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93 Cards in this Set

  • Front
  • Back
Normal newborn HR
120-160bpm
Normal newborn RR
30-60 respirations/min
Normal newborn temp
36.5-37.5 (97.7-99.4F)
Normal newborn Stomach capacity
30-90 ml
Normal newborn meconium passes within
12-48 hrs
LBW newborn
< 2500 grams at birth
VLBW newborn
<1500 grams at birth
Cyanosis
a blue coloration of the skin and mucous membranes due to the presence of deoxygenated hemoglobin in blood vessels near the skin surface. Needs medical treatment. Baby is not oxygenating well.
acrocyanosis
persistent blue or cyanotic discoloration of the digits, most commonly occurring in the hands. Typically does not require medical treatment.
caput succedaneium
- scalp swelling that extends across the midline and over suture lines and is associated with head molding. Does not usually cause complications and usually resolves over the first few days. Generally resulting from a long and difficult labor or vacuum extraction. Caput succedaneum is present at birth, whereas cephalhematoma generally is not.
cephalahematoma
collection of blood resulting from ruptured blood vessels between the surface of a cranial bone and the periosteal membrane. The scalp in these areas feels loose and slightly edematous. They may be unilateral or bilateral and do not cross suture lines. They may be associated with physiologic jaundice, because there are extra red blood cells being destroyed within the cephalhematoma.
Premature-
born prior to the completion of the 36th week gestation
-leads to major physiological consequences (RDS, cardiovascular, hepatic, jaundice)
Term newborn
37 to 41 weeks - baby has brown fat so thermoregulation is more stable
Postmature-
delivery after 42 weeks gestation
-complications: CPD (cephalicdisporportion), shoulder dystocia, hypoglycemia, meconium aspiration, polycythemis, congenital abnormalities, seizures d/t hypoxia, cold stress
-postmaturity syndrome: may look starved, skin dry cracked and peeling, may have thin umbilical cord, placenta may begin to calcify, may have oligohydramnios
Nursing care of the neonate receiving a circumcision
Circumcision should be assessed for signs of hemorrhage and infection every 30 mins for at least 2 hrs following the procedure. It is important to observe for the first voiding after a circumcision to evaluate for urinary obstruction related to penile injury and or edema. Petroleum and gauze are applied to the site immediately following the procedure to help prevent bleeding and can be used to protect the healing tissue afterwards.
Circumcision assessment and intervention
-Apply petroleum for next few diaper changes. prevents bleeding
-If bleeding does occur, apply light pressure with a sterile gauze pad. If this is not effective, contact the physician immediately
-Report to the care provider any signs or symptoms of infection, such as increasing swelling, pus drainage, and cessation of urination
-When diapering, ensure that the diaper is not loose enough to cause rubbing with movement or tight enough to cause pain
-If the infant’s care provider recommends oral analgesics, follow instructions for proper measuring and administration
-The nurse must also teach family members how to assess for unusual bleeding, how to respond if it is present, and how to care for the newly circumcised penis
• What are the common complications found in the neonate born to a mother with diabetes
Hypoglycemia- blood sugar less than 40- even though the high maternal blood sugar supply is lost, the infant continues to produce high levels of insulin, which deplete the infant’s blood glucose within hours after birth.
