1
Q
what to assess for the back in a newborn assessment?
A
- spine alignment
- skin over the spine
- movement and symmetry
- hips & gluteal creases
- palpation of the back (masses, gaps, step-offs)
2
Q
Spine alignment (normal & abnormal)
A
Normal: smooth, flexible, no curves or deformities and a straight, midline spine from neck to buttocks
Abnormal: Scoliosis, kyphosis, abnormal curvature
3
Q
what are you looking for when assessing the skin over the spine?
A
look for dimples, tufts of hair, skin tags, or discolouration
a sacral dimple is common, but if its deep, wide, or associated with hair/skin tags = may indicate spina bifida occulta
4
Q
what are you assessing when you palpate the back
A
should feel smooth & continuous with no gaps, step-offs, or masses
5
Q
what are you looking for when assessing movement & symmetry of the back?
A
observe limb movement while assessing the back:
- arms and legs should move equally & spontaneously
- asymmetry could indicate neurological/spinal cord issues
6
Q
what are you looking for when assessing the hips and gluteal folds
A
check gluteal folds/creases = should be symmetrical
asymmetry may suggest hip dysplasia or limb discrepancy
7
Q
what to assess for female newborn genitalia?
A
- inspect external genitalia
- Normal: enlarged clitoris and swollen labia majora/minora (usually due to maternal hormones, usually resolves in a few weeks
- Common normal finding: small amount of vaginal bleeding or mucus (“pseudo menstruation”), caused by sudden withdrawal of maternal estrogen after birth
8
Q
what to assess for newborn male genitalia?
A
- palpate testes-both should be descended into scrotum
- scrotal sac: check size, shape, & rugae/wrinkles (rugae indicate term maturity - preterm boys may have smooth scrotum w undescended testes)
- urinary meatus: should be at tip of penis (not on underside = hypospadias, or top = epispadias)
9
Q
“Freaky but Normal” things parents may notice
A
- vaginal bleeding in girls (due to maternal hormone withdrawal, “pseudo menses”)
- Galactorrhea (milk-like discharge from breast tissue in boys/girls = hormone related)
- breast buds in both sexes (temporary swelling from maternal estrogen)
10
Q
normal progression of stool changes of the newborn
A
- 1st stool: meconium (formed in utero) - usually passes w/in 48hrs
- day 2-4: transitional stools (thin, brown-green) - shows GI tract is maturing
- day 4 <: milk stool
- breastfed infant (yellow gold, soft, seedy, or mushy stool)
- formula fed infant (pale yellow, formed & pasty stools
11
Q
what could it mean if the newborn doesn’t pass stool
A
imperforate anus: birth defect, that prevents normal BM
(anus is missing, blocked or abnormal location)
12
Q
a newborn should have their fist void within ___ of life
A
24hrs of life
13
Q
what is “Brick Dust”
A
when the 1st urine is slightly pink/reddish due to uric acid crystals
14
Q
daily patterns of voiding (by day of life)
A
Day 1: at least 1 wet diaper
Day 2: at least 2 wet diapers
Day 3: at least 3 wet diapers
Day 4 and onward
At least 6-8 wet diapers per day once feeding is well established
15
Q
Normal characteristics of Urine
A
Colour: pale yellow to clear
Odor: mild, not strong
Volume: variable, but diapers should feel noticeably wet
16
Q
general inspection of a newborns extremities (hands & feet)
A
symmetry: arms & legs same length, move equally
position: flexed/tucked in naturally
Movement: strong, equal, spontaneous (weak/absent = possible injury or neuro issue)
17
Q
what to assess for a newborns arms & hands
A
check for 5 fingers
not extra (polydactyly) or fused (syndactyly) digits
18
Q
what to assess in a newborns palmar creases
A
Normal: 2-3 creases
single crease: may be normal or linked to genetic conditions (e.g., Down syndrome
19
Q
what to assess for a newborns legs & feet
A
check for clubfoot or positional deformities (often due to intrauterine positioning; usually correctable)
count toes: note extra (polydactyl) or fused ones (syndactyl)
20
Q
common newborn reflexes
A
sucking
rooting
grasping (palmar & plantar)
tonic neck (fencing)
stepping
21
Q
Key reflexes to remember for newborns
A
Moro (startle) reflex (present from 34+ weeks gestation - 5 months): sudden movement/loud noise = arms extend then flex in ( if absent may indicate neurological concern
Babinski (plantar reflex): toes fan out and big toe dorsiflexes when sole is stroked (normal: present at birth but abnormal after 24months)
