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251 Cards in this Set
- Front
- Back
- 3rd side (hint)
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In the GTPAL format what is G?
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The number of pregnancies
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The number of pregnancies carried to term eg, at least 37 wks
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T of GTPAL
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In the GTPAL format what is P?
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The number of pregnancies carried to preterm eg, between 20-37 wks
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The number of abortions or miscarriages
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A In the GTPAL format
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In the GTPAL format what is L?
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The number of children living at the time of the question
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Parity in the G/P system means?
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The # of x's the uterus has been emptied eg, If mom carried twins it only increases parity by 1
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ELISA technology, RIA, radioreceptor assays, latex agglutination, serum & urine
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Types of technologies used for pregnancy test
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r128c212
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Latex agglutination, radio receptor assay, and radioimmunoassay (RIA) tests are used to dectect hCG during early gestation but are not part of ___ tests.
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OTC
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What is the G in G/P?
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Gravida is the # of pregnancies, not fetuses, she has had
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c210
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# of pregnancies, not fetuses, mom has carried for at lest 20 wks.
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P (para) in G/P
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c210
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Where are serum and urine pregnancy tests performed?
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Clinics, offices, women's health centers, and lab settings
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c212
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ELISA is used for ___ pregnancy tests.
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Over the counter
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Instructor's info
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If a woman pregnant only once gives birth at week 35 and the infant survives, the GTPAL score is?
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10101
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c211
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The uterus may be palpated above the symphysis pubis sometime between the ___ & ___ wk of pregnancy.
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12th & 14th
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c213
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The uterus rises to the level of the umbilicus at ___ to ___ wks of gestation.
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22 & 24
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c213
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The uterus nearly reaches the xiphoid process at ______.
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term
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c213
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Between 14-20 wks the pulse increases ___ - ___ BPM and continues until term.
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10-15
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Instr info
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During pregnancy on ascultation you may hear splitting of ___ & ___.
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S1 & S2
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instr info
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During the 1st trimester BP is __ as pre-pregnancy, but gradually __ to 20th wk.
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the same, decreases
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During the 2nd trimester the systolic/diastolic BP ___ about ___ mm hgb.
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decreases, 5
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It's normal for the term mom to have a slightly ______ BP than before pregnancy
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lower
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The # of RBC ______ during pregnance
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increase
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In the musculoskeletal system there is an ______ in the lumbal sacral curve, also known as ______.
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increase, lordosis
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Mom's trying to compensate for the extra wt. Center of gravity is shifted forward
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Preg mom a has __ in muscle tone in her joints, esp in her pelvis, resulting in pain in her __ & her ___ may ache d/t changes in estrogen/relaxin.
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decrease, hips, back
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In early preg mom has prob w __ & __, she may lose ___, and her BS may ______ bc shes not eating as much
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N/V, wt, drop
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Motility of the gut is ______ during preg so mom may hv prob w ______.
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decreased, constipation
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______ may be hard to diagnose in preg bc the appendix is moved upward & laterally, high & to the right, away from McBurney point
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Appendicitis
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c226
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At 5 mo the preg mom w appendicitis may feel pain at the right side latteral to the ___
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umbilicus
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c226fig10-15
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Between 14 - 20 wks, the P increases __ - __ bpm, and persist till term
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10-15
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c218
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Sinus arrhythmia, premature atrial contractions, and premature ventricular systole.
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Things a preg mom may experience
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c218
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A pulse of __ bpm or greater is a concern for the mom.
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100
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Arterial BP (brachial artery) __ w age; activity level; presence of health prob; circadian rhythm; & use of alcohol, smoking & pain.
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varies
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c218
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Fetal heartbeat auscultated with Doppler/fetoscope; ultrasonography
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represents positive signs of pregnancy
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When assessing the (FHR) of a mom at 30 wks, the nurse counts a P of 82. Initially the nurse should:
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Notify the physician.
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Is this (HCT 33% ) (HGB 11 g/dl) result represent a low but acceptable value for a mom in the 3rd trimester of pregnancy?
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Yes
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The __ should be audible by 20 weeks with standard fetascope
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FHR
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Contract ≥10 min, Vigina leaking fluid/blood, Pelvic pressure push↓,Cramps feel like period; dull bckache; Abd cramps w or w/o diarrhea
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preterm labor
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S/S of preterm labor are x7?
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These contractions are not true labor pains bc they do not cause dilation/effacement of the cervix.