Hypocalcemia- tremors
Hyperbilirubinemia- may be caused by slightly decreased extracellular fluid volume, which increases the hematocrit level…this elevation facilitates an increase in red blood cell breakdown
Birth trauma- macrosomic infants can have shoulder dystocia
Polycythemia- fetal hyperglycemia and hyperinsulinism result in increased oxygen consumption which can lead to fetal hypoxia
RDS- insulin antagonizes the cortisol induced stimulation of lecithin synthesis that is necessary for lung maturation
Congenital malformations- may include transposition of the great vessels, ventricular septal defect, left or right ventricular wall hypertrophy, small left colon syndrome, and sacral agenesis
manifestations of hypocalcemia
tremors
Polycythemia caused by diabetic mother
fetal hyperglycemia and hyperinsulinism result in increased oxygen consumption which can lead to fetal hypoxia
RDS induced by maternal diabetes
- insulin antagonizes the cortisol induced stimulation of lecithin synthesis that is necessary for lung maturation
Congenital malformations caused by maternal diabetes
may include transposition of the great vessels, ventricular septal defect, left or right ventricular wall hypertrophy, small left colon syndrome, and sacral agenesis
drug addicted babies
Complications:
Greastest risk is intrauterine asphyxia, infection (HIV, hepatitis), alterations in birth weight (LBW), Low apgar scores, respiratory distress, jaundice, congenital anomalies and growth restriction, behavioral abnormalities (poor organization of thought), withdrawal, learning disabilities, increased meconium, increased SIDS
manifestations of drug addicted baby
Hyperactivity, hyperirritability, increased muscle tone, tremors, fever, tachypnea (greater than 60 breaths per min), vomiting, drooling, sensitive gag reflex, diarrhea, sweating, watery stool, high such but poor coordination, high pitch cry, inconsolable
****remember these signs have a lot of similarities to hypoglycemia….but hypoglycemia manifestations would happen 3hrs after birth, while withdrawal would begin 24 hrs after birth
****also never give these babies NARCAN
**** limit their stimulation, limit contact, and give them good skin care
-prevention is key….best to get mom off the drugs before the baby is born
Nursing management for a neonate receiving phototherapy (TANNING BED!!!!!)
Watch for seedy green stool, which means billi is breaking down
Always have eye protection on the baby- check eye patches frequently
Monitor temperature, skin integrity, intake and output
Record irradiance of bulbs in use
Feeding schedule must stay on time
Check positioning of equipment
Respiratory distress syndrome
-caused by lack of surfactant
Altered physiology:
Decreased number of alveoli, decreased surfactant, small lumen size, greater collapsibility of alveoli, insufficient calcification of bony thorax, weak or absent gag reflex, immature and friable capillaries in lungs, greater distance between alveoli and capillary bed
What risk factors put a neonate at risk for RDS?
-prematurity (#1 factor), perinatal asphyxia, hypovolemia, male, white, maternal diabetes, second born of twins, family predisposition, maternal hypotension, ceasarean with labor, hydrops fetalis, third trimester bleeding
If born at 26-28 weeks --- 50% chance of RDS
If born at 29-31 weeks --- 25% chance of RDS
African American girls have the best outcomes….white whimpy males have the worst.
What is the difference between the indirect and direct coombs test and what is each testing for?
Indirect coomb’s- antibodies in mother serum
Direct coomb’s – antibodies in infant’s cord blood
Positive test means that cells have been exposed
So… rohgam is appropriate for moms that are ABO incompatibility, or Rh –
-This must be given after the first pregnancy (72hrs)….this includes any miscarriages
• What is Rh & ABO incompatibility, when does it occur? What manifestations are seen in the neonate for each?
Mom in Rh- and baby is Rh+
Mom is type O (so she has A & B antibodies) and the baby is A, B, or AB
Consequences of this is Pathological jaundice
Death can occur
Erythroblastosis fetalis develops in an unborn infant when the mother and baby have different blood types. The mother produces substances called antibodies that attack the developing baby's red blood cells.
The most common form of erythroblastosis fetalis is ABO incompatibility, which can vary in severity.
The less common form is called Rh incompatibility, which can cause very severe anemia in the baby.
Symptoms of ABO or Rh incompatibility in a newborn baby may include:
• Anemia
• Edema (swelling under the surface of the skin)
• Enlarged liver or spleen
• Hydrops (fluid throughout the body's tissues, including in the spaces containing the lungs, heart, and abdominal organs)
• Newborn jaundice
Hydrops fetalis (severe anemia)
-cardiac decompensation, generalized edema, ascities, hydrothorax, enlarged heart and liver, fluid in lungs, massive swelling
SGA, AGA, LGA
SGA- below 10%
AGA- between 10th and 90%
LGA- over the 90th
IUGR-
growth does not meet expected growth pattern in utero
SGA risk factors
Poor prenatal care, multiple gestations, maternal conditions such as diabetes and hypertension, poor nutrition intake or high energy expenditure, congenital infections, genetic errors
LGA risk factors
Diabetic mother, genetic predisposition (mom and dad have bigger babies), multiparous mother, males, certain genetic disorders

****Mothers with severe diabetes or diabetes of long duration associated with vascular complications may give birth to SGA infants. The infant of the typical diabetic mother, when the diabetes is poorly controlled or gestational, is LGA.
