baby >5000g - baby is big but isnt as mature IUGR RDS

Answer 45

Regular contractions of uterus resulting in changes in the cervix before 37 wks PTB = 20 -36 wks Leading cause of neonatal mortality Spontaneous: unintentional/planned delivery before 37wks --> can be caused from inflam + infection Medically Indicated: Provider recommends preterm birth -- preecalmpsia Nonmedically indicated: Elective (NOT RECOMMENDED) Risks: Multiple gestation Uterine/cervical abnormalities Fetal anomalies Hydramnios + Oligohydraminos Infection Premature rupture of membranes HT, Diabetes, clotting disorders <17yrs or >35 yrs Obesity Smoking + illicit drug use Contradictions: Intrauterine fetal demise Lethal fetal anamoly nonreassuring fetal status Severe preeclampsia + eclampsia Chorioamnionitis Warning signs: Water breaks decrease fetal movement Increase vaginal discharge Fever

Answer 46

Late Preterm: Born 34-37wks Very Preterm: <32wks Viability: @ 25wks Perviability: 40% of infant deaths 20-25wks

Answer 47

describe the inability of the uterine cervix to retain a pregnancy in the absence of the signs and symptoms of clinical contractions, or labor, or both in the second trimester

Answer 48

Preeclampsia is a kind of high blood pressure some women get after the 20th week of pregnancy or after giving birth. s high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working normally. Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body. High blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy. Imbalance of vasodilator hormones (prostacyclin) and vasoconstrictor hormones (thromboxane) - Leading cause of maternal death - 20wks 140/90 @ least 4 hrs apart + proteinuria >300mg or new systemic disease. “PREECLAMPSIA WITHOUT SEVERE FEATURES” (MILD) “PREECLAMPSIA WITH SEVERE FEATURES” (SEVERE) Diagnosis Criteria >140/>90 mmhg after 20 wks proteinuria thrombocytopenia <100,000 renal insufficiency impaired liver f(x) PE Visual symptoms High Risk: >35 yr AA + low socioeconomic previous preeclampsia with another preg pregnant w. multiples have diabetes + HT, kidney disease, AI obese GTD SS Headache that doesnt go away Blurred vision Epigastric pain trouble breathing NV swelling in face + hands weight gain - 2-5lbs per week Proteinuria Thrombocytopenia Renal insufficiency Impair live function Pulmonary edema Visual symptoms Risk for fetus Morbidity intolerance of labor still birth placenta abruption IUGR Low birthweight Treatment Early detection Delivery monitor Hydra Liz one Mg sulfate Oral nifedipine Labetalol Consequences Maternal w. eclampsia 20% morality rate -- can occure up to 48hrs post increase risk of - abruptio placenta - retinal detachment - acute renal failure - cardiac failure - hemorrhage + stoke Consequences Fetal Fetal growth retardation Hypoxia Death

Answer 49

+1 fetus - either from the fertilization of one zygote that subsequently divides (MONOZYGOTIC) or fertilization of multiple ova. ● Monozygotic twins are from one zygote that divides in the first week of gestation. They are genetically identical and similar in appearance and always have the same gender. ● Dizygotic twins result from fertilization of two eggs and may be the same or differing genders. If the fetuses are of differing gender, they are dizygotic and therefore dichorionic. ● Either of these processes can be involved in the development of higher order multiples.

Answer 50

Temperature Tone Tremors Excoriation Nasal Stuffiness https://www.thecalculator.co/health/Finnegan-Score-For-Neonatal-Abstinence-Syndrome-(NAS)-Calculator-1025.html

Answer 51

* Supports infants and mothers rooming in together during infant hospitalization * Focuses on non pharmacologic treatments * Increases breastfeeding rates of opioid exposed newborns (OEN)s * Decreases pharmacologic treatment and duration of treatment for OENs * Decreases the average length of stay (LOS) for OENs.

Answer 52

Blood glucose is elevated but below clinical threshold Components: Central adiposity > 35 in Dyslipidemia Hyperglycemia HT Maternal Risk: DKA - 2nd tri HT Spontaneous Abortion Polyhydramnios Induction of Labor UTI, Hypergly, Postpartum, post hemorrhage exacerbation of diabetes symptoms Fetal Risk: Congenital defect Prematurity Hypogly, cal + mag asphyxia respir distress Still birth hyperbilirubinemia polycythemia ● Development of metabolic syndrome, prediabetes, and type II diabetes ● Impaired intellectual and psychomotor development

Answer 53

hormone made by the placenta prevents the body from using insulin effectively. Glucose builds up in the blood instead of being absorbed by the cells. insulin less effective, a condition referred to as insulin resistance Two main contributors to insulin resistance are: ● Increased maternal adiposity ● Insulin desensitizing hormones produced by the placenta risk: <25 yr HT, PCOS Increase in maternal adiposity insulin desensitizing hormone Family history/ age/ race/ obesity history of macrosomia Diagnosis: glucose testing 24-28 wk Complications: Macrosomia Shoulder dystocia HT + preeclampsia preterm birth + stillbirth C-section Risks for baby excessive birth weight preterm breathing difficulties hypoglycemia obesity + type 2 later in life stillbirth hyperbilirubinemia birth trauma RDS Prevention: maintain healthy lifestyle, keep active, don't gain more weight than recommended Findings: Glucose screening 24-28 wks of gestation Management: For most women with GDM, the condition is controlled with a well-balanced diet and exercise. ● Up to 40% of women with GDM may need to be managed with insulin. ● Oral hypoglycemic agents may be used, but there is not agreement on their recommended use during pregnancy. ● Cesarean birth is recommended for estimated fetal weight >4,500 g. ● Women with GDM need to be monitored for type 2 diabetes after the birth. Nursing Actions: Teach the woman to test glucose four times a day, one fasting and three postprandial checks/day (suggested glucose control is to maintain fasting glucose less than 95 mg/dL before meals, and between 120 to 135 mg/dL after meals)

Answer 54

HELLP syndrome is a serious pregnancy complication that affects the blood and liver. HELLP stands for these blood and liver problems: H--Hemolysis. This is the breakdown of red blood cells. Red blood cells carry oxygen from your lungs to the rest of your body. EL--Elevated liver enzymes. High levels of these chemicals in your blood can be a sign of liver problems. LP--Low platelet count. Platelets are little pieces of blood cells that help your blood clot. A low platelet count can lead to serious bleeding. HELLP may develop in women who do not present with the cardinal signs of severe preeclampsia. Risk for woman: Abruptio placenta Renal failure liver hematoma / rupture Death Risk for fetus Preterm birth Death Assessment: general malaise, nausea, and right upper gastric pain. unexplained brusing, mucosal bleeding, petechaie Treatment: Delivery of fetus + placenta --- resolve 48hrs post partum

Answer 55

occurrence of seizure activity in the presence of preeclampsia - can be ante, intra + post partum It can be triggered by cerebral vasospasm, hemorrhage, ischemia, edema Warning: persistent headaches epigastric pain NV hyperreflexia w. clonus restlessness Treatment Mg sulfate + hypertensive

Answer 56

1/200 The placenta attaches to the lower uterine segment near/over cervix vs. on the body of the fundus Painless intermittent bleeding Confirmed by ultrasound Risk Factors: scarring large placenta infertility, nonwhite, low socio, short interpreg diabetes, smoking cocaine use Painless bleeding Large placenta, Multiple gestation >35 yrs Maternal risk: Hemorrhagic + hypovolemia shock Blood loos Fetal Risk: Disruption of blood flow Morbidity + morality Fetal: Malpresentation IUGR fetal anemia Management: Avoid vaginal exam Monitor fetal vitals Check Amniocentesis + BPP - lung maturity When active bleeding: * Large bore IV access * Measure I&O * Weigh pads — counting or visual estimate is not sufficient (1gm=1ml) * CBC, coagulation studies, T&X * Oxygen to keep pulse ox > 95% * Anticipate possible emergent cesarean birth Bright red bleeding

