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241 Cards in this Set
- Front
- Back
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Define Gravida
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A pregnant woman.
Gravid: pregnant "heavy with child" Gravidity: Pregnancy |
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Define Para
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a woman who has procduced a viable infant, alive or not. Must be at >20 weeks gestation
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Define Nulligravida
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never pregnant
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Define Primigravida
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first pregnancy
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Define Multigravida
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many pregnancy
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Define Nullipara
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never delivered
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Define Primipara
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has had first delivery
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Define multipara
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many deliveries
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Define Grand mulitpara
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> 5 deliveries
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What is the length of a typical pregnancy?
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40 weeks or 280 days
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How do you calculate the length of pregnancy?
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1st day of Last Normal menstural period (LMP or LNMP)
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What is EDC?
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Estimated Date of Confinement aka Due Date
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How are the trimesters broken up?
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1st: weeks 0-12
2nd: weeks 13-27 3rd: weeks 28-40 **some argue for a fourth; which is the 1st 6 weeks of postpartum |
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What does it mean that a baby is born preterm?
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Baby is delivered between 20-37 weeks
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What does it mean that a baby is born term?
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Baby is delivered between 38-42 weeks
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What does it mean that a baby is born post-term?
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Baby is delivered after 42 weeks
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What is an abortion?
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A pregnancy that has ended before 20 weeks
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List the types of abortions
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Spontaneous (miscarriage)
Voluntary (Done at a clinic) Therapeutic (Done to save mother's life) |
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What is the antepartal period?
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Before birth; pregnancy
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What is the Intrapartal period?
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Within birth; Labor and Delivery
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What is the Postpartal period?
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After Birth; first 6 weeks
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What is the Neonatal period:
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The newly born, up to 28 days of life
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How many grams = 1 lb?
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454 grams
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How many grams = 1 oz.?
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28 grams
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How many cm = 1 inch?
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2.54cm
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What is family centered Maternity care?
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Care that is centered around the childbirth; gives adequate support to family and providing care for care focused on the mother and child.
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Define community standards of care in the OB setting and Give an example.
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Standards/Criteria expected from practitioners working in a particular setting or geographic area.
Standardized HIV testing of pregnant women in certain states |
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What is a Level I perinatal care unit like?
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They can care for mothers/neonates w/o illness or complications
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What is a Level II perinatal care unit like?
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An intermediate facility, can care for women with some complex OB problems and neonates with some short-term problems.
Can also care for Level I types |
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What is a Level III perinatal care unit like?
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Level III care for high-risk patients, they can also care for level I & II.
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Define Infant Mortality
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# of deaths in infants <1/ 1000 live births (in a given population)
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Define Maternal Mortality
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# of deaths during pregnancy cycle/ 100,000 live births (in a given population)
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At what point in gestation is surfactant produced?
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week 25-30 type II alveolar cells begin production of surfactant
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What are the functions of surfactant?
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1. Decreases surface tension of pulmonary fluids
2. Prevents alveolar collapse at end of expiration 3. Facilitates gas exchange 4. Lower inflation pressures needed to open airways 5. Improves lung compliance 6. Decreases Labor of breathing |
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What ways can we check if the lungs are mature enough in the gestational fetus?
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1) L/S ratio via amniocentesis; should be 2:1
2) Phosphatidylglycerol levels are present at 36 weeks of gestation 3) Lamellar bodies, at least 30-50,000 |
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How are the fluids in the lung of a fetus secreted upon delivery?
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1/3 of fluid is removed at birth, 2/3 is taken in by the pulmonary circulation and lymphatic system.
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How long does it take for the fluids from delivery to clear the lungs?
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Total time should be with 6-24 hours via vaginal delivery
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What is TTN?
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Transient Tachypnea of Newborn; a respiratory problem seen in the newborn shortly after delivery. It consists of a period of rapid breathing (higher than the normal range of 40-60 times per minute). It is likely due to retained lung fluid, and common in 35+ week gestation babies who are delivered by caesarian section without labor. Usually, this condition resolves over 24-48 hours
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What are the treatments for a neonate showing s/s of TTN?
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Oxygen support.
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What are the stimuli for breathing at birth?
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1. delivery into cold environment
2. tactile stimulation of back and feet 3. delivery into environment with light 4. Cord occlusion/clamped-cut |
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what is the respiration rate of Neonates?
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30-50, 40-60
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What are the characteristics of Neonate breathing?
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1. breathing is diaphragmatic
2. breathing is shallow, irregular depth and rhythm 3. Abdominal, synchronous with chest 4. short periods of apnea 5. REM sleep displays periodic breathing 6. During crying/motor activity shows gross irregular breathing |
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What kind of breathers are New Borns?
