unit exam 3 test grid

Question 1

abnormal newborn findings

Answer 1

• risk factors that affect the newborn: premature labor, diabetes, hypertension, placenta abnormalities, HIV infection, unhealthy lifestyle

Question 2

abortion

Answer 2

any pregnancy loss or termination
- possible causes include fetal chromosomal abnormalities, uncontrolled diabetes, hypothyroidism, maternal infection, reproductive abnormalities, or maternal injury
- threatened abortions, inevitable abortions, incomplete abortions, complete abortions, missed abortions
- signs and symptoms include lower abdominal cramping, vaginal bleeding
- medical care: if it’s complete, usually does not require additional treatment. If bleeding does not stop, may need dilation and curettage, vacuum extraction, or vacuum d&c

Question 3

abruption

Answer 3

• premature separation of the placenta from the wall of the uterus
• life threatening to both mother and fetus
• types of placental abruption: partial, complete
• risk factors: hypertension, abdominal trauma, cocaine, cigarettes, alcohol, multiple pregnancy, short umbilical cord, advanced maternal age, history of placental abruption, sudden decompression of the uterus, prolonged rupture of membranes
• class 0: asymptomatic; diagnosed after placental delivery
• class 1: mild; none or mild vaginal bleeding, slightly tender uterus, normal heart rate and bp and no fetal distress
• class 2: moderate; none to moderate vaginal bleeding, moderate to severe uterine tendernes, possible board like firmness of abdominal wall, possible severe contractions, maternal bradycardia, orthostatic bp changes, fetal distress, and hypofibrinogenemia
• class 3: severe; none to severe vaginal bleeding, very painful uterus, boardline firmness of the abdominal wall, signs of maternal shock, hypofibrinogenemia, poor blood clotting, and possible fetal death
• hypofibrinogenemia - lack of fibrin in the blood, which decreases clotting time

Question 4

acrocyanosis

Answer 4

• bluish color of hands and feet due to immature peripheral circulation first 24-48 hours after birth

Question 5

adequate feedings for newborn

Answer 5

• calorie needs based on their age, size, and sex
• higher during the first year of life
• measured by length and weight on growth chart
• calories are from protein, fat and carbohydrates in diet
• water from adequate breast milk or formula
• infants eat only small amounts first few days after being born

Question 6

apgar score

Question 7

assessment of a premature neonate

Answer 7

• skin is thin, and arteries an veins are visible
• skin is fragile, and looks smooth and shiny
• a moderately premature infant will have abundant lanugo
• partially formed fingernails and toenails
• ears may fold
• very preterm infants have less muscle tone
• the premature baby does not lie in a “fetal position” until 35 weeks
• possible complications: respiratory distress, hypothermia, heart problems, intraventricular hemorrhage in the brain, anemia, infection, fluid and electrolyte imbalances, apnea

Question 8

birth asphyxia

Answer 8

• known as preinatal asphyxia, asphyxia neonatorum, or hypoxic ischemic encephalopathy
• defined as acute brain injury caused by asphyxia when the baby did not get enough oxygen during the birth process
• possible causes: mother does not get enough oxygen during labor, mother’s bp is too high or too low during labor, placenta separates from the uterus too quickly, resulting in loss of oxygen, the umbilical cord wrapped too tightly around the neck or body, fetus is anemic and does not have enough RBCs to tolerate labor contractions, newborn’s airway becomes blocked, delivery is too long and difficult
• symptoms: cyanosis, difficulty breathing, gasping respiration, umbilical cord ph <7, apgar score <3 for more than 5 minutes

Question 9

birthmark, rashes, skin lesions

Answer 9

• hemangioma: newly formed capillaries in dermal and subdermal layers of skin
• nevus flammeus: dilated skin capillaries
• nevus simplex: stork bite, angel kiss
• melanocytic nevi: mole; uncommon in newborn
• erythema toxicum neonatorum: newborn rash; macules, papules, or vesicles on body
• acne neonarum: clogged hair follicles
• milia: occluded sebaceous glands
• dermal melanosis: mongolian spot; trapped melanocytes