Answer 57

Partial complete detachment of placenta - hematoma forms + destroys the placenta around it dark red bleeding The major clinical findings are vaginal bleeding and abdominal pain, often accompanied by hypertonic uterine contractions, uterine tenderness, and a nonreassuring fetal heart rate (FHR) pattern Grade: 1(mild) least amount of separation 2 (moderate) 3 (Severe) more separation + blood Risk Factor decreased placenta perfusion HT Seizure Blunt trauma to the maternal abdomen history of abruption smoke/cocaine use Risk for Fetus: LBW, asphyxia, still birth SS Sudden onset of intense pain board-like rigidity to the abdomen uterine irritability tachystole vaginal bleeding port wine stain amniotic fluid Management assess fundal height girth measurement shock weigh pads Restoring blood loss Anticipation and prepare for emergency delivery. check for DIC Partial abruption: concealed bleeding -- retroplacental Partial abruption: marginal bleeding placenta is halfway torn - bleeding is apparent Complete abruption: bleed could be concealed or apparent

Answer 58

The partial/complete placenta invades and becomes inseparable from the uterine wall. 0 leads to hemorrhage + may need a hysterectomy - 3000 - 5000 mL blood loss As many as 90% of patients with placenta accreta require blood transfusion, and 40% require more than 10 units of packed red blood cells Risk factors myometrial damage caused by C/S Advanced maternal age Multiparity Risks for woman Hemorrhagic + hypovolemic shock ~ 25-30% morbidity Increase risk of infection, thromboembolism, pyelonephritis, pneumoia, ARDS + renal failure Surgical complications Risk for Fetus Preterm ~ normally 34-36wks Assessment: Ultrasound Treatment: Planned c/s + hysterectomy Actions: Monitor CBC + clotting emotional support

Answer 59

Spontaneous or elective termination of pregnancy <20wks Induced: medical/surgical abortion before fetal viability Elective: at the request of the woman but not for a medical reason Therapeutic: abortion because of abnormalities Spontaneous: nonviable intrauterine preg w. either empty gestational sac or gestational sac containing embryo/fetus w/o heart activity 126/7 wks ---> miscarriage Termination of preg done transcervical by dilation of the cervix, evacuation, fetus out by cuttage, scrapping + vacuum Meds: mifepristone +misoprostol

Answer 60

Fertilized egg grows outside uterus as a result in blastocyst implanting itself other than endometrial lining - stunted growth + will be nonviable. - 95% happen in fallopian tube, 5% other ovary, abdominal cavity, cervix - most are tubual + tube lacks submucosal layer but can't support the growth of the tropoblast Risks: Pelvic inflam disease infertility endometriosis STI smoking Management: * SALPINGOSTOMY/SALPINGECTOMY * METHOTREXATE * MONITOR FOR BLOOD LOSS * EMOTIONAL SUPPORT

Answer 61

Grape Like Cysts 1. complete: fertilization of empty ovum (no embryonic tissue found) 2. Partial: some fetal tissue; normal ovum but 2 sperm 1/1500birth 1/1500 pregnancies * WOMEN WITH LOW PROTEIN INTAKE * >35 YEAR-OLDS * ASIAN WOMEN * EXPERIENCED PRIOR MISCARRIAGE * UNDERGONE OVULATION STIMULATION (CLOMID) SS: Rapidly growing uterus, vaginal bleeding, NV.HT. Abnormally high hcg * NAUSEA/VOMITING * HYPERTENSION * ABNORMALLY HIGH HCG LEVELS * NO FETAL HEARTBEAT * ULTRASOUND: NO FETUS (ONLY CYSTS) Management: no preg for 1 yr, monitor for malignancy Monitor of malignancy 20% BECOME MALIGNANT

Answer 62

excessive amniotic fluid >2000mL associated with fetal GI anomalies + maternal diabetes Treatment: remove amniotic fluid

Answer 63

scanty amniotic fluid <500mL risk: fetal adhesion + malformations Treatment: amniofusion

Answer 64

Tachypnea retraction of chest wall grunting/ flaring lethargy abnormal temp hypogly abdominal distension failure to pass meconium in 48 hrs failure to void in 24 hrs convulsions jaundice <24hrs jitteriness cant keep constant temp

Answer 65

Pulse 110 - 160 bpm (sleep <70) Respiration 30 -60 BP: 70-50mmHg - 90/60 @ day 10 Temp: Ax 97.7-99 skin 96.8 - 97.7 97.8 - 99

Answer 66

swelling under the skin of the scalp - fluid filled crosses suture lines

Answer 67

collection of blood from broken blood vessels that build up under scalp `doesnt suture line

Answer 68

premature closure of suture - restricts growth perpendicular + compensatory overgrowth in unrestricted regions

Answer 69

APGAR Birth Weight Measurements: Head, chest + length Vitals: temp, pulse, respiration Gestational assessment Physical maturity: Ballard exam + Dubowitz Points are given for each area of assessment. A low of -1 or -2 means that the baby is very immature. A score of 4 or 5 means that the baby is very mature (postmature). These are the areas looked at: Skin textures. Is the skin sticky, smooth, or peeling? Soft, downy hair on the baby’s body (lanugo). This hair is not found on immature babies. It shows up on a mature infant, but goes away for a postmature infant. Plantar creases. These are creases on the soles of the feet. They can be absent or range up to covering the entire foot. Breast. The provider looks at the thickness and size of breast tissue and the darker ring around each nipple (areola). Eyes and ears. The provider checks to see if the eyes are fused or open. He or she also checks the amount of cartilage and stiffness of the ears. Genitals, male. The provider checks for the testes and how the scrotum looks. It may be smooth or wrinkled. Genitals, female. The provider checks the size of the clitoris and the labia and how they look. Physical exam General appearance. This looks at physical activity, muscle tone, posture, and level of consciousness. Skin. This looks at skin color, texture, nails, and any rashes. Head and neck. This looks at the shape of head, the soft spots (fontanelles) on the baby’s skull, and the bones across the upper chest (clavicles). Face. This looks at the eyes, ears, nose, and cheeks. Mouth. This looks at the roof of the mouth (palate), tongue, and throat. Lungs. This looks at the sounds the baby makes when he or she breathes. This also looks at the breathing pattern. Heart sounds and pulses in the groin (femoral) Abdomen. This looks for any masses or hernias. Genitals and anus. This checks that the baby has open passages for urine and stool. Arms and legs. This checks the baby’s movement and development.