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Obligatory Nose Breathers until 3 weeks of age
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What is the purpose of fetal circulation?
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1. decrease blood flow to fetal lung; providing just enough blood to allow maturity of lungs
2. Direct blood to the placenta 3. Increase blood flow to head and heart |
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True or False:
Fetal pulmonary BP is < adult pulmonary BP |
FALSE:
Blood being diverted away from nonfunctional lungs causes an increase to fetal pulmonary BP |
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True or False:
Fetal systemic BP < Adult BP |
TRUE:
Blood is flowing directly back to the placenta readily causing a much lower systemic BP |
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what composes the umbilical cord?
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3 cords; veins and 2 artery held together in the cord via Wharton's Jelly.
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Does the Umbilical Vein carry Oxygenated or Deoxygenated blood?
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Oxygenated; the artery carries deoxygenated blood Away from the baby to the placenta back to the veins of the mother.
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What is the purpose of the Ductus venosus?
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Shunts arterial blood into inferior vena cava
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When does the ductus venous and arterosus close off?
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Functionally it closes off a few hours after birth; anatomically it closes off a few weeks after birth and becomes a ligament
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What is the purpose of the Ductus arteriosus?
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Shunts arterial and some venous blood from pulmonary artery to aorta
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What is the purpose of the foramen ovale?
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Connects the right and left atria
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When does the foramen ovale close off?
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Usually obilterated within hours after birth causing a shift of venous pressure to the right atrium
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Describe the changes to neonatal circulation
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1. umbilical cord clamped, neonate draws first breath
2. systemic vascular resistance increases 3. Blood flows through ductus arteriosus decreases 4. Most of right ventricular output flows through lungs, boosting pumonary venous return to the left atrium |
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What causes the closure of the foramen ovale?
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Increased systemic resistance and left atrial pressure rising in response to the increased blood volume to the lung causes the the structure to close
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What is the range for the neonatal HR?
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120-150 bpm awake
70-90 asleep 180 crying |
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What is normal range for BP for a neonate?
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60-80
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What is Acrocyanosis?
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Sluggish circulation of blood usually most noticeable after first few hours after delivery; the skin looks mottled and feels "chilly" usually found in palms and feet
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Describe perioral cyanosis?
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Neonate can have blue around philtrum (above lip) and lips, tongue and mucous membranes are pink; usually resolves spontaneously
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Do newborns have high or low H&H values?
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High!
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What are the benefits of delayed cord clamping?
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1. Decreases anemia
2. Decreases the need for transfusions 3. Increases stem cells 4. Decreases certain disorders (RDS, IVH, late onset sepsis, eye diseases) |
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what causes physiologic jaundice?
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Destruction of fetal RBCs leads to a spike in bilirubin that is transported to liver for conjugation. New borns are born with immature livers and cannot eliminate the bilirubin fast enough causing jaundice
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How is Bilirubin normally eliminated?
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Bilirubin is eliminated via urine and feces
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Who are most likely to develop jaundice?
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Asian, Greek, and Native American populations
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What are the signs of pathological jaundice?
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1. Occurs in the 1st 24 hours of life
2. Rise of bilirubm 5mg/dl every 24hrs 3. If baby is premature; small livers! 4. LBW neonates are more susceptable 5. Rh or ABO incompatibility 6. G6PD deficiency 7. High H/H |
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What condition other than jaundice can be caused by increased bilirubin?
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Kernicterus
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What is kernicterus?
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Condition in which neurotoxic levels of bilirubin crosses the blood brain barrier, causing irreversible CNS damage.
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At what level of bilirubin is Kernicterus inevitable?
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anything greater than 20mg/dl
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What are the s/s of Kernicterus?
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Similar to that of Cerbral Palsy
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What treatment(s) are recommended to treat hyperbilirubinemia?
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Blue light therapy
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What are the nursing considerations for caring for a baby receiving Phototherapy?
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1. Watch temperature--keep baby naked except the diaper under lights
2. Watch hydration status--sweat, pee, poop all part of water loss. Check turgor often @ abdomen 3. Protect eyes and genitals from light ---can cause mutagenesis 4. Reposition often--prevent skin ulcerations |
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True or False:
Adult blood is used for transfusions when needed it is called for newborns. |
TRUE:
Adult blood and other blood products such as plasma can be used as well. |
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Describe breastmilk jaundice
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1. usually occurs 3-6 days of life
2. often caused by insufficient calories and weight loss of the fetus |
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What is the treatment for breastmilk jaundice?
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Increase nursing, supplement breastmilk, if bilirubins are 14-16 mg/dl, stop breastfeeding for 24-48 hours and restart
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What are normal counts of WBC for newborns?