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Braxton Hicks contractions
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They are irregular & painless & occur intermittently throughout preg, and usually cease with walking or exercise
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Braxton Hicks contractions
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Nagele's rule is as follows:
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After determining the 1st day of the LMP, subtract 3 mo, add 7 days & 1 yr
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Or add 7 days to the LMP and count forward 9 mo
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According to Nagele's rule if the 1st day of the LMP was Sept 10th 2009, the EDB is?
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June 17th 2010
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Miscarriage, placental abruption, placenta previa Hormonal bleeding, Implantation bleeding
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Vaginal Bleeding - A danger sign in preg
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Miscarriage, ectopic pregnancy, abruption, cyst, uterine growth, ligament pain
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Pelvic or Abdominal Pain (A warning sign in preg)
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Miscarriage, preterm labor, Kidney/bladder infection, cyst, normal pregnancy pain are all danger signs of __.
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Persistent Back Pain
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Preterm labor, preterm rupture of membranes, miscarriage, Leaky bladder, watery mucous can be seen as a __.
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Gush of Fluid from Vagina (A danger sign in preg)
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Can indicate Pregnancy Induced Hypertension (PIH); Swelling
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Swelling of the Hands/Face ( A potential warning sign in preg)
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Severe Headaches, Blurry Vision
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PIH, Ecclampsia
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Causes of Regular Contractions prior to 37 Weeks (A potential warning sign in preg)
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Preterm labor; Gastric upset.
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Fetal distress, Fetal Demise, Slowed movements, anterior placenta
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No Fetal Movement - A potential warning sign in preg
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Observer, full partner, instrumental role, protector & supporter are a __ role in preg.
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mans
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c233
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Couvade syndrome eg, N/V GI complaints, fatigue, and other physical discomforts
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father's posible s/s
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c233
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During preg the __ often experiences a sense of loss or feels jealous at being replaced by the new baby.
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older child (Fear of losing his/her place in the fam hierarchy)
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c235
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Many cultural taboo's have to do with __ the mom and __ the baby.
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protecting, protecting
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What is the 1st NI if a preg mom has pallor, dizziness, faintness, breathlessness tachycardia, nausea, clammy (damp cool) skin?
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Position woman on her side until her s/s subside and VS stabilze WNL
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c243
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Female pt may prefer a female HCP, modesty needs, umbilical amulet use
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Cultural influences
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c259
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Regulate mom's emotional response, clothing worn, physical activity/rest, sexual activity, and dietary practices.
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Cultural prescriptions and proscriptions
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A cultural proscription establishes __.
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taboos
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Some stages a __ of a preg mom may go through are motivated to nurture/love a child, excited/pleased, and anticipation of his roll, or hostile of his roll
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father
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During preg a mom sees her dr __ during the 1st & 2nd trimester, __ at wk 28 & > __ at 36 & > wks.
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Every month, every 2-3 wks, every week
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An absolute SBP of __ mm Hg or more and a DBP of __ mm Hg or more suggest the presence of HTN.
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140; 90
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c243
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A SBP of __ mm Hg or more or a DBP of __ mm Hg or more in midpregnancy should be reported to the HCP
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125; 75
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c243
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A SBP of __ mm Hg or more or a DBP of __ mm Hg or more in later preg should be reported to the HCP
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130; 85
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c243
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A rise in SBP of __ mm Hg or more over baseline or a rise in DBP __ mm Hg over baseline should be closely monitored
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30; 15
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c243
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Good body mechanics, safety belts, shoulder harnesses, headrests, goggles, helmets are apart of __ safety edu.
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preg mom's
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c249
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No act requiring coordination, bal & concentration. Take rest periods; reschedule daily act to meet rest/relaxation needs
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Pt teaching during pregnancy
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c249r1335
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Citrus fruits, tomatoes, melons, and strawberries, and meats are high in __, and ↑ iron absorption.
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Vit C (During preg mom needs iron supplements most commonly.)
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c290
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Pt teaching during __: Read labels, adequate vent & clean air, gloves, properly rid wastes, no high altitudes
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Pregnancy
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c249r1335
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Bran, tea, coffee, milk, spinach, swiss chard, and egg yolk
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Foods tht decrease iron stores and should be avoided by preg mom
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c290
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__ is absorbed best if taken when the stomach is empty. Take b/t meals w liquid but not w milk, tea, or coffee.
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Iron
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Constipation is common with __ supplementation. A diet high in fiber w adequate fluid intake is recommended.