Question 10

PPH

Question 11

cervical cerclage

Answer 11

• the use of sutures around the cervix to prevent it from opening, usually performed at 12-14 weeks gestation and removed after 37 weeks gestation or the onset of labor

Question 12

complications w/ feeding

Answer 12

• loss of more than 7% of birth weight
• not gaining back birth weight by 10 days of age
• not having at least 2-3 bowel movements per day after day 2
• does not have at least 6 wet diapers/day by day 4 w/ clear or pale yellow urine

Question 13

cold stress

Answer 13

• brown fat rapidly metabolized
• can lead to metabolic acidosis in the newborn
• consequences of increased metabolic rate in cold newborn: increased need for oxygen, decreased surfacant production, increased use of stored glycogen turns to hypoglycemia, rapid metabolism of brown fat leads to metabolic acidosis

Question 14

delivery complications

Question 15

ectopic pregnancy

Answer 15

• occurs when the fertilized ovum implants outside the uterus, usually in the fallopian tubes, but can occur anywhere outside the uterus; can be life threatening to the woman and may require surgical interventions
• risks: advanced maternal age, reproductive anomalies, history of fallopian tube surgery, history of PID, repeated induced abortions, repeated STIs, use of IUDs, history of assisted reproductive technology, regular douching, smoking
• signs: vaginal bleeding and abdominal pain, if the fallopian tube ruptures may have severe abdominal pain, shoulder or neck pain, weakness, dizziness, decreased BP, increased heart rate
• medical care: methotrexate may be administered if the fallopian tube has not ruptured, if fallopian tube has ruptured laparoscopic surgery is performed to save the tube. Tube may be removed if fallopian tube cannot be saved or pt no longer desires future pregnancy

Question 16

maternal hormone exposure

Answer 16

• rh incompatibility occurs if a rh-negative womn is exposed to fetal blood cells that are Rh-positive
• isoimmunization may occur
• antibodies will attack any Rh positive blood cells. Fetus in the first pregnancy is rarely affected, but w/ subsequent pregnancies, alloimmune induced hemolytic anemia can occur
• blood test to determine Rh and blood type
• antibody tter test
• repeat the test at 28 weeks’ gestation; evaluate antibody levels at intervals if indirect coombs’ test is positive
• administer RhoGAM at 28 weeks of gestation
• amniocentesis

Question 17

fetal circulation

Question 18

fetal lung maturity

Answer 18

• chest pressure squeezes out secretions and amniotic fluid
• chest recoils, causing air to fill the lungs
• surfacant increases to keep alveoli open after initial breaths
• cutting umbilical cord causes respiratory centers in brain to begin working in response to dropping blood pH
• count respirations per minute
• suction mouth and nose
• monitor respiratory effort
• observe abdomen

Question 19

full term newborn assessment

Answer 19

• 1 and 5 minute APGAR scores
• before stimulating w/ touch, nurse should observe infant for positioning, sleep or wake cycle, skin color, respiratory pattern
• vital signs
• measurements: length, head and chest circumference

Question 20

gesational diabetes

Answer 20

• the condition in which the blood glucose level is elevated during pregnancy in a woman not previously diagnosed with diabetes
• caused by insulin resistance, a condition in which the body produces insulin but does not use it effectively
• production of insulin is not enough to overcome the effects of the placental hormones
• usually starts halfway through the pregnancy at about 20-24 weeks
• incidence: 3-10% of all pregnancies
• risk factors: age greater than 25 years, physical inactivity, obesity with a bmi of 30 or higher, previous gestational diabetes, previous birth of a baby weighing more than 9 pounds, unexplained stillbirth, african american native american hispanic or asian heritage, having prediabetes, having a parent or sibling w/ type 2 diabetes, history of pcos, increased thirst, feeling hungrier and eating more than usual, increased urination, fatigue, frequent infections of the bladder, vagina and skin, blurred vision
• individualized care based on the subtype of gestational diabetes
• weekly or biweekly appts
• 2 step glucose tolerance test at the first prenatal visit
• all pregnant women should receive an oral GTT between 24-28th weeks
• Hemoglobin A1c, BUN, serum creatinine, thyrotropin, free thyroxine, and capillary blood sugar levels 2-4 times daily in addition to routine tests
• monitor for diabetic ketoacidosis
• complications: diabetic retinopathy = hypertension in diabetic pregnancies can lead to preecampsia and stroke

