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142 Cards in this Set
- Front
- Back
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GU system changes
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-increased risk for UTI d/t dilated ureters
-increased GFR until delivery -increased clearance of urea and creatinine from increased renal function -glycosuria from increased GF without in increase in tubular reabsorption -decreased bladder tone -increased sodium retention increased vaginal secretions with a pH 3.5 to 6.0 |
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Metabolic changes
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-increased water retention
-increased lipid and cholesterol -increased need for iron -increased protein retention -weight gain of 25-35 lbs |
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Respiratory changes
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-compression of lungs=SOB
-increased tidal volume -increased chest circumference -abdominal breathing replaces thoracic as it progresses -2 bpm increase in respirations -lower threshold for CO2 d/t progesterone |
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Endocrine changes
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-increased BMI up to 25%
-increased iodine metabolism -need more Ca and VitD=slight hyperparathyroidism -slightly enlarged pituitary -increased cortisol to regulate protein and carb metabolism -decreased insulin production in early pregnancy |
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Hormonal changes
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-gum swelling d/t estrogen
-displacement of stomach/etc -delayed motility and gastric and gallbladder emptying d/t progesterone causing heartburn -N+V for FIRST TRI ONLY -hemorrhoids -constipation d/t progesterone -displacement of appendix from McBurney piont -bile saturation with cholesterol may cause gallstones |
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Cardiovascular changes
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-increased heart size/cardiac output
-increased blood volume -heart displaced up and left -blood volume peaks 3rd trimester increasing 30-50% -pulse increased 15-20 beats -pulmonic and apical systolic murmurs from decreased viscosity and increased flow -increased femoral venous pressure d/t pressure of uterus on vena cava -decreased CSF space d/t enlargement of vessels around dura mater -increased fibrinohen levels up to 50% d/t hormones -increased clotting factors VII, IX, and X=hypercoaguable state -WBC 10-11,000 peaks at 25,000 during labor |
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Changes in nutritional needs during pregnancy
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-300 more calories
-30g more of protein -400-800mg of Flolic Acid/ day -more iron, fiber, fluid, vits |
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Nagele's rule
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to determine EDD
LMP + 7 days -3 months + 1 year |
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Quickening
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light fluttering of fetal movement
-between 16 and 20 weeks |
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When can you hear FHR?
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-ultrasound = 12 weeks
-fetoscope= 16 to 20 weeks |
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Biparietal diameter
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-widest transverse diameter of fetal head
-can be measured after 12 to 12 weeks gestation to estimate delivery date |
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McDonald's rule
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-to find out how many weeks P
-measure from symphysis pubis Fundal ht in cm X 8/7= weeks P |
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Weight gain during pregnancy
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25-35 lbs if normal BMI
1lb a week after 1st trimester or 3/12/12 |
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Facial melisma
linea nigra chlosma palmar erythema |
"mask of pregnancy"
--------------------------------------- line on abdomen -------------------------------------- pigmentation of areola -------------------------------------- well delineated |
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subjective (presumptive) signs of pregnancy
objective (probable) signs positive signs |
Amenorrhea or spotting nausea/fatigue/ urinary frequency
breast enlargement increased skin pigmentation -------------------------------------- -Hegar's sign -Goodell's sign -Chadwick's sign -Ballottement -Pregnancy tests -Braxton Hicks contractions -abdominal enlargement -------------------------------------- -ultrasound-as early as 6 weeks -FHR-by 17 to 20 weeks -fetal movement-after 16 weeks |
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-Hegar's sign
-Goodell's sign -Chadwick's sign -Ballottement |
softening of lower uterine segment (isthnus) 6-8 weeks
--------------------------------------- softening of cervix --------------------------------------- blue color of cervix -------------------------------------- rebound of fetus when cervix pushed |
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Fundal Height from umbilicus
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can assess gestational age (16-32)
reaches up to ziphoid process above umbilicus after birth at umbilicus 4 hrs after birth |
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Common discomforts of pregnancy
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1st= urinary frequency, incontinence, fatigue, N+V(B6), breast tenderness, constipation, mucus membrane inflammation, cravings, leokorrhea
--------------------------------------- 2nd= sense of well-being, backache, leg cramps, varicoseities, gas, bloating --------------------------------------- 3rd=urinary frequency, incontinence, fatigue, constipation, leukorrhea, SOB, heartburn, indigestion, edema, Braxton Hicks Contractions |