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iron
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__ supplements before preg will decrease the likelyhood that mom will have a neuro tube defect, cleft lip, and cleft palate.
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folic acid
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Pt teaching
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Wants to be slim, resist adult advice, less likely to get care, more likely to eat poorly - hv eating disorders. Best to give nutritional counseling.
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Adolescent pregnancy
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Mom needs to decrease fat intake to __ - __ lbs wkly.
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1 to 2
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m129
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Preg mom needs to have intake of calories of __ per day, __ per day for breast feeding moms.
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300; 500
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Calories m129
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Preg mom needs __ to __ glasses of fluid per day or __ - __ mls. Limit __.
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6 to 8; 1500-2000 mls (Water, milk, juice). Limit caffein - causes vasoconstriction
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Fluids m128
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Wt gain after the 1st trimester of less than __ kg/mo or a gain of more than __ kg/wk indicates nutritional risk in preg
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1; 1
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box 12-3
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Preg teens are more likely to deliver their babies __ or have a baby with __.
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premature; low birth wt.
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If you began pregnancy at a normal weight, you should gain __ - __ pounds over the nine months.
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25–35
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If u gain b/t1-4 ½ lbs in the 1st trimester, u should put on about 1 lb wkly in the 2nd & 3rd trimesters
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If you began pregnancy underweight, you should gain __ - __ pounds over the 9 mo
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28 - 40
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If u gain b/t1-4 ½ lbs in the 1st trimester, u should put on about 1 lb wkly in the 2nd & 3rd trimesters
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If you began pregnancy overweight, you should gain only __ - __ pounds over the nine months.
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15–25
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If u gain b/t1-4 ½ lbs in the 1st trimester, u should put on slightly over 1/2 lb wkly in the 2nd & 3rd trimesters
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Mom needs plenty of fluids b/c she can have dehydration resulting in muscle __ leading to __ .
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contraction/irritablilty; pre-term labor
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The avg baby weighs about __ lbs, or __ gms at birth. About 10 % of all babies weigh more than __.
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7; 4,000 grams (8 pounds, 13 ounces)
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LGA babies weigh more than __ % of all babies and are over __ lbs.
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90; 9
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AGA babies weigh between the __ - __ %. These babies can be __ term, term, or __ term.
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10 - 90; pre-; post-
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m172
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SGA babies falls < __ percentile of all babies and wt < __.
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10th; 2500 gms
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grams X 0.0022 = pounds
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Milti gestation, poor nutrition, maternal cyanotic heart disease, collagen diseases, diabetes w vascular prob
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Causes of infant IUGR
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r1615c707box9-3
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Prior preg w IUGR, HTN-Chronic or gestational; recurrent antepartum hemorrhage; smoking
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IUGR baby
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box 9-3
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Fetal infect; drug addiction & alcohol abuse; fetal congenital anomalies;Hemoglobinopathies
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Causes of IUGR
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box 9-3
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Conditions occurring in the 1st trimester eg, __, __, and __can affect all aspects of fetal growth.
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infections, teratogens, and chromosomal abormalities
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c734
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Extrinsic condtions early preg can result in symmetric IUGR eg, __, __, & __ are all < 10th percentile.
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circumference, length, and weight
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c734
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__ growth restriction → SGA, usually w a ↓head circumference & reduced brain capacity
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Symmetric
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c734
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Asymmetric growth restricion in later stages of preg (for gestational age, wt. will be < __, whereas length & head circumference will be >__).
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<10th percentile; >10th percentile.
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Infants with __ IUGR have the potential for normal growth and development.
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asymmetric
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c734
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__ are indicated: 4-6 mo. GI tract more mature; ↓potential for food allergies, begins tooth eruption; extrusion reflex gone; ↑swallowing, and head control
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solid foods
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m181
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1st mo ↑5-10ozs wkly; 2-3 mos ↑5-8ozs;3-6 mos ↑2.5- 4.5ozs; 6-12 mos ↑1-3ozs; min 3 stools qday → yellow mustard color day 5
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Indicate breast feeding mom is producing enough food for her baby
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Do we look at stools, voiding, baby acting full, wt gain?
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Photo therapy uses __ light to decrease the bilirubin levels in the newborn.
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florescent
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Uses fluorescent light to expose skin to enhance bilirubin excretion. The effectiveness is determined by the decrease in bilirubin.