• Breastfeeding
o How do you know the baby is getting enough milk
Baby should feed every 2 to 3 hours (around the clock) for a total of 8 to 12 feedings/day
diaper patterns day 1-2
wet: 1-2

dirty 1-2
Stool type: meconium: dark, tarry, thick
diaper patterns day 3-4
wet: 3-5

dirty 3-4
Greenish, looser
diaper patterns day 5-6
wet: 6-8

dirty 3-6
yellow, seedy, loose
Impaired fertility
- inability to conceive after 1yr of regular, unprotected sex
Women: infertility
Ovarian (hormonal-ovarian cysts), Fallopian tubes (endometriosis- lining of uterus is in the fallopian tube scarring, STD), Uterine (fibroids- benign growth, congenital abnormalities- female parts were being mutated & high risk for ovarian cancer), Vaginal/cervical (infection, pH), Age, Obesity/underweight, excessive exercise, smoking/alcohol, chronic health problems, stress
Men: infertility
Birth defects (undescended testes, hypospadius), Varicoceles, Low hormone level (pituitary/thyroid), ejaculation problems, sexually transmitted diseases, substance abuse, environmental exposure, chronic health (diabetes, cystic fibrosis, autoimmune, hypertension, high cholesterol, heart disease, obesity), medications, excessive exercise, age
couple infertility
Subfertility of both problems, allergic responses, technique issues (obesity, positioning, timing, frequency-every other day), stress, assessment (postcoital test-have them have sex and then analyze it, sperm agglutination, counseling)
Semen analysis-
Liquification complete in 1 hour
Volume greater than 2ml
pH 7-8
Sperm count greater than 20ml per ml
Morphology greater than 30%
Motility greater than 50% moving forward
Manifestations of ovulation
1. Basal body temp charts- special thermometer that you take your temperature before you get up-Temperature will dip down….then spike when the woman is ovulating
2. Cervical mucus chart- mucous will become stretchy while you are ovulating
3. Ovulation most often occurs halfway through your menstrual cycle — the average cycle lasts 28 days, counting from the first day of one period (day one) to the first day of the next period. (this wasn’t in our notes.)
Candidias descriiption
fungal Diagnosis
pH <3.5
Hyphae, buds (KOH on wet prep)
DNA probe
Candidias s/s
Signs / symptoms
“cottage cheese” discharge
Severe pruritus (esp. at night)
Dyspareunia (dryness; burning)
Dysuria
Odor – often none, but may be musty or yeastyDiagnosis
Candidias r/f
Hormonal changes (pregnancy, menses, birth control pills)
Diabetes / HIV
Medications (antibiotics, corticosteroids)
Lifestyle (diet, stress, lack of sleep)
Candidias tx
Treatment
Topical antifungal creams/ovules
miconazole, clotrimazole, terconazole, butoaconazole
Oral fluconazole (Diflucan)
Prevention
Avoid douches / scented hygiene products
Change tampons / pads frequently
Avoid tight fitting clothing; choose cotton
Avoid hot tubs / hot baths
Bacterial vaginosis description
Causative agent – overgrowth of “harmful” bacteria
Most common vaginal infection
Bacterial vaginosis r/f
Anything that upsets the normal balance
New sexual partner / multiple partners
Douching
Pregnancy
Lesbian relationship
Bacterial vaginosis s/s
Signs / symptoms
Unpleasant odor / “fishy” (after intercourse)
Thin white or gray discharge (if present)
May have dysuria or vulvar itching
Many have no s/s
Bacterial vaginosis
Treatment
Topical or oral metronidazole or clindamycin
Prevention
Limit number of sex partners
Avoid douches / scented hygiene products
Change tampons / pads frequently
Avoid tight fitting clothing; choose cotton
Avoid hot tubs / hot baths
Bacterial vaginosis dx and complications
Diagnosis
pH <5.0-5.5
Clue cells on wet prep; + whiff test (with KOH)
DNA probe
Complications
susceptibility HIV transmission (both ways)
post op infection (hysterectomy or abortion)
risk of preterm delivery
susceptibility to other STD’s (herpes, chlamydia & gonorrhea)
Pelvic inflammatory disease (PID)
Gonorrhea description
Causative agent – bacterial Neisseria gonorrhoeae
Incidence
Number reported is very underestimated
Prevalent among adolescent females, lower economic status, drug users
