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143 Cards in this Set
- Front
- Back
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Hydrocephalus |
H2O on the brain |
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Meconium plug |
Last segment of the colon fails to relax causing mechanical obstruction. |
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Intestinal atresia/ intestinal stenosis |
Part of the bowel may not have developed well (atresia) or may not be narrowed (stenosis) |
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Malrotation |
Rotation of the midgut. Vomit is bile stained and may be feculent if obstruction is distal in the intestines. |
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Presentation of upper bowel in infants |
Bilious V w/i 1st or 2nd day p birth. |
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Presentation of lower bowel obstruction in infants |
Feeding intolerance and abd distention |
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Infantile hypertrophic pyloric stenosis (ihps) |
Stomach muscles contract forcibly to overcome the obstruction. |
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Ihps presentation |
Projectile V, dehydration, malnutrition, electrolyte changes. Vomit is not bile stained, but can be brown or coffee colored |
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Pathogenic gastroesophageal reflux (GER) |
infant may vomit or either immediately or a few hours after a feeding. |
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Esophageal Atresia |
Failure to develop the distal lumen. Excessive frothing soon after birth. may choke when attempting to feed. |
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Persistent vomiting in 1st 24 hrs may indicate |
Upper digestive tract obstruction or ICP |
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Seizure assessment/management in infants |
Eval prenatal and birth hx, perform exam, obtain vitals signs. Provide O2, assisted ventilations, BP and IV access. If BGL < 40mg/dL, give an IV bolus of 10% Dextrose Solution. Monitor resp status and O2 sat. Maintain normal body temp. Keep fam informed. |
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Common causes of neonatal seizures |
*hypoxic ischemia encephalopathy *Intracranial infections (meningitis) *Hypoglycemia *other metabolic disturbances *epileptic syndromes *intracranial hemorrhage *development defects *hypocalcemia *drug withdrawl |
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hypoxic ischemic encephalopathy |
damage to cells in the CNS from inadequate o2. Usually secondary to perinatal asphyxia. Is the single most common cause of seizures in both term and preterm newborns. |
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myoclonic seizure |
flexion jerks of the upper or lower extremities. May occur singly or in a series of repetitive jerks |
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Focal Clonic Seizure |
Clonic localized jerking. Occurs in both full term and premature infants |
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Tonic seizures |
tonic extensions of the limbs. flexion of the arms and extension of the legs may also occur. more common in premature infants |
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subtle seizure |
eye deviation, blinking, sucking, pedaling movements of the legs and apnea. |
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generalized seizure |
bilateral, synchronous and nonmigratory |
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Diaphragmatic hernia |
abnormal opening in the diaphragm. |
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Diaphragmatic hernia S/S |
resp distress, heart sounds shifted to the R, bowel sounds heard in the chest. |
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Diaphragmatic hernia assessment/management |
may be few or no s/s or severe hypoxia. Resuscitate on 100% o2. monitor HR continuously. Ultimately requires surgical correction. |
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Meconium stained amniotic fluid |
dark green fecal material that accumulates in the fetal intestines and is discharged around time of birth. carries a high risk of morbidity. |
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meconium stained amniotic fluid has a high risk of persistent pulmonary HTN: to lower risk: |
ensure a clear airway, keep newborn warm. minimize stimulation. provide supplemental o2 PRN. *If newborn is destressed: clear airway. do not dry or stimulate. intubate trachea. suction ett while withdrawing from trachea. *if intubation is unsuccessful, cont. standard resuscitation. take steps to minimize hypothermia. freq reassess. |
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Pneumothorax evacuation steps |
Clean area with etoh. prepare quip: 22G butterfly needle attached to extension tubing, 3 way stopcock, 20 mL syringe. *Insert needle above upper edge of 2nd rib. advance until air is recovered. Remove when there is no more air to withdraw. If symptomatic ongoing air leak, insert a 22g angiocatheter in a similar location. During transport, monitory for reaccumulation of the pneumothorax. |
