Week 7 Flashcards
1
Q
Causes of hypercoagulability during childbirth
A
■ Factor VIII complex increases during labor and birth.
■ Factor V increases following placental separation.
■ Platelet activity increases at delivery.
■ Fibrin formation increases at delivery.
2
Q
What is the criteria for postpartum hemorrhage?
A
blood loss greater than 500 mL for vaginal deliveries and 1,000 mL for cesarean deliveries with a 10% drop in hemoglobin and/or hematocrit
3
Q
What are the main causes of postpartum hemorrhage?
A
Uterine atony, retained placental fragments, lower general tract lacerations
4
Q
about how many people experience postpartum hemorrhage after a childbirth?
A
10%
5
Q
what are major complications of postpartum hemorrhage?
A
Hemorrhagic shock due to hypovolemia
6
Q
what is the difference between primary and secondary postpartum hemorrhage?
A
Primary occurs within the 1st 24 hours and is due to uterine anatomy, lacerations and or hematoma. Secondary occurs more than 24 hours post birth and due to hematomas, subinvolution, or retain placental tissue
7
Q
what are the risk factors of postpartum hemorrhage related to the baby?
A
■ Neonatal macrosomia: Birth weight greater than
4,000 grams
■ Chorioamnionitis
■ Congenital or acquired coagulation defects
8
Q
What is the major cause of postpartum hemorrhage?
A
Uterine atony
9
Q
what are the risk factors of postpartum hemorrhage related to the mother?
A
■ Maternal obesity
■ High parity
■ Prior PPH
■ Operative vaginal delivery: Use of forceps or vacuum extractor
■ Augmented or induced labor
■ Ineffective uterine contractions during labor: Prolonged first and second stage of labor
■ Precipitous labor and/or birth
■ Polyhydramnios
10
Q
What are 5 indications of primary postpartum hemorrhage?
A
■ A 10% decrease in the hemoglobin and/or hematocrit postbirth
■ Saturation of the peripad within 15 minutes
■ A fundus that remains boggy after fundal massage
■ Tachycardia (late sign)
■ Decrease in blood pressure (late sign)
11
Q
What are some medical managements to postpartum hemorrhage?
A
■ Bimanual compression of the uterus
■ Medications
■ Non-surgical interventions such as uterine packing
■ Surgical interventions such as hysterectomy
12
Q
What are some IV therapies to reduce the risk of hypovolemia in postpartum hemorrhage?
A
■ Isotonic, non-dextrose crystalloid solutions (normal saline
or lactated Ringer’s solution)
■ A ratio of 3 to 1: 3 liters of IV solution for each liter of
estimated blood loss
■ Blood replacement to reduce risk for hemorrhagic shock
13
Q
What are medications to administer in postpartum hemorrhage? And how do they work?
A
Oxytocin, methylergonovine, and carboprost to stimulate uterine contractions
■ Dinoprostone and misoprostol may be ordered but are not FDA approved for treatment of uterine atony.
14
Q
What are some non surgical interventions for postpartum hemorrhage?
A
Non-surgical interventions such as uterine packing with gauze or uterine tamponade
15
Q
What is a surgical intervention for postpartum hemorrhage was remark
A
■ Surgical interventions such as hysterectomy may be indicated when all other treatments have failed to contract the uterus.
16
Q
What are the second most common causes of primary postpartum hemorrhage?
A
Lacerations
17
Q
What are causes of pathological unconjugated hyperbilirubinemia
A
HEMOLYSIS OF RBCs
Rh/ABO incompatibilities
Bacterial and viral infections
Inherited disorders of RBC/bilirubin
metabolism
Glucose-6-phospate
dehydrogenase deficiency
18
Q
What are common sites of laceration during childbirth?
A
cervix, vagina, labia, and perineum.
19
Q
What are the risk factors of lacerations?
A
■ Fetal macrosomia
■ Operative vaginal delivery: Use of forceps or vacuum
extraction
■ Precipitous labor and/or birth
20
Q
What are the assessment findings of a Postpartum hemorrhage from a laceration?
A
■ A firm uterus that is midline with heavier than normal
bleeding
■ Bleeding is usually a steady stream without clots.
■ Tachycardia
■ Hypotension
21
Q
What are some nursing actions to take for a woman with lacerations and a postpartum hemorrhage?
A
■ Monitor vital signs and blood losss
■ Notify the physician or midwife of increased bleeding and firm fundus
22
Q
When and where do hematomas occur?