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phototherapy
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hypo/hyperthermia; lose a lot of liquid, (note loose green stools) need skin care; provide fluid prn; cover genitals
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complications associated with phototherapy
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m167
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How does phototherapy change bilirubin so that the baby is able to excrete it?
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Makes it water soluable
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An attribute of physiologic jaundice, the infant is otherwise __ in relation to the cardiorespiratory & neurologic, carbohydrate metabolism, feeding pattern, & elimination.
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well
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c653-655
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1st appears after 48 hrs & disappears by the end of the 9th or 10th day.
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Attributes of physiologic jaundice in pre-term infants
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c654
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An attribute of physiologic jaundice, in preterm infants, jaundice is 1st evident after __ & disappears by the __.
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48 hrs; 9-10 day
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c654
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W physiologic jaundice, infant predischarge tot serum bilirubin <the high risk, __ on the hr- specific nomogram
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95th percentile
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c654
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In physiologic jaundice, the serum concentration of unconjugated bilirubin usually does not exceed __ mg/dl in term infants and __ mg/dl in preterm infants
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12 ; 15
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c654
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An attribute of physiologic jaundice, direct bilirubin does not exceed __ - __ mg/dl/day
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1-1.5 mg/dl/day
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c654
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An attribute of physiologic jaundice, indirect or unconjugated bilirubin concentration does not increase by more than __ mg/dl/day.
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5
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c654
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The level of serum bilirubin which, if left untreated → sensorineural hearing loss; cognitive delays,& Kernicterus (deposition of bilrubin in brain).
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Pathologic jaundice
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An attribute of physiologic jaundice, in term infants, jaudice 1st appears after __ and disapppears by the end of the __
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24 hrs; 7th day
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d/t Immature liver function; 2-3 days after birth; spreads head to toe - shows in sclera; TX: phototherapy, exposure to indirect sunlight
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Physiologic Jaundice
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m165
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Blood antigen incompatibility; lesions - brain (kernicterus); renal tubules, intestinal mucosa; pancreas; spreads head to toe; more rapid than physiologic
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Pathologic Jaundice
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m165
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Fine hair; lanugo (earlier delivery more lanugo); pilable earlobes w little/no cartilage, testes not descended, sml rugae on scrotum
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pre-term
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m168
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M: testes undescended, sml amt rugae on scrotum; F: libia majora sml; clitoris and/or meatus uncovered
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Characteristics of a pre-term baby
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m168
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Absent or poorly dev sucking, swallowing; flacid mus tone; scarf sign - elbow crosses midline
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pre-term baby
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m168
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Upper 2/3 or absent sole creases; <5.5 lbs or 2500 gms; <18 inches; relaxed posture, extended limbs
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pre-term baby
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m168
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Why do you give a baby surfactant, how does it work?
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Can't produce enough surfactant. ↑resp compliance -breathe easier (O2 & CO2 exchange improved).
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How do you give it?
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Stimulate surfactant in the type 2 cells of the aveloi
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The goal of surfactant adm
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TX for RDS is supportive. Adequate __ and __ must be established and maintained in an attempt to prevent ventilation-perfusion mismatch and atelectasis.
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ventilation and oxygenation
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c727
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Exogenous __, which alters the typical course of RDS, may be adm at or shortly after birth.
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surfactant
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c727
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Positive-pressure ventilation, CPAP (continuous positive air pressure), & oxygen therapy may be used during __ illness.
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respiratory
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c727
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Prone/supine; side lying → ↑drainage+avoids aspiration; no neck hyprextn bc → ↓air exchange; trendelenbrug → IICP + ↓lung capacity
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RDS NI
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Once recovered return to supine position.c728
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Nasopharynx, trachea, & endotracheal tube (if intubated) only prn. Over suctioning → bradycardia, hypoxia, & intraventiricular hemorrhage
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RDS interventions
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c728
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Percussion, vibration, & postural drainage only prn to facilitate drainage of secretion;
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RDS NI; RDS usually affects pre-term babies
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c728
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Supplemental oxygen NI w regards to RDS, adm O2 __, & __ neonatal response to maintain O2 sat.
