Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
NCTC Maternity 4
| Question | Answer |
|---|---|
| Reflexes | help keep baby alive: winking, sneezing, gagging, sucking, grasping, cry, swallow, and lift head slightly. Will disappear |
| Moro reflex | draw up legs and fold arms across chest when jarred |
| Rooting reflex | causes infant's head to turn in direction of anything that touches the cheek |
| Tonic neck reflex | postural reflex that is assumed when baby sleeps: head turned to one side and the arm and leg extended on the side which the infant faces. The other arm and leg are flexed so that the infant appears to be fencing |
| Palmer reflex | when anything touches the baby's hand they grasp |
| Babinski | fans out toes when foot is stroked |
| Blinking | flash of light, puff of air |
| Suck - | object touches mouth sucks |
| Dancing reflex | prancing movements of the legs when infant is upright |
| Head circumference 12.5 to 14.1 inches | measure right above eyebrows |
| Molding | makes head seem misshapen from conforming to the size and shape of the birth canal |
| Caput succedaneum | swelling of the soft tissues of the scalp - crosses the suture line |
| Cephalohematoma | collection of blood beneath the cranium - does not cross the suture line |
| Fontanels - unossified spaces (soft spots) on the cranium | Anterior is diamond shaped, pulsating can be seen here. Posterior is triangular shaped |
| Sensory overload | occurs when there is too much stimuli. Where there is much noise, voices carry, and bright lights |
| Hearing well-developed at birth | Able to discriminate mom's voice from other voices at 3 days. Hearing is tested by nurses in nursery before discharge |
| Sleep | Normal newborns sleep 15-20 hours a day with gradual change as baby matures |
| First reactive phase | during the first 30 minutes after birth when infant is alert Best time to facilitate bonding between infant and parents |
| Sleep phase | infant gradually becomes more sleepy and less responsive Has deep sleep for several hours |
| Stability phase | occur after 24 hours when sleep-wake pattern stabilizes |
| Sleep factors | Horizontal rocking facilitates sleep Vertical rocking facilitates alert states |
| Quiet sleep | infant sleeps without moving |
| REM sleep | eye movement is evident beneath closed lids |
| Active alert | infant displays diffuse motor activity |
| Quiet alert | infant is awake, but quiet and relaxed |
| Pain | Heart respiratory rates increase Blood glucose levels rise |
| Respiratory function is begun with the clamping and cutting of the umbilical cord | First breath expands the lungs, although full expansion doesn't occur for several days Respiration is facilitated by holding head down and removing mucus Cry should be strong and healthy 1st hour is most critical Nurse should suction prn – mouth then nose |
| APGAR - Standardized method for evaluating the newborn's condition | Heart rate (0-2) Respiratory effort (0-2) Distress shown by: rate and character of respirations, color, and general behavior. Muscle tone (0-2) Reflexes and irritability (0 - 2) Color (should have acrocyanosis between the fingers and toes 0-2) |
| APGAR - Scores and what to do with them. | Scoring occurs at 1 and 5 minutes 6-9 great...below 6 needs extra resp. support. If below 6 then going to do a 10 min score also. |
| foramen ovale | ( causes problems later in life usually a stroke because the blood pools in the heart ...hole between atria) |
| ductus arteriosis | (bypassed the lungs - should close due to pressure changes ... fail to close shortly after birth or there are congenital abnormal openings, baby may be cyanotic because the blood continues to bypass the lungs and does not pick up oxygen. |
| Murmurs | may be audible from blood leaking through openings that have not closed yet....it must be charted though |
| Newborn has unstable heat-regulating system | Newborn has unstable heat-regulating system - when cold cannot maintain O2 saturation. blood vessels close to surface very little brown fat |
| Dry it off directly after birth | shivering just uses all glucose, and doesn't make heat baby cannot adapt to temp changes At risk for developing elevated temp if overdressed or overheated environment Body temp is influenced by room temp, number of blankets, and humidity |
