Test 2 Flashcards
Normal Newborn Complications (158 cards)
1
Q
Expected infant weight loss in the 1st few days after delivery
A
5-10%
2
Q
Formula for expected weight loss
A
(Birth Weight-Today’s Weight) x 100/Birth Weight
3
Q
Ways to enhance thermostability in newborns
A
- Skin-to-skin (STS)
- Wrap in blankets
- Radiant warmers
4
Q
In order for a newborn to be placed STS immediately upon delivery, the mother’s temperature should be…
A
Greater than 97
5
Q
An infant who is pallor in color could be a sign of…
A
Hypoxia or Anemia
6
Q
An infant who is ruddy (plethora) in color could be a sign of…
A
Polycythemia, increased Hct (risk for jaundice)
7
Q
Apnea up to 15 seconds is normal in a newborn. True or False?
A
True
8
Q
An infant who has a respiratory rate of 65, nasal flaring, retractions, and is making a grunting noise is exhibiting signs of…
A
Respiratory distress
9
Q
In what order do you bulb suction a newborn?
A
Mouth first, then nares
10
Q
An important nursing intervention when caring for a newborn in respiratory distress is…
A
Prevent cold stress
11
Q
Methods of heat loss in a newborn
A
- Evaporation
- Radiation
- Conduction
- Convection
12
Q
Shivering is often seen in an infant experiencing cold stress. True or False?
A
False
13
Q
Effects of cold stress on a newborn
A
Increased need for glucose and oxygen
Can lead to respiratory distress and hypoglycemia
14
Q
An infant with a head lesion that does NOT cross the suture line has a…
A
Cephalhematoma
15
Q
An infant with a head lesion that DOES cross the suture lines has a…
A
Caput Succedaneum
16
Q
How soon after birth should a newborn void?
A
Within the first 24 hours
17
Q
A female newborn who has white genitourinary mucous tinged with blood is experiencing…
A
Pseudomenstruation (withdrawal from maternal hormones)
18
Q
Male urethral opening on the bottom of the penis
A
Epispadias
19
Q
Male urethral opening on the top of the penis
A
Hypospadias
20
Q
An increased accumulation of bilirubin in an infant can lead to…
A
Kernicterus (bilirubin encephalopathy) due to staining of brain tissue
21
Q
Jaundice that is noted within the first 72 hours of life (after the initial 24 hours)
A
Physiologic Jaundice
22
Q
Jaundice that is noted within the first 24 hours of life
A
Pathologic Jaundice
23
Q
When is jaundice treated?
A
When bilirubin levels reach 13 mg/dl
24
Q
Nursing interventions for a newborn with jaundice
A
- Encourage frequent feedings (promotes stooling and the passage of bilirubin)
- Phototherapy (UV light)
- Ensure hydration in mother
25
Normal glucose level for a newborn
45 mg/dl or higher
26
An infant experiencing jitters, hypothermia, tachypnea, poor suck, and lethargy is exhibiting signs of...
Hypoglycemia
27
Infants most at risk for hypoglycemia include...
1. Premature
2. Postmature
3. Inadequate uterine growth restriction
4. Cold stress
5. SGA
6. LGA
7. Diabetic mother
28
Brachial nerve damage in a newborn is referred to as...
Erb's Palsy
29
A fetus will begin secreting it's own insulin by what gestational age in a normal pregnancy
10 weeks
30
A mother is at increased risk for developing gestational diabetes if she has a previous history of...
1. Family history
2. Increased BMI
3. Age greater than 25
4. Hypertension
5. Lipid abnormalities
6. Race/ethnicity
31
The majority of gestational diabetes cases can be controlled by...
Diet
32
A mother has a glucose screening result of 145. Is this considered normal or abnormal?
Abnormal (anything greater than 140 = abnormal)
33
Diagnosis of gestational diabetes is made by what results on a glucose tolerance test (GTT)?