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Umbilical Cord
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-20-22" long
-2 arteries and 1 vein -arteries carry deoxygenatedblood to placenta -vein carries oxygenatedblood to fetus -Wharton's jelly prevents kinking |
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Amniotic Fluid
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-cushion and temperature
-800 to 1200 mL -specific gravity 1.007 to 1.025 -pH 7.0 to 7.25 |
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foramen ovale
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between atria
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ductus arteriosus
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pulmonary artery to aorta =shunts blood away from lungs
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ductus venosus
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oxygenated blood from umbilical vein to inferior vena cava bypassing fetal liver
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Amniocentesis
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-after 14 weeks
-gestational age by LS ratio -lung maturity/surfactant LS ratio -creatinine levels -genetic disorders -metabolic disorders -blood disorders ABO/Rh MONITOR -FHR -maternal or fetal hemorrhage -infection -preterm labor -give Rhogam to Rh- mothers |
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LS ratio
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2:1= lung maturity via amnio
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Chorionic Villus Sampling (CVS)
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removal of chorionic villi from fetal placenta for chromosomal, enzyme, and DNA testing. done at 8-14 weeks
CAN NOT -neural tube defects CAN- gender/sex-linked condition - obtain written consent - drink fluid before test - advise not to void before test - lithotomy position for test - baseline maternal VS - baseline fetal heart rate |
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Non-Stress Test
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FHR in response to movement
between 32 and 34 weeks -15-30 baseline -meal stimulates -empty bladder -1 monitor each (uterus/FHR) -"event marker" pushed by pt Reactive-2 FHR 15bpm above baseline for 15 seconds/20 minutes nonreactive= above not met within 40 minutes |
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Oxytocin challenge test
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-given after non-stress test results
-IV tocin q15-20 minutes until 3 good contractions within 10 minutes -for pt at risk for uteroplacental insufficiency or fetal compromise from diabetes, heart dz, hypertension, renal dz, or hx of stillbirth -contraindicated in previuos c-section, 3rd tri bleeding, or risk for preterm labor |
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vibroacoustic stimulation
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-artificial larynx
-fetal head 1 to 5 seconds -try to pick up the FHR |
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biophysical profile
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4 to 6 things it tests for.....
-breathing movements -body movements -muscle tone -amniotic fluid volume -heart rate reactivity -placental grade -uses ultrasound -can detect CNS DEPRESSION |
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Nuchal Translucency Screening
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subQ collection of fluid behind fetal neck
HIGH=trisonomy 13/18/21 |
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Percutaneous umbilical blood sampling
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removal of fetal blood from cord with in utero- to DX hemophilias, hemoglobinopathies, congenital rubella, toxoplasmosis, and genetic disorders + BLOOD DZ
-2nd or 3rd trimester -1-2% chance of fetal loss monitor FHR up to 2 hrs after - obtain written consent - cleanse abdomen w/sterile - obtain baseline maternal VS - obtain baseline FHR |
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Fetal movement count
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-normal 280 a day
-record for 30 minutes x3/day -report fewer than 10/2 hours |
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HIV
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-progression to AIDS faster in P
-Kapos's sarcoma -anorexia,fatigue,wt loss -CD4T cells less than 200=AIDS DX= Western Blot/ELISA -NST weekly after 32 weeks -newborns tested again after 15 months -tested at birth and again at 1-2 months -Zidovudine (Retrovir) first 6 weeks -keep stump very clean |
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Gestational Diabetes
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RISKS
-fetal death -hypertension -sacral agenesis -incomplete spine -maternal diabetes later in life DX= 1 hour glucose +140mg/dL -screen ALL at 28 weeks TX=insulin or DiaBeta after 1st Tri -PO meds contraindicated |
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Alpha-Fetoprotein (AFP)
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AFP - fetal liver in amniotic fluid and maternal serum
HIGH = neural tube defects, anencephaly, omphalocele, and multiples LOW= Down's syndrome/trisonmy 18 |
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Shultz mechanism
Duncan mechanism |
shiny shultz"- fetal side
--------------------------------------- "dirty duncan'- maternal side |
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Ectopic Pregnancy
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-MEDICAL ER
-most commonly in fallopian tube SIGNS -amenorrhea or spotting -LOW HCG and Progesterone -bleeding -SHOULDER PAIN -mass in Douglas' cul-de-sac -Cullen's sign-periumbilical bluish color -severe pain,orthostatic hypotension, tachycardia, and dizziness may indicate-RUPTURE -meds until no HCG levels -AVOID pregnancy for 3x cycles |