| First temp is taken rectally to determine rectal patency | Best core temperature Routine temps are taken axillary Pulse and respirations are taken before temp |
| Pulse and respirations | take resp first - if crying give a gloved finger to suckle Pulse is taken apically (one full min) and should be 110 -160 and irregular Average B/P is low 80/46 Respirations are 35-50 |
| Report: | Temp < 97 and > 100 Pulse <110 and > 160 Respirations < 30 and > 60 Noisy respirations Nasal flaring or chest retractions |
| Musculoskeletal system | Skeleton is flexible since cartilage has not had calcium inlaid Movement is random and uncoordinated Muscular control proceeds from head to toe and center to periphery Baby should not feel limp when handled |
| Scarf sign - | infants attempt to prevent elbow from being brought farther than midline of the chest |
| Eyes | appear crossed due to lack of muscle coordination Permanent coloring is fixed between 6-12 months Tears do not appear until 1-3 months because lacrimal ducts are immature Tremors of the lips and extremities during crying are normal |
| Length and weight | ALWAYS PUT SOMETHING ON THE SCALE BEFORE PLACING THE BABY ON THE SCALE |
| Average length | 19-21 1/2 inches (46-56 cm) |
| Average weight | 6-9 pounds (2700-4000 gm) |
| Baby loses 5-10% of birth weigh | will be a calculation question on test May be due to loss of maternal hormones, fluid shifts, and loss of urine and feces Should normalize after 3-4 days Should be weighed at same time of day |
| first voiding | Notify MD if no voiding within the first 8 hours |
| Male genitalia | Testes are descended into the scrotum (cryptorchidism if undescended) |
| Circumcision | Plastibell: Gomco clamp Local anesthesia to minimize pain during procedure and prevent irritability and sleep disturbances afterward Holding and soothing with pacifier or sucrose solution |
| Pseudomenses | Blood-tinged vaginal mucus results from hormonal withdrawal from mom |
| Turgor | Tested on abdomen for springing back to natural state immediately |
| Lanugo | fine body hair disappears during the first week - if family is hairy then the baby can be very hairy More evident in preemies - can tell us more about gestational age. |
| Vernix caseosa | covers skin of newborn to protect from fluid |
| Milia | pinpoint pimples caused by obstruction of sebaceous glands Disappear in few weeks |
| Stork bites | flat red areas of nape and eyelids - red and even, will go away. Result from dilation of small vessels |
| Port Wine | won't go away-. can be treated with laser treatment; can grow because it is from the blood vessels. |
| Mongolian spots | bluish discolorations common in African-Americans and Native Americans and Mediterranean races - chart them size and location Disappear spontaneously in early years of life |
| Acrocyanosis | peripheral blueness of upper and lower extremities and is normal finding |
| Desquamation (peeling of skin) | Occurs during the first weeks of life |
| Physiologic jaundice (icterus neonatorum) | Bilirubin rises from normal 1 mg/dl to 5-6 mg/dl between 2nd and 3rd day of life and lasts 1 week This is normal and does not harm baby put in sunlight |
| Pathologic hyperbilirubinemia (BAD) | appears within the first 24 hours Influenced by genetic and ethnic factors has a blood incompatibality issue billirubin can collect in the brain and cause damage and death |
| Bathing - must wear gloves before first bath. ( baby has body fluids on it) | Powder is seldom used because it irritates the respiratory tract Bathing only takes place when baby's temp is stable Shampooing is performed last because exposing the large surface area of the head predisposes the infant to heat loss |
| Meconium is first stool | Mixture of amniotic fluid and intestinal secretions Thick, dark green, and sticky and is passed 8-24 hours |
| Straining at stool does not indicate constipation | Results from underdeveloped abdominal musculature Is considered normal and requires no intervention |
| PREVENTING INFECTION | Relatively harmless infections can be fatal to the newborn Handwashing technique teach parents - still the most important thing you can do to prevent infection. |