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10-30,000
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What is the best way to determine an infection in newborns?
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The number of immature WBC can be a clue to an infection
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What is the importance of Vitamin K and newborns?
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Vitamin K is a clotting factor that is normally in presence in newborns. Vitamin K is produced by intestinal bacteria and aids in clotting. NB don't have enough so are given 1mg injection at 1 hour of birth.
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What is the normal platelet count of newborns?
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150-400,000 per ul
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What can influence platelet counts of newborns?
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Phototherapy; phototherapy can cause an increase in transient aggregation defect (inability to clot)
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Describe the ranges of apgar score
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0-3: poor condition; need immediate resuscitation
4-7: fair condition, call pediatrician, maybe drug crossed the placenta 8-10: good condition |
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Why are newborns poor thermal regulators?
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Babies tend to take on the temperature of the environment due to their limited subcutaneous fat, large surface area in relation to their weight, and blood vessels lying closer to the skin
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What are the means of heat loss for new born?
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1. Convection --heat lost to the environment as air moves over
2. Radiation -- Heat loss to environment 3. Evaporation --Wetness takes heat away as it evaporates (sweat) 4. Conduction-- heat loss due to direct contact with cool object |
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What is normal range of temperature of Newborns and what temps are you to watch out for?
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36.4-37.2 Celsius
@ 36.0 or less stop feeding and warm up baby ASAP @ 37.5 call doctor ASAP--infection?!! 1/2 pts low try hats/blankets/give to mom for kangaroo hold. |
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Why is heat loss dangerous to Newborns?
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Heat loss increases metabolic rate x2! This leads to increase oxygen demand and enenergy use, leading to pysilogic stress, metabolic acidosis, which can lead to hypoxia, hypoglycemia, acidosis!
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How can heat loss lead to hypoglycemia?
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Glucose is burned up rapidly in the liver by the Newborn to keep warm leading to hypoglycemia
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Which babies, Term or Preterm babies tend to flex and pull away from cold conditions?
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term
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What is the major function of the liver in Newborns?
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1. Aids in Fe storage
2. Aids in carbohydrate metabolism |
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If the maternal diet was adequate in Fe, how long should the storage of iron last in the Newborn?
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Up to the age of 5 months
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When and what can you give to babies to aid in iron storage and supplies for the body?
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At 6 months babies can have iron fortified food such as rice
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When does glycogen get stored in the liver of newborns?
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In utero, at 9-10 weeks of gestation
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Why is glycogen and liver function so important?
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Liver stores glycogen for newborns, glycogen is the major energy source for fetus, major energy source of neonate until it begins feeding.
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What factors can influence glucose levels in newborns?
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1. Liver size
2. Liver output and uptake 3. Body temperature 4. Insulin amount 5. Muscular activity 6. Difficult labor 7. delayed feeding |
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Which population of newborns are at risk for HYPOGLYCEMIA?
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1. Born to Diabetic mother
2. SGA or LGA 3. Premature 4. Postmature 5. Fetal distress in labor/low apgars 6. Maternal Corticosteroid use (Betamethazone, dexamethazone) |
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What nursing actions can prevent hypoglycemia?
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1. Have early feedings
2. Check blood glucose, feed, recheck 30-60 minutes later after feeding 3. Treat with D5 if feeding doesn't resolve the issue |
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What is the critical level for Blood sugar in newborns?
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anything less than 30 mg/dl (or 25)
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What are some reasons for poor digestion in NB?
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1. Small livers = low amounts of bile = poor fat digestion
2. low amounts of lipase 3. GI tract is longer than body 4. Immature motility and spincter control 5. immature salivary glands till 3months |
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What is the normal calorie requirement for a newborn?
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108/ca/kg/day
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How much weight loss can a NB have?
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5-10% with first 5-10 days
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What is meconium?
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It is the initial stool; formed in utero made up of amniotic fluid, intestinal secretions and mucosal cells.
Uusally thick , tarry, green-black, 90% pass this within the first 24 hours, the rest @ 48. |
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What is the difference in stool for a bottle fed vs breast fed NB?
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If breast fed the stool should look seedy appearance of milk curds.
Formula fed have pale looking stools with firmer than breastfed newborns |
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Describe the renal system of a newborn
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Renal system is relatively immature at birth.
Babies are highly susceptible to dehydration, acidosis, electrolyte imbalance, limited ability to absorb sodium an hydrogen, and usually have low GFR until 34 week of gestation |
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How often should a NB be voiding?
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By 1 week 6-10 voids/day expected
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What is the role of IgG in NB?
