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65 Cards in this Set
- Front
- Back
Prolactin
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Secreted by anterior pituitary gland. Promotes milk production
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Oxytocin
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secreted by posterior pituitary gland in response to infant sucking. Causes uterine contractions and let down reflex
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Engorgement
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seen 2-3 days after delivery. Breast full hard, painful and tender. May have temp.
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Mastitis
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2-4 weeks postpartum. Usually d/t cracked nipples/bacteria from infants mouth (staph Aureus) Poor hand washing/hygiene. can occur from stasis of milk. S&S: breast tenderness, redness, warmth, fever, chills, malaise.
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Involution
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Rapid decrease in size of uterus after birth d/t decrease in estrogen and progesterone. Pelvic organ within 10 dys.
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Patient with boggy uterus
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Massage. ASSESS VS AFTER MASSAGE. May start methergine or pitocin to enhance contractions.
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Methergine
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stimulates muscle contraction and causes vasoconstriction. Dose 0.2mg PO or IM q4hrs.
SE: HTN, cramps, N&V, H/A, bradycardia and dizziness. |
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Lochia
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Volume=approx 225ml. Amount will decrease daily.
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Lochia amounts
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light-<4" stain on pad in 1hr.
moderate-<6 stain on pad in 1hr. 6-8 pads per day. heavy/severe->6 or saturation in 1hr=100ml. |
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Lab values
Platelets |
may decrease as a result of placental separation(helps clotting) If<150,000 @ risk for bleeding.
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H&H
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may decrease from blood loss, diuresis. Normal within 6 wks.
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Diuresis
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occurs first 2-5 days resulting wt loss=3 kg.
Failure to diurese assess for pulmonary edema. |
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non-nursing moms
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40% menstate in 1st 6-10 wks.
50% ovulate other 50% don't |
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Breastfeeding mothers
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50% menstrate by 12 wks d/t hormonal changes.
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Rhogam
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should be given to all RH NEGATIVE moms with rh POSITIVE baby with 72 hrs of delivery to prevent antibody formation/production. Antepartal dose at 28 wks.
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Average birth weight of newborn
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3405g=7lb, 8oz
2500-4000g=5lb. 8oz-8lb.13oz Can lose 5-10% of wt in the first 3-4dys d/t small fluid intake, and fluid loss. |
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Newborn measurements
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average length 50cm=20in
range 48 to 52cm=18-22in Head-32-37cm=12.5 to 14.5 Chest-32cm=12.5 in range 30-35cm= 12 to 14in |
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Thermoregulaton
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closely r/t rate of metabolism and oxygen consumption
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NTE
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zone exists when rates of oxygen consumption and metabolism are minimal
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Thermogenesis
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physiologic mechanisms that increase heat production
Include: increased BMR, muscular activity |
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Chemical thermogenesis or NST
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stimulates sympathetic NS to metabolize newborn's stores of brown fat(increases metabolic rate)
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Newborn temperatures
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Axillary 36.4-37.2=97.5-99F
Skin 96.8-97.7; 36-36.5 |
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subconjunctival hemorrhages
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red lines on sclera
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transient strabismus
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poor neuromuscular control of eye (cross eyed)
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Low set ears
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May indicate chromosomal abnormalities. Trisomies 13 and 18
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Newborns kidneys
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having functioning nephrons at 34-36wks. Although have decreased glomeruler function and decreased ability to concentrate urine d/t small size tubles.
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hypospadias
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urinary meatus located on ventral side of penis
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phimosis
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opening of foreskin is small can't be pulled back over glands; may interfer with urination
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ortolani's maneuver
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puts downward pressure on the hip and then inward rotation. If hip dislocated, will force femoral head back into the acetabular rim with a "clunk"
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Barlow's(dislocation) maneuvar
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Baby's thigh grasped and adducted with downward pressure. Femoral head slips out of acetabulum
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telangiectatic nevi
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stork bites
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nevus flammeus
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port wine stain
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physiologic jaundice
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accelerated obstruction of RBC and inability to breakdown bilirubin.
Bilirubin peaks in 3-5dys Should not exceed 13mg/dl |
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breast milk jaundice
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level peaks at 5-10mg/dl 2-3 wks of life.
