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L&D MT 2
| Question | Answer |
|---|---|
| how often do you monitor low risk babies? | 1st stage/early= every 60 minutes, 1st stage/active= every 30 min, 2nd stage/pushing= every 15 min |
| how often do you monitor high risk babies? | 1st stage early= every 30 minutes, 1st stage/active= every 15 minutes, 2nd stage/pushing= every 5 min |
| ways fetal oxygen supply can decrease | 1)reduction of blood flow through maternal vessels due to hypertension, hypotension, hypovolemia2)Reduction of O2 in maternal blood 3)Alterations in fetal circulation (cord compression). 4) Reduction of blood flow to intervillous space |
| non electronic monitoring of fetal heart rate | fetoscope |
| non electronic monitoring of uterine contractions | palpation of frequency, intensity, duration, resting ton |
| external fetal heart rate monitoring | external doppler applied around abdomen and placed over fetal back. coupling gel used to seal |
| advantages of external fetal heart monitoring | non invasive, can use with intact BOW and closed cervix, gives baseline, gives long term variability, gives periodic changes |
| disadvantages of external fetal heart monitoring | uncomfortable, hard to get consistent tracing (obesity, baby moving, mom wants to move), cant see short term variability, may record maternal pulse |
| internal fetal scalp electrode | used to measure fetal heart rate when mom is obese or if you can get reading with external monitoring. DONT use if herpes outbreak |
| advantages to fetal scalp electrode | consistent reading, no belts, records short term variability |
| disadvantages to fetal scalp electrode | invasive, requires ruptured BOW, dilation, skilled person to insert |
| extrenal tocodynamometer | measure uterine contraction frequency and duration, placed on fundus and secure with belts |
| advantages of external UC monitoring (toco) | non invasive, doesnt require RBOW, doesnt require special skill |
| disadvantages of external UC monitoring (toco) | poor tracing consistency, cant measure resting tone or intensity, restricts mvoement |
| Internal uterine pressure catheter (IUPC) | solid catheter with pressure transducer at catheter tip inserted into uterine cavity to measure UC |
| advantages of internal UC monitpring (IUPC) | accurate, comfortable, doesnt restrict movement, allows for amnioinfusion |
| disadvantages of internal UC monitoring (IUPC) | requires skill to insert, invasive, small chance of infection, requires ROM and dilation |
| resting tone | measured by palpation after a contraction on external mode, or measured on scale of 0-10 mmHg on internal mode |
| increased resting tone | can decrease fetal oxygen reserves rapidly, may indicate impending abruption or hyperstimulus with oxytocin or amnioinfusion without draining |
| contraction frequency | measured from beginning of one contractionn to beginning of the next, expressed as a range (ex. q 3-5) or can be irregular |
| contraction duration | measured from beginning of contraction to the end of contraction, should be 60-90 seconds |
| contraction intensity | palpated during a contraction at the fundus on external mode or read in mmHg on internal mode. Expressed as mild, moderate or strong |
| tachysystole | persistent pattern of more than 5 contractions in 10 minutes, contractions lasting more than 2 minutes, or contractions of normal duration occuring within 1 min of each other |
| baseline heart rate | the average heart rate measured for a ten minute period that is free of contractions or periodic changes |
| normal fetal baseline heart rate | 110-160 bpm |
| fetal tachycardia | heart rate above 160 |
| causes of fetal tachycardia | maternal hyperthermia (fever, infection), hypoxia, sympathomimetic drugs (epi, dopamine) |
| fetal bradycardia | heart rate below 110 |
| causes of fetal bradycardia | structural defects, viral infections (CMV), heart failure, maternal hypoglycemia, maternal hypothermia |
| variability | interplay between sympathetic and parasympathetic nervous systems, fluctuations in baseline FHR, indirect measurement of fetal oxygen reserves, CNS function, and fetal tolerance to labor |
| absent variability | <3 bpm above baseline; abnormal or indeterminate, caused by fetal hypoxemia, metabolic acedemia, congenital anomalies, preexisting neuro anomalies |