A
Hematomas occur when blood collects within the connective tissues of the vagina or perineal areas related to a vessel that ruptures and continues to bleed
23
Q
what are some risk factors for hematoma as postpartum hemorrhage?
A
Episiotomy is the major risk factor
■ Use of forceps
■ Prolonged second stage
24
Q
what are some assessment findings in a hematoma related to postpartum hemorrhage?
A
■ Presence of tachycardia and hypo
■ Hematomas in the perineal area present with swelling, discoloration, and tenderness.
severe pain in the vagina/perineal area
25
How can a hematoma after childbirth displace the uterus?
Hematomas with an accumulation of 200 to 500 mL can become large enough to displace the uterus and cause uterine atony, which can increase the degree of blood loss
26
What kind of pain do woman express when they have hematomas after childbirth?
severe pain in the vagina/perineal area, and the intensity of pain cannot be controlled by standard postpartum pain management.
express severe pain, a heaviness or fullness in the vagina, and/or rectal pressure
27
What is the medical management of postpartum hematomas?
■ Small hematomas are evaluated and monitored without surgical intervention.
■ Large hematomas are surgically excised and the blood evacuated. The open vessel is identified and ligated.
28
Nursing actions for hematomas and PPH?
■ Apply ice to the perineum for the first 24 hours to decrease the risk of hematoma.
29
What is it called when the uterus does not decrease in size and does not descend into the pelvis?
subinvolution
30
When does subinvolution of the uterus usually occur?
when the uterus does not decrease in size and does not descend into the pelvis.
later in the postpartum period
31
What are some risk factors of uterine subinvolution?
■ Fibroids ■ Metritis ■ Retained placental tissue
32
How might the assessment findings be of a uterine subinvolution?
■ The uterus is soft and larger than normal for the days
postpartum.
■ Lochia returns to the rubra stage and can be heavy.
■ Back pain is present.
33
What is the medical management of subinvolution of a uterus including diagnosis and pharmacological and procedural
■ Medical intervention depends on the cause of the
subinvolution.
■ A dilation and curettage (D&C) is performed for retained placental tissue.
■ Methergine PO is prescribed for fibroids.
■ Antibiotic therapy is initiated for metritis
Ultrasound evaluation to identify intrauterine tissue or subinvolution of the placental site
34
what is some education to provide to a woman who has a uterine sub involution
Provide education on ways to reduce risk for infection, such as changing peripads frequently, hand washing, nutrition, adequate fluid intake, and adequate rest
Monitor and report increased bleeding, clots, or a change in the lochia to bright red bleeding.
35
those who have fibroids are at a risk for what? And what are they given at discharge?
women who have fibroids are at risk for subinvolution. Provide instruction on the proper use of discharge medication, since these women are usually discharged with an order for Methergine PO.
36
What is the primary cause of secondary postpartum hemorrhage?
Retained Placental Tissue
37
The retained placental tissue can interfere with _________ and can lead to _______.
involution of the uterus
metritis
38
It's a risk factor to retained placental tissue
■ Manual removal of the placenta
39
what are the assement findings of retained placental tissue?
■ Profuse bleeding that suddenly occurs after the first
postpartum week
■ Subinvolution of the uterus
■ Elevated temperature and uterine tenderness if metritis is
present
■ Pale skin color
■ Tachycardia
■ Hypotension
40
What is the medical management of retained placental tissue?
D&C is performed to remove retained placental tissue.
■ IV antibiotic therapy may be prescribed because of the
increased risk for metritis.
41
How often should the nurse assess the fundus and Nokia after a hemorrhage?
Assess the fundus and lochia every hour for first 4 hours and PRN after hemorrhage.
42
Instruct women to report to their health care provider any sudden increase in what four things?
lochia, bright red bleeding, elevated temperature, or uterine tenderness.
43
Why might a doctor prescribe IV antibiotic therapy after retained placental tissue removal?
may be prescribed because of the increased risk for metritis.
44
Retained placental tissue occurs when small portions of the ______, referred to as _____, remain attached to the uterus during the ____ stage of labor
Placenta, cotyledons, third
45
What is another word for hemabate?
Carboprost Tromethamine
46
What is the indication for hemabate?
PPH that has not responded to oxytocin or methylergonovine therapy
47
What are common side effects of hemabate?
