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SAC Exam #2

Modules 3, 4, 5

Wht about newborn's body surface area? larger in relation to mass and dec. SQ tissue
newborn's skin? thin w/ blood vessels close to surface, 2x wrap for warmth
Newborn's arms and legs to reduce heat loss will flex
What part of newborn's body loses heat fastest? What to do? Head, put a cap
APGAR 10 pts possible at 1min/5min; 10min for bad baby; for APPEARANCE, PULSE, GRIMMACE, ACTIVITY, RESPIRATION
Methods of Heat loss Convection, Radiation, Evaporation, Conduction
What is convection? Drafts over skin
What's evaporation? Water on/from skin/body
What is conduction? Something cold touching baby's skin
What is Radiation? Something cold close to baby (no draft)
Non-shivering thermogenesis? Brown Fat Metabolism; fat from back of neck metabolizes, which creates heat for baby, but metabolism causes increase O2 need
Risk of non-shivering thermogenesis? metabolism of brown fat causes dec. in glucose --> hypoglycemia
Signs of cold baby? mottled skin, tachypneic
Effects of cold stress/overheating on baby? increased metabolic rate, inc. O2 need, inc. glucose consumption
What does glucose metabolism in presence of insufficient O2 leads to what? production of acid --> metabolic acidosis
What do blood vessels do to preserve heat? Which ones? Vasoconstrict; Peripheral and Pulmonary blood vessels
What is the weight of term baby? 5lbs 8oz
How much will a baby weigh to be considered LGA? Greater than 4000g
Norms for respiration and SpO2? 30-60rr/min; 96-1000%
What are the shunts that most fetal blood bypasses through lungs and liver? Ductus arteriosus, Foramen ovale, Ductus venosus
Acrocyanosis Bluish discoloration of hands/feet d/t reduced peripheral circulation; accentuated if cold
What happens at birth with the fetal shunts and pulmonary vessels? why? Shunts close, Pulmonary vessels dilate because of changes in blood O2 levels and pressure shifts in heart, pulmonary, and systemic circulations
Where is placement to check HR? At 3rd/4th intercostal space, left of midclavicular line
Where do most newborn heart murmurs come from? What is ordered? PDA= patent ductus arteriosis; Echocardiogram ordered
Signs of respiratory distress in newborn? Retractions, Nasal flaring, Grunting, Tachypnea, Apnea, Cyanosis
Why is neonate less effective in fighting off infections? Immature hypothalamus and immature inflammatory response
When do full term newborns receive antibodies? Last trimester
What kind of immunity is provided when mom breastfeeds? Passive immunity
What is 1st stool from newborn? When? What if they don't? Meconium, w/in first 24hrs of life; if none, may have obstruction
Urobilinogen? Conjugated bilirubin excreted in stools
When is newborn's first void? What if not? usually w/in 24 hours; inadequate fluid intake --> dehydration --> metabolic acidosis
How much fluids does baby need to maintain fluid balance? 65mL/kg (30mL/lbs) during first 2 days, then 100-150mL/kg (45-68mL/lbs)/day
Who is at risk for hypoglycemia? SGA, LGA, Preterm, Postterm, GDM - because of inadequate stores or excessive consuption of glycogen/fat for metabolism
Sings of hypoglycemia? Jitterness, Poor muscle tone, Diaphresis, Poor sucking, Tachypnea, Dyspnea, Cyanosis, Apnea, Low temp, High pitched cry, Irritable, Lethargy, Sz, Coma
At what level is hypoglycemic? What to do? Less than 40mg/mL; feed and reassess in 30-45min
When will cord stump detach? 10-14days
How much birth weight is lost? Why? 5-10%; d/t normal loss of extrcellular H2O + less calorie consumption
How much calories needed to meet energy needs for growth & development? 110-120 cal/kg (50-55cal/lbs)/day
how often should baby feed; by breast & bottle? Breast- q 1.5-3hrs; Bottle- q 3-4hrs
Nutrients in breast milk Amino acids, Protein, Carbs, Fat
Signs of INFANT problems w/ breastfeeding falls asleep w/in 5min, refusing to feed, tongue thrust, smacking sounds, cheek dimpling, failure to open wide, turned in lower lip, choppy jaw motions, no audible swallowing, formula use, less than 3 stools by 3rd day
Signs of MATERNAL breastfeeding problems Hard,tender breasts, painful nipples, flat/inverted nipples, edema/pain in breast, fever, aches, malaise
Chronic HTN elevated BP prior to 20 wks gestation