22
Q
general newborn care that happens approx 20-24hrs old
A
vital signs
infant bath
metabolic screen (PKU)
Bilirubin screen (jaundice) - TCB then TSB if needed
New* RSV (or can happen with vit K at 1hr)
23
Q
metabolic screen
A
checks if baby can process phenylalanine (an amino acid)
if not processed the phenylalanine builds up = brain damage
done using heel prick (part of newborn screening panel)
24
Q
Jaundice screening
A
the liver breaks down bilirubin - if it can’t, bilirubin builds up
high bilirubin = toxic to brain
step 1: measure TcB using skin sensor
step 2: if high, confirm with TSB test (blood test)
25
early feeding cues
stirring, mouth opening, turning head, and rooting
Early = "I'm hungry"
26
Mid feeding cues
stretching, increased moving, hand to mouth
Mid = "I'm really hungry"
27
Late feeding cues
crying, agitated body movements, turning red
Late cues = "Calm me, then feed me"
28
symptoms a parent should report
activity change (very sleepy/listless/restless/continuous crying)
difficulty breathing
fever (T>38 degrees)
increasing jaundice (sleepiness, sclera colour changes)
frequent vomiting large amounts, projectile
diarrhea
feeding problems (refusing to eat several feeds in a row)
less than 6 wet diapers/days after day 6
29
induction
starting labour artificially BEFORE it begins on its own
30
purpose of induction
to initiate contractions and begin labor
31
examples of induction
ambulation
membrane stripping
prostaglandin (PO or intravaginal)
IV oxytocin
Nipple stimulation (controlled by dr's orders)
32
Augmentation
helping an EXISTING labour progress more effectively
33
purpose of augmentation
to strengthen/increase the frequency of contractions that have already started
34
examples of augmentation
increasing oxytocin dose
AROM (artificial rupture of membranes)
balloon catheter
position changes and walking
35
goal of induction
protect the health of both mother and baby by delivering safely
36
methods of induction that can be used
natural methods (walking)
mechanically opening the cervix
meds to start/induce contractions (oxytocin)
AROM
37
differences between induced and natural labour
Natural labor: contractions build up slowly but induced can start more quickly and be stronger
Induced labor: standard orders are to use EFM = less mobility Can request IA
38
medical indications for INDUCING labour (*need a good medical reason to induce)
Post dates >42wks *most common reason
Gestational HTN
Fetal distress (decelerations)
Diabetes
Preeclampsia >37wks
SROM at term w GBS +ve
Intrauterine growth restriction (IUGR)
Sig maternal disease not responding to treatment
Oligohydramnios
Chorioamnionitis
Sometimes logistical concerns
39
why would you induce a pregnancy that is past 42wks
mom or babes health is at risk
placenta concerns
GDM or HTN
40
what used to be an indication for induction but is NOT anymore?
fetal Macrosomia (suspected >4000g)
41
cautions for induction
grand multipara (G5)
unfavorable or unripe cervix
brow or face presentation
overdistention of uterus (polyhydramnios or multiples)
lower segment uterine scar (extreme caution)
pre-existing hypertonic uterus
prior Hx of difficult labour &/or traumatic delivery
availability of C-section delivery
42
why is Grand para a caution for indication
increased risk for mal-presentation, placenta previa, PPH, ruptured uterus
43
why is brow/face presentation a caution for induction?
the diameter of the head trying to pass through the pelvis is much larger than in a normal vertex presentation
induction & augmentation can lead to obstructed labor, fetal distress, & maternal trauma (e.g., perineal tears, uterine rupture)
44
contraindications to induction
complete placenta praevia, placental abruption (abruption placenta)
transverse fetal lie
prolapsed cord
prior classic uterine incision
vaginal bleeding with unknown cause
active genital herpes infection
abnormal FHR patterns
*convenience*
45
Before an induction: steps to confirm if ready to induce
1) vaginal exam - cervical readiness (bishop score) How "ripe" or ready the cervix is for labour
2) Ultrasound - fetal & placental assessment
3) Non-stress Test (NST) - fetal well-being
46
cervical readiness (Bishop score)
how "ripe" or ready the cervix is for labour
originally used to help predict the LIKELHOOD of a woman entering into labour naturally = higher score more likely to go into labour
47
the Bishop Score gives a # based on...