| minimal variability | 3-5 bpm above baseline; abnormal or indeterminate, caused by fetal hypoxemia, metabolic acedemia, congenital anomalies, preexisting neuro anomalies, tachycardia, extreme prematurity, sleep state |
| moderate variability | 6-25 bpm above baseline, normal, normal acid base balance |
| marked varibaility | >25 bpm above baseline |
| acceleration | a visually apparent abrupt (onset to peak less than 30 sec) increase in FHR above baseline rate, at least 15 bpm above baseline and last 15 sec in term babies, indication of fetal well being. |
| Causes of accelerations | tactile stimulation, wakes up baby (vag exam, FSE application, abdominal palpation, external sounds), breech position, OP position, fetal movement, uterine contractions |
| decelerations | decrease in FHR below baseline caused by dominance of parasympathetic response |
| early deceleration | visually apparent gradual decrease in and return to baseline associated with uterine contraction- benign pattern, not tx necessary |
| shape/timing/magnitude of early deceleration | tend to be uniform, gradual onset (>30 sec from onset to nadir) simultaneous with contraction, FHR rarely drops below 100, magnitude may be proportional to contraction, variability usually present |
| mechanism of early deceleration | head compression against cerivx causes transient increase in ICP which results in decreased cerebral blood flow. This leads to vagal stimulation and slowing of heart rate |
| late declerations | uniform, gradual onset (>30 sec onset to nadir), late in relation to onset of UC, lowest point of deceleration occurs after peak of contraction, does not return to baseline until after UC ends, magnitude may be proportional to UC or not, repetitive, bad |
| causes of late decelerations | uteroplacental insufficiency/fetal hypoxemia r/t insufficient placental perfusion during UC. |
| excessive uterine activity (tachysystole) - problem | causes uteroplacental insufficiency. can be spontaneous, caused by pitocin (turn down or off), or abruption |
| placenta abruption | separation of placenta from uterus |
| maternal disorders that can cause uteroplacental insufficiency/decels | hypotension (supine, hemorrhage, sysmpathetic block), hypertension (PIH, preeclampsia), diabetes |
| prevention of late decelerations | avoid compression of vena cava (supine position), use oxytocics judiciously, maintain hydration, increase fluids prior to regional anesthesia |
| interventions to stop late declerations | left lateral position change, discontinue pitocin, oxygen per tight face mask @ 8-10 L/min, tocolytics (terbutaline), increase IV fluids, notify physician |
| variable decelerations | caused by cord compression, not uniform, variable in appearance, abrupt onset (<30 sec onset to nadir) and return to baseline, varies in relation to contraction with duration, intensity and timing |
| treatment of variable decelerations | maternal position change (release pressure from cord), d/c pit until pattern improves, rule out prolapsed cord obtain order for amnioinfusion (tx of oligohydramnios), increase IV fluids, give oxygen by face mask, notify physician |
| prolonged decelerations | drop in fetal heart rate lasting longer than 2 minutes but shorter than baseline change (10 minutes)- BAD |
| causes of prolonged decelerations | disruption in fetal oxygen supply- umbilical cord compression or prolapse, hypertonic uterine activity/prolonged tachysystole, uteroplacental insufficiency, sustained head compression, hypotension after spinal/epidural, placental abruption, etc |
| treatment of prolonged decelerations | check for prolapsed cord, maternal position change, decrease uterine activity, oxygen, notify physician, increase IV fluids, if no recovery in 3-4 min, prep for emergency csection |
| maternal etiologies for intolerance to labor | hypotension (supine, hemorrhage, anesthesia), CVD, respiratory depression/disease, dehydration, malnutrition/anemia |
| fetal etiologies for intolerance to labor | infection, anemia, hemorrhage, malformations |
| uterine etiologies for intolerance to labor | too frequent contractions (spntaneous or induced), tetanic uterine activity (high resting tone) |
| placental etiologies for intolerance to labor | abruption, placental previa (placenta attached to uterus and cervix), infarctions, vascular degenerations |
| umbilical cord etiologies for intolerance to labor | compression, occlusion, prolapse |