Answer 70

Moro: startle reflex - lifts arms and legs curl them back toward body and throw head back abnormal Moro reflex which only involves one side of the body. Other babies may have no Moro reflex at all. Some causes of an abnormal or absent Moro reflex may include infections, muscle weakness, injuries from childbirth, peripheral nerve damage and spastic cerebral palsy. disappear around 6 mo. Rooting: when you touch the cheek of an infant baby turns head The rooting reflex in babies usually lasts for about four months. After that, rooting becomes a voluntary response rather than a reflex Sucking: 32 weeks inside the mother’s womb. roof of the mouth is stimulated or when you place the mother’s breast or a bottle in his/her mouth, the baby will place the lips over the nipple and squeeze it between the tongue and roof of the mouth. Next, the baby will move his/her tongue to the nipple to suck and milk the breast. The sucking reflex usually lasts until the baby is four months old. Tonic Neck: fencing reflex, the tonic neck reflex happens when the baby's head turns to one side. This is triggered when you stroke or tap the side of the baby’s spine while the baby lies on his/her stomach. Tonic neck reflex may last until the baby is around five to six months old. Grasp: stroking or touching the palm of a baby may cause the baby to automatically close his/her hands. The grasp reflex may last until the baby is about five to six months old. Babinski: firmly stoke the sole of the baby’s foot. The baby’s big toe moves upward or toward the top of the foot and the other toe fans out. until the child is about two years old, but for some, it goes away after a year. Stepping: walking or dancing reflex. Stepping reflex happens when you hold the baby upright with his/her feet touching a flat surface. You will notice that the baby will move his/her legs as if he/she is walking or trying to take steps although the baby is still too young to actually walk. lasts for about two months. Defensive reflexes Blinking Cough Gag Sneeze Yawn Extrusion

Answer 71

Test checks a baby's heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed. Babies usually get the test twice: 1 minute after birth, and again 5 minutes after they're born. tells the health care provider how well the baby is doing outside the mother's womb heart rate 0- absent 1 -60-100 2 >100 Respir 0-absent 1- slow irregular weak 2 cry Reflex 0-no response 1-grimace 2-cry Color 0 cyanotic 1pink and blue 2 pink Muscle tone 0flaccis 1some flexion 2active motion

Answer 72

EXTRAUTERINE PHYSIOLOGIC TRANSITIONS * RESPIRATORY, CIRCULATORY, THERMOREGULATION

Answer 73

blocking avenues of heat loss, and applying adequate radiant warmth. defined as the external temperature range within which metabolic rate and hence oxygen consumption are at a minimum while the infant maintains a normal body temperature

Answer 74

Test: 24-28 wks POS > 140 --> 3 hr --> Fasting 95, 1hr 180, 2hr 155, 3hr 140 --> POS need 2+ values for diag Neg 1 value. retest at 32wks NEG <140 --> routine prenatal care

Answer 75

occurs when a woman's immune system is sensitized to foreign erythrocyte surface antigens, stimulating the production of immunoglobulin G (IgG) antibodies. Rh- woman at risk of having baby with hemolytic anemia Sensitized woman: Fetal blood + maternal blood mix and Rh- mother and Rh+ fetus create IgM antibodies. Rhogam won't help but will help for the next pregnancy Intervention: Indirect Coombs - detection of Ab circulating in blood monitor pregancy delivery correct fetal anemia - Intrauterine transfusion Transfusion of erythropoietin + iron Management: Rhogam @ 28wks if Rh+ newborn repeat dose of Rhogam within 72hrs NO NEED IF Rh- GIVEN ANYTIME RISK OF BLOOD MIXING test father WHEN MIGHT YOU ADMINISTER RH IMMUNOGLOBULIN? * AFTER BIRTH OF AN RH+ INFANT * AFTER SPONTANEOUS OR INDUCED ABORTION * AFTER ECTOPIC PREGNANCY * AFTER INVASIVE PROCEDURES DURING PREGNANCY * AFTER MATERNAL TRAUMA

Answer 76

MOST COMMON INCOMPATIBILITY ISSUE

Answer 77

1/6 infected FETAL RISK: -spontaneous abortion -preterm labor IUGR + infection MUST DELIVER C/S during outbreak Antivirals after 36wks - ACYCLOVIR want to reduce the viral load (inhibits viral shedding)

Answer 78

In the vaginal tract + GI RISK: STILL BIRTH Want to decrease the bacterial load before birth to reduce infant infection. Medications: penicillins + antibiotics

Answer 79

1. Urinary output <20ml/hr 2. Blood pressure 104/62 3. respiration of 7 4. absent reflexes 5. lethargy 6. excitability

Answer 80

* WEIGHT * AVERAGE FULL TERM (7LB 8 OZ); RANGE OF 2500-4000 G * 70-75% NEWBORN’S BODY WEIGHT WATER HEAD CIRCUMFERENCE * AVG 33-35 CM * 2 CM GREATER THAN CHEST CIRC. * MEASURED PROMINENT PART OF SKULL CHEST CIRCUMFERENCE * NIPPLE LINE ABDOMINAL CIRCUMFERENCE * LENGTH * AVG RANGE 18-22 INCHES (48-52 CM)

Answer 81

Gestation Age: Ballard score -- number of weeks infant is during the gestational age GESTATIONAL AGE CAN PREDICT AT-RISK INFANTS , AND CAN HELP YOU KEEP ALERT FOR PROBLEMS Physical assessment: checking the physical appearance, auscultation, vitals muscle tone, level of consciousness

Answer 82

ANTERIOR FONTANELLE * DIAMOND SHAPED * CLOSES: 18 MONTHS * POSTERIOR FONTANELLE * TRIANGLE SHAPED * CLOSES: 8-12 WEEKS * WHAT’S NORMAL? * NO BULGING * NO DEPRESSION

Answer 83

TEARLESS CRYING * PERIPHERAL VISION * CAN FIXATE ON NEAR OBJECTS * CAN PERCEIVE FACES, SHAPES AND COLORS * BLINK IN RESPONSE TO BRIGHT LIGHT * PUPILLARY REFLEX IS PRESENT Variation: subconjunctival hemorrhage EARS * SOFT AND PLIABLE * READY RECOIL * PINNA PARALLEL WITH INNER AND OUTER CANTHUS Variation: low set ears Skin tag

Answer 84

NOSE * SMALL AND NARROW * MUST BREATHE THROUGH NOSE * ASSESS FOR CHONAL ATRESIA Variation: tight frenulum MOUTH * LIPS PINK * TASTE BUDS PRESENT * FLAT PHILTRUM * ANKYLOGLOSSIA (TONGUE TIED) * EPSTEIN PEARLS-KERATIN CONTAINING CYSTS – NO SIGNIFICANCE Variations: cleft lip

Answer 85

CHEST – CYLINDRICAL * BREASTS – ENGORGED, WHITISH SECRETION * RESPIRATIONS * DIAPHRAGMATIC * 30-60 PER MINUTE * HEART RATE 110-160 BPM * NORMAL HEART SOUND * MURMUR SOUND

Answer 86

* NASAL FLARING * INTERCOSTAL , SUBSTERNAL OR XIPHOID RETRACTIONS * EXPIRATORY GRUNTING OR SIGHING * SEESAW RESPIRATIONS * TACHYPNEA

Answer 87

instability of the hip may be assessed/ development of dysplasia

Answer 88

Female: Vaginal tag Pseudomenstration + uric acid crystals Male: HYPOSPADIAS * PHIMOSIS * HYDROCELE - one big teste * CRYPTORCHIDISM

Answer 89

Acrocyanosis: CAUSED BY POOR PERIPHERAL CIRCULATION Mottling Jaundice Erythema Toxicum Milia * VERNIX CASEOSA * FORCEPS MARKS * TELANGIECTATIC NEVI * MONGOLIAN SPOTS * NEVUS FLAMMEUS

Answer 90

EVAPORATION *(H2O VAPOR) * CONVECTION * (AIR CURRENTS) * CONDUCTION * (DIRECT SKIN CONTACT) * RADIATION *(INDIRECT SOURCE) Large body surface in relation to mass less insulating fat LESS ADIPOSE TISSUE * PRETERM * SMALL FOR GESTATIONAL AGE (SGA) * BROWN FAT METABOLISM Response to cold: Increase metabolic rate + muscle activity peripheral vasocon metab of brown fat Excess heat loss = hypothermia consequences hypogly metabolic acidosis decrease surfacant respir distress hypoxia delayed fetal neonate circ weight loss risk factors preterm SGA sepsis prolonged resuscitation hypo neurolog, CV or endocrine Signs: <97.7 cool skin lethary pallow jitteriness tachypnea grunting hypotonia weak suck