Diarrhea, nausea, vomiting, and fever
48
Treatment of phototherapy is determined by the level of _____ and the ____ of the neonate in ____
Bilirubin, age, hours
49
what are the different types of phototherapy systems?
Various types of phototherapy delivery systems are available, including blue lights, white lamps, halogen lamps, fiberoptic blankets, and blue light emitting diodes (LED)
50
How does phototherapy work?
y results in photoconverting bilirubin molecules to water-soluble isomers that can be excreted in the urine and stool without conjugation in the liver
51
What is the most effective colored lights for phototherapy?
Lights on the blue-green spectrum
52
How quickly should total serum bilirubin levels drop after four to six hours of the initiation of phototherapy?
One to two mg/dL
53
How often should you administer phototherapy?
Continuously except for feedings or parental visits when eye patches are removed
54
What would you do if phototherapy is not effective or severe hemolytic disease is present?
Exchange transfusion where approximately 85% of the neonates red blood cells are replaced with donor cells. It reduces the levels of bilirubin left
55
how should bili lights be positioned from the infant and from the Incubator?
■ Fluorescent “bili lights” should be positioned 18–20 inches from the infant.
■ Fluorescent lights should be positioned 2 inches from the top of an incubator
56
What kind of device should be used to measure the irradiance of lamps?
photometer
57
What should cover the bank of lights in phototherapy?
Plexiglas
58
Why should you monitor intake and output?
Phototherapy results in increased insensible fluid loss.
59
Why is it important to feed a jaundiced neonate every two to three hours?
important to provide adequate fluids to compensate for insensible fluid loss, and promote excretion of bilirubin
60
complication of hyperbilirubinemia is _______.
kernicterus
61
Bilirubin accumulates within the brain and becomes toxic to the brain tissue, which causes neurological disorders such as _______, _______, _____, and _______
Deafness, delayed motor skills , hypotonia , intellectual deficits
62
Common physiological characteristics of the neonate place the neonate that increase the risk for physiological jaundice:
■ Neonates have an increased RBC volume
■ RBC have a life span of 70–90 days, compared to 120 days in adults.
■ produce more bilirubin (6–8 mg/kg/day) than adults.
■ reabsorb increased amounts of unconjugated
bilirubin in the intestine due to lack of intestinal bacteria, decreased gastrointestinal motility
■ Neonates have a decreased hepatic uptake of bilirubin from the plasma due to a deficiency of ligandin, the primary bilirubin binding protein in hepatocytes.
■ Neonates have a diminished conjugation of bilirubin
63
Risk Factors for Physiological Jaundice
■ Asian, Native American, and Greek ethnicity
■ Fetal hypoxia
■ ABO incompatibility (the woman is blood type O and the neonate is blood type A or B)
■ Rh incompatibility (the woman is Rh negative and the neonate is Rh positive)
■ Use of oxytocin during labor
■ Delayed cord clamping, which increases RBC volume
■ Breastfeeding
■ Delayed feedings, caloric deprivation, or large weight loss
■ Bruising or cephalohematoma
■ Gestational age of 35–38 weeks
■ Maternal diabetes with macrosomia
■ Epidural bupivacaine
■ Asphyxia
■ Older sibling with jaundice
64
________ jaundice is typically visible after 24 hours of life
Physiological
65
As total serum bilirubin levels rise, jaundice will progress from the newborn’s ____ downward toward the ___ and _____ extremities
Head, trunk, and lower
66
What should the bilirubin normal levels be?
5–6 mg/dL
67
How does jaundice associated with ineffective breastfeeding happen
Dehydration can occur.
Delayed passage of meconium stool promotes reabsorption of bilirubin in the gut.
68
What are causes of pathological unconjugated hyperbilirubinemia
HEMOLYSIS OF RBCs
Rh/ABO incompatibilities
Bacterial and viral infections
Inherited disorders of RBC/bilirubin
metabolism
Glucose-6-phospate
dehydrogenase deficiency
69
How many days after delivery is endometritis usually diagnosed?
usually diagnosed within the first few days after delivery
70
What is the most common sign of endometritis?
Fever is the most common sign
71
What are other signs besides fever of endometritis?
chills, uterine tenderness, and foul smelling lochia.
72
side effects of phototherapy:
■ Eye damage
■ Loose stools
■ Dehydration
■ Hyperthermia
■ Lethargy
■ Skin rashes
■ Abdominal distention
■ Hypocalcemia
■ Lactose intolerance
■ Thrombocytopenia
■ Bronze baby syndrome
73
What is the treatment for endometritis?