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Adm O2 carefully & monitor neonatal response to maintain O2 sat
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c728
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Thermal interventions w regards to RDS are as follows:
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Maintain neutral thermal environment to conserve O2 & glucose use
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c728
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Monitor ABG's, acid-base bal, O2 sat, RR & pattern, breath sounds, airway patency; observe for grunting, nasal flaring, retractions, cyanosis a sign of respiratory distress
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RDS NI; sx appear at birth or within 6 hrs after birth
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c728;
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Hypotonia, pallor, apena, bradycard;↓activity,O2,perfusn;resp distress,hypotentn, temp instibility,cyanosis,tender abd, abd distention,V,bloody stool, arhythmia of abd wall
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NEC (necrotizing enterocolitis), a very dangerous disorder to have
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Placenta ages/calcifys; wide eyed; meconium aspiration; ↓amniotic fluid, vernix; no lanugo; wt loss; ↓subq fat
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S/s of posterm babies >42 wks gestation x8?
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m173
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S/s of __ babies; Dry, wrinkled, leathery skin; long finger/toe nails; M-pendulous scortum; F labia majora fully covered; Hypoglycemia
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posterm
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m173
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Wht is the most important NI in preventing neonatal infection?
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Wash hands and wear gloves
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How can mom pass HIV to her newborn?
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Through breast milk
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How can mom pass HIV to her unborn?
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Sharing a Blood Supply; Maternal circulation starting 1st trimester; During labor by inoculation/ingestion of blood & other fluids
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Avoid litter boxes & raw meat; Mom → fetus; TX: Maternal-spiramycin; Child-sulfadiazine, folic acid, pyrimethamine
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Toxoplasmosis
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m175
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Don't giv during preg; Cardiac disease; cataracts; IUGR; postnatal growth retardation; hear loss; purpura; fetal death
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Rubella
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m177
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Wash hands; antiviral agents for life to prevent sight loss; Mom may be asymptomatic but may not be
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Cytomegalovirus
|
m178
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Infection of skin, eye, mouth, liver, lungs, CNS; TX: acyclovir 10mg/kg/day, IV q8hrs for 14 days
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Herpes simplex
|
m178
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Prenatal screening for all moms; ↑risk of LBW; bathe child right after birth; xfer by placenta/blood & body fluids
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Hepatitis B
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GBS = strep m175; TX during labor, affects on newborn, edu of mom
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Immuno globuli; Immunization of newborn - 3 doses at birth, 1 mo, & 6 mo
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Hep B or HBV (hepatitis B virus)
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TX during labor, affects on newborn, edu of mom
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Who is at risk for Rh incompatibality and what are we going to do about it?
|
2nd fetus lysis of his/her blood cells due to mom producing antibodies; Rhogam 28 wks & birth of the Rh+ newborn.
|
c766-767
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Why are young kids more prone to tonsillitis, otitis media, upper respiratory tract infections?
|
The eustation tube is straighter and shorter; Immune sys is not developed
|
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Incubation 14-16 days to 2-3 wks; Contagious: 1 day before lesions erupt until 6 days after vesicles have formed crust
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Chicken pox
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m188
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Incubation: 14-21 days; Contagious: B/f and after swelling; virus present up to 7 days b/f &10 days aftr swelling
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Mumps
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m192
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Incubation: 10-20 days; Contagious: 4 days before rash till 5 days after
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Measles (Rubeola)
|
m193
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Fever/malaise, H/A, earache aggravated by chewing; parotitis w pain; submaxillary & sublingual infections, orchitis, meningitis
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S/s of Mumps
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m192
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|
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Fever, malaise, cough, conjunctivitis, Koplik spots (minute red spots w bluish-white center)
|
Measles (Rubeola)
|
m193
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Childhood immunization schedule for HepB #1?
|
birth
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Childhood immunization schedule for DTaP (Diphtheria, tetanus, pertussis)?
|
2mo, 4mo, 6 mo, 15-18 mos, 4-6 yrs
|
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Childhood immunization schedule Measles, Mumps, Rubella?
|
12-15 mos, 4-6 yrs or 11-12 yrs
|
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Immunization contraindications, avoid adm live-virus to children w __ immune system?
|
impaired
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Immunization contraindications, avoid if child is __
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allergic
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Immunization contraindications, avoid adm during __ illnesses.
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febrile
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Immunization contraindications, postpone for __ - __ mos in children who hv received passive immunity.
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3-7
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Immunization contraindications, avoid additional doses of live vaccines within __ days of prior
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30
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Deafness - conductive hearing loss; tympanic mebrane ruptures→ drainage, bulging or retracting tympanic membrane
|
S/s of Ottis Media
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The more infections a child is xposed to the more immunities acquired
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How does fluid in the ear affect the childs ability to hear?