Answer 91

Period of reactivity - awake crying respirations high and irregular period of inactivity - sleeping 2 hrs second period of reactivity - cycle through active/quiet alert increae in bowel activity interested in feeding

Answer 92

1. Air replaces fluid PROCESS OF LABOR ¨ INITIAL INFLATION OF LUNGS § MECHANICAL STIMULATION § FIRST BREATH/GASP * SURFACTANT NEEDED FOR ALVEOLAR STABILITY * DECREASES SURFACE TENSION * INCREASES COMPLIANCE * LECITHIN VERSUS SPHINGOMYELIN (L/S RATIO) 2:1 2. onset of breathing BREATHING STIMULATED * CHEMICAL STIMULATION: * ↓PH: DIRECTLY STIMULATES RESPIRATORY CENTER * ↓PO2 AND ↑PCO2: STIMULATE RESPIRATORY CENTER VIA CENTRAL/PERIPHERAL CHEMORECEPTORS * PROSTAGLANDINS (SUPPRESS RESPIRATIONS) DROP WITH CLAMPING OF CORD 3. increase in pulmonary blood flow BLOOD FLOW INCREASES TO LUNGS * OXYGENATION OCCURS compression of thorax squeezes amniotic fluid from lung - lung expansion increase O2 + vasodil First breath: increase aveolar O2 + decrease arterial pH --> dilation of pulmonary artery --> decrease pulmonary vascular resistance --> increase blood flow --> increase O2 + CO2 exchange Mechanical stimulation: compression of the throax; passive inspiration fluid out air in Sensory: tactile, auditory + visual Thermal: coming from warm aqueous environment to cooler -- stimulates breath Chemical: birth stimulates mild hypercapnea - increase CO - hypoxia/ acidosis

Answer 93

FETAL CIRCULATION * HIGH PULMONARY VASCULAR RESISTANCE: * OXYGENATION OF FETUS OCCURS IN PLACENTA (PLACENTA IS LOW RESISTANCE) Neonatal circulation - MAJOR PHYSIOLOGICAL CHANGES SYSTEMIC VASCULAR RESISTANCE INCREASES/ PULMONARY ARTERY PRESSURE DROPS: * AFTER CORD CLAMPED/PLACENTAL CIRCULATION LOST Closure of fetal shunts Foramen Ovale - closes when L atria pressure > than right Ductus Arteriosus - connects pulmonary a w. descending aorta; closes 15hrs post birth could remain open if lungs fail to expand or when PaO2 levels drop Ductus Venosus - closes by day 3

Answer 94

HEART RATE * 110–160 IN FIRST WEEK OF LIFE: APICAL FOR 1 FULL MINUTE * SLEEPING TO 100 * CRYING TO 180 * BLOOD PRESSURE (BP) * AVERAGE 70-50/45-30 MMHG AT BIRTH * HEART MURMURS * 90% ARE TRANSIENT * CARDIAC WORKLOAD * RIGHT VENTRICLE STRONGER AT BIRTH

Answer 95

Maternal conditions - diabetes, HT Fetal Conditions - congenital anomalies Antepartum conditions - placenta/ amniotic fluid Delivery complications Neontal difficulties -lack of respir effort - Blockage - impaired cardiac + lung f(x)

Answer 96

Tachypena rectration of chest wall grunting + flaring Lethargy Abnormal temp Hypogly abdominal distention failure to pass meconium in 48 hrs Failure to void 24 hrs convulsions jaundice <24hrs jitteriness can't maintain temp

Answer 97

required metabolic testing by state. Unable to metabolize phenyalanine -- amino acid. Builds up phenydryrovic + acetic acid = brain damage

Answer 98

Hep B and IgG should be administered within 24hrs PKU Congential heart screen hearing screen Parental Edu 5 rights of teaching: time, context, goal, content method feeding cues bathing holding infant changing diaper cord care/circumcision normal voiding + stooling Car seat safety - r infant or toddler should ride in a rear-facing car safety seat shaken baby sleep position SIDS Signs of illness

Answer 99

30s of life - evaluating transition NEONATAL RESUCITATION PROGRAM -Thermoreg -APGAR -Physical examination - newborns gestational classification Admission Assessment: Physical Assessment General measurement Gestational age - within 4hrs -- predicts at risk infants On going Progress of adaptation nutritional status - ability to feed behavioral state

Answer 100

6 physical and 6 nerve and muscle development (neuromuscular) signs of maturity. The scores for each may range from -1 to 5. The scores are added together to determine the baby's gestational age. Posture: no flexion 0 arms and legs very flexed 5 Square window: >90 -1 0 -4 Arm recoil: 180 -1, <90 4 Popiteal: >180 -1 <90 5 Scarf: can over cross arm -1 can cross midline 4 heal to ear: all the way -1 only to hip 4 skin: transparent -1 leathery 5 lanugo: none -1 mostly bald 4 plantar: smooth -1 creases 4 breast imperceptible -1 full areola 4 eye/ear: fully fused -1 thick cartilage 4 genitals: smooth/ prominent clitoris -1 rugage disent + majora covers 4

Answer 101

Deep Sleep Light sleep drowsiness quiet alert active alert crying

Answer 102

Habituation: prevents overstimulation Orienting response: ability to follow objects motor organization: spontaneous movement consolability: ability to self sooth cuddliness: response to being held

Answer 103

Glucose values decrease within1 hr but stabilize 2-3hrs -optimal 70-100mg -hypo = <40mg/dl Risks: diabetic mom >4000g or LGA Hypothermia neonatal infection Respir distrress post/pre term SGA neonatal resuscitation birth trauma SS jitteriness apnea hypotonia irritability lethary temp instability

Answer 104

Latch Audible swallow Type of nipple Comfort Hold 0 -2 0 too sleepy 1 attempt 2 grasps breast

Answer 105

blood vol = 80-90 ml/kg of body weight -- delaying cord clamp can increase to 100ml erythropoietin secreted RBC lifespan shorter than an adult - 90 days leukocytosis is normal

Answer 106

40% of abdomen + is palatable iron storage; 5-6 mo Regulation of glucose; ability to convert glycogen to glucose >40mg/dl Coag of blood Bilirubin conjugation --> needs to be conjugated in order to be excreted.

Answer 107

HEME (IRON) + GLOBIN (PROTEIN)-----’HEME’ FRAGMENTS FORM UNCONJUGATED/INDIRECT BILIRUBIN (FAT SOLUBLE---CAN’T EXCRETE) BILIRUBIN ENZYMATICALLY CONVERTED (CONJUGATED) IN LIVER * WATER SOLUBLE FORM (DIRECT BILIRUBIN) -- ELIMINATED IN URINE AND STOOL. * NEED ACTIVE INTESTINAL ELIMINATION AND HEPATIC CIRCULATION * REQUIRES ADEQUATE CALORIES AND HYDRATION * A DELAY IN FEEDS CAUSES RE-ABSORPTION FROM INTESTINE>> INCREASES SERUM LEVELS Newborn at risk because more destruction of RBC ABO/Rh incompatibility Delayed cord clamping bruising + birth trauma decreased liver f(x) drugs maternal enzymes Breastfeeding Jaundice: poor feeding dehydration peaks 2-4 days of life Breastmilk jaundice - appears healthy peak 2-3 wks stop feeding for 12-24 genetic componet related to milk consumption

Answer 108

In order to pass the infant care seat challenge, the premature neonate must be able to maintain adequate oxygenation, heart rate, and respiratory rate during trial.