| DISCHARGE PLANNING | will not discharge unless there is a car seat 8-10 wet diapers per day Signs and symptoms of problems and who to contact: elevated temp, refusal of two feedings in a row, two green watery stools, frequent or forceful vomiting, lack of voiding or stooling |
| THE PRETERM NEWBORN | Under 38 weeks Also known as "preemie" or "premature" Most common admission into the neonatal intensive care unit |
| Premature birth | largest single factor in infant mortality in first year of life Also combined with low birth weight, lead to high rates of infant mortality and morbidity |
| Gestational age is actual time from conception to birth that the fetus remains in the uterus | Preterm is < 38 weeks Term is 38-42 weeks Postterm is > 42 weeks |
| Level of maturation | Refers to how well developed the baby is at birth and the ability of the organs to function outside of the uterus |
| When a preemie is evaluated at regular intervals at the pediatrician.... | their "real" age gestational instead of birth age is used.ex. if they were born 4 weeks early they are evaluated like they are a month younger. |
| Causes of Premature birth - unknown but factors that influence are: | Multiple births Illness of the mother Malnutrition Heart disease Diabetes mellitus Infections Smoking Alcohol consumption Drug abuse |
| Physical Characteristics of a preterm baby | Skin is transparent and loose Superficial veins may be visible beneath scalp and abdomen Lack of subcutaneous fat Lack of lanugo Abundant vernix caseosa Short extremities Few sole creases Protruding abdomen Short nails Small genitals Open labia majora |
| Inadequate respiratory function | lungs not developed Chest muscles are underdeveloped Distended abdomen causes pressure on the diaphragm Stimulation of the respiratory center in the brain is immature Gag and cough reflexes are weak due to inadequate nerve supply |
| Respiratory distress syndrome (hyaline membrane disease) | Decreased gas exchange due to lung immaturity Caused by decreased synthesis or release of surfactant |
| decreased synthesis or release of surfactant | L/S ratio (lecithin/sphingomyelin) test determines the amount of surfactant in the amniotic fluid (usually comes to normal amounts at 34 weeks) Atelectasis (lung collapse) occurs |
| Respiratory distress syndrome (hyaline membrane disease)- Manifestations: | Resp rate > 60 (tachypnea) Grunting Nasal flaring Cyanosis Intercostal and sternal retractions Edema Apnea Ventilator support |
| Respiratory distress syndrome (hyaline membrane disease) - Treatment | Inject mom with steroids - helps baby form surfactant Surfactant replacement administered right after birth or during the first 24 hours Positive pressure oxygen helps prevent postnatal alveolar collapse (CPAP) Evaluation of oxygen needs by: Color ABGs |
| Apnea (not uncommon in preterm newborn) | Cessation of breathing for longer than 20 seconds Apnea monitors alert to this complication i) Gentle rubbing of feet, ankles, and back may stimulate breathing ii) Next will suction nose and mouth and raise baby's head iii) Last will use ambu bag |
| Sepsis (generalized infection of the blood stream) | Risk is due to immature body systems Liver is immature and forms antibodies poorly Body enzymes are inefficient Stores of nutrients, vitamins, and iron are deficient |
| May be no local signs of infection | Signs include: low temp, irritability or lethargy, poor feeding, respiratory distress Prevention is of utmost importance Handwashing is extremely important |
| Infection treatment | IV antibiotics, maintain warmth and nutrition, monitor VS, provide care to conserve energy, incubator to separate from other babies Poor control of body temperature |
| Heat loss is caused by: | Baby's ability to make heat is less than ability to lose heat Premature infant is inactive, has weak muscles, is less resistant to cold, and cannot shiver Metabolism is high and preterm infant is prone to low blood glucose |
| cold stress | Causes increased need for oxygen and glucose Nursing care – skin probe to monitor temp, place under radiant warmer or incubator |
| Hypoglycemia | Common among preemies Caused by insufficient time in utero to acquire stores of glycogen and fat Aggravated by need for increased glycogen in the brain, heart, and other tissues as a result of asphyxia, sepsis, RDS, unstable body temp |