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Heart Disease
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-heart works harder
-may see undiagnosed problems -risk peaks 28 to 32 weeks -tachycardia -dyspnea -fatigue -DIASTOLIC murmur at APEX -CRACKLES at BASE |
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Hydatidiform Mole
-Molar Pregnancy |
AKA gestational trophoblastic dz
egnancy in which the chronic villi become fluid filled clusters of prolifferative tissue resulting in the loss of pregnancy and possibly choriocharsinoma - brownish vaginal bleeding - nausea and vomiting - extremely high hCG levels - hyperemesis gravidarum - PIH prior to 24 weeks - NO FHR or fetal movement - amenorrhea - hyropic vesicles expelled V - rapid uterine enlargement -follow up RISK of NEOPLASM |
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Hyperemesis Gravidarum
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ecssessive vommitting during 1st tremester (vommitting during any other trimester is not normal)of pregnacy thought to be caused by high HcG levels
-AGB=ALKALOSIS -high Hb and HCT -hypokalemia -NPO when first admitted w/IV -monitor fundal height -give salt |
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Preeclampsia
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-hypertension and proteinuria
MILD -140/90 BP+ - 300mg proteinuria/24 hours SEVERE -160/100 BP+ -5gm of proteinuria in 24 hours -less than 500mL urine/24 hours -vision problems -RUQ tenderness -fetal growth restriction ECLAMPSIA -new onset grand mal seizures -labor induced ASAP with mild -labor induced NOW if severe -bed rest LEFT LATERAL position -high protein moderate salt -SEIZURE PRECAUTIONS -corticosteriods for FETAL LUNGS -MAG SULFATE -assess for HELLP SYNDROME -monitor BP q1-4 hrs if severe -risk for PLACENTAL PREVIA so do type and cross match |
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HELLP syndrome
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Hemolysis
Elevated Liver enzyme levels Low Platelet count |
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Magnesium Sulfate
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-CNS depressant
-relaxes smooth muscle WATCH FOR -decreased respirations/BP/DTRs -drooling, dysphagia -weakness, flushing -decreased URINARY output (100mL/4hrs) -should be 5-8mg/dl MAX -stop drug if issues occur anecdote=CALCIUM GLUCONATE |
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Placenta Previa
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-low implantation
-painless bright red bleeding esp after 3rd trimester -hospitalized if less than 34 weeks -no vaginal/rectal exams unless ready to do a c-section -restrict maternal activity Risks: -over 35 years old -multiples -trauma -cocaine use/smoking -hx of previous -asian |
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Abruptio Placenta
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premature seperation after 20wks
can cause death / DIC ER for mother and baby - intense localized uterine pain - increase in abdominal size - rigid abdomen -painful/ dark red "port wine" Risks: -smoking/cocaine use -age over 35 year old -poor nutrition -multiples/XS pressure/ fluid -avoid vaginal exams -LEFT LATERAL RECUMBENT -give O2 |
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Placenta Accreta
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chorionic villi remain imbedded in the myometrium and stop placental seperation
- boggy uterus - acute profuse V bleeding - placenta doesn't separate |
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attitude
lie presentation position station engagement |
flexion
--------------------------------------- spine to spine (axis) -------------------------------------- presenting part vertex (military, brow, face) breech (frank, complete, footling) --------------------------------------- part to maternal pelvis 3 letters of position L/R- side of pelvis O/M/S/A- part A/P- front or back -------------------------------------- part to level of ischial spines -5 to +4 --------------------------------------- station =0 |
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Preliminary signs of labor
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Lightening/fetal descent=2-3 wks
Braxton Hicks Cervical dilation, softening,effacement-days before nesting-burst of energy bloody show-mucus plug expelled increase in vaginal secretions rupture of membranes |
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Cervical effacement
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normally 2cm = 0%
0cm= 100% |
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TRUE LABOR
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-regular
-BACK discomfort that spreads -progressive changes -get CLOSER TOGETHER -INCREASE in intensity -may see bloody show |
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FALSE LABOR
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-irregular
-discomfort in ABDOMEN -no cervical changes -may GET BETTER with walking -do NOT progress -no bloody show |
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Leopold's Maneuvers
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-palpate fundus
-abdomen to locate back -pubic symphysis -level of decent -head flexion |
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tetanic contractions
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sustained prolonged contractions with little rest between
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Contractions
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frequency- start of one to start of the next. should use a 10-mimute or more strip
duration-from start to stop intensity- subjective/internal strong=forehead moderate=chin mild= nose increment - systole acme-peak (50-80mmHg) decresendo-diastole relaxation- 5-18mmHg |
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Stage 1 of labor