Broad-spectrum IV antibiotics and rest
74
What is POST- BIRTH signs?
Pain in chest
Obstructed breathing or SOB
Seizure
Thought of harming baby or self
Bleeding through one pad/hr and size of an egg or larger
Incision that is not healing
Red or swollen leg that is painful or warm to touch
Temperature of 100.4°F or higher
Headache that does not get better even when taking analgesics
75
What are the two primary psychological complications?
Postpartum depression and postpartum psychosis are the primary psychological complications.
76
Approximately ___% of women will experience major mood disorders that have a profound effect on their ability to care for themselves and/or their infants
15%
77
what is a general definition of postpartum depression?
the woman has a depressed mood or a loss of interest or pleasure in daily activities for at least 2 weeks
78
Postpartum depression must have four of the following symptoms
■ Significant weight loss or gain: a change of more than
5% of body weight in a month
■ Insomnia or hypersomnia
■ Changes in psychomotor activity: agitation or retardation
■ Decreased energy or fatigue
■ Feelings of worthlessness or guilt
■ Decreased ability to concentrate; inability to make decisions
■ Recurrent thoughts of death or suicide attempt
79
what is the major difference between postpartum Blues and postpartum depression?
PPD is disabling; the woman is unable to safely care for herself and/or her baby
80
What are some risk factors to postpartum depression?
■ History of depression before pregnancy
■ Depression or anxiety during pregnancy
■ Inadequate social support
■ Poor quality relationship with partner
■ Life and child care stresses
■ Complications of pregnancy and/or childbirth
81
What is some medical or psychiatric management for mild and moderate postpartum depression?
■ Mild PPD
■ Interpersonal psychotherapy
■ Moderate PPD
■ Interpersonal psychotherapy
■ Antidepressants
82
What are the four primary causes of PPH in T’s?
Tone: uterine atony
Tissue: retained placental fragments
Trauma: lower genital track lacerations
Thrombin disorder DIC
83
When would you not give hemabate?
Patients with asthma
84
When would you not give methylergonovine?
Patients with htn
85
What does REEDA stand for?
Redness, ecchymosis, edema, discharge and approximation of perineum
86
A life-threatening lung disorder that results from underdeveloped and small alveoli and insufficient levels of pulmonary surfactant
Respiratory Distress syndrome
87
What two combined factors can cause an alteration in alveoli surface tension that eventually results in atelectasis.
underdeveloped and small alveoli and insufficient levels of pulmonary surfactant
88
The effects of atelectasis are:
■ Hypoxemia and hypercarbia
■ Pulmonary artery vasoconstriction
■ Right-to-left shunting through the ductus arteriosus and foramen ovale as the neonate’s body attempts to counteract the compromised pulmonary perfusion
■ Metabolic acidosis that occurs from a buildup of lactic acid that results from prolonged periods of hypoxemia
■ Respiratory acidosis that occurs from the collapsed alveoli being unable to expel excess carbon dioxide
89
RDS affects ___% of all premature infants, the majority of these born at less than ___ weeks’ gestation
10%, 28
90
What is pulmonary surfactant made of?
Pulmonary surfactant is a substance that is composed of 90% phospholipids and 10% proteins.
91
■ Pulmonary surfactant is produced by _____ ___ ___ within the lungs.
■ The alveolar cells begin to produce _____
around _____ weeks and continue to term.
■ It reduces the ______ within the lungs and increases the ______ which prevents the alveoli from collapsing at the end of _____.
type II, alveolar cells
pulmonary surfactant, 24–28
surface tension, pulmonary compliance, expiration
92
Tests used to evaluate fetal lung maturity are:
Phosphatidylglycerol (PG), Lecithin/sphingomyelin (L/S) ratio
93
Where is PG synthesized, present in, and decrease the risk of what?
■ PG is synthesized from mature lung alveolar cells.
■ It is present in the amniotic fluid within 2–6 weeks of
full-term gestation.
■ The presence of PG indicates lung maturity and a decrease indicates risk of respiratory distress syndrome.
94
Lecithin/sphingomyelin (L/S) is detected where, and why is the ratio important?
■ Lecithin and sphingomyelin are two phospholipids that are
detected in the amniotic fluid.
■ The ratio between the two phospholipids provides information on the level of surfactant.