Gonorrhea s/s
Signs / Symptoms
Male – asymptomatic 10%; urethritis (discharge, dysuria), epididymitis
Female – most asymptomatic (50%); cervicitis and urethritis – abnormal vaginal discharge, irregular bleeding, lower abdominal pain, or dyspareunia
Gonorrhea dx
Diagnosis
Culture
NAAT’s/ NA – DNA specific
Gram stain
Gonorrhea complications
Complications
Neonatal gonoccoccal ophthalmia
More resistant organisms emerging
Increases susceptibility to HIV infection
Accessory gland infections (Bartholin’s &Skene’s glands)
PID  infertility, ectopic pregnancy, chronic pain
Fitz-Hugh-Curtis syndrome (perihepatitis)
Disseminated gonorrhea
Gonorrhea tx
Treatment
Rochephin injection
Cefixime (Suprax)oral
Ciprofloxacin oral--- resistant strains
Need to co-treat for Chlamydia if not ruled-out
Treat partners
Trichomonis description
Causative agent – protozoan (Trichomonas vaginalis)


Risk factors
Sexual activity (exposure to)
Trichomonis s/s
Signs / symptoms
Yellow, green, or gray discharge; “foamy”
Strong odor
Dysuria
Dyspareunia
Vulvar irritation/ itching
Trichomonis dx
Diagnosis
pH <5.0
Trichomonads; + whiff test (with KOH)
DNA probe
Trichomonis complications
Complications
susceptibility HIV transmission (both ways)
risk of preterm delivery or low birth weight
risk for premature rupture of membranes
Trichomonis
Treatment
Oral metronidazole
Must treat partners to prevent reinfection
Prevention
Abstinence
Long-term mutually monogamous relationship
Condoms
Avoid sharing wet bathing suits
Syphilis description
Causative agent – spirochete Treponema pallidium
Incidence
Most infective 1st and 2nd stages
Syphilis s/s
Signs / Symptoms
• Primary
• Chancre – painless , indurated ulcer with clean base; highly infectious
• Secondary
• 3-6weeks /p chancre
• Rash, lymphadenopathy, alopecia, condylomata lata
• Tertiary –
• No lesions
• Early latent <1 year
• Late latent> 1 year
• Active – aortitis, gumma, iritis
Syphilis dx
• Diagnosis
• RPR, VDRL (screening – not specific)
• FTA-ABS (diagnostic -- antibody)
• Darkfield microscopic / fluorescent antibody exam
• May be difficult to diagnosis in primary stage
Syphilis complications
• Complications
• Vertical transmission to fetus
• Stillbirth, neonatal death, , deafness, neurological impairment, bone deformities
• Travels through lymph and blood to body - CNS
neurosyphilis
• Few months to few years after infections
• Early -- Meningitis, meningovascular syphilis, ocular involvement
• Late -- General paresis, tabes dorsalis, ocular involvement, cognitive dysfunction
Syphilis tx
Treatment
• Penicillin IM
Instructions for diaphragm use after delivery:
diaphragm should be rechecked for correct size after each childbirth and whenever a woman has gained or lost 10lbs.
diaphragm disadvantages
Must be left in place for 6 hours after intercourse
Must be fitted by health professional
20% failure rate
Increased risk of UTI, toxic shock syndrome if used > 24 hours
No protection against STD’s
Needs spermicides to be effective
Replacement on yearly basis
Natural family planning method for birth control
• Basic “rules”
• Ovulation occurs 12 -16 prior to menses
• Ovum are viable for 1-3 days after ovulation
• Sperm are viable for up to 3-5 days in the vagina
• NFP – abstinence during “fertile days”
• FAM – abstinence or barrier method during “fertile days”
natural family planning advantages
• Can assist with getting pregnant
• No hormones / chemicals – all natural
Most effective when uses several basic methods together
natural family planning disadvantages
• Has to have total commitment from both partners to the method
• May limits when couple may have intercourse -- no sex for 8-16 days of each cycle
• 20-25% failure rate
IUD
Mirena (hormone – progestin), lasts 5 yrs, same s/e as progestin only BC
Paragard (no hormone), made of copper, which acts as spermicide, lasts 10 yrs
Norplant
Subdermal implant, upper arm. Norplant is no longer used in US. Equivalent is Impanon, which is progestin only. Same s/e as progestin only BC. Good for 3 yrs, highly effective, must get in clinic, must weigh <198lbs.