| signs of intolerance to labor | increased baseline FHR, baseline variability decreases, late, variable, or prolonged decels |
| general interventions for nonreassuring FHR patterns | position change, IV fluid increase, discontinue/slow pitocin, maternal O2 administration by face mask, amnioinfusion, tocolytics |
| amnioinfusion | infusion of room temperature isotonic fluid into uterine cavity if the volume of amniotic fluid is low- tx for oligohydramnios and cord compression |
| category I tracing | normal- baseline fHR 110-160, variability moderat 96-25 bpm), late or variable decels absent, early decels absent or presnt, accels present or absent. Strongly predictive of normal acid base balance, no action required |
| catergory II: indeterminate tracing | comprises all fHR patterns not in I or III. Not predicitve of abnormal fetal acid base status, requires evaluation and surveillance |
| category II abnormal tracing | absent baseline variability AND either reccurent late decls, reccurent variable decels, or bradycardia. Includes sinusoidal patterm. Predictive of abnormal fetal acid base status and require intervention |
| pueriperium | postpartum period. begins with birth if placenta and includes the return of body systems to or near pre pregnancy state. Lasts until 6 weeks after birth of newborn. |
| fourth stage of labor | rapid decrease in estrogen and progesterone after expulsion of placenta is responsible for tiggering anatomic and physiologic changes in postpartum |
| nursing asessments immediately after birth | VS Q 15 x 1hr, then q1 up to 4 hr, temp after birth and after recovery period, check bleeding, shaking tremors because of calcium release (give blanket or order tums) |
| when should a mom start breastfeeding? | within first hour |
| when can a mom who has had anesthesia leave the recovery area? | when anesthesia is completely worn off |
| postpartum physical assessment: BUBBLEE | Breasts, uterus, bladder, bowels, lochia, episiotomy, extremities |
| PP assessment of breasts | assess, ask mom about pain level, latching, engorgement, look for crackling, blisters, etc |
| PP assessment of uterus | want to be firm/contracted and midline. If deviated get her up to pee |
| PP assessment of bowels | ask about bowel movements, might be constipated or might not want to strain, might have pain, might need stool softener |
| PP assessment- bladder | if uterus is deviated, ask her to empty bladder |
| PP assessment- lochia | discharge from vagina after childbirth, disengagement of tissues, Assess color, amount, and clots |
| PP assessment- episiotomy | turn to side, open cheeks and look for signs of infection (redness, swelling, discharge), could also have hemorrhoids |
| PP assessment- extremities | increased risk of clots, assess extremities for redness, swelling, symmetry, homans sign |
| uterine involution | return of uterus to nonpregnant state, decrease in size of myometrial cells. Process begins immediately after expulsion of placenta with contraction of uterine muscle |
| fundal location at end of thrid stage (immediately after delivery) | 2 cm (2 finger breadths) below umbilicus |
| fundal location 12 hours after delivery | 1 cm (1 fb) above umbilicus |
| uterine involution/fundal location progress | fundus decreases 1-2 cm per day |
| how long does it take for the fundus to reach the true pelvis? | 2 weeks |
| how long does involution take? | 4-6 weeks |
| afterpains | caused by PP contraction of the uterus (involution) |
| afterpains in primiparas | uterine tone good, fundus firm, more effective contractions- mild uterine cramping |
| afterpains in multiparas | more contractions, myometrium tends to relax and recontract. Have a lot more pain after birth |
| causes of increased afterpains | overdistension of uterus, oxytocin, methergine, hemobate(controls bleeding), cytotec, breastfeeding |
| lochia | liquid discharge from uterus after chlldbirth, can last 4-8 weeks |
| lochia rubra | bright red blood, right after delivery, lasts 3-4 days |
| lochia serosa | pinkish brown, lasts about 3 weeks, lighter flow |
| lochia alba | yellow-white, lasts about 10-14 days |
| foul smelling lochia | indicative of left over products of consumption (placental pieces still in uterus) or infection |
| excessive lochia/bleeding causes | uterine atony and failure of uterine muscle to contract firmly |
| subinvolution | failure of uterus to return to normal prepregnancy state |