95
A L/S ratio in non diabetics vs diabetics
■ A L/S ratio greater than 2:1 in a nondiabetic woman
indicates the fetus’s lungs are mature.
■ A L/S ratio of 3:1 in a diabetic woman indicates the
fetus’s lungs are mature.
96
Complications of respiratory distress syndrome (RDS) include:
■ Patent ductus arteriosus
■ Pneumothorax
■ Bronchopulmonary hypertension
■ Pulmonary edema
■ Hypotension
■ Anemia
■ Oliguria
■ Hypoglycemia and altered calcium and sodium levels
■ Retinopathy of prematurity
■ Seizures
■ Intraventricular hemorrhage
97
The normal range of PaCO2 is :
35–45 mm Hg.
98
The normal range of PaO2 is
60–70 mm Hg
99
Assessment Findings of RDS in x-ray
X-ray exam shows a reticulogranular pattern of the peripheral lung fields and air bronchograms
100
General assessment findings for RDS
■ Tachypnea is present.
■ Intercostal retractions; seesaw breathing patterns occur.
■ Expiratory grunting.
■ Nasal flaring is present.
■ Skin color is gray or dusky.
■ Breath sounds on auscultation are decreased. Rales are present as RDS progresses.
■ The neonate is lethargic and hypotonic.
101
Acidosis may result from sustained ____ in RDS
hypoxemia
102
Ventilation types of respiratory support for RDS
Oxygen therapy by mask, hood, or cannula for neonates requiring short-term oxygen support
CPAP
High-frequency oscillatory ventilation
Extracorporeal membrane oxygenation therapy (ECMO)
103
What does an ECMO do?
a cardiopulmonary bypass machine with a membrane oxygenator that is used when the neonate does not respond to conventional ventilator therapy. Blood shunts from the right atrium and is returned to the aorta, allowing time for the lungs to heal and mature.
104
_______ and __________ may further decrease surfactant ________.
Hypoxemia and acidosis, surfactant production.
105
Benefits of Surfactant Therapy
■ Prophylactic therapy decreases the occurrence of RDS and mortality in preterm neonates.
■ Decreased risk of pneumothorax
■ Decreased risk of intraventricular hemorrhage
■ Decreased risk of bronchopulmonary dysplasia
■ Decreased risk of pulmonary interstitial emphysema
106
Cold stress increases _________, may promote ________, and may further impair_______.
oxygen consumption
acidosis
surfactant production
107
Why is cold stress bad for RDS?
Cold stress increases oxygen consumption, may promote acidosis, and may further impair surfactant production.
108
Why is dehydration and overhydration bad for RDS?
■ Dehydration impairs ability to clear airways because mucus becomes thickened.
■ Overhydration may contribute alveolar infiltrates or pulmonary edema
109
_________ and _______ are the two most important predictors of an infant’s health and survival.
Period of gestation and birth weight
110
________ and _________are the second leading causes of infant death in the United States, the first being ________ and ________.
Prematurity and low birth weight
congenital malformations and chromosomal anomalies
111
how many weeks is very premature?
born at less than 32 weeks gestation
112
how many weeks is premature?
Neonates born between 32 and 34 weeks gestation
113
Neonates born between 34 and 36 weeks’ gestation
Late preterm
114
which race has the most incidents of preterm neonates?
Non Hispanic blacks
115
what is the weight for low birth weight?
less than 2500 grams at birth
116
what is the weight for very low birth weight?
Less than 1500g at birth
117
what is the weight for extremely low birth weight?
Less than 1000g at birth
118
what are some common complications related to Premature birth?
retinopathy of prematurity, respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, Periventricular intraventricular hemorrhage, and necrotizing enterocolitis
119
what is the ballard score for a preterm neonate?
At or below 37 weeks
120
___ and ___ increase with greater gestational age.
Tone and flexion
121
what colour is the skin of a preterm neonate?
Translucent, transparent, and red
122
how is the fat on a preterm neonate?
Decreased
123
about what weeks do creases on the anterior part of the foot appear?
28-30 weeks
124
when do eyelids on a neonate open?
26 to 30 weeks gestation
125
___ sutures are _____ among premature, low birth weight neonates
Overriding common
126
what are some non modifiable risk factors of preterm labor and birth?
