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65 Cards in this Set

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Prolactin
Secreted by anterior pituitary gland. Promotes milk production
Oxytocin
secreted by posterior pituitary gland in response to infant sucking. Causes uterine contractions and let down reflex
Engorgement
seen 2-3 days after delivery. Breast full hard, painful and tender. May have temp.
Mastitis
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.
Involution
Rapid decrease in size of uterus after birth d/t decrease in estrogen and progesterone. Pelvic organ within 10 dys.
Patient with boggy uterus
Massage. ASSESS VS AFTER MASSAGE. May start methergine or pitocin to enhance contractions.
Methergine
stimulates muscle contraction and causes vasoconstriction. Dose 0.2mg PO or IM q4hrs.
SE: HTN, cramps, N&V, H/A, bradycardia and dizziness.
Lochia
Volume=approx 225ml. Amount will decrease daily.
Lochia amounts
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.
Lab values
Platelets
may decrease as a result of placental separation(helps clotting) If<150,000 @ risk for bleeding.
H&H
may decrease from blood loss, diuresis. Normal within 6 wks.
Diuresis
occurs first 2-5 days resulting wt loss=3 kg.
Failure to diurese assess for pulmonary edema.
non-nursing moms
40% menstate in 1st 6-10 wks.
50% ovulate other 50% don't
Breastfeeding mothers
50% menstrate by 12 wks d/t hormonal changes.
Rhogam
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.
Average birth weight of newborn
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.
Newborn measurements
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
Thermoregulaton
closely r/t rate of metabolism and oxygen consumption
NTE
zone exists when rates of oxygen consumption and metabolism are minimal
Thermogenesis
physiologic mechanisms that increase heat production
Include: increased BMR, muscular activity
Chemical thermogenesis or NST
stimulates sympathetic NS to metabolize newborn's stores of brown fat(increases metabolic rate)
Newborn temperatures
Axillary 36.4-37.2=97.5-99F
Skin 96.8-97.7; 36-36.5
subconjunctival hemorrhages
red lines on sclera
transient strabismus
poor neuromuscular control of eye (cross eyed)
Low set ears
May indicate chromosomal abnormalities. Trisomies 13 and 18
Newborns kidneys
having functioning nephrons at 34-36wks. Although have decreased glomeruler function and decreased ability to concentrate urine d/t small size tubles.
hypospadias
urinary meatus located on ventral side of penis
phimosis
opening of foreskin is small can't be pulled back over glands; may interfer with urination
ortolani's maneuver
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"
Barlow's(dislocation) maneuvar
Baby's thigh grasped and adducted with downward pressure. Femoral head slips out of acetabulum
telangiectatic nevi
stork bites
nevus flammeus
port wine stain
physiologic jaundice
accelerated obstruction of RBC and inability to breakdown bilirubin.
Bilirubin peaks in 3-5dys
Should not exceed 13mg/dl
breast milk jaundice
level peaks at 5-10mg/dl 2-3 wks of life.
sucking reflex
disappears by 12 months
rooting reflex
when newborn side of mouth or cheek touched. Disappears 4-7 months
palmar grasp
disappears 3-4 months
moro or startle reflex
disappears 6 months
babinski
fanning of toes. Infant has (+) sign until 12 months of age
stepping reflex
disappears about 4-8wks
tonic neck 'fencer position'
extremities straightened on same side head is turned to. Disappears by 3-4 months
Neonatal transition
first few hours of life when the newborn stabilizes respiratory and circulatory functions
Surfactant mixture
surface-active phospholipids(lecithin and sphingomyelin)
Major areas of change occur in cardiopulmonary adaptation
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.
Hematocrit
may rise 1-2g/dl above level d/t placental transfusion, low oral fl intake, and diminished ECF volume
Hemoglobin
declines over first 2 months of life d/t decrease in RBC production and increase in loss.
Blood coagulation
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.
Newborns needs
105-108kcal/wt/day
50-55kcal/lb/day
140-160ml/kg/day
Notify if take in<30ml/feeding
drugs and breastfeeding
Observe infant for
signs if drug reaction. Rash, fussiness, lethargy, changes in sleep habits or feeding patterns
Weight gain in visit
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
Apgar score <6 at 1 min and <7 at 5 min
Infant not making good transiton to extra-uterine life. Requires extra monitoring/intervention
Respiratory failure #1 cause of death in preterm infants
Inufficient surfactant. Inadequacy of alveoli to exchange gases. Weak musculature to head body alignment to maintain patent airway.
S&S of respiratory distress
SeeSaw breathing, sternal retractions, xiphoid retractions, nasal flaring, expiratory grunt, diminshed breath sounds. PaCo2<50mm.Hg
PCO2>60mmHg, increasing exhaustion, cyanosis-late finding.
Respiratory Distress syndrome
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.
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.
Meconium Aspiration Syndrome
presence of meconium in a fluid-asphyxial insult
clinical manifestations of MAS
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.
signs of distress at birth
pallor, cyanosis, apnea, slow HR <100, low apgar scores (below 6) at 1 and 5 minutes. Require resusitation to establish resp effort
S&S of hypoglycemia
glucose <40mg/dl for fetus. Tremors, jitteriness,lethargy, cyanosis, temp instability,poor feeding, hypoxia and in extreme cases seizures.
erythroblastosis fetalis
severe hemolytic reaction. Causes severe anemia, cardiac failure, edema, ascites, hypoxia, and possibly death.
Kernicticus
hyperbilirubinemia. Impaired neurological function from the deposition of unconjugated bilirubin in basal ganglia. Hyperbilirubinemia=total bilirubin >13-15mg/dl
Fetal alcohol syndrome
alcohol crosses placenta and interferes with protein synthesis. Abnormal structural development and CNS dysfunction. Growth deficiencies (IUGR). Distinctive facial abnormalities.
Phenylketonuria(PKU)
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.
Maple syrup Urine disease
Inborn metabolic disorder. Causes feeding problems and neurologic signs. Problem with breakdown of certain AA. Formula low in branched-chain AA=leucine, isoleucine,valine.
Galactosemia
unable to utilize galactose and lactose. SS:vomiting after ingestion, diarrhea, poor wt gain, jaundice, mental retardation. Nutramagen, meat and soy based formulas.