```
2 or more plasma glucose levels greater than:
95 (fasting)
180 (after 1 hour)
155 (after 2 hours)
140 (after 3 hours)
```
34
Glucose Tolerance Test includes...
High carbohydrate diet for 2 days, fasting after midnight day of test (FBS), ingesting 100g of oral glucose, checking BG at 1, 2, and 3 hours.
35
A mother with a previous history of DM will require a 2-4 times insulin increase during the second half of pregnancy. This is due to...
Development of insulin resistance
36
Maternal risks for a women with a previous history of DM include...
1. Hydraminos (due to polyuria experienced by fetus)
2. Pregnancy induce HTN
3. Infections
4. Hyperglycemia and Ketoacidosis
37
Neonatal risks for a fetus with a mother who has a previous history of DM include...
1. Macrosomia (large, beefy baby)
2. Respiratory distress syndrome (diabetes hormones slow down the production of surfactant)
3. Intrauterine Growth Restriction (IUGR)
4. Hyperbilirubinemia (decreased O2 leads to increased RBC production)
38
An infant born to a mother with a previous history of DM is at greatest risk for what 2-4 hours after birth?
Hypoglycemia
39
Nursing management goal for a mother with a history of DM includes...
1. Maintain glucose between 80-120 mg/dl (promote bedtime snacks to increase blood sugar through night)
2. Report FBS of greater than 105 or if greater than 120 post partum (2 hours)
3. Encourage exercise
4. Infection prevention
40
Important patient education regarding breastfeeding and diabetes is...
Insulin does NOT transfer into milk, but glucose DOES
41
Acronym for the group of viral/infectious diseases that can occur during pregnancy
```
T (toxoplasmosis)
O (Other diseases: STDs)
R (Rubella)
C (Cytomegalic Inclusion Disease: CMV)
H (Herpes Virus serotype 2: HSV-2)
```
42
Infections that have the potential to cause the greatest harm to a neonate during pregnancy
1. CMV
2. Rubella
3. Varicella-zoster
4. Herpes simple
5. Hepatitis B
6. HIV
43
An infant who has been exposed to toxoplasmosis could develop...
Blindness, neurological disorders, retardation
| If contracted at less than 20 weeks, miscarriage results
44
An infant who has been exposed to STDs could develop...
Conjuctivitis, pneumonia
| Increased risk for ectopic pregnancy in mother (should be screened at prenatal visits)
45
An infant who has been exposed to Rubella could develop...
```
Congenital anomalies (NEONATAL CATARCTS), retardation, deafness
Monitor rubella titers (can cross over placental barrier)
```
46
An infant who has been exposed to CMV could develop...
Nervous system disorders, low birth weight, deafness
47
An infant who has been exposed to Herpes virus could develop...
Serious neurological deficits, blindness
Over 50% infant death if left untreated
If mother has active lesions during delivery, definitive C/S (no exceptions!)
48
An infant born to a HIV positive mother and has a positive titer indicates the infant has HIV. True or False?
False - Sero levels will convert to normal at 18-24 months (use PCR for earlier determination of infection)
49
A HIV positive mother has a viral load of 1500. Will she deliver vaginally or via C/S?
Will deliver via C/S (greater than 1000)
50
When is HIV at greatest risk for transfer to the fetus?
If contracted as a primary infection during the pregnancy
51
Leading cause of life-threatening perinatal infections
Group Beta Streptococcus
52
An infant with early onset GBS will manifest what symptoms?
1. Sepsis
2. Pneumonia
3. Meningitis
53
An infant with late onset GBS will most likely manifest... after the first week of birth.
Meningitis (may cause death or permanent neurological deficits)
54
Optimal screening for GBS is...
35-37 weeks gestation
55
A patient who is GBS positive needs at least 1 dose of anitibiotics how long before delivery to be considered "safe"?
4 hours, otherwise infant will require complete course of antibiotics after birth
56
Hypertension that precedes pregnancy or develops at less than 20 weeks gestation
Chronic Hypertension
57
What is the cardinal sign of pre-eclampsia?