| Signs of hypoglycemia | tremors, weak cry, lethargy, convulsions With prematurity, may have weak or absent suck reflex and will need gavage or parenteral feedings Glucose >40 BAD |
| Hypocalcemia - Calcium is normally transported through the placenta during the 3rd trimester | Treated by early feedings and calcium supplements Can also give calcium gluconate IV |
| Preemies have an Increased tendency to bleed | Blood is deficient in prothrombin Capillaries are fragile and susceptible to injury during delivery Causes intracranial bleeding Monitor for bulging fontanelles, lethargy, poor feeding, seizures |
| Retinopathy of prematurity | Produces separation and fibrosis of the retina leads to blindness Primary cause of blindness in newborns weighing less than 1500 gm Caused by high levels of oxygen in arterial blood monitor ABG's Prevention is crucial |
| Necrotizing enterocolitis (NEC)- Acute inflammation of the bowel that leads to necrosis | Signs – abdominal distention, bloody stools, diarrhea, bilious vomitus Nursing interventions: VS, infection control techniques, careful resumption of oral fluids, measure abdominal girth ( just above umbilicus) , bowel sounds |
| Immature kidneys - Improper elimination of body wastes contributes to electrolyte imbalance and disturbed acid-base relationships | Dehydration occurs easily Limited salt tolerance Increased susceptibility to edema Nursing implications – accurate I&O with weighing of diapers, assess for signs of dehydration or overhydration, document: fontanelle status, tissue turgor, weight, I&O |
| Jaundice (hyperbilirubinemia)- Immature liver contributes to icterus | Causes skin and whites of eyes to assume a yellow color Liver is unable to clear the blood of bile pigments from the normal postnatal destruction of RBCs The higher the bilirubin, the more yellow the color, and the greater the risk |
| Pathological jaundice occurs within 24 hr of birth | Secondary to an abnormal condition such as ABO incompatibility In preterm infants, level increases more slowly than full-term and lasts longer Treatment aimed at preventing kernicterus Serious complication that causes brain damage and/or death |
| Milk jaundice in breastfed babies | is seen about 4th day when milk comes in Early breast milk jaundice requires increase in breastfeeding Late breast milk jaundice may require breastfeeding to be discontinued temporarily Caused by lack of substances to help conjugate bilirubin |
| phototherapy | In the presence of sunlight it makes the breakdown of the biliruben eyes must be covered to prevent damage uncover every two hours |
| Kangaroo Care | Uses skin-to-skin contact against mom or dad's naked breast Skin warms and calms the child and promotes bonding Protocols are being developed |
| Prognosis | Growth rate of preterm nears that of the term newborn by 2 Based on current age minus the number of weeks before term the infant was born Usually catch up in two years. |
| THE POSTTERM NEWBORN- Postterm if goes beyond 42 weeks gestation Refers to the infant showing characteristics of postmature syndrome | Death is uncommon today due to early detection and intervention Cause is unknown but involves inadequate placental functioning as it ages Mortality rate is higher than for term infants Morbidity rates are also higher |
| Problems associated with postmaturity: | Asphyxia from chronic hypoxia in the uterus from deteriorating placenta Meconium aspiration Dystocia due to increased fetal size Seizures resulting from hypoxia hypoglycemia - also contributes to respiratory problems |
| Expect induction or cesarean if testing determine gestation is past 42 weeks or fetal distress | Observe for respiratory distress, hypoglycemia, hyperbilirubinemia Incubator placement for fat stores loss and vulnerability to cold stress |
| TRANSPORTING THE HIGH-RISK NEWBORN Special nursery team is required | Stabilization of baby before transport is important Send copies of all records – birth stats, vitals, blood work, prenatal records Transport incubator provides warmth Show mom baby before transport - take a picture Contact parents after arrival of infant |