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Fluid/pus may fill the middle ear space & affect the ability of the eardrum & the bones in the middle ear to move the way they normally do
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For recurring __ Myringotomy: Surgical incision of the eardurm to allow drainage of middle ear; Adenoidectomy
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ottis media
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Can hv a tonsillectomy after infection subsides, not b/f age 3-4; Adenoidectomy: assess hearing, smell & taste
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tonsillitis
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SIDS, why do we ask the child to be placed on its back?
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Prevents asphxia (CO2 rebreathing) while asleep
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Tubes remain in ear 6 mos b/f rejection of grommet (normal); dont take baths
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Patient teaching for myringotomy
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m203
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Place child on side; avoid coughing, clearing throat,red/brown fluids,straws, citrus juices, milk, ice cream, pudding; keep NPO til alert
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Tonsilitis NI (following surgery)
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SIDS, what are the complications of placing the child on its back?
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plagiocephaly (contorted head); torticollis (stiff neck)
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Inflammation of the tonsils, obstruction of airway, difficulty swallowing/breathing; child breathes through mouth
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Tonsillitis s/s
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Production of hCG begins __ - __ days after after conception in the blood but it can be done __ days after conception
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6-11; 4
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Home tests are accurate __ - __ days after missed period.
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6-9
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Felt by mother like quickening fatigue and breast changes
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presumptive
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Changes felt by the nurse ballottement - floating object in uterus, which can be felt during a baginal exam
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Probable
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Sx of pregnancy
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↑Vaginal discharge/becomes more acidic/thicker; more sensitive; vagina more vascular; feels more sexual; external structures enlarge; ↑risk for infection
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Signs of preg
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Bluish coloration evident around the fourth week of gestation from ↑esterogen
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Chadwick's sign
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Softening of lower uterine segment 6-8 wks which causes urinary frequency bc the uterus is laying on the bladder due to antiflexion
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Hegar's sign (Cervical changes during preg)
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Softening of the cervix usually after the 2nd mo eg, after 6wks
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Godell's sign (Cervical changes during preg)
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Easy flexion
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McDonalds sign (Cervical changes during preg)
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BP usually remains the same as prepregnancy, but will gradually decrease to 20 wks
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1st trimester
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SBP & DBP decrease 10 mm hg d/t vasodialation. Murmur abuible s1, s2
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2nd trimster
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For HTN put mom on her __
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back
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Nose bleeds, voice changes, earaches, and impaired hearing
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Changes in pregnancy
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Greater risk for __ bc fibrinogen is decreased and ↑risk for infection
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clotting (changes in pregnancy)
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↑risk of ___ bc the bladder capacity ↑ to 1500cc
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UTI (Changes during pregnancy)
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During pregnancy do not take __ bc it will cause hypovolemia, and ↑BUN & creatinine
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diuretics (changes during pregnancy)
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Carpal tunnel; acrosthesia (numbness/tingling of hands)
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changes in pregnancy
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Tension HA (light headedness d/t BP changes & glucose level; Hypocalcemia (mus cramps or tentany)
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changes in pregnancy
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__ problems are common bc empting time increase
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Gallbladder (changes in pregnancy)
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Sharp stabbing pain is __ bc moms ligmanents are stretching
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Normal (changes in pregnancy)
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↑HR in 3rd trimester; Occasional palpitations; At 20 wks audible murmur over the pulmonic area & s1/s2 split
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CV (changes in pregnancy)
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Mom needs more calcium & vit D; She can be slightly hypoglycemic
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Changes in pregnancy
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Regular, frequent, and hard contractions; Bloody spotting, or fluid leaking
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Labor contractions
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Lay dow on side and place pillow b/t legs. Count contractions from beginning of one → beginning of the next
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How to determine type and intensity of contractions
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Irregular and sporadic contractions more than 10 min apart
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Braxton hicks
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Sympathy pains
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father's reaction
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2yrs "mommy is fat"; 3-4 ask for story of their beginning, listen to heart beat & feel baby moving, ask wht baby will ware and be fed
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What child might ask
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Mom can pratice deep breathing, foot circling, and alternately contracting and relaxing different muscle group
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Mom's activities during work and travel
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Preg mom flying is not recommended after __ wks
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36 (or if high risk)
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How long can preg mom sit in a car?
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Stop and walk every hr
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How often should preg mom be moving around to get circulation moving in her legs?