Previous preterm birth
Multiple abortions
Race and ethnic group
Uterine cervical anomaly
Multiple gestation
Polyhydramnios and oligohydramnios
Pregnancy and induced hypertension
Placenta previa after 22 weeks
DES exposure
Short interval between pregnancies
Abruptio placenta
Parody of zero or greater than 4
Premature rupture of membranes
Bleeding in first trimester
127
how is the cry and reflexes of a premature neonate?
Tremors and jittery movement with weak cry and diminished or absent reflexes
Immature suck and swallow and breathing patterns
128
what are bradycardia and apnea in neonates?
Sociation of breathing for at least 10 to 15 seconds and heart rate of less than 100 beats per minute
129
what heart condition is related to a patent ductus arteriosus?
Heart murmur
130
why might a neonate appear pale and weak?
Anemia that is common amongst very low birth weight babies
131
how is lung maturity in fetuses determined?
Lecithin or sphingomyelin ratio or phosphatidylglycerol before elective induction or cesarean birth, and for women in preterm labor.
132
Corticosteroids, ________ OR _______, are administered to the pregnant woman if the woman pre - sents in preterm labor, or if preterm birth is anticipated
Betamethasone, dexamethasone
133
corticosteroid administration results in reduced what conditions?
reduced respiratory distress syndrome, NEC, cerebroventricular hemorrhage, need for respiratory support, systemic infections, admission to the NICU, and neonatal death
134
What is some rrespiratory interventions of neonates?
Nasal continuous positive airway pressure (NCPAP) or intubation
135
What are some medications for preterm infants?
■ Sodium bicarbonate to treat metabolic acidosis if present
■ Dopamine or dobutamine for treatment of hypotension
■ Erythropoietin administration to stimulate production of RBC if indicated
■ Evidence suggests that erythropoietin administration may reduce the need for RBC transfusions among preterm/low birth weight infants
■ Antibiotic therapy as indicated to decrease risk of infection or treatment of infection
■ Opioids to treat pain associated with procedures that cause moderate to severe pain, such as with surgical procedures
136
What are some invasive interventions done for a premature neonate
Blood transfusion if the neonate is anemic
IV fluids
Parenteral intravenous nutrition
Central line for long term parenteral nutrition
Umbilical artery and umbilical vein catheters
137
what are some nursing actions to take when dealing with the respiratory system of a premature infant?
Assessing for respiratory distress like grunting, flaring, retracting, and cyanosis
Providing respiratory support and suctioning the airway as needed for removal of secretions
possible long term oxygen via nasal cannula or oxygen hood
Humidified oxygen
138
what are ways to maintain a neutral Thermal environment for a premature baby?
Drying off the infant immediately
Keeping the head covered
Using plastic barriers made of polyethylene to cover preterm neonates after birth
139
what are some ways to check the gavage feedings of a premature infant?
Check the bowel sounds, assess the abdomen for bowel loops and discoloration, Measure abdominal growth
Check with gastric residuals
140
what are ways to maintain a neutral Thermal environment for a premature baby?
Drying off the infant immediately
Keeping the head covered
Using plastic barriers made of polyethylene to cover preterm neonates after birth
141
what are some ways to check the gavage feedings of a premature infant?
Check the bowel sounds, assess the abdomen for bowel loops and discoloration, Measure abdominal growth
Check with gastric residuals
142
what are some electrolyte imbalances that can occur with premature infants?
Hyperkalemia related to elevated potassium levels
Hyponatremia rrelated to low sodium levels my client and hypernatremia
143
what kind of feedings do neonates get if they are on trophic feedings
small volume enteral feedings
144
why would you give a premature infant a pacifier doing gavage feesings?
Nonnutritive sucking eases the transition from gavage feeding to bottle feeding, and results in decreased length of hospital stay for preterm neonates
145
how would you treat a preemie’s skin?
■ Use adhesives sparingly
■ Change diapers frequently
■ Change positions frequently
■ Apply emollients to dry areas
■ Use water, air, or gel mattresses
146
Conditions for transitioning to oral feedings occurs when the neonate:
■ Has cardiorespiratory regulation
■ Demonstrates a coordinated suck, swallow, and
breathe
■ Demonstrates hunger cues such as bringing hand to the
mouth, sucking on fingers
■ Maintains a quiet alert state
147
Gavage feedings are appropriate for neonates who are
< 32 week’s gestation or who can’t safely receive oral feedings
148
Procedure for gavage feeding
1. Use a size 5–8 french feeding tube.
2. Measure the OG tube from mouth to the ear, and from the ear to the lower end of the sternum.
3. Check for proper placement after each insertion
and before each feeding by:
■ Placing syringe on end of tube and pulling to remove stomach contents, and/or
■ Injecting a small amount of air into the tube with a syringe while listening for a whooshing/gurgling sound with a stethoscope
4. Use tape to ensure that the tube is secured.
5. Check for residuals before starting the feeding by aspirating stomach contents.. Note the amount, color, and consistency of the contents.