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pneumothorax s/s |
severe resp distress unresponsive to PPV. unilateral decreased breath sounds. |
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Apnea |
resp pause > 20 seconds. Common in newborns before 32 wks gestation |
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Primary apnea |
causes by o2 deprivation; usually corrected by stimulation, such as drying/ slapping the newborn's feet. Typically preceded by an initial period of rapid breathing |
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Secondary apnea |
when asphyxia continues after primary apnea, infant responds with a period of gasping respirations, falling HR and decreased BP. |
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Management of secondary apnea |
HR < 100 bpm= provide PPV If still < 60 bpm = begin compressions If still < 60 bpm= epinephrine rpt every 3-5 minutes PRN |
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Gastric decompression indications |
prolonged bag mask ventilations (> 5-10 min). Abd distention that impedes ventilation. Diaphragmatic hernia or gastrointestinal congenital anomoly. |
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Gastric decompression steps |
Determine length of tube to insert, use an 8F feeding tube and measure the length from the bottom of the earlobe to the tip of the nose to 1/2 way between the xiphoid process (lower tip of the sternum) and the umbilicus. Insert the tube through the mouth to the appropriate depth. Leave the nose open to allow for ventilation. Attach a 10 mL syringe and suction the stomach's contents. Tape the tube to the newborn's cheek. Remove syringe form the feeding tube to allow venting of air from the stomach and intermittently suction the feeding tube. |
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Intubating a newborn steps |
Preoxygenate. Suction PRN. Bag if becomes bradycardic. Place laryngoscope blade in oropharanyx. Visualize cords. Place ETT b/t vocal cords until black line is lvl with cords. limit attempt to 20 sec. confirm placement with chest rise and fall, auscultation, mist in ETT, equal breathing sounds and clinical improvement. Tape tube to face and monitor closely. |
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How far do you advance an ETT in a full term and premature infant |
Full term: advance 9 cm at the lip. Premature: advance 6 1/2 - 7 cm at the lip |
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Umbilical vein catherization steps |
clean the cord with antiseptic. attach a 3 mL syring and stop cock to a sterile umbilical vein line catheter and prefill. Cut the cord with a scapel. Insert a "low-UV line" into the umbilical vein. Flush the catheter with NS and secure in place. |
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Bradycardia intervention |
Epi for HR < 60 bpm. 1:10,000 mg/mL dose: 0.1-0.3 mL/kg . Admin rapidly followed by 0.5-1 mL NS flush. Use an umbilical vein catheter. Check pulse rate 1 min after admin. May rpt every 3-5 min PRN. |
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Low blood volume intervention s/s of hypovolemia |
fluid resuscitation may be needed. Fluid bolus consists of 10 mL/kg of saline, LR or O Rh-neg blood given IV ever 5-10 min. s/s: pallor, persistent low HR, weak pulses, no improvement in circulatory status after resuscitation efforts. |
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Acidosis intervention |
suspect if bradycardia persists after adequate ventilation, chest compressions, vol expansion. A 10 mL/kg bolus of NS may aid in improved perfusion and clearance of acid. Do NOT admin sodium bicarbonate. |
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Respiratory depression secondary to narcotics |
provide ventilatory support. transport immediately. tx: admin 0.1 mg/kg of naloxone via IV/IM. |
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hypoglycemia intervention and s/s |
s/s: decreased stimuli response, hypotonia (poor muscle tone) apnea, poor feeding, seizures. If bgl is < 40 mg/dL, give IV bolus of 10% dextrose solution. recheck lvl in about 30 min. may need to follow with a 10% dextrose infusion. |
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Pierre Robin sequence s/s and tx |
condition present at birth marked by a small lower jaw (micrognathia). The tongue tends to fall back and downward (glossoptosis) and there is a cleft soft palate. Positioning the pt chest down may relieve the obstruction. If not relieved insert oral airway. |
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macroglossia |
large tongue size |
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BVM correct timing |
40-60 bpm |
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Infantile intubation indications |
meconium stained fluid is present and newborn is not vigorous; congenital diaphragmatic hernia. no response to bag mask ventilations and chest compressions. prolonged PPV is needed. craniofacial defects impede the ability to maintain airway. |
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Infantile intubation equip |