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IgG provides passive immunity to infections that generated maternal antibody response; eventually declines after few months
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What is the role of IgM?
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IgM protects against blood borne infections; High levels of IgM in cord blood = intrauterine exposure to syphilis, rubelle, CMV (cytomeglovirus)
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What is the role of IgE?
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IgG is produced in hypersensitivity responses (allergies)
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what is the role of IgA?
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IgA provides local mucosal immunity to respiratory and GI viruses and bacteria; most predominant Ig in colostrum
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At what point are the neurons fully myelinated?
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By 4 years of age
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Describe the moro reflex?
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Baby should have a startle reflex with spreading of the limbs and flexing inward
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What reflexes are you looking for in a NB?
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1. Moro
2. Palmar and plantar grasp 3. Tonic Neck 4. Babinski 5. Stepping 6. sucking |
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TRUE or FALSE
A baby can track objects in space? |
TRUE:
Babies can process complex visual information and track objects in space so that they can defend against unpleasant stimuli |
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What is Brazelton's theory on "orientation" and "habituation" on vision?
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Babies can become fixated on an object, look it over, become oriented to it and will turn away (becoming habituated)---this is similar to habituating to a noise in the background.
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What kind of toys should you provide for a new born?
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Toys that have complex visual stimuli; anything that has patterns, geometric shapes, contrast, but their biggest preference is to human faces.
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What sounds do babies prefer?
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Low frequency sounds are found to be soothing vs high; babies can also distinguish between a woman's voice.
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What scents do babies prefer?
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They prefer sweet odors such as milk vs. noxious ones such as smoke. These help babies root toward the nipple when feeding.
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Describe the taste response in babies?
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Babies prefer sweet over salty/unsweetened, the sweeter a forumula is the more it will suck
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How is the sucking/feeding response between bottle fed vs. breast fed?
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Breast fed babies tend to suck at a steady rate vs. Breast fed who do it in bursts
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How do males vs females differ in approaching a baby?
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Men tend to approach quiet babies by stroking, patting them and jarring them awake
Women tend to quiet the child and stroke them and comfort them with pats |
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List the periods of Reactivity of the NB
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1. Period of reactivity
2. Period of sleep/inactivity 3. second period of reactivity |
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Describe the First period of Reactivity
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1. Lasts 30 minutes long
2. 1st 15 minutes are quite alert, eyes, open focuses on stimuli around 3. 2nd 15 minutes are active alert; burst of movement, maybe crying, strong sucking reflex, good point to breast feed! |
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Describe the period of inactivity/sleep
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1. Lasts for 2-4 hours
2. Baby is drowsy/falls asleep 3. HR, RR slows become more regular 4. Temp may fall 5. Have bowel sounds 6. Relaxed posture and difficult to rouse 7. Breast feeding usually impossible to initiate |
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Describe the 2nd period of reactivity
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1. Lasts 4-6 hours
2. Baby is Awake and alert 3. Lots of gastric and respiratory mucus 4. Color change 5. Bowel sounds increase 6. Often 1st void occurs 7. Parents can reattempt feeding/attachment |
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When are NB screening tests done?
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at least 24 hours after birth since some are feeding dependent.
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What kind of treatment are given to the eyes of newborn?
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Newborns receive initally Erythromycin ointments, this prevents blindness that can be caused by gonorrhea and chlamydia
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What is the typical umbilical care of newborns?
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1. Check for 3 vessels before clamping
2. Umbilical stump can be either: a. treated with alcohol; triple dye or none. 3. Diaper should be kept below cord stump to allow to dry 4. Stump should fall off 5-14 days |
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Can NB have a full bath?
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NO BATHS until umbilical stump falls off. Till then wet sponge baths.
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How much vitamin K is given to a newborn?
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usually 0.5-1 mg into vastus lateralis via TB syrince with 25 gauge needle
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What are the potential problems with circumcision?
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Bleeding, infection, difficulty in voiding, separating of wound edges, irritation of meatus that can lead to ulceration/stenosis.
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What infections are circumsized babies susceptible to ?
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MRSA, Sepsis, Necrotising facitis
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What is colostrum?
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It is the initial breast milk that is high in protein, inorganic salt, less fat and carboy hydrates than milk.
It also contains IgA antibodies. |
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How can you teach a mother to resolve issues such as flat or inverted nipples?
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1. Teach about Hoffman's exercise: thumbs at base of nipple, push in toward breast tissue, while pulling thumbs away from each other
2. Use breast pump |
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Describe the mechanism of lactation
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1. Baby is put to breast
2. Stimulation sends impulses to spinal cord and brain 3. oxytocin released from posterior pituitary gland 4. oxytocin stimulates anterior pituitary to release prolactin, stimulating milk production |
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What factors other than a baby's sucking can effect milk let down?