Answer 109

IUGR SGA/LGA Preterm Diabetic CHD Errors of metab Substance abuse

Answer 110

LBW - low birth weight <2,500 but greater than 1,500 VLBW - very low <1,500 AGA - avg gestational age SGA - small for gest. age - newborn is normal but small; may have had delayed growing asym IUGR LGA - large for gest age

Answer 111

Fetal factors: Conditions that affect growth: chromosomal, TORCH, malformation Maternal: Chronic HT, Age <15, >35, drug exposure, use + asthma Placental: inadequare delivery of nutrients; abruption utero insufficiency Patterns; Symmetrical: <28wks organs of normal size symmetrically small chromosomal abnormalities Asymmetrical: >28wks - rapid cell proliferation hyperplasia/hypertrophy malnutrition Normal # cells Brain Heart larger problems could be corrected by proper nutrition

Answer 112

Head is disproportionally large in comparison to rest of body wasted appearance of extremities reduced subcutaneous fat scaphoid abdomen wide skull sutures Poor muscle tone loose dry skin thin umbilical cord Complications Chronic hypoxia; decrease tolerance to labor--> could lead to organ dysfunction Hypogly; not enough glycogen reserves not enough fat Hypothermia Polycythemia - response to chronic hypoxia - bone marrow stim to create RBC Factors contributing Congenital malformation - more severe IUGR more severe malformation Intrauterine infection - TORCH (toxo, rubella, CMV, herpes) Hypoxia - learning disabilities / cognitive difficulties Interventions free of respir compromise stabilize temp + hypogly

Answer 113

>90% of babies >4000g ANTICIPATE PLAN FOR DELIVERY Birth trauma : cephalopelvic disproportion, macrosomia, brachial injury, nonreassuring FHR, body dytocia increased risk of c/s hypogly polycythemia - type of blood cancer. It causes your bone marrow to make too many red blood cells. These excess cells thicken your blood, slowing its flow, which may cause serious problems, such as blood clots Infant of diabetic mother complications: hypogly, hypcalcemia, hyperbili, birth trauma, polycythemia, RBS, malformation

Answer 114

>42 wks - 4-14% of pregnancies -Post maturioty syndrome due to deterioration of placenta f(x) Risk of perinatal asphyzia + meconium passage polycythemia Hypogly decrease in amniotic fluid = cord compression at risk for MAS

Answer 115

Term: 37-40 weeks Postterm: 42+ wks Late preterm: Your baby is born between 34 and 36 completed weeks of pregnancy. Moderately preterm: Your baby is born between 32 and 34 weeks of pregnancy. Very preterm: Your baby is born at less than 32 weeks of pregnancy. Extremely preterm: Your baby is born at or before 25 weeks of pregnancy.

Answer 116

IUGR, Facial anomalies - .5 -2 / 1000 Small head <10% Effects of exposure to alcohol Phenotypic - include growth restriction + CNS abnormalities + facial dysmorphology - small eyes, smooth philtrum, thin upper lip Cognitive + behavorial disabilities Interventions: reduce stimuli, extra feeding time, reinforce parenting

Answer 117

NOT FULLY ACTIVATED * FEVER NOT RELIABLE INDICATOR OF INFECTION * IGG CROSSES PLACENTA * PASSIVE ACQUIRED IMMUNITY * TRANSFERRED PRIMARILY IN THIRD TRIMESTER * BEGIN IMMUNIZATIONS AT 2 MONTHS OF AGE * IGA IN COLOSTRUM * PROVIDES PASSIVE IMMUNITY

Answer 118

Keep the baby wrapped in a warm blanket. Position the baby away from vents and drafts. Place a stocking cap on the neonate’s head. Change wet clothing immediately.

Answer 119

Vitamin K is needed to activate clotting factors.

Answer 120

Human milk contains multiple antibodies, enzymes, and immune factors.

Answer 121

Asymmetrical Moro reflex This response may be related to temporary or permanent birth injury to clavicle, humerus, or brachial plexus. This reflex disappears by age 6 months. This is a priority reflex to assess in a newborn.

Answer 122

There are at least eight wet diapers and several stools per day. The most concrete indicator that the breastfeeding baby is receiving enough milk is at least eight wet diapers and several stools per day.

Answer 123

Breast milk can be kept in a deep freezer for 6 to 12 months. Breast milk can be safely kept in a deep freezer for 6 to 12 months; in a freezer attached to a refrigerator, it can be safely stored for 3 to 6 months.

Answer 124

foramale ovale: small hole in the septum of upper part of heart ductus arteriosus: bv in the developing fetus that connects trunk of pulmonary artery to proximal descending aorta Ductus venosus: bv that shunts a portion of umbilicord blood flow to ivc pulmonary bv: high resistance in utero

Answer 125

HEALTHY PEOPLE 2020 GOALS; ◦ 81.9% OF MOTHERS INITIATE BREASTFEEDING IN THE EARLY POSTPARTUM PERIOD ◦ 25.5% EXCLUSIVELY BF AT 6 MONTHS ◦ 34% CONTINUE AT 1 YEAR INITIATE BREAST-FEEDING WITHIN 1 HOUR OF BIRTH §BREAST ONLY – NO BOTTLES, ARTIFICIAL NIPPLES, PACIFIERS §ROOMING-IN WITH UNRESTRICTED BREAST-FEEDING §NO FOOD OR DRINK OTHER THAN BREAST MILK UNLESS MEDICALLY INDICATED Contradictions of BF: HIV, untreated TB, T-cell Leukemia, toxic chemicals, illicit drug use, babies with galactosemia antimetabolites + chemo

Answer 126

CALORIES 100-120KCALS/KG/DAY * PROTEIN FOR CELL GROWTH: WHEY AND CASEIN * CARBOHYDRATES FOR ENERGY * FAT FOR BRAIN AND CNS DEVELOPMENT * FLUIDS 100-150 ML/KG/DAY * IRON: RESERVES DEPLETED BY 5-6 MONTHS; FLURIDE * VITAMIN D, K

Answer 127

COLOSTRUM ◦THICK WATERY CONSISTENCY, YELLOW ◦HIGHER IN PROTEINS, FAT SOLUBLE VITAMINS, AND MINERALS THAN MATURE MILK ◦EASY TO DIGEST ◦MATERNAL ANTIBODIES TRANSITIONAL MILK IMMUNOGLOBULINS AND PROTEIN DECREASE LACTOSE, FAT AND CALORIES INCREASE VITAMIN CONTENT EQUAL TO MATURE MILK 20 CAL/OUNCE PROVIDES NUTRIENTS FOR FIRST 4-6MONTHS 8-12 FEEDINGS IN A 24 HOUR PERIOD Mature Milk - adjusts to infant's needs

Answer 128

High risk newborn can be defined as a newborn, regardless of gestational age or birth weight, who has a greater-than-average chance of morbidity (illness) or mortality (death) because of conditions present at birth or the stress of birth itself. High risk period encompasses human growth and development from age of viability up to 28 days after birth. Includes the prenatal, perinatal and postnatal periods Complications Common problems that can appear in newborn period Gestational age and birthweight –related issues Drug exposure Congenital anomalies Hypothermia Hypoglycemia RDS TTN MAS PPHN Sepsis Hyperbilirubinemia

Answer 129

Mortality: neonatal period 1-28 days Morbidity: risk decreases as gestational age and birthweight increase