suction (10F tubing with 5F-8F available). suction set to 100 mmHg. Laryngoscope, blades (straight #1 for full term. #0 for preterm) Shoulder roll and tape, ET stylet: 2.5 mm <28 wks, 3.0 mm 28-34 wks, 3.5 mm 34-38 wks and 4.0 mm >38 wks |
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What does APGAR stand for? |
Appearance (skin color) Pulse-rate Grimace- irritability Activity- muscle tone Respiratory- effort |
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APGAR description |
A- 2: completely pink 1: body pink- extremities blue 0: centrally blue, pale P- 2: >100 1: <100 >0 0: absent G- 2: Cries 1: Grimaces 0: no response A- 2: Active motion 1: some flexion of extremities 0: limp R- 2: strong cry 1: slow and irregular 0: absent |
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Acrocyanosis |
hands and feet are blue; pink centrally |
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central cyanosis |
cyanosis in core and mucous membranes |
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newborn |
within first few hours after birth |
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neonate |
within first month of birth |
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initial stabilization of newborns |
warming, positioning, clearing airway, drying and stimulating breathing |
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After head is delivered: |
suction mouth THEN nose, clamp and cut the umbilical cord, clear secretions and assess the resp effort. confirm newborn's airway patency, breathing and HR. place newborn on mother's chest. do an initial rapid assessment. monitor ABCs and ensure thermoregulation. |
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At the end of pregnancy, what stimulates contractions and labor? |
prostaglandins and oxytocin |
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Path the ovum travels |
ovaries>uterus>fallopian tubes |
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Uterus |
muscular inverted pear-shaped organ that lies b/t urinary bladder and rectum. |
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Fundus |
dome-shaped top of uterus |
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Cervix |
Narrowest portion of the uterus that opens into the vagina |
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Uterine cavity |
interior of the body of the uterus |
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cervical canal |
interior of the cervix |
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uterus layers |
outer: perimetrium middle: myometrium innermost: endometrium |
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Vagina fxns |
receptacle for the penis during sex. passage for menstrual flow. passage for childbirth. |
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episiotomy |
an incision in the perineal skin to prevent tearing during childbirth |
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mammory glands |
purpose- lactation. s/s of preg: breast enlargement, tenderness and milk excretion |
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placenta |
tissue attached to uterine wall that nourishes fetus through the umbilical cord |
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blastocyst |
oocyte that has been fertilized and multiplies into cells. It migrates to the endometrial wall and becomes implanted a wk after conception. Triggers development of placenta tissues. |
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umbilical cord |
contains 2 arteries and 1 vein. Vein carries blood to the fetus and arteries carry blood to the placenta. |
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amniotic sac |
fluid-filled bag-like membrane in which the fetus develops. Encloses the fetus in amniotic fluid (watery fluid that provides the fetus with a weightless environment in which to develop. |
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gestational period |
time it takes for the fetus to develop in utero (38 wks). calculated from the 1st day of last menstrual cycle. |
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Circulatory changes during pregnancy |
blood vol increases up to 50%, # of RBCs increase, heart size increases, CO increases 40% |
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Cardiac changes during pregnancy |
HR gradually increases 15-20 bpm, ECG changes may include ectopic beats, SVT, slight LAD, and lead III changes. Lying supine can cause compression on the inferior vena cava. If pressure is not relieved CO is decreased. |
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Respiratory changes during pregnancy |
The diaphragm is pushed up by the uterus. Maternal o2 demand increases. Decreases threshold to CO2. Causes the bronchi to dilate. regulates mucous production. O2 consumption and tidal vol increases: affects acid-base balance then returns to normal 3 wks postpartum. Inspiratory reserve vol increases. |
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Gravidity |
# of times a woman has be pregnant regardless of outcome. |
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Primigravida |
