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88 Cards in this Set

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What is the most important safety measure for baby who is having phototherapy?
What is the most important safety measure for baby who is having phototherapy?
- Maintain eye masks over newborn’s eyes (answer)
- Keep newborn undressed, place surgical mask over male genitalia
- Given to babies with Hyperbilirubinemia
What is first thing you would notice on a baby with hydrocephalus?
What is first thing you would notice on a baby with hydrocephalus?
- Increase in head circumference
- Measure the infant’s head circumference daily
- Frequently reposition the infant’s head to prevent sores
- Assess the infant for signs of increased ICP such as vomiting and a shrill cry
What is the Moro reflex?
What is the Moro reflex?
- Elicited by striking a flat surface that the infant is on, or allowing the head and trunk of an infant in a semi-sitting position to fall backward to an angle of 30 degrees
- Infant’s arms/legs extend symmetrically, then abduct, fingers spread to form a “C”
Newborns with Galactosemia, what are they unable to metabolize?
Newborns with Galactosemia, what are they unable to metabolize?
- Inability to metabolize galactose into glucose
- Inability to metabolize galactose into glucose which may cause failure to thrive, cataracts, jaundice, cirrhosis, sepsis, and mental retardation if not treated
- If a galactosemic infant is given milk, unmetabolized milk sugars build up and damage the liver, eyes, kidneys, and brain
- Give infant a milk substitute because galactose is present in milk
- DX for Galactosemia – Blood/urine levels for galactose
When doing the Phenylketonuria (PKU) newborn screening, what are we trying to prevent?
When doing the Phenylketonuria (PKU) newborn screening, what are we trying to prevent?
- Mental retardation
- Phenylketonuria (PKU) – defect in protein metabolism leading to accumulation of amino acid phenylalanine which causes mental retardation
- Provide special synthetic formula
- Restrict meat, dairy products, diet drinks, protein, and aspartame
- DX for PKU – Guthrie test
You are checking the mouth of a newborn, what are you assessing for?
You are checking the mouth of a newborn, what are you assessing for?
- Cleft Palate
- Cleft palate/lip – failure of the lip or hard or soft palate to fuse
- Determine the most effective nipple for feeding
- Feed infant in upright position, feed slowly, burp frequently, cleanse mouth with water after feedings
When putting your finger in the baby’s mouth, what reflex are you checking for?
When putting your finger in the baby’s mouth, what reflex are you checking for?
- Sucking reflex- begins when a nipple or finger is placed in the mouth of a newborn
What is the rooting reflex?
What is the rooting reflex?
- Rooting – when the cheek of a newborn is stroked, newborn will turn head in direction of stroke; they are hungry
Preterm infants, what is the number one priority?
Preterm infants, what is the number one priority?
- Respiratory Distress Syndrome (RDS) - due to decreased surfactant
- Occurs as a result of surfactant deficiency in the lungs
- Surfactant assists in alveoli expansion
- Characterized by poor gas exchange and ventilator failure due to atelectasis leading to respiratory acidosis and hypoxemia
- ABGs show hypercapnia (increase in CO2)
- Birth weight is not an indicator of fetal lung maturity
- Risk factors that contribute to RDS: decreased gestational age (preterm)
- Complications from RDS are related to oxygen therapy and mechanical ventilation:
- Pneumothorax
- Pneumomediastinum
- Retinopathy of prematurity
- Bronchopulmonary dysplasia
- Infection
- Intraventricular hemorrhage
- Monitor respiratory rate > 60/min, labored breathing, intercostal and substernal retractions, rales, nasal flaring, expiratory grunting, cyanosis
- Monitor pulse oximetry, nutrition, VS, and IV
- Suction as needed, provide mouth and skin care, maintain thermoregulation, decrease stimuli
- Correct respiratory acidosis with ventilator, correct metabolic acidosis, with sodium bicarbonate, maintain adequate oxygenation
- Provide emotional support for the parents
With circumcision, we are concerned about what?
With circumcision, we are concerned about what?
- Worried about bleeding
- Monitor for bleeding every 15 min x 1 hour, then every hour x 24 hour
When there is an injury to the head, what is of most concern?
When there is an injury to the head, what is of most concern?
- Swelling
Is lanugo more likely with post term or preterm newborn?
Is lanugo more likely with post term or preterm newborn?
- Preterm
- S/S of Preterm – thin, smooth, shiny or translucent skin, visible veins, lanugo, minimal creases in soles/palms
Is vernix caseosa more likely with post term or preterm newborn?
Is vernix caseosa more likely with post term or preterm newborn?
- Preterm
- Vernix caseosa – more obvious in creases and folds
What are the Post term infant characteristics?
What are the Post term infant characteristics?
- Rugae on scrotum
What are the Preterm infant characteristics?