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Latent Phase- 0-3cm
exited/sociable Active Phase-4-7 cm effacement 100% contractions 5-8 minutes apart -last 45 to 60 seconds fatigued/helpless/anxious Transition Phase-8-10cm contractions 1-2 minutes apart -lasting 60-90 seconds and strong |
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Stage 2 of labor
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pushing stage
shortest about 40 minutes/painful signs of coming birth: bulging perineum crowning dilated anus short pushes 6-7 seconds |
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Cardinal movements of labor
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-engagement
-descent -flexion -internal rotation -extension -external rotation |
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Stage 3 of labor
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from baby to placenta
5-30 minutes signs of placental separation: -globular/firm uterus -lengthening of cord -gush of blood |
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Stage 4 of labor
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expulsion of placenta to 4 hours mother hemodynamically recovers
pulse 60-70bpm fever only above 100.4 pain 3 or less low adrenaline= cold/shiver |
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Effleurage
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-light abdominal stroking with fingertips in circular motion mild to moderate pain
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Opioids for labor pain may cause respiratory depression if given within ........
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2 hours of labor
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Lumbar epidural
spinal local infiltration pudendal block paracervical block general |
-at least 4cm to ???
-hypotension if not enough fluids ------------------------------------- -fast onset -used for ER c-sections ----------------------------------- only relief for delivery ------------------------------------ only relief for delivery ------------------------------------- -increases risk of forceps delivery ------------------------------------ -only if needed |
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Fetal blood sampling
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-monitors blood pH
-membranes ruptured -2-3+ cm dilated -presenting part -2 or less(station) -pH of 7.25+ is normal -pH 7.2-7.24 is preacidotic -pH less than 7.2 is sever acidosis |
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Amniotic Fluid Embolism
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-d/t ROM, abruptio placenta,etc
-CHEST PAIN -cyanosis -pink, FROTHY sputum -acute SOB -tachypnea -anxiety -fetal distress -AGS=hypoxemia TX -intubation and ventilation -CPR -ER C-section |
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DIC
Disseminated intravascular coagulation |
-increase in prothrombin, platelets, and other coagulation factors =widespread thrombus formation and decreased clotting factors =hemorrhage
causes -abruptio placentae -amniotic fluid embolism -retained fetus after death -ABNORMAL BLEEDING -oliguria -shock DX -decreased fibrinogen -positive D-DIMER TEST -prolonged PT and PTT -decreased platelets TX -may need blood products |
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Dystocia
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-hard labor
-related to the 3 Powers -arrested descent -hypotonic contractions -fetal wt greater than 4500g TX -Pitocin may help |
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Fetal Distress
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-meconium
-bradycardia or FHR above 180 -loss of fetal movement -no progress TX -O2 at 6-8 L/min by face mask -Left Lateral Position |
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Postpartum hemorrhage
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500+mL of blood loss w/n 24 hrs
-can occur up to 6 weeks after -Methergine/Pitocin |
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Inverted Uterus
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-can occur during placental delivery
-large sudden gush of blood -severe pain -low Hb and HCT TX=Tocolytic agent:terbutaline |
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Intrauterine Fetal Death
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death of fetus after 20 weeks
- decreased estriol levels - lack of movement - lack of FHR Spalding's sign (overriding of the fetal cranial bones) |
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Lacerations
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trauma
trickle bright red w/firm fundus --------------------------------------- 1st- skin/superficial 2nd- muscle 3rd- anal sphincter 4th- wall of rectum |
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Subinvolution
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failure to return to size
retained fragments/ full bladder boggy fundus too high and lochia doesn't change color |
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Postpartum Infection
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100.4+ after the 1st 24 hours after birth occuring on at least 2 of the 10 days
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ER BIRTH
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PROLAPSED CORD
-visible -variable decelerations/bradycardia TX modified Sims, Trendelenburg, knee-chest UTERINE RUPTURE -"something ripped" AMNIOTIC FLUID EMBOLISM O2 8-10L/min |
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ABO incompatibility
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mother has type O- fetus has anything else. not as severe because most species of anti-A and anti-B antibodies are immonuglobin M (IgM) and cannot cross placenta. these antibodies are also produced/acquired from foods/etc so the incompatibility cannot be eliminated