Proteinuria
58
Methyldopa (Aldomet) is used to treat...
Mothers with chronic hypertension
59
Development of a blood pressure greater than 140/90 during the SECOND HALF of pregnancy with no development of proteinuria
Gestational hypertension (will regress after delivery)
60
What causes the proteinuria seen in pre-eclampsia?
Renal involvement
61
Generalized vasospasm during pre-eclampsia leads to...
Decreased tissue perfusion (can lead to cerebral hemorrhage, liver damage, and decreased placental perfusion)
62
A pregnant patient experiencing a blood pressure greater than 140/90, generalized edema, proteinuria, clonus, and double vision is exhibiting signs of...
Pre-eclampsia
63
What causes epigastric pain in worsening pre-eclampsia?
Liver involvement
64
Only cure for pre-eclampsia
Delivery (risk still continues for several days post-partum)
65
Self-care patient education for pre-eclampsia includes...
1. Rest
2. Well-balanced diet (increased protein)
3. No salt restrictions
4. Take daily weights
5. Awareness of signs/symptoms
66
Magnesium Sulfate (MgSO4), hydralazine, and oxytocin are administered for..
Severe pre-eclampsia
67
This drug competes with calcium and depresses the CNS (used to treat pre-eclampsia or preterm labor)
Magnesium Sulfate
68
Antidote for MgSO4
Calcium Gluconate (1 gm slow IVP)
69
Therapeutic levels of MgSO4
4-8 mg/dL
70
Toxic effects of magnesium sulfate that are seen when serum levels are greater than 8
1. Decreased LOC
2. Lethargy, drowsiness
3. Slurred speech
4. Hypotension
71
Antihypertensive agents used to treat pre-eclampsia
Labetolol
| Hydralazine
72
Patients with eclampsia are at risk for...
Generalized, grand mal seizures
73
HELLP Syndrome involves...
```
H (Hemolysis)
E (Elevated)
L (Liver enzymes)
L (Low)
P (Platelets)
```
74
HELLP Syndrome is characterized by...
Pain in the RUQ (jaundince, N/V, edema may be present)
75
Betamethasone is given to treat...
HELLP Syndrome (if less than 34 weeks gestation)
76
Implantation of the placenta in the lower uterus
Placenta Previa
77
Common cause of planceta previa
Scar tissue (limits the number of areas for the placenta implantation)
78
Pregnancies in which placenta previa occurs can be delivered vaginally. True or False?
False - Automatic C/S
79
Sudden onset of PAINLESS uterine bleeding is a classic sign of...
Placenta Previa
80
Should a vaginal exam be performed on a pregnant patient with placental previa?
No! Risk for placental disruption
81
Separation of the implanted placenta before the fetus is born
Abruptio Placental (Abruption)
82
There is vaginal bleeding in a concealed placental abruption. True or False?
False
83
A patient presenting with uterine tenderness, abdominal pain, and a board-like abdomen is exhibiting symptoms of...
Placental Abruption
84
Maintenance fluid of choice for volume replacement in hemorrhagic conditions
Lactated Ringers
85
Implantation of fertilized ovum outside uterine cavity
Ectopic Pregnancy
86
Major nursing role in ectopic pregnant
Maintaining hemodynamic status
87
Ectopic pregnancies are most commonly caused by...
Scar tissue (STDs, IUD, multiple abortions)
88
Methotrexate is used to treat...
Ectopic pregnancy in an UNRUPTURED tube (inhibits cell division)
89
A patient with a positive pregnancy test and that is experiencing sudden pain in RLQ (or LLQ), hemorrhage, and pain radiating under scapula is exhibiting signs of...
Ruptured tube
90
A patient exhibiting exaggerate signs/symptoms of pregnancy, increased hCG levels, an absence of a fetal sac on ultrasound, and has an early diagnosis of pre-eclampsia may be have...