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15 min walk each hour to prevent thrombi
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Ideally mom should go to the doctor b/f preg and start folic acid supplements to decrease likelihood of her baby having neural tube defects
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When do we want to start talking to mom about nutrition
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The mom ad baby are competing for nutrition
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The teenage pregnant mom
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The expected wt gain for mom carrying multiples is __ - __ kgs.
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16-20
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Causes include smoking, malutrition, HTN, multiple pregnancies
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SGA
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Pneumothorax, aspiration, and hypoglycemia are common bc they don't have the fat store to work off of
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SGA
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Commonly delivered by diabetic mom's.Frequently delivered by c-section & hv amniotic fluid aspiration which can → resp distress
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LGA
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Infants whose growth rate does not meet expected growth pattern
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IUGR
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Extrinsic conditions can result in __ eg, head circum, length & wt are < 10th %
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IUGR
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The baby usually has a smaller head circum and reduced brain capacity.
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IUGR eg, SGA
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Growth restriction in latter stages stages of preg, as a result of materal/placental factors → __
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asymmetric growth restriction
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Wt. < 10th% while length & head circum >10th%. These babies hv potential for normal growth/development
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asymmetric growth restriction
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Common prob affecting these infants: perinatal asphyxia, meconium aspiration, immuno-deficiency, hypoglycemia, & polycythemia, temp instability
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asymmetrical growth restricted babies
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To measure __ milk, mom has to use pump & place in bottle ( inconvenient)
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breast
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Usually require 8-12 feedings in a 24 hr period.
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Infants. Teach mom she should awaken infant ≥ q3hrs during the day & ≥ q4hrs nightly
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≥ (means at least in this case)
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Avg feeding time is 20-30 or approx 15 individually. Varies depending on the two's dynamics
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Breastfeeding for baby
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Teach mom to look for behavior of contentment or sleepiness; 1st 24hrs after birth should hv ≥ 1 wet & 1 stool diper
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How to know breastfeeding mom is producing enough milk for baby
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By day 3, 3-4 wet diapers & 1-2 stools (meconium →yellow); >4th day mom's milk's come in, 6-8 wet diapers & ≥ 3 stools q24hrs
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How to know breastfeeding mom is producing enough milk for baby
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> (means after in this case)
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At birth a wt loss of 7% is normal. 7-10 days transitional milk comes in & mature milk > 2wks (20cal/ox + nutrients meets infants needs)
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How to know breastfeeding mom is producing enough milk for her baby
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Monitor: T, ↓fluid, dehydration, stools, rash, cardio & resp, retina (baby should ware eye patch)
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Phototherapy. Don't give glucose. The buttox will need to be cleaned to protect integrity.
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dehydration d/t insensible water loss; stools (motility will ↑); a maculopapualr rash can appear; cardio/resp bc blue light makes it hardr to detect color of baby
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The appearence of jaundice during the 1st 24hrs of life or persistence > WNL indicates potential __ process and requires further investigation
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pathologic
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This is 1st noticed at head eg, sclera, mucous membranes → thorax, abd, extremities. Will pregress more rapidly that the pathologic form
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Jaundice
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Can be identified by blanching the skin, inspection of the sclera and mucous membranes, and by dark concentrated urine
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Jaundice
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F: labia majora sml, clitoris and/or meatus uncovered; Reflexes- sucking/swallowing absent/poorly dev; May need IV or gavage feedings
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preterm baby
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Muscle tone-flaccid whn u lay the baby down, all aprts of the body touch the mattress (sprawled out)
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pre-term
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Can a larg baby be preterm?
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yes
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Head large in relation to body. Lack of subq fat
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preterm babies. should get subq fat in third trimester
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Babies born < 32 wks do not have adequate amts of pulmonary __ to survive extrauterine life.