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1. sensation of breastfeeding
2. baby crying---can be other than own 3. sigh of babies 4. pain/stress can inhibit milk let down |
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What factors can effect a mother's breastmilk?
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1. maternal diet
2. maternal rest/activity 3. maternal contentment 4. supply/demand |
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how much can a newborn's stomach hold at day 1? day 3? day 7?
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Day 1 5-7 ml
Day 3 0.75 - 1oz. Day 7 1.5 - 2.0 oz |
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If a mother is experiencing low breast milk production how can we aid the breast feeding process?
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Use of:
1. lact-aid/tube a breast with formula to supplement breast milk 2. Finger feeding of baby with formula/breast milk 3. supplemental feeding |
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What things should you teach to a new mom when demonstrating about breast feeding?
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1. clean hands/nipples
2. make sure mother is in supported position 3. baby is awake and alert 4. BAby is at level of mom's breast ( tummy to tummy) 5. One of baby's hand on either side of mom's breast |
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What should a successful latch look like?
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1. mother is relaxed, baby supported in her arms
2. baby sucking on areola, not just nipple 3. baby top and bottom look evereted; like a fist mouth 4. baby's chin pressed into breast; if nose occluded, mother presses on breast to make airway |
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What kind of advise can you give to a mother about sore nipples?
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1. seek a lactation consultant
2. break suction correctly --finger in mouth to break feeding 3. use different positions for feeding 4. feed baby before it is ravenous, less sore breast first 5. avoid engorgement |
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What advise would you give mom about nipple care?
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1. express milk, rub into nipple
2. make sure tissues gets to dry after feeding 3. avoid soap/quick drying 4. use lansinoh cream 5. use nipple shields/gel pads 6. pump breasts often 7. |
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What safety guidelines would you teach moms about formula feedings with babies?
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1. make sure the formula is not expired before use
2. formula not kept > 2 hours out of fridge 3. if kept in fridge no > 48 hours 4. don't reuse partially used bottles 5. don't heat in microwave 6. don't prop bottles when feeding |
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When should you switch formula to regular milk?
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Formula should be used for 1st year and beyond, change to dairy products during 2nd year of life starting with yogurt.
There are many transitional formulas; full fat cow's milk should be used until age 2 |
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What things can a mother do to suppress lactation?
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1. don't bind breast
2. drink if thirsty 3. cut down on salt 4. take vitamin b6 200 mg 5x day 5. sage tea 6. use cabbage leaves |
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What is mottling on a NB?
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mottling happens when cold, it is a lacy pattern of dark and light caused by vasomotor fluctuation, it is of no consequence to the baby.
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What is the Harlequin sign?
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It is where a the blood vessels on one side of the body dilate while the other side constricts giving the appearance of a harlequin. This can be either single or multiple episodes
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Where can you fist detect jaundice on a baby?
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Usually on face, mucus membranes of mouth. This is done by blanching the tip of nose, gum line, sclera, forehead/sternum and looking for jaundice
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Describe Erthema Neonatorum Toxicum
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AKA Normal newborn rash, it is non pathological of unknown etiology, seen usually in first few days of life, looks like "flea bites", peaks in 24-48 hours of life then disappears a few hours or days
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How do you check for skin turgor on a baby?
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Assess over abdomen, should be elastic, feeding should be initiated first before doing assessment
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What is Vernix Caseosa?
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It's a natural waxy substance that covers the baby in utero, helps lubricates the skin, looks like white cheese substance
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What is milia?
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Exposed sebaceous glands; appear to be raised white spots on face, especially on the nose
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A baby has marks with reddened areas over cheeks and jaws for the 1st 2 day of life and baby. No signs of facial paralysis is shown. What kind of marks are these?
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Forceps marks, usually seen in babies with difficult forceps delivery.
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A pale pinkish red spot is seen on the eyelids/ nose, lower occipital bone/nape of the neck of a light complected baby. Highly noticeable during crying. What do you suspect it to be?
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Telangiectatic Nevi aka Stork bites
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An asian baby has come in and upon initial inspection you notice a grey-blue mark near the lumbosacral area. Baby show no signs of pain upon palpation. What do you suspect it might be?
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Mongolian spot, these usually disappear in late infancy or early child hood
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A flat purple-red, sharply demarcated spot is seen on a new born on its right cheek; what do you suspect and what precautions should you take when inspecting the site?
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Port-wine stane aka Nevus Flammeus; don't blanch the area, stain will either fade or increase in size over time, can be disfiguring. Check to see of other diagnosis has been screened. Seizures+NF can be seen in genetic disorders.