PIH Developing HTN after 20wks gestation; sustained 140/90 or +15 systolic and/or +20 diastolic
Types of Pregnancy Induced Hypertension Pre-eclampsia, Eclampsia, HELLP syndrome
Pre-eclampsia Renal involvement that leads to proteinuria
Eclampsia CNS involvement leading to seizures
HELLP syndrome Hemolysis, Elevated Liver enzymes, Low Platelets
Generalized edema fluid retention especially in hands/feet
Proteinuria >300mg/dL protein/24hr OR 100mg/dL in 2 random 6hr samples; develops after edema and inc. BP
Risk factors of PIH first pregnancy, -16y.o. or +35y.o., family hx, obesity, CRD, DM, mult. gestation, chronic HTN, pre-existing vascular disease, Angiotensin gene T235
Bio Changes of PIH Dec. brain perfusion, Dec. liver perfusion, Dec. renal perfusion, Dec. Uterine/Placental perfusion
what does Dec. brain perfusion in PIH lead to? cerebral edema and small cerebral hemorrhage; hyper-reflexia, scotomas (floating things in vision), visual changes, sz
What does dec. liver perfusion in PIH lead to? impaired liver function, hepatic edema, sub-capsular hemorrhage, elev liver enzymes, epigastric pain
What does dec. renal perfusion in PIH lead to? Edema (dec GFR--> protein leaks across glomerular membrane reducing colloid osmotic pressure, fluid shifts to interstitial space) = hypovolemia
How does body respond to hypovolemia? Inc. Angiotensin II and aldosterone retaining both water and salt
S/S of dec renal perfusion in PIH? Inc. BUN/Cr, inc. uric acid, edema, Inc. hematocrit, dec. urine output, excess wt gain (>2 lbs/wk)
What does dec. Uterine/placental perfusion in PIH lead to? IUGR, Placenta Abruption, inc. risk of fetal death
Anti-hypertensive for PIH? Apresoline/Hydralazine
Nursing actions for PIH? Tocolytics and/or antihypertensives, fetal monitoring, bedrest (left lateral), calm environment, sz precautions, v/s/I&O/DTR q hr, daily wt, Mg level q 6hrs
signs of altered tissue perfusion in PIH? Urine output <500mL/day, 3+ pitting edema, edema of hands/face
monitor interventions for PIH monitor for edema q 4hrs, monitor for proteinuria, monitor BP q hr, monitor urine output q hr, monitor lung sounds q 2hrs, monitor for dyspnea, monitor fluids q hr
manage interventions for PIH admin MgSO4 2g/hr IV, place foley to measure UO, admin fluid restriction 100mL/hr
What does MgSO4 do? magnesium sulfate used to control sz; relaxes smooth muscle and reduces vasoconstriction
What is #1 complaint for pre-eclampsia? Headache not relieved by reg. strength Tylenol --> disorientation
What is diabetes? a deficit in carb metabolism whereby glucose can't enter cell and body cells become energy depleted and results in fats/proteins being broken down for energy.
When do they screen for GDM? at 24-28wks using 1hr 50g oral GTT.
what happens if GTT = >135mg/dL? 3hr 100g GTT given
What are the criteria for diagnosing GDM? Fasting 95mg/dL OR 1hr= 180mg/dL OR 2hr= 155mg/dL OR 3hr= 140mg/dL; need 2 of these values
Risk factors for Maternal GDM? Hydramnios, Pre-eclampsia/Eclampsia, Hyperglycemia leading to ketoacidosis, Dystocia, Monilal vaginitis, c/s birth
Fetal GDM risk factors? Congenital anomalies, Macrosomia, IURG, RDS, Hypoglycemia
White's classification of Diabetes in Pregnancy? Class A1 --> Class A2--> Class B--> Class C--> Class D--> Class F--> Class H--> Class R
Breakdown of how diet for GDM should be? 40-50% calories from Carbs; 15-20% from protein; 20-30% from fats
How many meals a day for GDM? 3 meals and 3 snacks
What is okay glucose level when fasting? After meal? 70-100mg/dL; 2hrs after meal= <120mg/dL
How do they assess for lung maturity? Amniocentesis
Types of placenta previa? Marginal, Partial, Total
S/S of CONCEALED Placenta Abruption? INC. fundal height, Hard,boardlike abd, High uterine baseline tone, PERSISTENT abd pain, early hemorrhage, PERSISTENT late decels, Decreasing baseline variability, slight/absent vag bleed
S/S hypovolemic shock? Inc. pulse, dec. blood pressure, weak/diminished/thready pulse, cool,moist skin, dec. Urine output, dec H&H, ALOC
GDM risk factors? Obesity, >25y.o, previous preg w/ GDM, hx abnormal GTT, family hx of DM, high risk ethnic group
MgSO4 action? Ca antagonist which inhibits UCs by interrupting flow of extracellular Ca into smooth muscle
dose for MgSO4? 4-6g loading dose over 30min, then maintenance dose 2-3g/hr IV