Dilation (how open the cervix is)
Effacement (How thin it is)
Consistency (soft or firm)
Position (Posterior or Anterior)
Station (how low the baby's head is)
48
what is a favorable (ripe) bishop score
score >8
the cervix is soft, short, anterior, & partially dilated
labour induction is likely to succeed
49
what is a unfavorable (not ripe) bishop score?
score <6
cervix is long, closed, posterior, & firm
induction is likely to fail = cervical ripening (prostaglandins or balloon) needed first
50
what does the Non-stress test (NST) evaluate
the NST evaluates fetal heart rate response to fetal movement
51
what is the goal of the Non-stress test?
confirm that the baby can handle the stress of contractions
52
what is a reactive non-stress test
baby's HR accelerates appropriately with movement = safe to proceed
53
what is a non-reactive stress test
baby may not tolerate labour = postpone induction or investigate further
54
maternal risks when undergoing induction
PPH - overstimulation of uterus (atony)
Infection - AROM
Increased risk for CS
Placenta implantation abnormalities for future pregnancies
Longer hospital stays
More hospital readmits
WORSE CASE = death
55
babes risks when undergoing induction
Abnormal FHR patterns due to tachysystole
Resp distress = strong/freq contractions (stressed infants often MEC before birth = resp/infection issues)
Increase risk for NICU admission
56
Natural Induction Methods for cervical ripening
Walking
Nipple stimulation/hand expression - oxytocin
Sexual intercourse/Human sperm - contains prostaglandins = ripens the cervix
Orgasm - lower uterine stimulated
57
what natural induction methods are NOT recommended
enema
castor oil herbal supplements
58
Pharmacological Induction methods for cervical ripening
medications that contain synthetic versions of the body's natural prostaglandins = for cervical ripening
- Prostaglandins
- Dinoprostone (Cervidil - vaginal insert) & Prepidil - vaginal gel)
- Misoprostol (Cytotec)
59
purpose of Prostaglandins
purpose is to ripen the cervix &/or stimulate contractions
- at low levels, prostaglandins help the cervix soften and open
- at higher levels (or in sensitive individuals) they also stimulate uterine contractions
60
how do Dinoprostone (Cervidil/Prepidil) work
Softens the cervix by breaking down collagen fibers & increasing water content (ripening)
Can also stimulate uterine contractions
61
Misoprostol (Cytotec)
Given vaginally, orally, or sublingually
Do not give concurrently with oxytocin
62
what is the purpose for mechanical Induction methods for cervical ripening
soften, efface, & dilate the cervix to prepare for induction with pharmacological (oxytocin)
63
when is mechanical Induction methods for cervical ripening used?
BEFORE starting oxytocin or if the bishop score <6 (aka unfavorable cervix)
64
examples of mechanical Induction methods for cervical ripening
Cervical ripening balloon (CRB)
Laminaria
Membrane sweep
65
benefits of mechanical Induction methods for cervical ripening
low risk of uterine tachysystole (compared to pharmacological)
Can be combines w pharmacological agents later if needed
66
risks of mechanical Induction methods for cervical ripening
infection (due to device insertion)
bleeding
accidental rupture of membranes
67
how does a Cervical Ripening balloon (CRB) work?
a catheter w small balloon is inserted through the cervix and inflated w saline
the balloon applies direct pressure on the cervix = mechanically stretches it open & stimulates prostaglandin release
often falls out on its own once cervix reaches 3-4cm dilation
68
how does Laminaria (seaweed) work?
Sterilized dried seaweed sticks that are inserted into the cervix; absorb fluid and swell up to 10x their size
this slow expansion gently dilates cervix over several hrs
(works like a tampon)
69
key nursing points for Laminaria
- used less often today but still effective, especially in early induction or termination procedures
Monitor for:
- cramps
- discomfort
- signs of infection
70
Membrane Stripping (Sweeping)
the HCP inserts a gloved finger into the cervix and separates the amniotic sac from the uterine wall w a sweeping motion
71
what is the purpose of Membrane Stripping (Sweeping)
to stimulate natural prostaglandin release & start contractions
commonly used at term/postdates before using meds
72
key points of Membrane Stripping (Sweeping)
often done in office setting
may cause mild cramping, spotting, or irregular contractions
labour may start within 24-48hrs
73
in Membrane Stripping (Sweeping), nurses should monitor for:
bleeding
leakage of fluid
regular contractions
74
when you change the uterine environment... what do you assess first?