What are the Preterm infant characteristics?
- Lanugo (hair that covers the baby)- over shoulder, pinnas, and forehead
- Vernix caseosa(substance that coats baby’s skin)- more obvious in creases and folds
- Undescended testicles, few scrotal rugae
What does sparse mean?
What does sparse mean?
- Thinly dispersed or scattered
What does scanty mean?
What does scanty mean?
- Small or insufficient in quantity or amount
- limited or less than sufficient in degree, quantity, or extent
What are we checking for in hydrocephalus?
What are we checking for in hydrocephalus?
- Measure the Head circumference
Are these normal or abnormal finding in a newborn?
Are these normal or abnormal finding in a newborn?
- Bluish discoloration (acrocyanosis) NORMAL
- Vernix on the groin NORMAL
- A scrotum with numerous rugae NORMAL
- Umbilical cord with one artery and one vein ABNORMAL (umbilical cord has 2 arteries and one vein)
What is an indication of a POSTTERM newborn?
What is an indication of a POSTTERM newborn?
- Peeling, cracked, dry, leathery skin, long, thin body
- Wasted appearance, thin with loose skin
- Lots of creases on feet
What is an indication of a Preterm newborn?
What is an indication of a Preterm newborn?
- Soft pliable ear cartilage
- Legs in frog-like position
What abnormal finding would you report to the doctor?
What abnormal finding would you report to the doctor?
- Report any discoloration like jaundice
- Hyperbilirubinemia - Elevation of serum bilirubin levels resulting in jaundice
- Jaundice appears in a cephalocaudal manner, first being noticed in the head and progresses down the thorax, abdomen, and extremities
Are you going to report:
- Heart Rate of 92 –
- Weight of 4 pounds –
- Head of circumference - 20 cm or inches –
- Chest circumference of 13 inches -
Are you going to report:
- Heart Rate of 92 – Yes
- Weight of 4 pounds – Yes
- Head of circumference - 20 cm or inches – Yes
- Chest circumference of 13 inches - NO
Perimeters for Newborn (Normal):
Perimeters for Newborn (Normal):
- Weight 2,500 to 4,000 grams (5.5 to 10lbs), same time daily
- Length- 45to 55cm (18 to 22 inches), top of head to heel
- Head circumference- 32 to 36.8 (12.6 to 14.5 inches) at level of infants eyebrows
- Chest circumference- 30 to 33 cm (12 to 13 inches) at the nipple line
Normal newborn, 39 weeks gestation, do you want a positive or negative Babinski reflex?
Normal newborn, 39 weeks gestation, do you want a positive or negative Babinski reflex?
- Positive
- Babinski – when the sole of the foot on the side of the newborn’s small toes is stroked upward, the toes will fan upward and out
- Positive Babinski – abnormal in adults
What are normal skin deviations?
What are normal skin deviations?
- Milia – Small, raised white spots on the chin, nose, and forehead that disappear spontaneously
- Mongolian spots – frequently present on dark skinned infants
- Epstein pearls
- Telangiectatic nevi (stork bites) – flat pink or red marks on neonates upper eyelids, back of neck and middle of forehead
- Nevus flammeus (port wine stain) – capillary angioma
- Erythema toxicum (neonatorum) – Pink rash during first 3 weeks of life
- Cephalohematoma - (ABNORMAL)
What is the reflex of the baby when they want to eat?
What is the reflex of the baby when they want to eat?
- Rooting- when the cheek of a newborn is stroked, newborn will turn head in direction of stroke
Is calf pain normal?
Is calf pain normal?
- No
- DVT- unilateral calf tenderness, welling, extremity coolness and pallor
- S/S of Thrombophlebitis: Tenderness, pain, heat, increased extremity diameter, low grade fever and chills
- Superficial – localized redness and an enlarged, superficial hardened vein
At what phase does the mother accept neonate as a separate individual?
At what phase does the mother accept neonate as a separate individual?
- Letting-go phase:
- Client assumes her position at home and her new maternal role, views infant as individual
- Focuses on the forward movement of the family as a unit
- May reassert relationship with her partner and resume sexual intimacy
- Increased demands of home and newborn care may lead to mild depression
What is the taking-in phase?
What is the taking-in phase?
- Begins immediately after birth, lasts a few hours to a couple of days
- Passive-dependent behavior, relies on others to meet needs for comfort, rest, closeness, and nourishment, looks at infant
- Focuses on her own needs and is concerned about the overall health of her newborn, excited, talkative, repeatedly reviewing and talking about labor and birth experience
What is the taking-hold phase?
What is the taking-hold phase?
- Begins in the 2nd or 3rd postpartum day and lasts 10 days-several weeks
- Woman’s focus is on asserting her independence in competently caring for her newborn, kisses, embraces, cares for infant
- May verbalize anxiety about exhaustion, feelings of incompetence in new role
- Needs nurturing and acceptance, may experience postpartum blues
What are s/s of cystitis (UTI)?
What are s/s of cystitis (UTI)?
- Inflammation of bladder and urethra