Answer 130

CNS: hyperactivity hyperirritability increased muscle tone exaggerated reflex tremors + jerks sneezing hiccups yawning short unquieted sleep fever Respir Tachy >60 excessive secretions GI: disorganized vigorous suck vomit droooling sensitive gag reflex hyperphagia diarrhea poor feeding <15ml for 1st day of life + 30mins or more Vasomotor: Stuffy nose, yawning sneezing flushing sweating sudden circumoral pallor Cutaneous signs excoriated buttocks, knees elbows facial scratches pressure point abrasions

Answer 131

ospital-based nursing care ◦ Reducing withdrawal symptoms ◦ Promote adequate respiration, temperature, nutrition◦ Carefully monitoring pulse and respirations ◦ Monitoring temperature for hyperthermia ◦ Providing small, frequent feedings, ◦ Administering medications as ordered ◦ Swaddling ·EAT, SLEEP, CONSOLE: prioritizes a newborn’s inability to take an age- appropriate volume of food, sleep more than one hour after feeding, or be consoled within ten minutes. ·Finnegan Symptom Prioritization

Answer 132

Signs of hypoglycemia: Jittery Tachypnea Diaphoresis Hypotonia Lethargy Apnea Temperature instability

Answer 133

The majority of bilirubin is produced from the breakdown of Hb into unconjugated bilirubin (and other substances). Unconjugated bilirubin binds to albumin in the blood for transport to the liver, where it is taken up by hepatocytes and conjugated with glucuronic acid by the enzyme uridine diphosphogluconurate glucuronosyltransferase (UGT) to make it water-‐soluble. The conjugated bilirubin is excreted in bile into the duodenum. In adults, conjugated bilirubin is reduced by gut bacteria to urobilin and excreted. Neonates, however, have sterile digesive tracts. They do have the enzyme β-‐ glucuronidase, which deconjugates the conjugated bilirubin, which is then reabsorbed by the intestines and recycled into the circulation. This is called enterohepatic circulation of bilirubin PHYSIOLOGIC JAUNDICE Hyperbilirubinemia commonly occurs ager first 24 hours (typically 2-‐5 days) Increased bilirubin related to rela:ve polycythemia and short life span of fetal red bloods (80 days) Decreased uptake of bilirubin by the liver Decreased enzyme ac:vity and ability to conjugate bilirubin –low levels of enzyme to conjugate Decreased ability to excrete bilirubin Increased enterohepatic circulation-‐increased B-‐glucoronidase (a deconjuga:ng enzyme) Breast feeding ATHOLOGICAL JAUNDICE Jaundice that occurs within the first 24 hours of life. Total serum bilirubin levels above 12 mg/dL in a term neonate or 15 mg/dl in a preterm baby or >95th % on nomogram Total serum bilirubin levels that increase by more than 5 mg/dL per day (or 0.2 mg/dL per hour) Conjugated bili >2 mg/dl Jaundice lasting >1 wk term/ > 2k premature

Answer 134

Unconjugated bilirubin in excess of that which can bind to albumin can cross the BBB Can cause neurotoxicity-‐ signs: Lethargy, irritability Arching of neck (retrocollis) and trunk (opisthonos) Kernicterus-‐ movement disorder, athetoid form Of CP, Deafness, seizure, coma, limited upward gaze

Answer 135

Phototherapy TcB Exchange Transfusion ◦ If newborn has active hemolysis, unconjugated bilirubin level of 14 mg/dl, weighs less than 2500g, less than 24 hours old... exchange transfusion may be best ◦ If mom O blood type or Rh (-‐) –check direct coombs and cord blood bili in baby Nursing care Assessments (VS, feedings, check BM status) Warmth (cold stress & acidosis) Phototherapy (eye patches, cover genitalia) Tactille simulation ***important*** Positioning-‐q2h Parental ques:ons/concerns/contacts

Answer 136

Phototherapy TcB Exchange Transfusion ◦ If newborn has active hemolysis, unconjugated bilirubin level of 14 mg/dl, weighs less than 2500g, less than 24 hours old... exchange transfusion may be best ◦ If mom O blood type or Rh (-‐) –check direct coombs and cord blood bili in baby Nursing care Assessments (VS, feedings, check BM status) Warmth (cold stress & acidosis) Phototherapy (eye patches, cover genitalia) Tactille simulation ***important*** Positioning-‐q2h Parental questions/concerns/contacts

Answer 137

Assess for sepsis 1-2/1000 10x higher in LBW Immature immune system Vertical transmission - transplacental + acensind prolonged ROM, intrapartal Horizontal: nosocomial infection Maternal factors: Poor prenatal nutrition Low socioeconomic status Hx STI’s Prolonged ROM >12 hrs Vaginal Group B strep Chorioamnionitis The maternal temperature in labor Premature labor Difficult or prolonged labor Fetal scalp electrode use Invasive procedures during labor and delivery Maternal UTI Fetal factors Prematurity Birth weight <2500 g Difficult delivery Birth asphyxia Meconium staining Congenital anomalies Male neonate Multiple gestatin Invasive procedures Length of stay Humidification in incubator or ventilator care Use of broad spectrum antibiotics Nursing Interventions Nosocomial infections are preventable ◦ Hand hygiene! EDUCATION Screening ◦ Antepartum/Intrapartum infection Blood Cultures, CBCD, Urine culture ◦ ophthalmic prophylaxis Supportive Care ◦ Resp, Cardio, fluid/electrolytes, hypoglycemia, acidosis

Answer 138

Hyaline membrane disease primary absence of pulmonary surfactant indicates failure to synthesize surfactant Assessment: grunting, flaring, retracting, tachy, skin grays, hypoxemia, acidosis Management O2, Pulse ox, surfactant replacement, CPAP, mechanical ventilation ECMO

Answer 139

Failure to clear fluid of out lunfs Exhibits distress shortly after birth SS: Expiratory grunting and nasal flaring subcostal retractions slight cyanosis Maintain adequate respir, nutritional, hydration status and education

Answer 140

Mechanical obstruction of airways chemical pneumonitis vasocon of pulmonary vessels inactivsation of natural surfactant assess for complications maintain respir + nutrition + hydration

Answer 141

20 0/7 wk - 36 6/7 wks decreasing in US @9.5% 2015 highest among AA + hispanic

Answer 142

unintentional delivery <37wk Cause: infection or inflammation

Answer 143

C-section/ labor absence of medical need

Answer 144

healthcare provider recommends preterm labor delivery Cause: preeclampsia

Answer 145

the inability of cervix to retain preg in absence of sign/symptoms of contractions, labor or both in 2nd tri

Answer 146

1+ fetus from fertilization of 1 zygote - divides or fertilization of 2 ova monozygotic twin = 1 egg that divides at 1st week of gestation dizygotic = 2 eggs fertilized

Answer 147

1. monochorionic (1 chorion) - 70% monozygotic 2. dichorionic (2 chorions) - always dizygotic

Answer 148

Spontaneous delivery HT + Preeclampsia gestational diabetes Antepartum hemorrhage acute fatty liver Abruptio placentae

Answer 149

Severe NV that causes dehydration, electrolyte imbalance + acid/base imbalance, starvation ketosis + weight loss. -hypokalemia + natremia - decrease urea Peaks @ 9-20wks Cause: increase of HCG, prog, + E, h.pylori, ambivalence towards preg.