Gestational Trophoblastic Disease (Hydatiform Mole)
91
The biggest danger with Gestational Trophoblastic Disease
Persistent disease may undergo malignant change and metastasize to distant sites (VERY aggressive)
92
Why is a bicornuate uterus more at risk for spontaneous abortion?
Diminished capacity due to heart shape
93
Stitch used to keep cervix closed during early gestational dilation
Cervical cerclage
94
Ideal labor pattern
Contraction every 2 minutes lasting 60 seconds
95
Coordinated, weak contraction common during the active phase of labor
Hypotonic contractions
96
Uncoordinated, irregular, painful contractions occurring during the latent phase of labor
Hypertonic contractions
97
Why are hypertonic contractions dangerous for the fetus?
Decreased blood flow to placenta and fetus
98
Condition in which the head of the infant is born, but the anterior shoulder cannot pass under the pubic arch
Shoulder dystocia
99
Why is shoulder dystocia a medical emergency?
Risk of asphyxia
100
McRobert's maneuver is used to correct...
Shoulder dystocia (apply pressure to help move the shoulder out)
101
A breech presentation in an infant increases the risk for...
Prolapsed cord
102
One of the most common problems with the passage during a delivery
Soft tissue obstruction (distended bladder or no recent BM)
103
Multifetal pregnancies can result in uterine overdistension causing...
Dysfunctional labor (Hypotonic contractions)
104
When assessing for an intrapartum infection, one of the most common signs is...
Fetal tachycardia (monitor both mother and fetal HR)
105
Delivery that occurs within 3 hours of the onset of labor is known as...
Precipitate Labor
106
Pharmacological measures can be used during precipitate labor. True or False?
False - Baby will be born sedated
107
Spontaneous rupturing of membranes before the onset of labor
Premature Rupture of the Membranes (PROM)
108
How can membrane rupture be tested for?
1. Nitrazine - Paper turns blue (pH of 6.5-7.5) indicates positive rupture
2. Ferning (DO NOT do vaginal exam before ferning test)
109
Management for PROM includes...
1. Delivery within 12-24 hours if near term
| 2. Conservative management if pre-term to allow for fetal lung maturation
110
Complications involved with PROM could include...
```
Infection (monitor amniotic flluid)
Prolapsed cord (monitor fetal VS)
```
111
Labor that occurs after 20 weeks of gestation, but before the completion of the 37th week
Pre-term labor
112
Pre-term labor usually has very subtle signs/symptoms. True or False?
True
113
An initial intervention with pre-term labor is...
Hydration!! Dehydration can stimulate the release of oxytocin
114
Terbutaline, MgSO4, and Bethamethasone are all referred to as...
Tocolytics (used to treat pre-term labor)
115
A positive fetal fibronectin after 20 weeks will indicate...
Delivery within the next 2 weeks
116
False positive fetal fibronectin results can occur due to...
1. Bleeding
2. Intercourse
3. Infection
117
Bronchodilator used to prevent and treat pre-term labor in pregnancies greater than 20 weeks
Terbutaline Sulfate (Brethine)
118
Always assess what before administering Terbutaline Sulfate (Brethine)?
Pulse! Hold if HR is greater than 120
119
Antidote for Terbutaline Sulfate
Inderal
120
Nursing interventions for the administration of Terbutaline Sulfate include...
1. Monitor for s/s of pulmonary edema, hypoglycemia, and hypokalemia
2. Administer before other medications
3. Educate patient to check pulse before taking
121
Why are higher doses of MgSO4 given during pre-term labor as opposed to pre-eclampsia?
Trying to prevent labor
122
Corticosteroid given during pre-term labor to stimulate the production of lecithin in fetal lungs
Betamethasone (Celestone)
123
Sign of a prolapsed cord
Change in FH (variables, bradycardia)
124
What should always be done when FH changes or with a sudden rupture of membranes (SROM)
Vaginal exam to check for prolapsed cord
125
In the incidence of a prolapsed cord, the mother should assume what position?