Question 21

hyperbilirubinemia

Answer 21

• the most common condition that requires medical attention in newborns —> jaundice

Question 22

hypoglycemia in newborns
- physiologic and pathological jaundice
- risk factors: prematurity, blood type incompatability w/ the mother, lack of effective breastfeeding, excessive bruising from an extended labor or a malpresentation in labor such as face presentation
- signs and symptoms: visually detected when level reaches 5-6 mg/d, first appears on the face; sclera may be tinted yellow also. yellow color spreads down the body as bilirubin level rises
- medical management: breastfeeding or bottle feeding, breasfeeding at lest 8-12 times or bottle feeding 8-10 times a day, 6 wet diapers and three stools per day is most favorable to eliminate bilirubin through the GI tract & kidneys, phototherapy
- nursing interventions: encourage breastfeeding 8-12 times a day, or bottle feeding 8-10 times a day, monitor the number of stools, weigh diapers for accurate urine output information, place eye patches to protect newborn’s eyes during phototherapy, expose the maximum a mount of skin to the light except for the genital area, monitor newborn’s behavior; irritability or lethargy could indicate that the bilirubin level is irritating the brain, monitor body temp for hypothermia from being undressed

Answer 22

• preeclampsia and stroke
• accelerated fetal growth, LGA, macrosomia
• preterm delivery
• cesarean birth
• birth injuries: brachial plexus injury, facial nerve injury, and cephalohematoma
• after birth, infant is at risk for hypoglycemia that may lead to neonatal seizures, coma, and brain damage
• increased risk for respiratory distress syndrome
• stillbirth
• neonatal mortality
• preventing fetal complications w/ gestational diabetes: fetal movement counting, NSTs, contraction stress test, ultrasonic biophysical profile
• plasma glucose level of >30 mg/dL in the first 24 hours of life and less than 45 mg/dL thereafter, long term complications include intellectual disability, developmental delays, personality disorders, decreased head size, seizures
• check blood sugar with heel stick blood sample
• blood glucose levels can drop if the newborn has no glycogen stored in the liver, has used up stored glucose for ehat production or a birth stress, is an IDM and has hyper9insulinism, cannot feed enough to keep glucose level in an acceptable range

Question 23

lochia assessment

Answer 23

• bleeding during pregnancy is always abnormal, especially in the first trimester because it threatens the viability of pregnancy
• should go from heavy and red to light and brown
• bleeding disorders of early pregnancy include spontaneous abortion, ectopic pregnancy, gestational trophoblastic disease (GTD)

Question 24

neonatal abstinence syndrome

Answer 24

• a group of similar behavioral and physiological signs and symptoms in the neonate caused by withdrawal from various pharmacologic agents
• withdrawal symptoms of chemically exposed infants depends on age of the neonate, drug, drug’s half life, time of the mother’s last use
• neonatal abstinence scales are tools used to evaluat newborn reflexes and behaviors that indicate the severity of withdrawal symptoms and plan for medical interventions
  medical interventions: transfer to NICU IV fluids as ordered, provide medications to reduce symptoms and gradually wean from the substance, administer phenobarbital as ordered to control seizures, avoid administering naloxone to the mother at the time of deliver; it causes abrupt withdrawal and seizures for the neonate
• nursing interventions: assess for signs of withdrawal and report any signs and symptoms immediately, administer and monitor pharmacological treatment, protect the skin from diarrhea, bottle feed w/ high calorie formula, encourage breastfeeding if not contraindicated, provide parenting e4ducation to the caretakers, communicate w/ and provide a referral to a social worker for post discharge care and follow up
• long term effects: poor growth throughout childhood, hyperactivity and ADD, impaired cognition, poor language development, higher rates of criminal behavior and substance use disorder

