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133 Cards in this Set
- Front
- Back
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newborns are at risks for health problems when... (10)
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1. immaturity
2. dysmaturity 3. physical disorders 4. complications at birth 5. low socio 6. exposed to envir dangers 7. preexisting maternal conditions 8. obsetric factors 9. med conditions like preeclamp 10. obstetric complications |
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what is neonatal mortality?
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number of deaths of infant in the first 28 days of life per 1000 live births
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what are some factors that can cause IUGR? (6)
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1. malnutrition
2. vascular complications 3. maternal disease 4. maternal factors 5. placenta factors 6. fetal factors |
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what are the s/s of hypoglycemia in newborn?
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1. lethargy
2. jittery 3. poor feeding 4. apneic spells |
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if bs is severely low, what should you do?
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iv dextrose 5-10% to maintain glucose level betwen 40-97mg/dl
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hypoglycemia has ____brown fat and glycogen stores?
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decreased brown fat and glycogen stores
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why do you need to correct hypoglycemia early?
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to prevent brain damage
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babies that have hypothermia have what? (4)
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1.diminshed subq fat and adipose tissue
2. small muscle mass 3. depletion of brown fat 4. a large surface area |
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what can happen if baby has cold stress? (the consequences) (5)
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1. increases o2 requirement
2. can cause hypoglycemia from using glycogen stores 3. decreases surfactant production 4. can cause them to become acidotic 5. they may return to fetal circulation method |
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what are 4 things that cold stress can do to a baby? what can it lead to?
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1. norepi is released causing pulmonary vasoconstriction
2. decreased surfactant can cause atelectasis 3. anaerobic metabolism can cause increased nonesterfied fatty acids which can cause hyperbilirubinemia 4. increased metab rate can cause hypoglycemia |
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why can babies get hyperbilirubinemia?
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because of the increased anaerobic metab that causes an increase in nonesterfied fatty acids that can cause hyperbilirubinemia
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if a baby has neurologic defects, what should you carefully watch out for?
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aspiration
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why might rubella and cmv be harmful to the baby?
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can cause direct invasion of the brain and other vital organs
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what do you tell the parent of a baby with asymmetrical continued growth difficulties?
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that they are expected to catch in wt to normal growth by 3-6 months of age
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what do you tell the parent of a baby with symmetrical growth difficulties?
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that they will not catch up with their peers
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preterm babies are at risk for? (14)
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1. apnea
2. ASPIRATION 3. patent ductus arteriosus 4. RDS 5. intravascular hemorrhage 6. hypocalcemia 7. necronizing enterocolitis 8. anemia 9. hyperbilirubin 10. infx 11. retinopathy 12. speech defects 13. neurologic defects 14. sensory/neural hearing loss |
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SGA babies are at risk for? (10)
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1. perinatal asphyxia
2. aspiration syndrome 3. hypothermia 4. hypoglycemia 5. hypocalcemia 6. polycythemia 7. congenital malform 8. intrauterine infx 9. growth difficulties 10. learning disabilities |
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LGA babies are at risk for?
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1. birth trauma (CPD)
2. c/s 3. hypoglycemia 4. polycythemia 5. hypoeviscosity |
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how to care for LGA (prevention)? (2)
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1. early detection and monitor hypoglycemia
2. early feeds |
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what are some possible complicatins for LGA?
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1. hypoglycemia
2. hypocalcemia 3. hyperbilirubin 4. birth trauma (fx, brachial palsy, facial paralysis, intracranial bleeding) 5. polycythemia 6. RDS |
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what are the r/f for RDS? (5)
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1. white race
2. male 3. preterm 4. DM 5. asphyxia |
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what are the s/s of developing RDS? (3)
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1. tachypnea
2. grunting respirations 3. retractions |
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what are complications that may occur from RDS? (3)
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1. retinopathy of prematurity
2. bronchopulm dysplasia 3. pneumothorax |
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how to care for LGA (prevention)? (2)
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1. early detection and monitor hypoglycemia
2. early feeds |
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what are some possible complicatins for LGA?
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1. hypoglycemia
2. hypocalcemia 3. hyperbilirubin 4. birth trauma (fx, brachial palsy, facial paralysis, intracranial bleeding) 5. polycythemia 6. RDS |
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what are the r/f for RDS? (5)
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1. white race
2. male 3. preterm 4. DM 5. asphyxia |
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what are the s/s of developing RDS? (3)
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1. tachypnea
2. grunting respirations 3. retractions |
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what are complications that may occur from RDS? (3)
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1. retinopathy of prematurity
2. bronchopulm dysplasia 3. pneumothorax |
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what is used to tx respiratory acidosis in infants?
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sodium bicarb
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who does transient tachypnea of the newborn affect? (2)
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1. primarily AGA
2. near term preterm |
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what ar the causes of respiratory distress (intrauterine asphyxia) of transient tachypnea?
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1. maternal oversedation
2. maternal bleeding 3. prolapsed cord 4. breech birth 5. maternal diabetes |
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how is transient tachypnea of newborn?
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no initial respiratory distress at birth
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decrease in o2 leads to what kind of shunting in RDS newborns?
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increased right to left shunting
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RDS causes what to happen?