often see enlargement of liver/spleen in newborn |
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Rh sensitization
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an antigen/anti-body response that can occur if an Rh - woman has an Rh + fetus
- fetal anemia - + fetal indirect Coombs' test - positive fetal antibody titers - hemolysis of fetal red cells - hemolytic DZ of newborn --------------------------------------- RhoGAM (Rh immunoglobulin) given at 28 weeks then again within 72 hours of birth- IM in deltoid |
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G-TPAL
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Gravidity= # of pregnancies
Term= between 38-42 weeks Preterm- before 38 weeks Aborion Living children |
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APGAR
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1 minute - initial adaptation
5 minutes -CNS status at 10 if 5 minute score <7>< A= apperance/ color P= pulse(100 />100) G= grimace (frown/cough,sneeze) A=activity(some/tight flexion) R=respiratory depression= losses- color/resp/tone/reflex/heart rate -------------------------------------- resuscitation needed if less than 7 |
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Kleihaur-Betke test
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-detects fetal RBCs in maternal circulation
-degree of fetal-maternal hemorrhage -helps calculate appropriate dose of RhoGam |
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Shoulder Dystocia
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stuck baby
McRobert's maneuver- thighs flexed and abducted Suprapubic pressure- pushing down |
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FHR decelerations during labor
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early, late variable
parasympathetic -------------------------------------- Early= mirrors contraction due to head (vagus) compression considered benign Late= starts after peak and continues after contraction stops. suggest fetal hypoxia =turn on side / 8-10L O2 Variable= U, V, W-shaped can occur at any time due to cord compression |
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FHR accelerations during contractions
transitory accelerations w/contraction |
normal= intact sympathetic nervous system response
-------------------------------------- up to 25bpm= normal more than 30bpm= hypoxia -------------------------------------- minimal= side/ 8-10L O2 marked= side/8-10L/ stop pit |
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baseline FHR
tachycardia bradycardia |
110-160 bmp
--------------------------------------- above 160bmp or more than 30bmp above previous baseline= hypoxia, maternal fever, fetal anemia, etc --------------------------------------- less than 110bmp or decrease of more than 30bmp below previous baseline that lasts more than 10 minutes= hypoxia, hypotension, drugs, etc |
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Parity
Nullipara Primipara Multipara |
# which fetuses have reached age of viability
-------------------------------------- fetus has not been viable --------------------------------------- pregnant once with a viable fetus(es) --------------------------------------- twice or more w/viable |
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Gravidity
Gravida Nulligravida Primigravida Multigravida |
pregnancy
-------------------------------------- a pregnant women --------------------------------------- 1st time --------------------------------------- never been pregnant --------------------------------------- 2 or more |
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Reva Rubin
maternal role framework |
taking-in phase= mother is dependent (tired/sore/etc) and is reliving the birth experiance, may ID features on naewborn
taking-hold phase= 2/3 day to a few weeks- regains control of body functions, conserned about present, health of herself and child, and wants to provide care letting-go phase= reestablishes relationships with other people, more confident, lets go of fantasy and accepts reality |
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what to assess during postpartum period
how often to perform postpartum assessment |
vital signs
temp- above 100.4 could be infection pulse-50-70bpm respirations- 16-20 blood pressure-close to baseline pain level -0-2 BUBBLE-EE 1st hour= x15 min 2nd hour= x30 min 1st 24 hours= x4 hours after 24 hours= x8 hours --------------------------------------- bradycardia 50-70 bmp due to reduced cardiac output for about 2 weeks |
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lochia
stages w/times how to describe amount of lochia discharge? what do you do first if bleeding during postpartum? |
vaginal discharge after birth
--------------------------------------- rubra- red- 3 to 4 days- should NOT return once gone serosa- pinkish/brown- 3 to 10 alba- white- 10 to 14 days up to 6 weeks --------------------------------------- all might smell fleshy should not saturate a pad in under an hour -------------------------------------- massage fundus/ empty bladder |
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Feeding infant normal food
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birth weight x2 / at least 13 lbs
sucking reflex gone= 4-6 months cereal -then fruit -then veggies - meats -eggs last no honey until at least 1 year no cows milk for 1 year (renal) citrus, strawberries, wheat, cow's milk, egg whites, peanut butter= allergies 1 food at a time no faster than 1 every 3-5 days may take 20x to accept food |
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Terbutaline
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-stops preterm contractions
SE -TACHYCARDIA take pulse first -LOW POTASSIUM -nervousness, tremors,chest pain -IV -maternal pulse no more than 140 -FHR no more than 180 -monitor vs q15 minutes ANTIDOTE= Propranolol (Inderal) |
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Mastitis
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-S.aureus