| causes of subinvolution | big, boggy uterus, bleeding, retained Products of consumpiton, puerperal infection |
| cervix changes postpartum | changes in shape, size and consistency. Shortens, firms, regains form (firm in 3-5 days) |
| vagina PP | estrogen depletes- vagina decreases in size, regains tone, regains rugae, edema, redness, dryness (lack of estrogen) |
| what is necessary forthickening of vaginal mucosa and return of lubrication after childbirth? | return of ovarian function |
| dyspareunia | painful sex until return of ovarian function and lubrication |
| 1st degree laceration | scratch, cut |
| 2nd degree laceration | through perineal muscles |
| 3rd degree laceration | through sphincter |
| 4th degree laceration | vagina to anus tear |
| Non breastfeeding moms PP | rapid decrease in prolactin, engorgement, distended, swollen, firm, tender, warm breasts, painful |
| engorgement | distention, swelling,firming of breasts due to temporary congestion in VEINS and LYMPHATIC circulation |
| what should you teach non breastfeeding mother in terms of comfort and interventions to decrease milk flow? | wear supportive bra/binder, ice packs. do not pump, dont stimulate nipples, cabbage leave inhibit milk production, mild analgesics |
| breast feeding moms PP | high level of prolactin, infant sucking stimulates milk production |
| Postpartum cardiac output | increases |
| normal blood loss during birth | 300-500 ml (1200 ml is considered PP hemorrhage) |
| hemoglobin and hematocrit PP | increases by 3-7 days |
| clotting factors in PP | increased (+immobility = risk for VTE) |
| wbc levels PP | increased |
| what finding indicates puerperal infection? | temperature 100.4 for 2 days |
| what happens to renal function PP? | reduced |
| how long does it take for abdomen to return to prepregnancy state? | about 6 weeks, muscle tone in 4-6 weeks. Striae/stretch marks fade but stay, linea nigra fades/disappears |
| GI system PP | constipation due to poor muscle tone, hydration change, perineal soreness, might not want to strain, give stool softener!!! |
| why might a mom get a severe headache after epidural? | leakage of CSF |
| what should you tell a mom with epidural headache? | lay down flat and dont move |
| return of menses in non breastfeeding moms | prolactin levels decline after birth. menstruation occurs 5 weeks- 5 months after delivery |
| return of menses in breastfeeding moms | prolactin levels in blood suppress ovulation (only is exclusive breastfeeding). Menstruation return in 8-12 months, but ovulation can occur before that |
| what should you do in mothers who are Rh negative? | administer rhogam |
| what psychosocial factors should the nurse assess PP? | overall emotional status, knowledge base regarding PP changes and newborn, past parenting experience, cultural background, financial status, social support |
| postpartum baby blues | due to hormonal changes and adjustment to parenting, cry for no reason, let down feeling, restlessness, fatigue, insomnia, headache, anxiety, sadness, anger, lasts 3-5 days |
| postpartum depression | depression/blues lasting more than 10 days, anhedonia (dont like things you used to), hx of depression is a risk factor |
| rubins 3 stages of maternal adjustment | 1) Dependent- Taking In Phase 2) Dependent-Independent- taking hold phase 3) Interdependent- Letting go phase |
| Dependent- Taking In Phase | baby blues, focused on themselves, reliance on others to meet needs for comfort, rest, closeness, nourishment, desire to review birth process, lasts 5-6 days |
| dependent-independent: Taking hold phase | focus on care of baby and competent mothering, desire to take charge, eagerness to learn and practice, handling of physical discomforts and emotional changes, still have need for nurturing and acceptance by others |
| Interdependent Letting Go phase | focus on forward movement of family as a unti with interacting members, reassert relationship with partner, resume sex, resolve individual roles, go back to work |
| Discharge teaching- self care | basic care of self and newborn, recognize s/s that indicate problems and how to get help, targeted teaching tailored to patient needs, written materials |
| discharge teaching- sexual activity/contraception | no sex for 6 weeks recommended, discuss contraception, ovulation can occur before 6 weeks, breastfeeding not reliable contraception |