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sucking reflex
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disappears by 12 months
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rooting reflex
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when newborn side of mouth or cheek touched. Disappears 4-7 months
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palmar grasp
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disappears 3-4 months
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moro or startle reflex
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disappears 6 months
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babinski
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fanning of toes. Infant has (+) sign until 12 months of age
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stepping reflex
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disappears about 4-8wks
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tonic neck 'fencer position'
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extremities straightened on same side head is turned to. Disappears by 3-4 months
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Neonatal transition
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first few hours of life when the newborn stabilizes respiratory and circulatory functions
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Surfactant mixture
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surface-active phospholipids(lecithin and sphingomyelin)
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Major areas of change occur in cardiopulmonary adaptation
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Increased aotic pressure and decreased venous pressure. Increased systemic pressure and decreased pulmonary artery pressure. Closure of foramen ovale.(closes in 1-2hrs blood flows from aorta to pul. artery. Closure of ductus arteriosus. Closure of ductus venosus. Closure forces perfusion to liver.
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Hematocrit
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may rise 1-2g/dl above level d/t placental transfusion, low oral fl intake, and diminished ECF volume
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Hemoglobin
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declines over first 2 months of life d/t decrease in RBC production and increase in loss.
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Blood coagulation
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made by liver and activated by vitamin K. absence of normal flora in newborn results in low vit K levels.
Aquamephyton 0.5-1mg IM. VL 25 gauge 1/2 in needle. |
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Newborns needs
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105-108kcal/wt/day
50-55kcal/lb/day 140-160ml/kg/day Notify if take in<30ml/feeding |
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drugs and breastfeeding
Observe infant for |
signs if drug reaction. Rash, fussiness, lethargy, changes in sleep habits or feeding patterns
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Weight gain in visit
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Formula fed-30g(1oz)/day first 6 months
breastfed-0.5oz/day for first 6 months. 15g(0.5)oz per day for 2nd six months |
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Apgar score <6 at 1 min and <7 at 5 min
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Infant not making good transiton to extra-uterine life. Requires extra monitoring/intervention
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Respiratory failure #1 cause of death in preterm infants
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Inufficient surfactant. Inadequacy of alveoli to exchange gases. Weak musculature to head body alignment to maintain patent airway.
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S&S of respiratory distress
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SeeSaw breathing, sternal retractions, xiphoid retractions, nasal flaring, expiratory grunt, diminshed breath sounds. PaCo2<50mm.Hg
PCO2>60mmHg, increasing exhaustion, cyanosis-late finding. |
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Respiratory Distress syndrome
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aka Hyaline membrane disease. Inadequate surfactant and alveoli. 24-48hrs after birth. Peak around 72hrs. When born may be given surfactant via ET=Exosurf or survanta.
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Cardiovascular problems
Patent Ductus Arteriosus |
Causes pulmonary congestion b/c fetal and adult blood going to R.atrium after cutting of cord. Increased resp effort. Co2 retention & decreased O2 levels. Bounding femoral pulses b/c bl can't flow correctly through body.
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Meconium Aspiration Syndrome
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presence of meconium in a fluid-asphyxial insult
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clinical manifestations of MAS
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Fetal hypoxia in utero-few days/min prior to birth. Slowing FHR or weak/irregular. Loss of beat to beat variability. Meconium staining of amniotic fluid.
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signs of distress at birth
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pallor, cyanosis, apnea, slow HR <100, low apgar scores (below 6) at 1 and 5 minutes. Require resusitation to establish resp effort
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S&S of hypoglycemia
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glucose <40mg/dl for fetus. Tremors, jitteriness,lethargy, cyanosis, temp instability,poor feeding, hypoxia and in extreme cases seizures.
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erythroblastosis fetalis
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severe hemolytic reaction. Causes severe anemia, cardiac failure, edema, ascites, hypoxia, and possibly death.
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Kernicticus
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hyperbilirubinemia. Impaired neurological function from the deposition of unconjugated bilirubin in basal ganglia. Hyperbilirubinemia=total bilirubin >13-15mg/dl
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Fetal alcohol syndrome
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alcohol crosses placenta and interferes with protein synthesis. Abnormal structural development and CNS dysfunction. Growth deficiencies (IUGR). Distinctive facial abnormalities.
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Phenylketonuria(PKU)
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Phenylalanine=essential AA excess converted to Tyrosine. When unable to convert Phenylalaine to tyrosine. When unable to convert excess builds up. Can cause mental retardation. Tx: Diet that limits ingestion of phenlalanine.
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Maple syrup Urine disease
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Inborn metabolic disorder. Causes feeding problems and neurologic signs. Problem with breakdown of certain AA. Formula low in branched-chain AA=leucine, isoleucine,valine.
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Galactosemia
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unable to utilize galactose and lactose. SS:vomiting after ingestion, diarrhea, poor wt gain, jaundice, mental retardation. Nutramagen, meat and soy based formulas.
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