- Monitor for S/S of UTIs: urgency, frequency, dysuria, retention, hematuria, pyuria, suprapubic pain, costovertebral angle pain, fever, chills, malaise, cloudy, blood tinged, malodorous urine
- Fundal height above umbilicus or baseline level, fundus displaced from the midline over to the side, bladder bulges above the symphysis pubis, excessive lochia, tenderness over the bladder
What do you suspect when patient has an infection, for example fundal or uterine infection?
What do you suspect when patient has an infection, for example fundal or uterine infection?
- Pain from the abdomen
Patient has mastitis. What is the IMMEDIATE treatment?
Patient has mastitis. What is the IMMEDIATE treatment?
- Encourage use of ice packs or WARM packs, especially on affected side
Patient breasts are engorged. What would be the best intervention for the patient?
Patient breasts are engorged. What would be the best intervention for the patient?
- Encourage early demand breastfeeding for lactating mother to reduce engorgement
- Feed the baby!!!!!!!
Are you going to report a mother’s temp of 99.2?
Are you going to report a mother’s temp of 99.2?
- no – it’s dehydration – hydrate (give fluids)
What would be important problems to report?
What would be important problems to report?
- Redness and bleeding on breast 9 days out
- Systolic B/P of <90
What are the positive signs of bonding?
What are the positive signs of bonding?
- Eye to eye contact, cuddling
- Facilitate bonding process by placing infant skin to skin with the mother
- Encourage parent to cuddle, feed, diaper, and inspect the infant
- Provide quiet, private environment to enhance bonding process
- Praise support and reassure the mother
- Encourage the mother/parents to discuss feelings, fears, and anxieties
- Bonding and attachment describe the emotional process where parents come to love and accept their child and the child comes to love and accept the parents
What causes afterpains?
- Pain after breastfeeding
What causes afterpains?
- Pain after breastfeeding
Why do we encourage patient to do Kegal exercises?
Why do we encourage patient to do Kegal exercises?
- To strengthen perineal muscles
Elevation of temperature (low grade) due to dehydration after labor during the first 24 hours
Elevation of temperature (low grade) due to dehydration after labor during the first 24 hours
- Encourage fluid intake
Do wash the nipple with soap and water?
Do wash the nipple with soap and water?
- No
What should you teach a patient who is breasting feeding?
What should you teach a patient who is breasting feeding?
- Encourage supportive, well fitting bra
Assist client into comfortable position for breastfeeding
Assist client into comfortable position for breastfeeding
- Stroke infant’s lips with nipple, infant takes in part of areola and nipple, not just nipple tip
Does Oxytocin cause the Let-Down reflex?
Does Oxytocin cause the Let-Down reflex?
- Yes
What process causes engorgement?
What process causes engorgement?
- Breast engorgement occurs due to lymphatic circulation, milk production, and temporary vein congestion due to VASODILATION
What helps relieve pain with episiotomies?
What helps relieve pain with episiotomies?
- Apply ice packs
On the 10th day is there a palpable fundus?
On the 10th day is there a palpable fundus?
- No
- By ten days postpartum, the uterus lies within the true pelvis and should not be abdominally
How fast does the uterus move?
How fast does the uterus move?
- Fundal height steadily descends into the pelvis approximately 1 fingerbreadth (1cm) per day
- Starts at the Umbilical
- Lasts 6 weeks
What would you expect to see within an hour of full term baby?
What would you expect to see within an hour of full term baby?
- Expect to see a firm uterus at the level of the umbilicus
Second postpartum, what will the discharge look like?
Second postpartum, what will the discharge look like?
- Rubra (bright red discharge)
- Last 1-3 days after delivery
What is the sequence for LOCHIA?
What is the sequence for LOCHIA?
- RUBRA – Bright red color, bloody consistency, fleshy odor, may contain small clots, transient increase during breast feeding and upon rising, lasts 1-3 days after delivery
- SEROSA – Pinkish brown color, serosanguineous consistency, contains old blood, serum leukocytes, and tissue debris, lasts from appoximately day 4 to day 10 after delivery
- ALBA – Yellowish, white creamy color, fleshy odor, contains leukocytes, decidua, epithelia cells, mucus, serum, and bacteria, lasts approximately day 11 up to and beyond the 6 weeks postpartum
4TH stage of labor, what is the pt at risk for?
4TH stage of labor, what is the pt at risk for?
- Hemorrhage - bleeding
If the fundus is displaced, what do you ask the patient to do?
If the fundus is displaced, what do you ask the patient to do?
- Void, empty bladder
To prevent hemorrhage of the uterus what do you do?
To prevent hemorrhage of the uterus what do you do?
- Massage the uterus
When do you massage the fundus?
When do you massage the fundus?
- When it is boggy
How long does postpartum last?
How long does postpartum last?
- 6 weeks
What do you see with Holman's sign?
Dorsiflexion
S/E of breastfeeding?
S/E of breastfeeding?