Answer 150

Presentational - 1/2 Gestational - glucose intolerance (placenta creates HPL that antagonizes insulin, sparing glucose for fetus.) Type1 : body isnt making insulin - body attacks destroys insulin producing cells - glucose can't get into cells + trys to get rid of extra w. kidney Type 2: body is producing enough insulin but not properly produced overweight can't stop insulin production. fat deposits on cell can't open. Challenge to manage because of HPL P HgH Corticotropin-releasing hormone Shift energy source from ketone -> free fatty acid Treatment: Euglycemic control minimize complication prevent prematurity -> keep the lowest possible glycosylated hemoglobin w/o going into hypoglycemia

Answer 151

Blood glucose is elevated but below clinical threshold Components: Central adiposity > 35 in Dyslipidemia Hyperglycemia HT Maternal Risk: DKA - 2nd tri HT Spontaneous Abortion Polyhydramnios Induction of Labor UTI, Hypergly, Postpartum, post hemorrhage exacerbation of diabetes symptoms Fetal Risk: Congenital defect Prematurity Hypogly, cal + mag asphyxia respir distress Still birth hyperbilirubinemia polycythemia

Answer 152

a hormone made by the placenta prevents the body from using insulin effectively. Glucose builds up in the blood instead of being absorbed by the cells. insulin less effective, a condition referred to as insulin resistance risk: <25 yr HT, PCOS Increase in maternal adiposity insulin desensitizing hormone Family history/ age/ race/ obesity history of macrosomia Diagnosis: glucose testing 24-28 wk Complications: Macrosomia Shoulder dystocia HT + preeclampsia preterm birth + stillbirth C-section Risks for baby excessive birth weight preterm breathing difficulties hypoglycemia obesity + type 2 later in life stillbirth Prevention: maintain healthy lifestyle, keep active, don't gain more weight than recommended

Answer 153

Preeclampsia is a kind of high blood pressure some women get after the 20th week of pregnancy or after giving birth. s high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working normally. Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body. High blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy. - Leading cause of maternal death - 20wks 140/90 @ least 4 hrs apart + proteinuria >300mg or new systemic disease. High Risk: >35 yr AA + low socioeconomic previous preeclampsia with another preg pregnant w. multiples have diabetes + HT, kidney disease, AI obese family history of preeclampsia SS Headache that doesnt go away Blurred vision Epigastric pain trouble breathing NV swelling in face + hands weight gain - 2-5lbs per week Proteinuria Thrombocytopenia Renal insufficiency Impair live function Pulmonary edema Visual symptoms Risk for fetus Morbidity intolerance of labor still birth placenta abruption IUGR Low birthweight Treatment Early detection Delivery monitor Hydra Liz one Mg sulfate Oral nifedipine Labetalol

Answer 154

HELLP syndrome is a serious pregnancy complication that affects the blood and liver. HELLP stands for these blood and liver problems: H--Hemolysis. This is the breakdown of red blood cells. Red blood cells carry oxygen from your lungs to the rest of your body. EL--Elevated liver enzymes. High levels of these chemicals in your blood can be a sign of liver problems. LP--Low platelet count. Platelets are little pieces of blood cells that help your blood clot. A low platelet count can lead to serious bleeding.

Answer 155

occurrence of seizure activity in the presence of preeclampsia - can be ante, intra + post partum It can be triggered by cerebral vasospasm, hemorrhage, ischemia, edema Warning: persistent headaches epigastric pain NV hyperreflexia w. clonus restlessness Treatment Mg sulfate + hypertensive

Answer 156

1/200 The placenta attaches to the lower uterine segment near/over cervix vs. on the body of the fundus Risk Factors: scarring large placenta infertility, nonwhite, low socio, short interpreg diabetes, smoking cocaine use Painless bleeding Maternal risk: Hemorrhagic + hypovolemia shock Blood loos Fetal Risk: Disruption of blood flow Morbidity + morality Management: Avoid vaginal exam Monitor fetal vitals Check Amniocentesis + BPP - lung maturity

Answer 157

Partial complete detachment of placenta - hematoma forms + destroys the placenta around it Grade: 1(mild) least amount of separation 2 (moderate) 3 (Severe) more separation + blood Risk Factor decreased placenta perfusion HT Seizure Blunt trauma to the maternal abdomen history of abruption smoke/cocaine use SS Sudden onset of intense pain board-like rigidity to the abdomen uterine irritability tachystole vaginal bleeding port wine stain amniotic fluid Management assess fundal height girth measurement shock weigh pads

Answer 158

The partial/complete placenta invades and becomes inseparable from the uterine wall. 0 leads to hemorrhage + may need a hysterectomy - 3000 - 5000 mL blood loss

Answer 159

Spontaneous or elective termination of pregnancy <20wks Induced: medical/surgical abortion before fetal viability Elective: at the request of the woman but not for a medical reason Therapeutic: abortion because of abnormalities Spontaneous: nonviable intrauterine preg w. either empty gestational sac or gestational sac containing embryo/fetus w/o heart activity 126/7 wks ---> miscarriage Termination of preg done transcervical by dilation of the cervix, evacuation, fetus out by cuttage, scrapping + vacuum Meds: mifepristone +misoprostol

Answer 160

Fertilized egg grows outside uterus as a result in blastocyst implanting itself other than endometrial lining - stunted growth + will be nonviable. - 95% happen in fallopian tube, 5% other ovary, abdominal cavity, cervix - most are tubual + tube lacks submucosal layer but can't support the growth of the tropoblast Risks: Pelvic inflam disease infertility endometriosis STI smoking

Answer 161

Spectrum of placental-related tumors - group of rate disease in which abnormal cells grow inside the uterus after conception MOLAR: hydatidiform mole cili turn into cyst in uterus ~ grape like NONMOLAR: gestational trophoblastic disease- almost always malignant SS: Bleeding, NV, HT, no fetal heartbeat +movement

Answer 162

Most prevalent in 1-2tri; may be associated w. abnormalities like still birth, fetal growth restriction, neurological development - hyperactivity

Answer 163

1 Hr - if over 140 test at 3hrs if positive if they have 2+ criteria (fasting 95mg, 1hr 180 mg, 2hr, 155, 3hr 140). If neg retest at 32 wks If neg at 1 hr - routine prenatal; care Glycosylated hemoglobin alc should be less than or equal to 6%

Answer 164

RH Factor ABO Incompatibility Ectopic Preg HSV GBS Preeclampsia Gestational Trophoblastic Disease

Answer 165

Rh is inherited protein found on the surface of RBC Rh- doesnt have protein Rh+ has protein Rh- women at risk of having baby w. hemolytic anemia w/o treatment fetus will have jaundice, anemia, brain damage, HF + death Sensitized woman when Rh+ from infant mixes with Rh- mother = creation of Ab Cause: molar preg, ectopic pre, spontaneous abortion, therapeutic, manual removal of placenta, amniocentesis + CVS Tests: indirect coombs (Ab screen), testing father/amnio, early birth, intrauterine transfusion(Correct anemia), exchange transfusion(erythropoietin+ fe) Prevent sensitization give RhoGam at 28 wks + 72 hrs after birth

Answer 166

Mother type O infant A/B Maternal serum Ab cross placenta - hemolysis of fetal RBC - mild anemia -jaundice Not treated antenatally or prophylactic

Answer 167

Group B Strep. In GI/GU Treatment: decrease the bacterial load to limit exposure to fetus

Answer 168

Grape Like Cysts 1. complete: fertilization of empty ovum (no embryonic tissue found) 2. Partial: some fetal tissue; normal ovum but 2 sperm 1/1500birth SS: Rapidly growing uterus, vaginal bleeding, NV.HT. Abnormally high hcg Management: no preg for 1 yr, monitor for malignancy

Answer 169

excessive amniotic fluid >2000mL associated with fetal GI anomalies + maternal diabetes Treatment: remove amniotic fluid