S/E of MgSO4? flushing, thirst, lethargy, N/V, SOB, pulmonary edema, visual changes
Terbutaline action? Beta-mimetic drug that stimulates beta-adregnergic receptors on smooth muscles that interferes w/ muscle contraction
Dose for Terb? 0.25mg SQ; then 2.5-5.0mg PO q 2-4hrs
S/E of Terb? inc. pulse, inc. glucose, dec. K, palpitations
Nursing implications for MgSO4? continuous fetal monitoring, monitor v/s (*rr*) q hr, monitor UO q hr, fluid restrict to 100mL/hr, Mg level q 4-6hrs, CALCIUM GLUCONATE on hand
Nursing implication for Terb? hold if pulse >110-120bpm, contraindicated for DM
Nifedipine (Procardia) action? Ca antagonist; blocks Ca in Ca channels of myometrial cells
Procardia dose? initial dose 30mg PO, followed by 10-20mg q 4-6
S/E Procardia? facial flushing, HA, dec. BP, Inc. liver enzymes, MONITOR BP
Indomethacin (Indocin) action? Prostaglandin, synthetase inhibitor; stops enzymes that make prostaglandins that start labor
Indocin dose? 100mg rectal, followed by 25-50mg q 4-6hrs PO
Indocin S/E HA, GI upset, HYPOtension, oligohydramnios, premature closure of DA (?), dec. UO, hyperbilirubinemia; MONITOR AMNIOTIC FLUID VOLUME
Management for MgSO4 for Preterm labor? Loading dose 4-6g over 30min, [v/s (especially rr), DTR, UO q hr], Mg level q 6hrs, fluid intake q hr (100cc/hr fluid restriction), monitor for s/e (flushing, sweating, n/v, CNS/resp depression), CALCIUM GLUCONATE @ bedside, pt on bedrest
What is Celestone (betamethasone)? Non-tocolytic agent used in preterm labor pts who are high risk for delivery to help w/ fetal maturity
What is the best measurement of pain? Pt's subjective description
what does it mean if pt's description starts to worsen? inc. intensity of uterine contraction
In pre-eclampsia, what causes reduced blood flow to the kidneys? Inc. peripheral resistance
In pre-eclampsia, what happens when protein leaks acorss glomerular membrane? protein loss reduces colloid pressure, then allows for fluid to shift to interstitial space = edema
What does reduced blood flow to kidneys affect? GFR --> dec. UO
How often do you assess lung sounds w/ preeclampsi? q 2hrs
what does dec. colloid oncotic pressure in preeclampsia lead to? Where? Edema in hands, feet, and lungs
With MgSO4, when is pt on 100cc/hr fluid restriction, preterm labor or preeclampsia? Both
What is the spontaneous/elective termination of a pregnancy before 20 weeks gestation? abortion
what is another name for spontaneous abortion? Miscarriage
what are complications from abortion? bladder injury, bowel injury, inc. risk of breast CA, affect on future preg, lac of cervix
Reasons people give to abort? Fetal anomalies, maternal conditions (pre-eclampsia, diabetes, cardiac conditions), victims of rape/incest
Where is immunoglobulin IgA? Breastmilk, provides infection protection
Where is immunoglobulin IgG? crosses placenta, w/ Rh inompatibility
Suction D&C? terminates pregnancies from 3-12wks (1st trimester)
Treatment for Syphilis? Penicilin
How is HPV diagnosed? Genital warts and abnormal pap
Why should one NOT receive hormonal contraceptives? Clotting issues, CA hx, smoking
Methods of permanent sterilization? Vasectomy, Tubal ligation, Essure
When mom has Positive Indirect Coombs, do we give Rhogam? No, she is already sensitized; won't do any good
Presumptive signs of pregnancy? Amenorrhea, nausea, fatigue, frequency, breast sensitivity, quickening
Probable signs of pregnancy? Abd enlargement, Positive preg test, Chadwicks sign, Goodell's sign, Hegar's sign, Braxton Hicks contractions
Chadwick's sign? discoloration of cervix, vagina, labia because of inc. estrogen
Goodell's sign softening of cervix
Hegar's sign? softening of the uterus, between cervix and fundus
What is quickening? Feeling the fetus move in the uterus
Positive signs of pregnancy? FHTs, seeing fetus in US, palpation of fetus
Nagele's Rule? 3mos from LMP + 7days = EDC
When is AFP done? High? Low? 15-18wks; high= neural tube defect; low = Down's syndrome
How do they assess fetal lung maturity? Amniocentesis; L/S ratio and progesterone level
Components of Biophysical Profile? Fetal breathing, body movement, tone, Amniotic fluid index (AFI)- to r/o oligo/polyhydramnios, NST for fetal heart reactivity,
On who and why do Contraction Stress Test? On PIH moms because uterus tends to wear out
Created by: cobedad