| discharge teaching- prescribed meds | continue prenatal vitamin, stool softeners, pain meds |
| when should first newborn checkup be? | within 7-10 days |
| when should moms PP check up be? | at 6 weeks PP |
| what factors is length of stay determined by? | physical condition of mother and newborn, mental and emtotional status of mother, social support at home, client education needs for self management and infant care, financial constraints |
| why are more and more moms discharge early? | efforts to reduce health care costs, consumer demands to have less medical interventions and more family focused experiences, low risk childbirth |
| concerns with early discharge | some problems might not show up until after 24 hours: jaundice, feeding difficulties, infection, unrecognized respiratory or cardiac problems |
| Newborns and Mothers Health Protection Act of 1996 | all health plans are rquired to allow the new mother and newborn to remain in the hospital for a minimum of 48 hours after a normal vaginal birth and for 96 hours after a cesarean birht unless attending provider in consultation wit mom decides on early dc |
| benefits of breastfeeding | designed for human infants and is nutritionally superior to any alternative. considered a living tissue, bacteriologically safe and fresh, nutrients in breast milk more easily absorbed than those in formula, provides antibodies to infant(IgA) |
| colostrum | more concentrated than mature milk, rxtremely rich in immunoglobulins |
| supply meets demand principle of breast milk | the more an infant nurses, the greater the milk supply |
| physiological signs of feeding readiness | VS within normal limits, unlabored respirations, nares patent, no cyanosis, active bowel sounds, no abdominal distention |
| cues for feeding readiness | hand to mouth or hand to hand movements, sucking motions, rooting |
| breastfeeding positions | cradle, cross cradle, football, lying down |
| LATCH scoring system | Latch, Audible swallowing, Type of nipple, Comfort, Hold; 0-2 for each category, 6 or less requires teaching |
| formula feeding | fortified infant formulas (iron), cows milk not suitable to meet nutritional needs. Educate parents about readiness for feeding, feeding patterns, techniques, bottles, nipples, preparation, vitamin and mineral supplementation, weaning, solids at 6 mo |
| First Period of Reactivity | lasts up to 30 minutes after birth, heart rate increased to 160-180, gradual decrease to 100-120 bpm, want it to normalize at 120-160 bpm. Respirations 60-80 irregular |
| period of decreased responsiveness | period of sleep or marked decrease in motor activity, lasts 60-100 min. Rapid, shallow respirations (60-100 per min) |
| second period of reactivity | 2-8 hours after brith, brief periods of tachycardia and tachypnea, meconium passed, mucus produced |
| lethicithin/sphingomyelin ratio | shows if lungs are mature enough, assessed with amniocentesis, should be at least 2:1 |
| When are lungs usually mature, vascularized, with surfactant and sacules? | usually adequate by 32-35 weeks |
| Chemical factors that initiate breathing in newborn | medulla stimulation caused by decreased PO2, increased PCO2 and decreased pH, decreased prostaglandin with cord clamping |
| Mechanical factos that initiate breathing in newborn | decreased intrathoracic pressure at birth; lungs/body compressed during labor, pressure outside higher, baby takes in air to equalize pressure |
| thermal factors that initiate breathing in newborn | medulla stimulation caused by stimulation of temperature receptors in skin |
| sensory factors that initiate breathing in newborn | touch, taste, smell, sound, sights |
| signs of respiratory distress | asymmetric chest movements, apnea >20 sec, RR<30, diminished breath sounds SEESAW RESPIRATIONS, grunting, nasal flaring, retractions, deep sighing, tachypnea(>60), irregular breathing, excessive mucus, fine crackles, stridor |
| seesaw respirations | chest wall retracts and abdomen rises with inspiration |
| ductus arteriosis | connects aorta and pulmonary artery, closes after birth |
| foramen ovale | hole between right and left atrium, closes after birth |
| normal infant heart rate- sleeping | 85-100 |
| normal infant heart rate- awake | 120-160 |
| acrocyanosis | hands and feet bluish for a couple of hours, then pink up later. peripheral circulation sluggish |