Answer 170

scanty amniotic fluid <500mL risk: fetal adhesion + malformations Treatment: amniofusion

Answer 171

2hrs after birth - general survey, physical assessment, gestational assessment + pain assessment

Answer 172

assessed 33 responses in 4 areas 1. habituation - response to repetitive light/sound stimuli 2. movement + muscle tone 3. reflexes 4. neurobehavioral items

Answer 173

assesses physical + neuromuscular activity + maturity - less time than dubowitz classifies if neonate is avg for gestational weight, lga or sga

Answer 174

cycle through initial period of reactivity 15-30 mins post birth increased respiration, rapid HR, grunting, flaring Relative inactivity - 30 mins -2hrs infant will sleep Second period of reactivity cycle through active/quiet alert interested in feeding/sucking

Answer 175

28 behaviors items, 18 reflex - 6 categories 1. habituation: decrease stim from repetitive stim protects from overstim 2. orientation: the ability to focus on visual auditory stim 3. motor maturity: control/coordinate motor activity 4. self quieting: comforting self 5. social behaviors: response to cuddling 6. sleep wak states - 2 sleep 4 wake

Answer 176

Tachypnea retraction of chest wall grunting/ flaring lethargy abnormal temp hypogly abdominal distension failure to pass meconium in 48 hrs failure to void in 24 hrs convulsions jaundice <24hrs jitteriness cant keep constant temp

Answer 177

Assessment of physical maturity characteristics - skin transparent friable -1 gelatinous translucent -0 smooth pink visible veins 1 superficial peeling rash few veins 2 cracking pale areas 3 parchment deep cracking 4 leathery cracked wrinked 5 lanugo - diabetic moms have babies w. more hair on back non sparse abundant think bald areas mostly bald Sole smooth sole / small foot >50mm no crease faint red marks anterior transverse cease only creases anterior 2/3 cracked lethary Ear/eye formation lids fused loosely -1 / tightly -2 lids open pinna flat stays folded Slightly curved pinna, soft recoil well curved pinna soft ready recoil formed and firm instant recoil thick cartilage Genitals Smooth flat scrotum/clitoris prominent clit prominent small minora/scrotum empty tests in upper cancl rare rugue/ clitoris prominent, enlarging minora majora + minora equally prominent/testes descending testes down good rugae/ majora large testes pendulous deep rugae/ majora covers clit and minora Breast imperceptible barley flat areola no bud stippled areola raised areola full areola 5-10mm Neuromuscular Posture Square window arm Recoil Popliteal angle scarf sign heal to ear

Answer 178

Pulse 110 - 160 bpm (sleep <70) Respiration 30 -60 BP: 70-50mmHg - 90/60 @ day 10 Temp: Ax 97.7-99 skin 96.8 - 97.7 97.8 - 99

Answer 179

swelling under the skin of the scalp - fluid filled crosses suture lines

Answer 180

collection of blood from broken blood vessels that build up under scalp - doesnt suture line

Answer 181

premature closure of suture - restricts growth perpendicular + compensatory overgrowth in unrestricted regions

Answer 182

develops when an infant's soft skull becomes flattened in one area, due to repeated pressure on one part of the head

Answer 183

white dots on skin

Answer 184

papules on skin last up to 5 days

Answer 185

Vernix Caseosa Forceps marks telangiectatic nevi mongolian spots nevus flammeus stork bites

Answer 186

Tonic-neck Moro Grasping Rooting Sucking Babinski Trunk incurvation Protective Blink yawn cough sneeze extrusion reflex

Answer 187

thermoregulation feeding practices skin/cord care prevention of infection security stool/void patterns safety - car seat sleep position, sids Illness - >100 and <97.7, frequent vomiting refusal of 2x feeding, difficult awakening, breathing difficulties, cyanosis w/wo feeding, inconsolable, no wet diapers for 24 hrs Before discharge Hep B + HBig PKU Hearing screening CHD CDC newborn screen

Answer 188

HR + Auscultation respiration rate muscle tone relex irritability color Score: o-3 - severe distress 4-6 moderate difficulty 7-10 stable

Answer 189

birth - 28 days need to maintain bodyheat respiration f(x) decrease risk of infection proper hydration + nutrition Proper care

Answer 190

increase aveolar O2 + decreased Aterial pH --> dilation of pulmonary artery -> decrease vascular resistance -> increase blood flor -> increase O2 + Co2 exchange

Answer 191

Cyanosis abnormal resp pattern - tachy + apnea retraction of chest wall grunting flaring hypotonia

Answer 192

1. reactivity 1-2 hrs 2. sleep 1-4 3. 2nd period of reactivity 2-8 hrs

Answer 193

Systemic vascular resistance increase / pulmonary artery pressure - after cord clamp Closure of shunts - foramen ovale, ductus arteriosus, ductus venosus

Answer 194

Maternal conditions - diabetes, HT Fetus conditions - congenital anomalies Antepartum - placenta / amniotic fluid Delivery complications Neonatal difficulties - lack of respir effort, blockage, impaired cardiac lung f(x)

Answer 195

Blood vol 80-90 ml/kg increase of erythropoietin secreted leukocytosis is normal - increase WBC

Answer 196

small stomach - marble as milk transitions fat increases more enzyme amylase lipase meconium 8-24 hrs weight loss 3-4 day; 3.5% formula, 7% BF

Answer 197

limited capacity to concentration of urine - cant reabsorb water to maintain organ f(x) - void 24 hrs -brick dust stains

Answer 198

40% of abdomin iron storage regulation of blood glucose-- glycogen -> glucose >40mg coagulation of blood bilirubin conjucation

Answer 199

passive immunitiy - Ab pass through placenta ; IgG by third tei Active immunity IgA in colostrum

Answer 200

Rapid weight gain by 4-6 mo 2x weight 1yr 3x 100-120/kg /day

Answer 201

feeding >8 in 24 hrs swallowing Soft breasts after feeding # of wet diapers increase Stools begin to lighten

Answer 202

cavities when putting juice/soda in bottle. Hold baby while feeding.

Answer 203

Abnormal brain and neuron development Lbw Premature FAS leading cause of mental retardation

Answer 204

Cardiac maternal events - death Abruption Fetal effects - vasoconstriction neuroexfitation

Answer 205

Withdrawal symptoms from neonate

Answer 206

Decreased fertility Increased risk of miscarriage Previa IUGR cognitive impairment

Answer 207

Polyuria Polydipsia Weight loss Polyphagia

Answer 208

Diaphoresis and disorientation

Answer 209

Maternal diabetes

Answer 210

1/6 infection Fetal risk: Spontaneous abortion Preterm labor IUGR neonatal infection Antiviral therapy after birth - acyclovir

Answer 211

Urinary output 20mL/hr Blood pressure 104/62 Respiration of 7 Absent reflex Lethargy Excitability

Answer 212

N: provide warmth clear airway dry stimulate - rapid assessment R; assess breathing p: assess heart rate

Answer 213

Cooling of moisture with air

Answer 214

Heat from body is taken away from air

Answer 215

Heat is transferred to an object that you are touching

Answer 216

Heat is lost to an object further away

Answer 217

Avelolar stability Decreases surface tension Increases compliance L/S ratio

Answer 218

heart rate 0- absent 1 -60-100 2 >100 Respir 0-absent 1- slow irregular weak 2 cry Reflex 0-no response 1-grimace 2-cry Color 0 cyanotic 1pink and blue 2 pink Muscle tone 0flaccis 1some flexion 2active motion

FINAL EXAM Flashcards

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