| Hydrocephalus ("water" and "head") Pathophysiology | Characterized by increase of cerebrospinal fluid in the ventricles of the brain Causes increase in head size, pressure changes in the brain Results from imbalance between production and absorption of CSF |
| Hydorcephalus - Manifestations: signs and symptoms depend on time of onset and severity of imbalance | Increase of head size Bulging fontanelles Separation of cranial sutures Shiny scalp Dilated veins "Sunsetting eyes" Chiari malformation – foreshortened occiput with brain stem protruding through cervical canal |
| Dandy-Walker syndrome – prominent occiput with atresia of two foramen | Lethargy, irritability Shrill, high-pitched cry Vomiting and anorexia Convulsions |
| Hydrocephalus diagnosis | Transillumination - flashlight held against head in darkened room to observe for areas of increased luminosity Daily head measurement EEG, CT and MRI to determine obstructions and visualize enlarged ventricles Ventricular tap |
| Hydrocephalus treatment | Shunt placement for bypassing the area of obstruction Shunt into right atria or peritoneal cavity Complications: obstruction of shunt, infection- look for signs and symptoms of intracranial pressure |
| nursing care | Monitor for signs of ICP Monitor signs of infection at insertion site or along shunt line: increase in VS, poor feeding, vomiting, pupil dilation, decreased level of consciousness, seizures Monitor head and chest circumferences |
| Spina bifida (divided spine) | Prevention of neural tube defects by prenatal intake of folic acid 0.4 mg until at least the 12th week of gestation when neural tube formation is complete Folic acid intake should begin during pre-pregnancy counseling |
| Spina bifida Occulta | opening is small with no protrusion of cord- hidden May detect tuft of hair, dimple, lipoma, or portwine birthmark May not require treatment unless neuromuscular symptoms occur: Progressive disturbances of gait, footdrop, or bowel or bladder dysfunction |
| Spina Bifida Cystica | -opening is larger with protrusion of cystic mass (babies are usually born with flaccid legs.) Meningocele - sac contains portions of membrane and CSF Meningomyelocele - sac contains membranes and spinal cord and is the most serious |
| Spina Bifida treatment | Surgery to return sac contents to body - prevent infection and cosmetics Now we are doing this surgery during the fetal time in utero |
| Spina bifida Nursing Care | Prevention of infection or injury to sac Positioning to prevent pressure on sac and deformities Moist sterile dressings to prevent drying and protect mass until surgery |
| Cleft Lip (Harelip) -Opening in the upper lip resulting from failure of mouth structures to unite during embryonic stage | Occurs more frequently in boys May be unilateral or bilateral Treatment and nursing care Cheiloplasty (surgical repair of cleft lip) Repaired by 3 months Improves infant sucking and appearance May require elbow restraints to keep hands from lips |
| Cleft palate Failure of hard palate to fuse resulting in passageway between nasopharynx and the nose Leads to infections of respiratory tract and middle ear causing hearing loss; tooth decay is also a complication | Is more common in females Surgical repair usually 12-18 mo to prevent speech difficulties Emotional support for long-term repair of facial deformities Elbow restraints may be used to prevent injury turn spoon sideways to feed so no pointy tip in the mouth |
| Clubfoot- Characterized by foot that twisted inward or outward Mild cases are due to malposition in uterus and resolve without intervention | 95% are talipes equinovarus (where feet ar bent inward During infancy: manipulation and casting Monitor toes for circulation checks: capillary refill, pallor, cyanosis, swelling,coldness, numbness, pain, burning long term - need emotional support |
| Developmental hip dysplasia - Head of the femur is partly or completely displaced from the shallow hip socket | Most common indication is limited abduction of the affected hip Infant is placed on back on table with knees and hips flexed Normal hip will allow hip to be abducted to table; dysplastic hip will not |
| Barlow’s test | adduction and extension of hips while stabilizing pelvis, will feel dislocation as femur leaves the acetabulum |
| Ortolani's click | can be audible when hip is checked |