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A dark, red, rough textured, sharply demarcated, mark is seen on the head of a baby at birth. Upon reinspecting 3 months later, the mark has seem to shrunk in size somewhat, what do you suspect it to be?
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Nevus Vasculosus aka strawberry mark, these can take 7-10 yrs to disspear
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What is a cafe au lait spot and what is the concern of them?
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Flat pigmented spots, that are sharply demarcated that seem like "coffee with milk"
1-3 spots are okay, but greater # and any greater than 5 mm can be a concern since they are linked to neurofibromatosis. (elephant man's disease) |
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How much weight loss should be seen in newborns in the first 5-10 days of life?
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5-10%, if greater there is a warrant for concern, after first 6 months should gain 198 grams/week
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How much bigger should a baby's head vs. it's chest circumference?
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Head circumference should be 2 cm > chest circumference, should be measured from most prominent part of the occiput to just above eye brow. Avg. 32-37
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What should you notice about a newborn's head as you inspect it?
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1. it should be large, 1/4 of total body size
2. palpate suture lines; are they open or closed 3. I.d. fontanels 4. evaluate symmetry 5. evaluate molding |
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How long does it take to for the anterior fontanels to close?
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18 months
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What should you not see when inspecting the fontanels?
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Bulging or depression. Bulging can mean ICP; depression can be a sign of dehydration
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What is Caput succadaneum?
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Diffuse, soft-tissue edema of scalp caused by pressure on head in L&D, it crossed the suture lines, scalp ecchymosis may be present, usually due to vacuum extractor.
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What causes cephalohematoma?
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Usually not seen hours afterbirth, it is a collection of blood due to rupture of blood vessels between skull and periosteum. No eccyhmosis see and it doesn't cross suture lines. Usually resolves in 2-6 weeks
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What are you looking for when you are inspecting the face of Newborn?
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1. are there sucking pads in cheeks and sucking callous on upper lip
2. Chin is recessed, nose flattened 3. Lips sensitive to touch 4. look for symmetry and movement of features, note for paralysis |
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White spots are noticed on the eyes of a baby, what are these?
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Brushfield signs, one of the hallmark signs of Down syndrome
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Can baby produce tears?
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No, lacrimal glands are immature for weeks or months so tears are abnormal!
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How should the eyes of a newborn appear under an opthalamoscope?
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There should be red reflex under an opthalmoscope directed on it; AA babies will look yellow.
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What are you looking for upon inspection of the ears of a New Born?
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Symmetry, placement, as well as tags and sinuses. Low set ears,Tags and sinuses can be a concern since they are abnormal and might be a sign of abnormal kidney development as well.
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What might you find upon inspection of the mouth of a NB?
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Epstein pearls---whitish-yellow cysts that form on the gums and
roof of the mouth Precocious Teeth - immature teeth that need to be extracted Short frenulum |
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What might you find upon inspection of the nose?
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Nares should be ptatent, r/o choanal atresia ---narrowing/blockage of nasal blockage. Large amount of discharge from nose can be sign of congenital syphilis. Sneeze reflex should be intact.small nasal discharge.
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Upon inspection of the baby a lump of fat on the back of the neck was noticed, is this a note of concern?
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Yes, this is one of the hallmark signs of downs syndorme.
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When inspecting the neck what should you look for on a NB?
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short creased folds, good ROM, no masses or webbing, head lag
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Are Supernumerary nipples normal?
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Yes, extra nipple are normal, they usually appear along the milk line, from outer upper shoulders to middle of pubic bone
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What is witch's milk?
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fluid that can be produced from both sexes of baby from the breast due to maternal hormones that crossed the placenta
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Describe a normal cry of a baby?
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A normal cry can last for 3-7 minutes after consoling measures used, can be strong lusty, and medium pitched.
Weak cries---neuro-disorders, High pitched cries can indicate hypoglycemia or neurological disorders as well. |
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Describe the respiration of NBs?
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Usually Diaphragmatic, associated with rise/fall of abdomen
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How do you know a NB is in respiratory distress?
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Nasal flaring, intercostal or xiphoid retractions, grunting, seesaw respiration, sustained tachypnea, stridor on inspiration, abnormal AP diameter.
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What is the normal HR for a NB?
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120-150 bpm
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What is the normal BP for a NB?
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63-70/40-50
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What should you be inspecting for on a NB's abdomen?
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Should be round, symmetric in contour, slightly protuberant, superficial veins visible, good bowel sounds, no blue umbiligius, no rigidity/pain.
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A female NB upon inspection of the genitalia shows enlarged labia, as well as bloody discharge in the diaper that disappeared spontaneously over time. Should you be concerned?