| blood volume in infant | 80-85 ml/kg; approximately 300 ml; can be increased with delayed cord clamping |
| benefits of delayed cord clamping | increased blood volume, increased Hct and Fe, less anemia |
| disadvantages of delayed cord clamping | higher possibility of jaundice |
| levels of RBCs/Hct/Hgb in newborns | HIGH. Rbcs= 4.8-7.1, Hgb 14-24, Hct 44-64 |
| levels of wbcs in newborn | Elevated- 18,000 at birth, 23000-24000 at day 1 of life. |
| platelet levels in newborn | 150000-350000 (normal) |
| coagulation in newborn | vitamin K dependent clotting factors are deficient b/c of lack of flora in intestine that makes vitamin K |
| thermoregulation | the maintenance of balance between heat loss and heat production |
| conduction | heat flows to cooler surface in direct contact (put baby on cold table and it will lose heat) |
| convection | heat flowing to cooler air (room is cool, baby loses heat) |
| evaporation | conversion of liquid to vapor (wet baby loses heat) |
| radiation | heat flow to cooler surface in close proximity (baby near a cold table loses heat) |
| cold stress | increased RR in response to increased need for O2 to stay warm/for energy. If infant cant maintain adequate O2 levels, vasoconstriction occurs and O2 uptake by lungs decreases. PO2 decreases and pH decreases. Increased anaerobic metabolism (met aciosis) |
| brown fat | thicker than normal fat, depletes/metabolizes to produce heat, found at nape of neck, axillae, around kidneys and mediastinum |
| Which babies are at risk for cold stress? | premature infants and flaccid infants |
| methods of thermogenesis (heat generation) | 1) Flexed Position (smaller surface area), 2) peripheral vasoconstriction 3) brown fat |
| nursing interventions to prevent heat loss | bathe only after temp stabilizes, use warmers/isolettes, bundle/swaddle babies, keep hat on, keep out of drafts, keep ambient temperature at 22-26 C, skin to skin contact |
| when should the newborn's first void occur? | within 48 hours (98% void within 30 hours) |
| normal amount of voids in first 1-2 days and afterword | 2-6 voids in first 1-2 days, 6-8 voids per day afterward |
| what might the first voids look like in a newborn? | may be cloudy (mucus) and may be reddish/orange because of uric acid crystals (may indicate dehydration if red urine persists after 1 week of life) |
| at what age are the kidneys fully functional? | 2 years of age |
| what week of gestation does sucking become coordinated? | 32 weeks |
| what is stomach capacity at birth vs. day 3? | birth: 30 ml 3rd day of life: 90 ml |
| meconium | initial fecal material (sticky, tarry, black/green), passed within first 12-24 hours of life |
| What functions does the liver carry out in newborns? | 1) Stores iron 2) metabolizes carbs 3) produces substances essential for clotting of blood 4) conjugates bilirubin |
| how long do the liver's iron stores last in full term infants? | 4-6 months (preterm lower), breastmilk has more iron |
| jaundice | yellow pigment of the skin due to hyperbilirubinemia - results from breakdown of rbcs in neonates. Occurs when levels of unconjugated bilirubin exceed liver's ability for conjugation |
| Unconjugate bilirubin (INDIRECT) | formed from breakdown of rbcs. Rbcs->Hgb->Heme-> bilirubin by reticuloendothelial cells. Unconjugated (indirect) bilirubin is not soluble or excreteable. unbound indirect bili can cause neurotoxicity. |
| conjugated bilirubin (DIRECT) | unconjugated bilirubin that has been broken down by the liver to a soluble, excreteable form. Excreted in feces. |
| Why does proper feeding prevent jaundice? | feedign stimulates peristalsis and rapid passage of meconium. This diminishes the amount of reabsorption of unconjugated bilirubin through enterohepatic circulation |
| total bilirubin | indirect and direct bilirubin |
| Physiologic Jaundice | caused by rapid breakdown of fetal rbcs, increased reabsorption of bilirubin, and impaired/slowed conjugation. Occurs AFTER 24 hours |
| Pathologic Jaundice | pathologic in origin or sever enough to warrant tx. Appears DURING/WITHIN first 24 hours. Caused by delayed cord clamping, hemolytic disease of newborn, altered hepatic function |
| breast milk jaundice | indirect hyperbilirubinemia starting AROUND 5-6 DAY, lasting beyond the first week. |
| kernicterus | encephalopathy caused by neonatal hyperbilirubinemia, caused by breakdown of hemoglobin levels of 20-25+, poor prognosis |