-Chills -Fever of 101.1F + -redness, edema -breastfeed that side first |
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Immunoglobulins at birth ?
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IgG crosses placenta
-short life span 25 days -produces own by 3 months IgM -undetectable at birth -does not cross placenta -makes it by 20 weeks -high levels in neonate=infection IgA -limits bacterial growth in GI -found in milk |
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Cephalohematoma
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blood in periosteum-does not cross suture -no overlying skin discoloration, firmer-lasts a few weeks to months
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caput succedaneum
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edema of scalp- crosses suture-lasts about 3 days
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Hemorragic disease of the newborn
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from lack of Vit K
- decreased prothrombin time - prolonged clotting time - bleeding from the nose, umbilical cord, circumcision, gastointestinal tract, or scalp - generalized ecchymoses - internal hemorrhage |
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anterior fontanel
posterior fontanel |
"soft spot" 12-18 months
---------------------------------------- 8-16 weeks |
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neonate/infant eyes
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-may be blue/gray at birth
-permanent color by 6 months -tearless crying until 2 months -transient strabismus -doll's eyes reflex for 10 days -may see hemorrhage from birth |
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Epstein's pearls
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-false teeth
-may be seen at birth |
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Fetal Alcohol Syndrome
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-no amount is SAFE
-CNS dysfunction -decreased IQ -microcephaly -maxillary hypoplasia -short palpebral fissures -thin upper lip |
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episadias
hypospadias |
dorsal side
------------------------------------ ventral side |
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Jaundice
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above 6mg/dl within 1st 24 hrs
-remains elevated 7 days in fullterm -remains elevated 10 days in premie -may cause Kernicterus -DX-conjugated above 2mg/dl -phototherapy= cover eyes/green stools |
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Immunizations during pregnancy
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NO LIVE VACCNES
-MMR -Varicella KILLED are OKAY -tetanus -diptheria -rabies -Hep B |
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Coombs Test
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-checks for sensitization
-Rhogam can be given if - -too late if it is + |
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1st period of reactivity
period of increased responsiveness 2nd period of reativity |
30 minutes
awake/alert/ elevated heart and breathing/ sucking reflexes/etc good time to breastfeed 30-120 minutes sleep/ decreased response 2-8 hours meconium |
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acrocyanosis
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cyanosis of hands/toes/feet- with blotchy or mottled skin - normal- occurs in response to cold
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vernix caseosa
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white substance made by fetal oil glands protects skin and does not have to be removed- it will absorb- found in creases and hair
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stork bites
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AKA salmon patches
superficial vascular areas on nape of neck and eyelids and between eyes and upper lip- concentration of immature blood vessels more visible when crying- will dissapear within a year |
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milia
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unopened sebaceous glands- often on nose but also chin/forehead will dissapear in 2-4 weeks
epstein's pearls- in mouth or gums |
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mongolian spots
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blue/purple spots on lower back in dark skinned - disapear within 4 years
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erythema toxicum
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AKA newborn rash
face/chest/back lack of pattern eosinophils react to environment disapear in a few days |
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harlequin sign
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dilation of vessels on one side
'clown suit' pale on nondependent side immature autoregulation of flow common in low weight less than 20 min= no tx |
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nevus flammeus
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AKA port wine stain
capillary angioma below dermis mature dilated vessels permanent may be associate w/structural malformations, bony or muscular overgrowth, certain cancers |
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nevus vasculosus
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AKA strawberry mark or strawberry hemangioma
raised, rough, dark red common in preterms/near head disapears by 3 years |
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molding
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elongated shape of head because of passage - normal within a week
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orlani maneuver
barlow maneuver |
uppward rolling
downward rolling listen for clicks femoral head slipping in and out of acetabulum |
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what is the normal posture of a newborn?