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NO, this is normal due to maternal hormone that is still present in the body of the NB
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If no stool has been passed in 48 hours by the NB what should your concern be?
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Possible imperfortate anus & anal atresia, needed to be r/o by digital rectal exam
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What things should you notice upon inspection if you are trying to rule out DDH?
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Limited abduction on affected hip, femur appears shortened, deeper creases in thigh, Ortolani maneuvers creates clicks upon ROM
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What is the ballard exam?
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an exam that determines Gestational Age through neuromuscular and physical assessment of a newborn fetus
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What are some of the presumptive signs of pregnancy?
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1. missed menses
2. N/V 3. Breast tenderness 4. Fatigue 5. Ptyalism 6. Skin pigmentation changes |
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What are some of the probably signs of pregnancy?
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1. Enlargement of the uterus (must rule out tumors)
2. Chadwick's sign - bluish discoloration of the cervix, vagina, and labia ( must rule out cancer) 3. Fetal movement |
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What are the positive signs of pregnancy?
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Ultrasound shows fetus
Xray shows fetus Fetal heart tones |
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What do pregnancy test "test" for to have a positive pregnancy result?
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BhCG (Beta sub-unit of Human Chorionic Gonadotropin) found in blood/urine, usually detectable only during pregnancy and levels rise after implantation
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When are serum tests ordered for BhCg?
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High risk pregnancies ---levels usually rise in a predictable manner
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What can alter the BhCG test?
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ectopic pregnancy and miscarriages
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At what age do you offer genetic screening of the NB?
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35 yrs of age of mother
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what are some ways to establish EDC?
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Crown Rump length of the fetus, BPD and femur length comparison
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Why is it important to get the BPD earlier in the pregnancy rather than later?
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BPD can be accurate up to +/- 7 days if taken at 16-18 weeks, but +/- 4 weeks toward end of pregnancy
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AT what point is a baby considered to term?
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38+ gestational wekks
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AT what point is a baby considered preterm?
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20-37 gestational weeks
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explain the acronym TPAL
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T-erm
P-reterm A-bortion (any pregnancy ended prior to 20 weeks) L-iving today |
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Translate the following TPAL Score:
G1 P0000 |
1st pregnancy, no term, no preterm, no abortion, none living
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Translate the following TPAL Score:
G1 P1001 |
1st pregnancy, 1 term, 1 living
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Translate the following TPAL Score:
G4, P3013 |
Pregnant 4 times, carried 3 to term, no preterm, 1 abortion, 3 living
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Translate the following TPAL Score:
G2 P1103 |
Pregnant 2 time, Carried 1 to term, 1 preterm, no abortion, 3 are living. Meaning she had twins and 1 lone baby.
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How much should the cardiac rate increase during pregnancy?
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10-15 BPM
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How much does the blood volume increase
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30-50%
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What is Vena cava syndrome?
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Hypotensive syndrome caused by supine position; fetus compresses IVC or pelvic veins causing low bp, sweatiness, and dizziness
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How do you prevent Vena Cava Syndrome?
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reposition---have mom lie on their sides
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what is the WBC of a pregnant woman?
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can go up to 12,000 (norm is 4-10,000)
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Why is the pregnant woman's blood hypercoagulable?
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Increased fibrin, fibrinogen, and clotting factors
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Why does the pregnant woman look anemic on lab exams?
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High amounts of plasma vs RBC volume, giving a false sense of anemia
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How does the respiratory system change during pregnancy?
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Progesterone causes respiratory enter to be more sensitive to C02, amount of air breathed/minute increases 40%, breathing is more efficient; less air in lungs after expiration, flaring rib margins noticeable, breathing is more diaphragmatic than costal
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How is the GI tract effected by pregnancy?
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Progesterone causes stomach to have less peristalisis and tone, there is decreased gastric activity due to less gastric acid and pepsin. This also results in increased constipation, hemorrhoids, increase in gallbladder disease, lowered albumin levels, and increased general edema, and heartburn.
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How is the urinary system affected by pregnancy?
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1. Enlarging uterus can compress ureters, increasing susceptibility to UTIs, GFR is increased due to increase blood flow and plasma in blood
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What do the following hormones do during pregnancy? Estrogen and progesterone
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Estrogen --aids in uterine develpment and ductal system of the breasts.
Progesteronee -- greatest role in pregnancy; stops uterine contractility, maintains endometrium, and increases glandular tissues in the breast |
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AT what point does the placenta make estrogen and progesterone independently of the corpus luteum?
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Only after the 1st trimesters does the placenta starts producing it's own hormones, till then the corpus luteum is the main producer of progesterone.