| Treatment Developmental hip dysplasia -(controversy exists) | Triple diapering of the newborn until Pavlik harness fitting Pavlik harness maintains abduction to put constant pressure on acetabulum Traction may be necessary if child is already walking Followed by casting in spica cast for 5-9 months |
| Spica cast | HOB is elevated so urine and feces drain away from cast Frequent changes of position required Do not use bar between legs for turning |
| Phenylketonuria (PKU)- Is hereditary disorder caused by faulty metabolism of phenylalanine in protein foods Hepatic enzyme is missing | Results in: Severe retardation, evidenced in infancy Repeat tests should be done within 2 weeks after dismissal from hospital Close dietary management with protein supplements Solid foods that are low in phenylalanine are varied - cookbooks available |
| Maple syrup urine disease - Caused by a defect in the metabolism of amino acids Normal-appearing infant develops characteristic sweet urine, sweat, and cerumen | Symptoms develop abruptly – feeding difficulties, loss of moro reflex, hypotonia, irregular respirations, convulsions Treated by hydration and dialysis, life-long diet low in leucine, isoleucine, and valine Formulas of soy-protein bases are availabe |
| Galactosemia - Cause by missing enzyme necessary for galactose and lactose metabolism | Can cause cirrhosis of the liver, cataracts, mental retardation Symptoms begin abruptly and worsen gradually – lethargy, vomiting, hypotonia, diarrhea, failure to thrive, jaundice Eliminate milk and lactose Stop breastfeeding Soy-formulas for feeding |
| Down syndrome - One of most common chromosomal abnormalities Incidence is 1:600-800 births Higher in mothers over 35 or fathers over 55 | Trisomy 21 (accounts for 95% of cases) Protruding tongue that interferes with sucking Short thick hands with curved little finger and simian crease Congenital heart defects |
| Hemolytic disease of the newborn: Erythroblastosis fetalis Occurs when RH- mother has become sensitized so that her antibodies attack the RBCs of the fetus | Indirect Coombs test indicates previous exposure to RH+ antigens Usually given at 28 weeks and within 72 hours of birth Also administered after abortion, amniocentesis, or when there is bleeding during pregnancy |
| Manifestations and Treatments for Hemolytic disease of the newborn | Anemia and jaundice (severe jaundice causes kernicterus-brain damage) Enlarged liver and spleen may cause excessive edema Phototherapy facilitates destroyed RBC removal to lower bilirubin levels Exchange transfusions after birth |
| Intracranial hemorrhage - Birth injury resulting from trauma or anoxia Occurs more frequently in pre-term infant with more fragile blood vessels Blood vessels within the skull are broken and bleeding into the brain occurs | Inability to move normally, lethargy, poor sucking reflex, irregular respirations, cyanosis, twitching, forceful vomiting, high-pitched cry, convulsions, opisthotonic posturing, tense fontanel, one pupil smalle |
| Transient tachypnea of the newborn (AKA RDS) | Characterized by tachypnea, chest retractions, grunting, mild cyanosis Resolves suddenly after 3 days Caused by slow absorption of fluid in lungs after birth Treatment is supportive, warmth, energy conservation, supplemental oxygen |
| Meconium aspiration syndrome (MAS) | Occurs after fetal distress inutero when fetus makes gasping movements that brings meconium into lungs or with first breath before mouth and nose suctioning |
| Neonatal abstinence syndrome is drug withdrawal from addicted mothers | Characterized by tremors, hyperirritability, wakefulness, diarrhea, poor feeding, sneezing, yawning Treatment includes quiet environment, reduction of stimuli, close observation for seizures Phenobarbital, paregoric, tincture of opium may be prescribed |
| INFANT OF A DIABETIC MOTHER - Hyperglycemia in mother produces hyperinsulinism in baby Insulin acts as growth hormone causing large babies (LGA-macrosomia) | Low blood sugars are common in the infant due to abrupt loss of maternal glucose Nursing care includes close monitoring of VS, early feeding, frequent assessment of blood glucose levels Monitor for signs of irritability, tremors, respiratory distress |
Created by:
736699267