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