- After Pains (Uterine Contractions)
S/S of dehydration?
S/S of dehydration?

- Tachycardic, Low grade fever
- give fluids
Don't teach patient to have baby just grab end of nipple
Don't teach patient to have baby just grab end of nipple
Let down reflex?
Let down reflex?

- Responsible for milk in 2-3 days
Why is pericare important after delivery?
Why is pericare important after delivery?

- To prevent infection
What do you do if uterus is off to one side?
What do you do if uterus is off to one side?

- Bladder is full
- Catheterize
Puerperium lasts for how long?
Puerperium lasts for how long?

- 6 weeks
Risk bladders full and bleeding
Risk bladders full and bleeding

- Hemorrhage
When is milk produced?
When is milk produced?

- 2-3 days after delivery of the infant
- Let-down affect
With Uterine atony?
With Uterine atony?

- Make sure bladder is empty
Risk factors for DIC?
Risk factors for DIC?

- Abruptio placenta, amniotic fluid embolism, missed abortion, fetal death in utero, severe preeclampsia or eclampsia, septicemia, cardiopulmonary arrest, hemorrhage, hydatidiform mole
S/S of pulmonary Embolus:
S/S of pulmonary Embolus:

- Dyspnea, tachypnea, cough, hemoptysis, pleuritic pain, murmurs, right sided heart failure, peripheral edema, distended neck veins, fever, chills, hypotension, apprehension
Mouth (first) and nose must be cleared of excess secretions upon delivery of the head
Mouth (first) and nose must be cleared of excess secretions upon delivery of the head
What is newborn circulation?
What is newborn circulation?

- Readjustment of atrial pressure in the heart
How does baby lose heat?
How does baby lose heat?

- Baby loses heat through conduction, convection, evaporation, and radiation
Neonatal morbidity and mortality are related to gestational age and birth weight
Neonatal morbidity and mortality are related to gestational age and birth weight
Is cephalohematoma abnormal?
Is cephalohematoma abnormal?

- YES
- Blood between periosteum and skull
Why do we give erythromycin eye drops?
Why do we give erythromycin eye drops?

- To prevent blindness in baby's with gonorrhea
Cleft mouth, check for cleft palate
Cleft mouth, check for cleft palate
What is a protruding tongue a sign of?
What is a protruding tongue a sign of?

- Down syndrome
When is a circumcision contraindicated?
When is a circumcision contraindicated?

- When hypospadias or epispadias is present
S/S of cold stress
S/S of cold stress

- Cyanotic trunk, depressed respirations can lead to hypoxia, acidosis, and hypoglycemia, avoid infant heat loss
S/S of hypoglycemia?
S/S of hypoglycemia?

- Jitteriness, irregular respirations, cyanosis, weak high pitched cry, lethargy, twitching, eye rolling, seizures, BS <40, give oral glucose or formula immediately, have mother breastfeed
What is a failure to gain weight called?
What is a failure to gain weight called?

- Failure to Thrive
Birth weight is not an indicator of fetal lung maturity
Birth weight is not an indicator of fetal lung maturity
Baby with Respiratory distress syndrome?
Baby with Respiratory distress syndrome?

- Provide emotional support for the parents
Untreated Hypoglycemia causes?
Untreated Hypoglycemia causes?

- Mental retardation
Kernicterus (bilirubin encephalopathy) can result when bilirubin levels are at or > 25 mg/dL can cause cerebral palsy, epilepsy, or mental retardation
- May require and exchange transfusion
Kernicterus (bilirubin encephalopathy) can result when bilirubin levels are at or > 25 mg/dL can cause cerebral palsy, epilepsy, or mental retardation
- May require and exchange transfusion
During phototherapy, maintain eye mask over newborn's eyes to prevent inflammation and injury
During phototherapy, maintain eye mask over newborn's eyes to prevent inflammation and injury
S/S of Hydrocephalus?
S/S of Hydrocephalus?

- Excessive spinal fluid accumulation in the ventricles of the brain causing the head to enlarge and the fontanels to bulge: sunsetting sign is common in which the whites of the eyes are visible above the iris