6. Gravity or pump over 15–30 minutes.
7. Continuous tube feedings may be ordered.
8. To remove after the feeding, pinch it closed and remove it swiftly.
9. Assess neonate for feeding intolerance throughout
149
what are some advantages to breastfeeding a preemie?
Decreases the incidence of NEC
150
how would you manage pain in a premature infant?
Assess the neonate for signs frequently
Promote non nutritive sucking during painful procedures
Administer opioids
Use swaddling, positioning, kangaroo care and therapeutic touch
Decreased environmental stimulus
151
what are some ways to decrease stress and enhance neurodevelopment in a premature infant?
Maintain a quiet setting to decrease negative physiological responses
Keep lighting dim
Clustering activities for care
Allowing break in care if neonate becomes stressed
minimizing handling newborns who are unstable
Reposition every two to three hours
Position the neonate in sideline or prone position line Nathan degrees next flexion with both and hands placed towards the midline
Create a nest with blankets
152
why would you position a neonate sideline or prone?
To enhance gastric emptying and oxygenation
153
what are some benefits to kangaroo care?
■ Decreases risk of low body temperature.
■ Reduces illness, infection, and pain perception.
■ Improves daily weight gain and mother-infant attachment.
■ Decreases the length of hospital stay
154
What is bronchopulmonary dysplasia?
a chronic lung problem that affects neonates who have been treated with mechanical ventilation and oxygen for problems such as RDS
155
At how many weeks is a post term neonate delivered?
After the completion of 41 weeks gestation
156
What is the threshold for macrosomia?
4000 to 4500 grams
157
What are possible risk factors of post term neonates?
anencephaly
History of post term pregnancies
First pregnancy
Grand multiparous women
158
Post mature neonates are at risk for what conditions?
Meconium aspiration
Fetal hypoxia
Neurological complications such as seizures
Hypoglycemia
Hypothermia
Polycythemia
Birth trauma
159
Why a post mature neonate be at risk for meconium aspiration?
The presence of meconium in the amniotic fluid related to fetal hypoxia places the neonate at risk for meconium aspiration syndrome because the mature fetus can poop in the amniotic fluid due to fetal asphyxia
160
Why would a post mature infant be at risk for fetal hypoxia?
related to placental insufficiency and a decrease in amniotic fluid, which increases the risk of cord compression
161
Why would a neonate that is pause my chair be at risk for neurological complications?
asphyxia during labor and birth due to alteration in oxygenation
162
What might cause they postmature infant to have hypothermia?
■ A lack of development of subcutaneous fat
■ Loss of subcutaneous fat related to insufficient nutrient transport through the placenta
163
What is the hematocrit level that is considered polycythemia in a neonate and how does a new unit get polycythemia?
Polycythemia, a compensatory response, is caused by an alteration in oxygenation associated with placental insufficiency; hematocrit greater than 65% is considered polycythemia in a neonate
164
Assessment Findings of postmature neonate
■ Dry, peeling, cracked skin
■ Lack of vernix
■ Profuse hair
■ Long fingernails
■ Thin, wasted appearance
■ Meconium staining
■ Hypoglycemia
■ Poor feeding behavior
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Medical Management of postmature neonate
■ Oxygen therapy administered for perinatal depression or
respiratory distress
■ Hematocrit to assess for polycythemia
■ Blood glucose monitoring for hypoglycemia
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Assess postmature neonates for:
■ Gestational age with use of gestational age scoring system ■ Birth trauma if neonate is macrosomic
■ Respiratory distress/cyanosis
■ Oxygen saturation if respiratory distress or cyanosis is
present
■ Signs of meconium staining
■ Blood glucose levels- hypoglycemia
■ Vital signs
■ Weight – intake and output
■ Gross anomalies
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why is it important to measure the intake and output of neonates that are post mature?
Postterm infants may be poor feeders and thus are at risk for inadequate fluid intake