1st pregnancy |
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Multigravida |
2 or more pregnancies |
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Parity |
# of live births |
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Primipara |
1 delivery |
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Multipara |
2 or more births |
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Grand multipara |
more than 5 births |
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nullipara |
never delivered |
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False labor signs |
Contractions are irregularly spaced, intervals between contractions remain long, intensity of contractions remain the same, analgesics lessen pain, no cervical changes |
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True labor signs |
Contractions are regularly spaced, interval gradually shorten, intensity gradually increases, analgesics do not lessen pain, cervix has progressive effacement and dilation |
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Listening to fetal heartbeats placement of stethoscope |
place the bell over abd at 4:00 position about 2in from umbilicus. note: palpate woman's pulse at the same time. if they are the same you may be hearing an echo of her pulse. change position. |
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pregnancy position of transport |
lateral recumbent position. |
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No time for transport due to imminent delivery: |
Find a clean and private area. Reassess vitals and fetal HR and tones. time contractions and perform exam. notify staff at hospital. provide and update on status after delivery. If delivery does not occur 30 min or complications occur notify hospital and rapid transport. |
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Maternal seizures causes |
HTN, toxemia, preeclampsia (eclampsia) or seizure disorder. |
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Maternal seizure tx |
MAGNESIUM SULFATE!!! high flow o2. |
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Maternal seizure complications |
abruptio placenta, hemorrhage, disseminated intravascular coagulation. |
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Gestational diabetes mellitus (GDM) |
inability to process carbohydrates during pregnancy |
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Gestational diabetes mellitus tx |
diet control, or oral hypoglycemic meds PREHOSPITAL: high flow o2, iv fluids, d50w if low bgl |
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hyperemesis gravidarum: assessment and tx |
persistent n/v during preg. leads to dehydrations and malnutrition. 100% supplemental o2. start iv and NS. diphenhydramine if protocol allows. check bgl. |
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TORCH syndrome |
refers to infections that pass through the placenta to the fetus: Toxoplasmosis Rubella Cytomegalovirus Herpes |
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Toxoplasmosis |
causes form handling or eating contaminated food or from cat litter. If infected early in preg, decreased chance of passing to fetus although s/s are more severe. 50% transmits to fetus. newborns usually do not show any signs of infection but may develop learning, visual or hearing disabilities. |
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Rubella |
viral infection- born blind/deaf. cardiac/resp abnormalities |
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Cytomegalovirus |
may cause lung, blood, liver problems, swollen glands, rash, poor wt gain |
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Herpes |
s/s appear within 2 wks- tingling sores, muscle ache/pain, swollen glands in groin area |
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abortion |
expulsion of fetus before 20th week of gestation. |
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habitual abortion |
3 or more consecutive miscarriages |
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threatened abortion |
abortion attempting to take place |
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imminent abortion |
spontaneous abortion that cannot be prevented |
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incomplete abortion |
part of the products of conception remain in uterus |
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missed abortion |
fetus dies during 1st 20 wks but remains in utero |
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s/s of missed abortion |
uterus feels like a hard mass, fetal sounds not heart |
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septic abortion |
uterus becomes infected following abortion |
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3rd trimester bleeding |
any detachment of the ovum or embryo from the uterine wall. large vol of blood present. women can lose 40% of circulating blood vol before s/s present. |
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ectopic pregnancy |
ovum implants somewhere besides uterus. s/s severe abd pain; hypovolemic shock |
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abruptio placenta |