Fetal Heart Rate (FHR)
75
purpose of Surgical Methods for induction or Augmentation (NOT ripening)
used to "speed it up NOT start up labour"
Purpose:
to stimulate/strengthen contractions once cervix is already favorable
does not soften/dilate the cervix
enhances pressure of fetal head on cervix = stronger contractions
76
when are surgical methods for induction & augmentation used
when cervix is ripe (soft & 2-3cm dilated)
2 station
head is engaged (to prevent cord prolapse)
77
Amniotomy (AROM - artificial rupture of membranes)
intentional breaking of the amniotic sac using a sterile amnihook during a vaginal exam
allows direct observation of amniotic fluid (for meconium, infection, etc)
78
what is oxytocin?
a pharmacologic agent used for induction or augmentation
- oxytocin (synthetic Pitocin) is a pharmacologic (drug-based) uterotonic that stimulates uterine contractions
- it mimics the body's natural oxytocin but allows precise titration by IV pump
- once cervix is ripe, Oxytocin can safely & effectively induce/augment labor
79
risks of Oxytocin
uterine tachysystole or hypertonus
hypotension
fetal distress/hypoxia
uterine rupture (especially w previous scar)
hyponatremia/water intoxication (rare, prolonged infusion)
water intoxication
80
what is tachysystole?
too many or too strong contractions = less O2 to baby (>5 contractions in 10 mins)
81
what are the features of Tachysystole
- resting period <30sec between contractions
- contractions lasting >90secs
- abnormally strong tone (uterus feels hard - "forehead firm")
- abnormal or atypical FHR (late decels, tachycardia, minimal variability)
82
why is tachysystole dangerous
no rest between contractions = decreased uteroplacental perfusion = decreased fetal oxygenation = distress or acidosis
83
how to manage tachysystole?
- decrease or stop oxytocin immediately
- reposition patient (left lat, side-to-side)
- administer tocolytic (e.g., Nifedipine, Terbutaline)
- continuous fetal monitoring
- provide emotional support & reassurance = decreases anxiety & helps the mother remain calm
84
what is the half life of oxytocin
half life is around 1-5 mins (uterine response occurs within 2-5mins of IV administration
85
induction risks from Syntocinon after delivery
- risk of PPH/PP atony is increased with induction
watch for signs of PPH (bleeding when stand up, peri pad count, clots)
86
Syntocinon vs oxytocin
syntocin is synthetic & oxytocin 9s natural
- syntocin = increases the chance of needing other interventions and unnatural contraction rhythms can occur
- oxytocin = triggers the endorphin effect & only flows when the cervix is ready = natural rhythm
- oxytocin is the love hormone = acts as a bonding hormone b/w mom & babe
87
Labor dystocia
"failure to progress" in active labor
delay or arrest of cervical dilation or descent
*most common cause of primary C-section in Canada
- significantly slower or no progress despite adequate contractions
88
shoulder dystocia
after head delivery = shoulders stuck (obstetric emergency)
89
labour dystocia
slow or stalled labour progress (before birth)
90
the Ps of dystocia
1) Powers - ineffective contractions
2) Passenger - fetal size or position
3) Passageway - maternal pelvis/soft tissues
4) Psyche - maternal emotional state
91
hypertonic contractions
too strong/poorly coordinated = prolonged latent phase
92
hypotonic contractions
weak contractions = slowed active phase, increased risk of postpartum hemorrhage
93
nursing interventions labor dystocia
reposition the patient
encourage ambulation or position changes
encourage rest and relaxation
hydration (oral or IV)
empty the bladder frequency
94
factors associated with increased risk for dystocia
- high BMI - slower to progress in 1st stages
- epidural anesthesia - slows stage 2
- occiput posterior OP or sunny side up
- short maternal stature (less than 5ft tall)
- high station at complete cervical dilation
- not had a baby before
- macrosomia
- shoulder dystocia
95
what is precipitous labor/rapid labor
- delivery that occurs within less than 3hrs of the onset of regular uterine contractions
96
regular uterine contractions are rhythmic, coordinated tightening & relaxation of the uterus that:
- occur at consistent intervals
- increase in frequency, duration, & intensity over time, &
- result in progressive cervical change (dilation & effacement)
97
what is Augmentation
- when we enhance or speed up labor that has already started but slowed/stopped (dystocia)
- methods are used to strengthen or increase frequency of already occurring contractions
98
indications for Augmentation:
- active labour has started but contractions are weak or irregular (powers) = oxytocin given
- active labor but amniotic sac not ruptured on its own = AROM
- active labour has started & SROM/AROM but labor not progressing = oxytocin given
99
risks for synthetic oxytocin
- uterine hyperstimulation
- leads to fetal distress - C/S
- water intoxication = inhibits excretion & promotes fluid retention
- uterine ruptures (tear in uterus)
- umbilical cord prolapse (cord through the cervix before babe)
- birth of preterm babe IF dating not accurate
100
which of the following is NOT a benefit of breastfeeding
a) reduced risk of gastroenteritis
b) enhanced cognitive development in preterm & term infants
c) increased risk of dental malocclusions
d) protection against otitis media & resp illnesses
c) Increased risk for dental malocclusions
101
you are going to give your pp pt diphenhydramine due to intense pruritus. she is breastfeeding. you look the med up to follow all 10 med rights & it says the med "crosses the placenta & enters breastmilk & is contraindicated in lactation" What do you do (Select all that apply)
a) Give med as ordered
b) discuss the situation w your instructor before giving the med
c) Ask the LC for support
d) Call the pharmacy
b) Discuss the situation w your instructor before giving the med
c) Ask the LC for support
d) Call the pharmacy
102
you should teach parents to avoid using any kind of baby powder on their infant. (True or False)
True (b/c babe can breathe it in and it can go into their lungs & get a lung infection)
103
what would be important ABNORMAL info to note upon the immediate physical assessment of the newborn?