| Antibodies in the newborn | IgG via placenta, low levels of IgM produced by fetus, IgA via breast milk |
| signs of infection in newborn | lethargy, irritability, poor feeding, vomiting, diarrhea, decreased reflexes, pale skin |
| vernix caseosa | white, yellow cheesy substance, product of sebaceous glands, protective covering in womb, keeps baby from getting wrinkled. More on premies, less on postdate/term babies |
| mongolian spots | bluish black areas of pigmentation that can appear over any part of exterior surface of body, most commonly on back or buttocks, more common in darker skinned babies, gradually fade |
| telangiectatic nevi | "stork bite", pink, easily blanched, appear on upper eyelids, nose, upper lip, lower occipital area, nape of neck. Benign. |
| erythema toxicum | "flea bite"; lesions, erythematous macules, papules, vesicles anywhere on body |
| why do newborns have swollen breasts and leaking of nipples (witches milk)? | increased estrogen from mom |
| male genitalia assessment | testes descended, hydroceles (fluid filled sac in scrotum), hypospadias (abnormal position or urethral opening) |
| pseudomenstruation | vaginal bleeding r/t estrogen and moms hormones |
| molding | shaping of the head by the fetal overlapping of cranial bones to facilitate movement through birth canal |
| caput succedaneum | easily identifiable edematous are of the scalp, most commonly found on occiput. Extends across suture lines, disappears within 3-4 days |
| cephalohematoma | collection of blood between a skull bone and its periosteum, does not cross cranial suture lines, resolves within 3-6 weeks |
| ortolani-barlow tests | checks to make sure hips dont dislocate |
| what reflexes should the nurse check in the newborn? | moro (startle), tonic neck (opposite leg of where they are looking flexes), babinski (toes fan), gag, sucking, rooting, grasp, etc |
| 2 sleep state in infants | deep sleep and light sleep |
| 4 wake states in infants | drowsiness, quiet alert, active alert, crying |
| what factors influence infant behavior? | gestational age, time since birth, stimuli, medications during labor |
| how long is the neonatal period? | birth- 28 days of life |
| Apgar score | performed at 1 minute and 5 minutes. Assesses heart rate, respiratory effort, reflex irritability, muscle tone, and color |
| what vital signs do you take on a newborn infant? | heart rate, respiratory rate, temperature (axillary) |
| measurements to take at birth | length, weight, head circumference, chest circumference |
| why should you assess lips and mouth of dark skinned babies especially? | their skin might not show cyanosis, check mucous membranes for color |
| Vitamin K injection | decreased vitamin K dependent clotting factors (no gut flora to produce vitamin K), risk for bleeding. Given in vastus lateralis |
| erythromycin ointment | 1/4 in ribbon of ointment given along lower lid, dont rub in, may wait up to 1 hr to apply. Given as precautionary measure against ophthalmia neonatorum (inflammation of eye resulting from gonorrheal or chlamydial infection |
| hepatitis B immune globulin | given to infants born of hepatits B positive mothers, should be administered within 12 hours of birth, given with Hep B vaccine. Provides high titer of antibody to hep B surface antigen |
| umbilical cord care | keep clean and dry, no tub baths until cord falls off, fold diapers away from umbilicus, clean after soiling, daily head to toe bath not necessary |
| circumcision | elective procedure, usually delayed 12-24 hours until stabilized, do not feed 1 hour prior to procedure, consent required from one parent, rstraint required, anesthetic is physician preference |
| caring for circumcision | comfort measures, keep wound clean and dry, check urination within 12 hrs, monitor hourly for bleeding, assess for s/s of infection (wont occur immediately) |
| what is normal weight loss in infants ? | normal for newborns to lose 5-10% of weight in first 4-5 days |
| red flags after birth | gagging, turning blue, generalized cyanosis, weak cry, grunting, respiratory distress, decreased or absent movements, excessive twitching or trembling (do accucheck), projectile vomiting |
| anterior fontanel closure | 5 cm, diamond shaped, bigger, closes in 7-19 months |
| posterior fontanel | triangle, smaller, closes after 2-3 months |
Created by:
alexadianna
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