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hips abducted and partialy flexed
arms abducted and flexed @elbow fists cleched/ thumb inside neck should hold held briefly |
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what is in breast milk?
LATCH scoring tool? nutritional guidelines for lactating women who should NOT breast feed |
20cal/oz
whey/ lactose lipase and amylase ===================== does the mother need assistance? L=latch A= audible swallowing T= type of nipple C= comfort of nipple H= hold *nipple pain/etc- sign of improper technique ==================== +500 cal 1st year ===================== HIV antithyroid drugs antineoplastic drugs alcohol and street drugs active TB |
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normal breathing pattern of newborn?
what might you hear on auscultation? periodic breathing what are the signs of respiratory distress in newborn? |
shallow, irregular, abdominal
30-60 bpm ___________________________ may hear fine crackles on inspiration -------------------------------------- apnea of 5-10 seconds without changes in heart rate or color monitor -------------------------------------- cyonisis, tachypnea, expiratory grunting, sternal retractions, nasal flaring |
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what tests/ evaluations are used to determine gestational age after birth?
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Dubowitz/ Ballard or New Ballord
physical maturity- w/n 2 hours neuromuscular maturity- 24 hrs |
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how are newborns classified by gestational age?
how are low birth weight newborns classified by weight? |
APA
normal height, weight, head circumference, and BMI = lowest risk SGA less than 5.8 lbs / below 10th % or less than 2 standard deviations LGA more than 8.13lbs/ above 90th % -------------------------------------- low= less than 5.5 lbs very low= less than 3.5 lbs extremely low= less than 2.3 lbs |
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large gestational age infants
what might you see in a physical assessmnet? |
large body
plump face poor motor skills more difficult arosal (quiet/alert) |
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preterm
late preterm term posterm |
before 37 weeks
between 34 and 36 weeks 6 days from 38- 42 weeks after 42 weeks |
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posterm newborn
why is this a bad thing? what would you see on a physical assessment? |
AKA postmature, prolonged pregnancy, and postdates pregnancy
after 42 weeks -------------------------------------- placenta starts to degrade this causes reduces oxygen and nutrients the newborn may begin to waste ------------------------------------- dry, cracked, wrinkled skin long, thin arms and legs creases cover sole of feet wide-eyed and alert look lots of hair on head thin umbilical cord limited vernix/ lanugo meconium stained skin/ nails long nails |
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what would you see in a physical assessment of preterm newborn?