a) Loud continued crying
b) Apgars of 8 at 1min & 9 at 5 min
c) A 2-vesseled cord
d) Body pink with bluish extemities
c) A two-vessel cord
104
a nurse is explaining to a group of nursing students about the methods used for cervical ripening. the students demonstrate their understanding of the info when they identify which method as a pharmacological method to help dilate the cervix?
a) walking
b) CRB (cervical ripening agent)
c) Luminaria or dried seaweed
d) Cervidil
d) Cervidil
105
damond is in their 1st pregnancy & arrives at the birthing unit for induction of labour due to post dates. damonds membranes were stripped at 38wks. the dr has confirmed they are at 42wks gest. upon assessment the RN determines the cervix is 1cm dilated, firm, posterior, & at station -2. damond is not having any pain & denies contractions.
given this info is she a good candidate for induction with syntocinon?
No (b/c the cervix isn't fully dilated to a safe amount) this means that damond should expect a cervical ripening agent before receiving syntocinon
106
Brenna is admitted to the hospital in active labor. she has progressed from 2-7cm in 8hrs. She has been started on IV oxytocin to augment her contractions. which of the following is the MOST important nursing intervention at this time?
timing and recording the length of her contractions
107
what if the fetus of a woman in labor is DETERMINED to be in persistent occiput posterior position. what are the nursing interventions (select all that apply)
a) Position changes
b) Pain relief measures
c) Immediate cesarean birth
d) Oxytocin administration or titration
a) Position changes
b) Pain relief measures
108
a client is receiving an oxytocin infusion to augment labor. which of the following findings indicates that the oxytocin infusion is being administered safely?
a) contractions every 1-2mins, lasting 90secs, w variable decelerations
b) contractions every 2-3mins, lasting 60secs, & a fetal HR w mod variability & no decels
c) contractions every 4-5mins, lasting 30secs, & a fetal HR of 170bpm
d) contractions every 2mins, lasting 90secs, & a fetal HR w late decels
b) contractions every 2-3mins, lasting 60secs, & a fetal HR w mod variability & no decels
NURS330
flashcards
Decks in class (18)
# Cards
-
Peds Quiz #1114
-
Obs Module 1: Intro to Maternal Newborn Nursing99
-
Peds GI Disorders55
-
Peds Diabetes & Healthy Body Weights42
-
OBSTETRICS Module 7: Induction and Augmentation; Dystocia108
-
Peds Alterations in Neurologic Function71
-
OBSTETRICS Module 8 - Health Challenges in Pregnancy57
-
Obs Module 2: Signs, Factors, & Stages of Labor (The Birth Process)65
-
Obs Module 3: Assessments & Care in Labor (Intrapartum Care)61
-
Obs Module 4: Promoting Comfort & Pain Management During Labor38
-
Obs Module 5: Postpartum Assessment & Care for the Mother67
-
Obs Module 6: Newborn Assessment & Care78
-
Obs Module 9: Health Challenges in Labor & Birth7
-
Peds: Pediatric Trauma30
-
Peds: Pediatric Mental Health19
-
Peds: Care of the Child w a Blood or Neoplastic Disorder63
-
Peds: Promoting Oral Health in Children & Adolescents20
-
Peds: Pediatric Palliative Care & Pain Management21