Diaphragm
Latex cup in which spermicidal jelly is place prior to insertion into the vagina – covers the cervical opening
Advantages:
No hormones
May be placed ahead of time in anticipation of intercourse
Tubal ligation
Fallopian tubes are tied/cut, permanent method, expensive, invasive, woman will still ovulate and still have periods
Vasectomy
Vas deferens is tied or cauterized, highly effective, inexpensive, permanent, invasive
Importance of folic acid
prevents fetal neural tube defects (i.e. spina bifida), contributes to production of RBCs, is needed for lactation
• Found in green leafy vegetables, oranges, broccoli, asparagus, peanuts, artichokes, liver
• Folic acid is destroyed by heat and light
Normal weight gain during pregnancy for adolescents and adult women
• Depends on BMI
• If BMI is <19.8 = underweight – gain 29-40 lbs (12.5-18kg)
• If BMI is 19.8-26 = normal wt – gain 25-35 lbs (11.5-16kg)
• If BMI is 26.1-29 = overweight – gain 15-25 lbs (7-11.5kg)
• If BMI is >29.1 = obese – gain at least 15 lbs (7kg)
Wt gain patterns for average adult:
• 1st trimester: 3.5-5 lbs per week
• 2nd and 3rd tris: 1 lb per week
Neonatal needs for iron supplements in the bottle vs. breast fed baby
• Infant depends on maternal iron intake for iron storage in 1st 5 mos of life
• If bottle-feeding, use iron-fortified formula
• If breast-feeding, baby depends on mom’s iron stores
• Mom should take iron supplement 2-3 mos. postpartum
Sources of Calcium
• Dairy (best source)
• Canned fish w/ bone
• Green leafy veg EXCEPT for spinach
• Tofu
• Legumes
Sources of Vitamin D
Vitamin D aids Ca absorption
• 30 min of sunlight per day
• Fortified milk/dairy
• seafood
Maternal nutritional needs when breastfeeding
• Increase kcal by 200 in adition to pregnancy increase of 300 = total of 500 kcal needed for breastfeeding
• Increased protein
• Ca same as during pregnancy
• Supplement Iron for 2-3 mos pp
• Continue pregnancy fluid intake of nutritive fluids
Mineral needs prepregnancy
Calcium 1000
Phosphorus 700
Magnesium 310
Iron 18
Zinc 8
Iodine 150
Selenium 55
Mineral needs during pregnancy
Calcium 1000
Phosphorus 700
Magnesium 350
Iron 27
Zinc 11
Iodine 220
Selenium 60
Mineral needs while lactating
Calcium 1000
Phosphorus 700
Magnesium 310
Iron 27
Zinc 12
Iodine 290
Selenium 70
what is a doula and what is the scope of practice
• Experienced in childbirth – provides informational, physical and emotional labor support
• Advocates for the woman and her family
• Cannot perform clinical tasks
Bradly - Childbirth method
– To have the best, safest, and most rewarding birth experience possible
o Physical and mental preparation prior to labor (starts at 5th month)
o Focuses on communication
o Natural - no meds
o Husband as coach
o Excellent nutrition
o Breastfeeding begins at birth
o Relaxation and breathing
Lamaze -Childbirth method
Childbirth education empowers women to make informed choices in health care, to assume responsibility for their health and to trust their inner wisdom
o Belief that birth is a natural, normal life process
o Right to give birth without routine medical interventions
Leboyer - Childbirth method
Focus is on decreasing stress on baby by decreasing environmental stimuli at birth
o Avoidance of forcepts, low lighting in delivery room, warm bath for newborn
Birth Plans
o Identifies the aspects of the childbearing experience most important to the parents
o Outlines informed choices and and specifies options the couples may want to avoid
o i.e. parents may choose to have no external fetal monitoring
o by choosing this ahead of time the provider can explain that eliminating all monitoring during labor could jeopardize both mother and fetus.