Knee-Chest. Requires immediate delivery via emergency C/S
126
When the uterus completely or partially turns inside out as the placenta is delivered
Uterine Inversion
127
Signs/Symptoms of uterine inversion are...
1. Interior uterus seen through the cervix
| 2. Massive hemorrhage, shock
128
Most common form of uterine rupture
Dehiscence (splitting of an old scar)
129
A patient in labor with constant uterine pain and tenderness, burning at the peak of contractions, and whose fetus is showing signs of impaired oxygenation, may be experiencing...
Uterine rupture
130
Risk factors associated with an amniotomy (artificial rupture of membranes) include...
1. Infection
| 2. Prolapsed cord (be sure to assess fetal HR!)
131
What is a Bishops Score?
Pre-labor scoring system (involves dilation, effacement, station, cervix consistency, and cervical position)
132
Indications for induction of labor
1. Pre-eclampsia
2. Maternal diabetes
3. PROM
4. Chorioamnionitis
5. Post-term pregnancy
6. Fetal demise
7. Oligohydraminos
133
Medication used to ripen/soften the cervix to promote labor
Prostaglandins (Cervidil/Cytotec)
134
Make sure to monitor what VS after administration of prostaglandins?
Fetal HR 30 minutes after insertion
135
Most important thing to monitor for what administering prostaglandins
Uterine hypertonicity - If hypertonic, discontinue medication
136
Drug used to induce or augment labor by stimulating uterine smooth muscle contractions
Oxytocin (Pitocin)
137
What is the onset time of Pitocin?
Immediately
138
How many cc's is 1 mu/min of Pitocin?
3 cc's
139
Goal for Pitocin
Well contracted uterus
140
Important nursing assessment when administering Pitocin
Uterine Hypertonicity
141
What should be done if uterine hyperonicity or non-reassuring FH pattering are observed during an infusion of Pitocin?
```
STOP infusion
Increase main fluid rate
Position mother on left side to increase perfusion to baby
Administer O2 at 8-10 L
Notify the physician
```
142
Important post-op nursing care after a C/S delivery
Assess for uterine tone (fundal check)
143
What is the biggest risk for a vaginal birth after cesarean (VBAC)?
Uterine rupture
144
Pregnancy over 40 weeks gestation
Post-term pregnancy
145
Main risk to a post-term newborn are the result of...
Placental insufficiency
146
Infants require extra water in addition to feedings. True or False?
False - Breast milk and properly prepared formula fulfill water requirements
147
Average calorie need for an infant
110-120 cal/kg/day
148
Three phases of breastmilk
1. Colostrum - thick, yellow secretion during first week of lactation (contains antibodies and proteins)
2. Transitional milk - appears 48-72 hours after delivery; lasts for 7-10 days
3. Mature milk - Bluish tint, appears after 2 weeks
149
Cause of milk production
Sucking stimulation leads to the release of prolactin
150
Cause of milk ejection reflex
Nipple stimulation leads to the release of oxytocin
151
An infant who is rooting or smacking hand-to-mouth is exhibiting...
Early hunger cues
152
Ideal time for first breastfeeding of newborn
Within the 1st hour
153
How often and for what length of time should infants be fed?
Every 2-3 hours for no defined length of time
154
Causes of insufficient milk supply include...
1. Dehydration
2. Smoking
3. Inadequate diet
4. Inadequate rest
5. Use of caffeine or alcohol
155
Signs of breast milk letdown
Tingling in breast around 48 hours after delivery
| Mother feels uterine cramping (be sure to keep hydrated)
156
Formula feeding for newborns
1 oz on the 1st day
2 oz on the 2nd day
3 oz on the 3rd day
157
How long can breast milk be stored for?
Refrigerated - 48 hours
Refrigerated freezer - 1 month
Deep freeze - 6 months
*Never thaw, then refreeze*
158
Why is back-sleeping the preferred sleeping position?
Decreased re-breathing of air
Decreased overheating potential
Increased arousal
Less compression of vertebral arteries