Question 25

newborn safety

Question 26

newborn urinary patterns

Answer 26

6 wet diapers/day

Question 27

placenta previa

Answer 27

• low implanted placenta near the opening of the cervix
• bleeding occurs due to the placenta detaching from the uterus
• different forms of placenta previa: marginal, partial, complete
• risk factors include precious c section, cocaine use and smoking, previous placenta previa, uterine scarring from endometriosis, previous spontaneous abortion, short pregnancy interval, previous uterine surgery, previous or recurrent abortions, nonwhite ethnicity
• signs and symptoms: PAINLESS BRIGHT RED BLEEDING, spotting throughout the second and third trimesters, painless hemorrhaging in late pregnancy or when labor begins
• medical care: transabdominal or vaginal ultrasound for diagnosis, avoid vaginal cervical examination, management depends on the type of placenta previa, fetal gestational age, the amount of bleeding, and fetal status. bedrest, avoid exercise, sexual intercourse, and douching. onstress tests to evaluate fetal status, cesarean delivery for complete placenta previa and other types depending on the exact location and amount of blood. a trial of labor if placental edge is greater than 2cm from the cervical os, monitor bleeding and FHR, emergency cesarean birth if signs of fetal distress

Question 28

preeclampsia

Answer 28

• hypertension and proteinuria after 20 wks of gestation
• edema is commonly present
• incidence: 2-6% in healthy multiparous women
• risk factors: primigravida, advanced maternal age, previous history of preeclampsia, chronic hypertension and/or renal disease, multiple gestations, obesity, hydatidiform mole, egg donation or donor insemination, UTI

Question 29

preventing heat loss

Answer 29

• dy immediately after birth
• place skin to skin w/ themother
• cover the head
• monitor temp every 15 minutes fr the first hour
• avoid uncovering or exposing the entire body
• place under a preheated radiant warmer for procedures
• bathe after temperature stable for at least 2 hours
• avoid placing a crib near a draft or window

Question 30

SGA

Answer 30

• an infant whose weight is < 10% for his/her gesational age
• may have been affected by intrauterine growth restriction, limited fetal growth caused by a decrease in placenta perfusion during gestation
• abnormalities of the placenta or vessels restricting nutrients and oxygen to the developing fetus
• maternal hypertension
• uncontrolled, severe diabetes
• poor maternal nutrition
• maternal drug use or heavy smoking
• exposure to teratogenic substances
• maternal alcohol consumption
• multigestation
• parents of small stature
• diagnosed during pregnancy at routine visits upon measurement of fundal height and through ultrasound examination
• large head in relationship to the rest of the body
• thin extremities and trunk
• loose skin
• thin umbilical cord
• risks include: perinatal asphyxia during labor if SGA was due to placental insufficiency, meconium aspiration, hypoglycemia, hypothermia
• interventions include: perform gestational age assessment, observe for respiratory distress, detect rremors or jitteriness which are early signs of hypoglycemia, institute early feeding to prevent hypoglycemia, monitor for hypothermia, monitor for vital signs and daily weight, teach parents on keeping the infant warm and provide frequent feedings

Question 31

supplemental feeding

Answer 31

• advantages of formula: mother has a chronic illness and takes medications, provides adequate and acceptable nutrition, anyone can feed the infant, more comfortable to feed in public, food or alcohol intake won’t affect the baby, easier to leave the infant with someone else

Question 32

thermal regulation

Answer 32

• infants at greater risk of hypothermia: evaporation, conduction, convection, radiation heat losses
• lack of subcutaneous fat to provide insulation
• blood vessels close to the surface
• infants rely on brown fat to provide additional ehat
• metabolism of brown fat: nonshivering thermogenesis
• intervention: dry immediately after birth, place skin to skin w/ mother, cover the head, monitor temp every 15 min for first hour, avoid uncovering or exposing the entire body, placed under preheated radiant warmer for procedures, bathe after temperature stable for at least 2 hours, avoid placing a crib near a draft or window