premature separation of the placenta from the uterine wall, most occur in last trimester. s/s vaginal bleeding with bright red blood. no longer feeling fetus move. s/s of shock, tender abd and rigid uterus, fetal heart sounds may be absent. |
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placenta previa |
placenta is implanted low in uterus and obscures the cervical canal. s/s painless vaginal bleeding with bright red blood. uterus is soft and nontender. |
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Normal childbirth premonitory signs of labor |
lightening: a feeling of relief of pressure in upper abd, a simultaneous increase of pelvic pressure. bloody show is expelled |
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1st stage of labor |
begins with labor pains. early contractions= 5-15 min intervals. lasts until cervix is fully dilated. contractions get more painful. towards the end of stage the amniotic sac ruptures. |
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2nd stage of labor |
head descends to birth canal. position changes= internal rotation, extension, rotation to the side, movement of the shoulders. contractions more intense and freq. cervix is fully dilated, the fetus crowns. Concludes when newborn is fully delivered. Takes 1-2 hours in a nullipara and 30 min in multipara. |
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3rd stage of labor |
lasts until placenta is expelled and uterus contracts. |
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Cutting the umbilical cord |
tie/clamp the cord with clamps 2 inches apart, then cut b/t them. Examine ends to make sure there is no bleeding. Once cut wrap newborn in a dry blanket. |
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delivery of placenta |
usually within 20 min after delivery. instruct pt to bear down. fetal side should be gray, shiny and smooth. maternal side should be dark maroon with rough texture. place in plastic bag and transport. |
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postpartum care |
obtain vitals. place sanitary napkin in front of vagina. monitor mother closely. assess the fundus. note the lochia (vaginal discharge of blood and mucus that occurs following delivery of a newborn.) cover mother with blankets. |
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magnesium sulfate |
electrolyte: use for eclampsia. Can cause respiratory distress, HoTN, circulatory collapse. Admin slow IVP. |
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Calcium Chloride |
Supplement: manages hypocalcemia. Acts as an antidote to counter effects of mag sulfate. SE: n/v, syncope, bradycardia, dysrhythmias. Admin IVP with rpt doses. may be rpt in 10 min intervals to buffer mag toxicity. |
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Terbutaline |
tocolytic and sympathetic agent. Admin to suppress preterm labor. Used to tx pregnancy-induced asthma. SE: HTN, n/CP, cardiac dysrhythmias. Dose: 0.25mg SC. Rpt after 30 min. Admin a drip beginning with a starting infusion of 30mL/hr. |
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Valium |
sedative/anti-convulsant. indicated in eclampsia when seizures do not respond to mag sulfate. may also tx anxiety in HTN crisis. SE: n/v, respiratory depression, HoTN. Dose: 5-10 mg SIVP for seizure management 2-5 mg for anxiety. |
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Diphenhydramine |
tx hyperemesis gravidarum. SE: drowsiness, HA, tachycardia, HoTN. Dose: for emesis is 25-50 mg IV |
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Oxytocin |
causes uterine contractions. induces labor; control postpartum hemorrhage. should be used for postpartum bleeding ONLY after all products have been expelled from the uterus. SE: n/v, tachycardia, seizures, cardiac dysrhythmias. Dose: 3-10 units IM or 10-20 units in 500 or 1,000 mL NS. |
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Premature rupture of membranes assessment and management |
amniotic sac ruptures more than an hour before labor. The sac may self seal and heal itself. Labor begins within 48 hours. provide emotional support. |
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Preterm labor |
labor that begins after the 20th wk but before the 37th wk of gestation |
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fetal distress causes and management |
caused by hypoxia, nuchal cord, trauma, abruptio placenta, fetal development disabilities, prolapsed cord. Provide support and rapid transport. |
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uterine rupture assessment and management |
occurs during labor. s/s weakness, dizziness and thirst. Initial strong contractions that have lessoned. s/s of shock. tx for shock and rapid transport |
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precipitous labor and birth: high risk preg considerations |
entire labor time and birth usually occurs < 3hrs. Contractions are usually more intense. Assess woman post delivery for tears and bleeding. Newborns don't usually have adverse effects but may have facial bruising or a more than usual misshapened head. |