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surfactant
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Improve resp compl; breathe easier; preterm not able to produce enough on their own; helps lungs work better; Helps O2 CO2 exchange
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surfactant
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Without __ infants are unable to keep their lungs inflated and breaths take ↑effort→exhaustion/atelectasis
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surfactant
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Crackling, poor air exchange, pallor, use of accessory mus (retractions), occasionally apena, ↑O2 requirement/resp effort eg, atelectasis, ↓ functional residual capacity
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RDS
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Tachypena, grunting, nasal flaring, intercostal/subcostal retractions, hypercapina, resp or mixed acidosis, hypotension, and shock
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RDS
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Adequate vent & O2 established/maintained; exogenous surfactant; pos press vent; CPAP, & O2 therapy as needed
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Tx for RDS
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Cough w/wo sputum; rhonchi tachypnea, fine crackles, dullness percuss, retractions, nasal flaring, pallor to cyanosis, irritable, restless, lethargic; V; diarrhea, anorexia
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Sx of pheumonia
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p1324
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Antibiotic if bacterial, antipyretic therapy, assess of resp sys, hydration, suppl O2, suctioning to maintain patency
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Tx of pneumonia
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An inflammatory disease of the GI mucosa
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Necrotizing enterocolitis (NEC)
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Most common infants wt < 2000gms. GI compromise eg, ↓blood supply, death to mucosal cells, bowel lining; r/t sepsis, hypoxia, or after exchage xfusion
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NEC
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Lethargy, V, distended shiney abd, bloodly stools, absent bowel sounds
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NEC
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NC suction, NPO, IV fluids, electrolytes, fix hypoxia, antibiotics, severe damage may indicate colonostomy or ileostomy
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Tx of NEC
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Long think body d/t placenta clacifying and the baby becoming mal nurished, green tinged finger nails
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post-term baby
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Aspiration pneumonia, intrauterine hypoxia, HTN, hernias, septsis, and PPHN. Remove suction bccan cause mech obstruction → MAS
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S/s of Postterm babies
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PPHN Persistent pulmonary hypertension of the newborn
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Can cause preterm birth, growth retardation, microcephaly, hydrocephaly, jaundice, fever, visual problems
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Toxoplasmosis
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Multisystem disease caused by protozoan toxoplasma gondili. Diagnosis is done by an elevated blood serum Igm.
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Toxoplasmosis
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Don't get preg util 3mos aftf vaccine. Place mom on contraception for 1 mo after vaccine. Check for egg allergies. Get informed concent
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Rubella
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IUGR, jaundice, purpura, heptospleenomegaly, seiures, microcephally, intracelebral calcification, chorioretinitis, and hearing loss
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S/s of Cytomegalovirus
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Localized infection: skin, eyes, mouth; Generalized infection: liver, lungs and CNS
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Herpes virus (Cytomegalovirus)
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Low grade fever, irritability, restlessness, sneezing, diarrhea, V, HA, sore throat, cough, dysphasia, anorexia, abd pain
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URI (upper respiratory infection)
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dysphasia - Impairment of speech resulting from a brain lesion or neurodevelopmental disorder. The speech impairment in dysphasia is less marked than the severe or global language loss found in aphasia
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Caused by Varcella Zoster via resp secretions; Sx fever malaise, anorexia for 24hrs, rash
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Chicken Pox
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Provide warmth/local support w tight fitting underwear for orchitis; Bed rest, support, soft diet, hot/cold to neck
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Mumps
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Virus frm resp tract secreatn, blood, urine; Complications: otitis media, pneumonia, bronchiolitis, obstructive laryngitis, encephilitis
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Measles (Rubeola)
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Rubeola: rose-colored macular eruption.
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Immunizations w live viruses are contraindicated during __ bc of potential teratogenicity.
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pregnancy - measles (rubeola), rubella, chickenpox, and mumps are all contraindicated
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Tetanus, diphtheria, recombinant hep B, and rabies
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May be adm during pregnancy bc theay are killed viruses
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Rubella, and influenza
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Vaccines mom can hv during preg.
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__ are contraindicated if baby has anaphylactic reaction to vaccines and further doses are contraidicated w moderate or severe illnesses w or w/o fever
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Vaccines
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__ are not contraindicated w mild to moderate local reaction eg, soreness, redness, swelling after dose of inj antigen; mild acute illness w or w/o low grade fever
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Vaccines
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Most common disorder of young children tht is tx w antibiotics. Some concern ovr dev drug-resistant infection
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Otitis Media
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Caution against water entering middle ear→infection; prevent bath water frm entering ear; Notify HCP whn grommet dislodges aftr 6 mo
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Otitis Media pt teaching w regards to the tympanostomy tube
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lay on side, no coughing or clearing throat, inspect secretions & V; after alert giv cool water, crushed ice, popsicles, diluted fruit juice, provide ice collar
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Tonsillitis
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The prone position has bee associated w increased incidence of __.
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SIDS
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Studies __ show an increase in infant deaths, spiting up during sleep, aspiration, asphyxia, or resp failure as a result of sleeping supine.
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do not
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