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What is the role of HPL (human placental lactogen)
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It is an insulin antagonist, increases amount of free fatty acids, decreases maternal metabolism of glucose
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What is the role of Relaxin?
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inhibits uterine contractility, decreases strength of contractions, softens cervix, remodels collagen
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Why does a mucus plug develop in the endocervical canal?
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the plug seals off the canal and protects it against bacterial infection from traveling up the cervix
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What is the goodell's sign?
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Cervix becomes soft --texture consistency of lower lip, usually is like tip of nose
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What occurs to the vagina during pregnancy?
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Increased secretion, thick white and acidic, which decreases bacterial infections but increases yeast infections.
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At what pt is when EDC can be calculated by Fundal height and why?
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if the fundus is palplabe at the umbilicus it is 20 weeks gestation, midpoint of all development.
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A large overgrowth and fishy smell is emanating from a pregnant woman's vagina, what might be the cause?
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Bacterial vaginosis or fetal malformation if large amounts
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What do high levels of MSAFP suggest?
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Neural tube defects, but has high rates of false positives
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What do low levels of MSAFP suggest?
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down syndrome
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What are the 3 specific psychological process that women go through when pregnant?
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1 TM: period of adjustment
2 TM: period of radiant health 3 TM: Period of watchful waiting |
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Describe the period of adjustment in the 1st TM
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There are feelings of disbelief and ambivalence, even if planned. Baby doesn't seem "real"/rejection, 1st TM discomforts of N/V, weight gain, baby is a secret, libido decreases
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Describe the period of radian health in 2nd TM
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By now the woman is free from discomforts, quickening occurs, very introspective, develop mothering identity, transition from care receiver to care taker, can be guild producing, libido increases
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Describe period of Watchful Waiting
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Mom is eager for NB's arrival, active, preparation for CB and parenthood, fears surface, anticipatory grief process of loss of specialness, physically uncomfortable, libido decreases
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What is Couvade syndrome?
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when a male partner identifies with the pregnant partner, s/s N/V, weight gain, this is normal and temporary
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How much weight gain should an average woman gain
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25-35 lbs
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How many calories should be increased for a pregnant woman?
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300 cal/day; 4 cal/gm from carbs and protein, and 9 cal/gm from fats
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Why is Folic Acid so important in a pregnant woman's diet?
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A low folic acid diet has been linked to neural tube defects, RDA should be 600 mcg/day via whole grains, legumes, shellfish, dark green leafy vegetables
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What is pica?
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Pica is the urge to eat food without any nutritional benefit, such as dirt, soap,. This can be caused by Fe deficency
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What occurs in involution?
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Involution is when the uterus returns to it's normal size, shape and position.
Size: equal to fruit basket pear Shape: upside down pear Position: back to be pelvic organ |
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Describe how the uterus decreases in size
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The uterine wall contracts. There is autolysis of the uterine cells, muscle fibers get smaller, protein from myometrial cells become reabsorbed
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What changes does the endometrial lining go through?
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1. Uterine contractions decreases the placental site t 1/2 predelivery size
2. Blood loss is controlled by compression of blood vessels, compression of the sinuses, and clot formation in vessels that supply the decidua |
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Why is there an increase of WBC in postpartum?
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WBC infiltrate placental site, blood vessels, an surrounding tissue as the uterine walls contract to prevent infection. The area begins to necrotize 3 weeks for placental site and 3 weeks for water attachment site.
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What is Lochia?
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Lochia is a type of blood flow almost like a menstrual period following delivery.
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What are the 3 types of lochia?
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Rubra, Serosa, and Alba
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Describe Lochia Rubra
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Lochia Rubra is produced 2-3 days post delivery. It is bright red in color, consisting of blood, mucus, and decidual particles, and celluar debris from placental site
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Describe Lochia Serosa
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Lochia Serosa is produced 3-4 days, less oozing lbood, more watery, pinkish-tan in color, involution of placental site continues, blood decreases, wbc and cellular debris predominate
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Describe Lochia Alba
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Lochia alba is produced by day 10, yellowish white to white in color, gone by end of 3rd PP week, or brownish mucoid discharge for a few days
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If you see early Post partum hemorrhage what might you suspect?
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If seen with the first 24 hours, early PPH can be an indication that there might have been genital lacerations and retained placenta
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If you see Late Post Partum hemorrhage what might you suspect?
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This is seen after the first 24 hours, this is probably a retained placenta
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How do you do a fundal assessment post partum?
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1. support base of uterus with one hand
2. massage fundus straight down towards spine 3. note passage of clots, retained placenta, pieces of amniotic sac 4. reassess position and firmness of uterus |