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Post-term pregnancy: high risk preg considerations |
The fetus has not been born after 42 wks. Increased risk to fetus: fetus may become malnourished, increase risk of meconium aspiration. Increased risk of longer, complicated delivery due to larger fetus. Should be C-section |
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Fetal Macrosomia : high risk preg considerations |
fetus weighs more than 4,500g (approx 9 lbs). risk: gestational diabetes, mother excessive wt gain, male fetus, post-term preg, # of preg, fetal genetic conditions. Tx: support and rapid transport. If field delivery: encourage breastfeeding. Check newborn BGL. |
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Multiple gestation: high risk preg considerations |
prepare for more than 1 resuscitation. Consider the possibility of multiples if: first newborn is small. Abd is still fairly large after birth. The second newborn is usually born within 45 min. Check if there are one or 2 cords coming out of the placenta when it delivers. record the time of birth. |
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Intrauterine fetal death: high risk preg considerations |
fetus died in the uterus before labor. Labor can occur up to 2 wks of more after death. Do not attempt CPR on an obvious dead fetus. You should attempt CPR on normal-appearing newborns. |
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Amniotic fluid embolism S/S & Tx |
amniotic fluid enters woman's pulmonary and circulatory system through the placenta. Results in an allergic rxn response. S/S: resp distress, HoTN, cyanosis, possible seizures. Tx: support resp and circulatory system. Rapid transport. |
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Hydramnios |
AKA: polyhydramnios. Too much amniotic fluid. Potential causes: carrying multiples, fetal anemia, diabetes, fetal conditions that cause the fetus to stop swallowing the fluid. Pt's at risk: prolapsed cord, abruptio placenta and postpartum hemorrhage. |
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Cephalopelvic disproportion |
head of the fetus is larger than the pelvis. C-section is usually required. May cause massive hemorrhage. |
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Scenario: If the newborn's head cannot be externally rotated or the delivery cannot be completed: |
support the woman and fetus. rapid transport! |
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Breech presentation: |
buttocks delivers first |
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Breech delivery steps |
Position the woman with buttocks at edge of bed or stretcher, legs flexed. Allow newborn's buttocks and trunk to deliver spontaneously. Once the legs are clear, support the body. Lower the newborn slightly. Once the hairline is spotted, grasp the newborn's ankles and lift upward. If the head does not deliver within 3 min, it may suffocate. Do not try to forcefully pull the newborn out. |
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Transverse delivery presentation |
fetus lies crosswise in the uterus, one hand may protrude through the vagina. DO NOT ATTEMPT TO DELIVER. |
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Shoulder dystocia |
shoulder cannot get passed the woman's symphysis pubis. |
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McRobert's manuver |
Hyperflex woman's leg tightly to the abd. may need to apply pressure to the lower abd and gently pull on the head. |
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Prolapsed umbilical cord assessment and management |
umbilical comes out before the newborn. Shuts off the oxygenated blood supply from the placenta. Keep woman supine with hips elevated. Admin 100% o2. Have woman pant with each contraction. Gently push the presenting part back up the vagina until it no longer presses on the cord. Maintain pressure on the presenting part while another paramedic covers the exposed cord with dressings moistened in NS. Maintain position throughout urgent transport. |
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Uterine inversion |
potentially fatal complication of childbirth in which the placenta fails to detach properly and results in the uterus turning inside out. severity graded by how much the uterus has reversed itself. Very painful and may rapidly cause shock. |
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Uterine inversion management |
Keep pt recumbent. Admin 100% o2. start 2 iv lines with NS and titrate to vitals signs. Do not attempt to remove placenta if still attached. monitor vitals. Consider oxytocin to control hemorrhage. make 1 attempt to replace the uterus. cover all protruding tissues with moist sterile dressings and rapid transport. |
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Postpartum hemorrhage tx |
Tx: continue uterine massage. Encourage to breastfeed. If allowed by protocol, +10 units of oxytocin to the iv bag (1,000mL) and infuse at a rate of 20-30mL/min. Notify receiving facility. Rapid transport. Add a large bore IV en route and infuse NS wide open. Massage external bleeding from perineal tears with firm pressure. |