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scrawny
head very larger to chest size poor muscle tone undescended testes lots of lanugo (esp face/back) soft, pliable pinna fused eyelids soft, spongy skull bones matted, wolly scalp hair absent or few creases (palm/sole) minimal scrotal rugea prominent labia/ clitoris thin, transparent skin (see veins) breast, nipples not delineated lots of vernix caseosa ------------------------------------- murmur= patent passageways |
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infants of a diabetic mother
characteristic features common problems |
full cheeks/ rosy skin, 'no neck', buffalo hump, big shoulders, organomegaly = distended UPPER abdomen, lots of fat
hoarse cry --------------------------------------- mothers w/ vascular complications =LGA with lower risk or RDS (those w/out= SGA and higher risk) --------------------------------------- macrosomia respiratory distress syndrome hypoglycemia hypocalcemia and hypomagnesemia polycythemia hyperbilirubinemia congenital anomalies (heart) |
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fractures- newborn injury
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most often breech or shoulder dystocia in macrosomia
mid-clavicular fracture= #1 does not move arm on that side absent Moro on that side= heal fast (pin sleeve to shirt) shoulder dystocia #2 femoral or humeral long bone fractures (often mid-shaft)-loss of movement, swelling, pain= splinting, 2-4 weeks X-ray confirms |
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brachial plexus injury- newborn
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most often breech or shoulder dystocia in macrosomia
stretching, hemorrhage, or tearing of nerve-may be because of fracture Erb's palsy- upper brachial plexus injury (more common) arm hangs limp/ adducted/ extended/ internally rotated/pronated wrist w/ absent Moro, bicep, and radial reflex on side but grasp often intact= immobilize arm across chest then ROM Klumpke's palsy- lower brachial plexus (less common)- weakness in hand and wrist w/absent grasp reflex= hand in neutral position w/ROM |
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cranial nerve trauma- newborn
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facial nerve palsy most common- often due to forceps but also position in utero- eye open on affected side, limited movement, smoother= recovery 1 week to several months no TX
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WITHDRAWAL assessment
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W=wakefulness- sleeping less than 1-3 hours after feeding
I=Irritability T=temp variation, tachycardia, tremor H=hyperactivity, high-pitched/persistent cry, hyperreflexia, hypertonus D=diarrhea, diaphoresis, disorganized suck R=respiratory distress, rub marks, rhinorrhea A=apneic attacks, autonomic dysfunction W= weight loss/ failure to gain A= alkalosis-respiratory L= lacrimation |
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Vaginal culture for Group B strep
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Done on ALL pregnanct woman to test for group B beta-hemolyitic streptococci. Can cause respiratory distress/ death in infant who is exposed during birth. (strep is normal flora) Antibiotics given to mothers.
Tested after week?????? - culture of vaginal/ rectal cells - avoid tub bathing before test - menstrual flow -alters results - lithotomy position for test - if infection =avoid sex |
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Couvade Syndrome
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symptoms related to pregnancy occur in the woman's mate
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Transient Tachypnea of the newborn
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12-72 hours due to fluid in lungs
- cyanosis - grunting respirations - nasal flaring - tachypnea - spontaneous respirations chest x-rays show overexpansion of the lungs |
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Viability
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ability to live outside of the uterus- 20 weeks or more or more than 500g fetus
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Vitamin K
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fat-soluble vit promots blood clotting by increasing synthesis of prothrombin by liver
not produced by sterile gut-takes about a week 0.5-1mg IM in vastus lateralis 25g 5/8inch 90 degree w/n 1 hour |
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Oxytocin (Pitocin)
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may cause hyperstimulation
IV piggyback 10 Units/L want contractions x2-3 minutes lasting 40-60 seconds measure I+O/ ratio 1:2 may cause headache, N+V |
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eye prophylaxis in newborn
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prevents opthalmia neonatorum-purulent conjunctivitis that can cause blindness because of contact w/bacteria
0.5-1% erythromycin or tetracycline oinment can cause chemical conjunctivitis for 1-2 days |
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Rubella vaccine
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no it is teratogenic so pregnancy should be avoided for 3 months after
if titer is less than 1.10(08) then it should be given after delivery may have rash/ joint issues/ mild fever 5-21 days after but "german measels" could cause mental retardation in utero |
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Hep B vaccine in newborn
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if mother is HbsAg + = vaccine and immunoglobulin within 12 hours
if mother is - = then the vaccine by 2 months |
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Hygiene of uncircumcised male
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do not retract in newborn
-wash w/soap and water 1 daily -retract and clean glans w/soap and water 1x a week when older -dry area b4 replacing foreskin -teach to clean 1x daily in pre-school age |
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newborn resuscitation -steps
ABCDs of newborn resuscitation |
1) stabilization -dry/ bulb/ warm
2)Ventilation 3)chest compressions 4)epiniphrine/ volume expansion -------------------------------------- A- airway B-breathing =40-60 breath/min C-circulation=after 30 seconds 3 compressions:1 breath/ 2 sec D-drugs= epinephrine |
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Premature infant adjusted age
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age - (minus) # of weeks premature = use this when assessing 'normal' growth and development
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