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anearobic metabolism and acidosis which leads to pulmonary and peripheral vasocontriction
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pulmonary and peripheral circ vasoconstriction in RDS causes what to happen in pulmonary artery pressure, blood flow, and surfactant
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increase in pulmonary artery pressure and decrease in pulmonary blood flow and surfactant
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soon after birht, s/s that resemblc RDS with transient tachypnea of the newborn?
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1. expiratory grunting
2. flaring 3. mild cyanosis in room air 4. RR 100-140s |
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who is transient tachypnea of the newborn more prevelant in?
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c-section babies
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how do you help a baby with transient tachypnea of the newborn?
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1. oxyhood with 02 at 30 to 50%
2. IV fluids only (no PO for risk of aspiration |
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a baby has some trouble breathing. An x-ray is taken and shows normal after 72 hrs indicates...?
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transient tachypnea of the newborn
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how can you prevent meconium aspiration syndrome at birth? (3)
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1. delee suction on perineum or head delivered C/s
2. intubate prior to first breath 3. check larynx |
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if you notice meconium below vocal cords, what should you do? (8)
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1. put an iv in umbilical artery
2. monitor blood ph 3. intubate 4. utilize PEEPS 5. IV dopamine or dobutamine 6. cpt 7. prophylaxtic abx 8. monitor bp and pulmonary blood flow |
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why would you give dopamine or dobutamine in meconium aspiration syndrome?
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to maintain systemic blood pressure
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what is happening in abo incompatibility?
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when the mother is type o and child is type a or b
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what does direct combs do?
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determines presence of maternal rh positive antibodies in fetal cord blood
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what can abo incombaility result in?
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hemolytic disease
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what is the tx of abo incompatibility?
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phototherapy
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what is erythroblastosis fetalis?
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when the maternal antiboedies enter fetal circulation which attach fetal rbc
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how does the fetus respond in erythroblastosis fetalis? (5)
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1. increases rbc production
2. jaundice 3. anemia 4. compensatory erythropoiesis 5. erythroblast (immature RBC) |
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what is hydops fetalis?
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the most severe form of hemolytic disease, causes multiple organ failure, massive generalized edema, and may cause intrauterine death
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what is a primary concern in infants of infants of diabetic mothers?
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hypoglycemia after delivery
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what should you worry about if the mother got narcotics during childbirth?
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rr depression in baby
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fetal asphyxia can cause the fetus to do what?
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pass meconium into the amniotic fluid
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what are common causes of fetal asphyxia? p. 287 (4)
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1. placental insufficiency
2. prolapsed cord 3. placenta abruption 4. placenta previa |
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difficult or prolonged increases risk for what?
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birth trauma
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biophysical score of less than 8 indicates?
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baby may need to be delivered b/c may cause asphyxia
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8/10 biophysical score indicates?
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healthy baby
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what do you look for in biophysical profile?
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1. fetal breathing movt
2. gross body movt 3. fetal tone 4. reactive nst 5 amnio fluid volume |
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what is normal reactive nst?
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greater than 2 accleration of greater than 15 bt/15 sec for 20 or 40 min
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what is abnormal reactive nst
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less than 2 acclerations and does not last 15 sec
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what is inappropriate test for an hiv baby?
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elisa test because won't show positive yet (15 months)
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when can you test for hiv in babies?
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15 months
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apgar score of __ for 1 minute or __ at 5 min indicates not satisfactory extrauterine life
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6, 7
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babies that got an umbilical lines should closely assessed for? what may it indicate?
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blue discoloration or blanching or vasospasm
may indicate removal of line |
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what are maternal r/f for prematurity? (6)
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1. age
2. smoking 3. poor nutrition 4. placenta problems 5. previous preterm delivery 6. incompetent cervix |
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what are the fetal r/f for prematurity? (2)
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1. multiple gestation pregnancy
2. infection |
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signs of respiratory distress typically develop within?
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1 to 2 hours after delivery
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what is the most common cause of death in preterm infants within the first 72?
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respiratory failure
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s/s of neonatal respiratory distress? (9)
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1. tachypnea
2. intercoastal or subcostal retraction 3. nasal flaring 4. seesaw rr movement 5. diminished breath sounds 6. pa02 less than 50mmhg 7. paco2 above 60 mmhg 8. increasing exhaustion 9. cyanosis |
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how is the cardiovascular in preterm? (3)
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1. incomplete muscular of pulmonary blood
2. lower pulmonary resistance 3. left to right shunting |
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immunoglobins cross the placenta when?
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third trimester
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swallow reflex is weak until when?
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33-34 wk gestaion
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what are predisposing factors for infx PP? (4)
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1. prolonged ROM
2. trauma 3. manual removal 4. delivery outside of hospital |
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what are s/s of localized infx? (5)
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1. localized pain
2. dysuria 3. low grade fever 4. redness 5. puss |
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what to do if pt had a localized infx pp?
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culture the organism and THEN give abx
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what is the most common infx of PP?
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endometritis?
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endometritis is an infx of the?
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uterine cavity
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a women is having backache, complaining of uterine tenderness, foul smelling lochia discharge, has a temperature and high WBC, chills, and her uterine does involute as fast as it should be....what would you suspect?
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endometritis
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what are the s/s of endometritis? (7)
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1. backache
2. uterine tenderness 3. stinky lochia 4. chills 5. increased wbc 6. temp 7. delay in uterine involution |
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what is the mgmt of endometritis? (3)
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1. give ordered meds
2. say to them PELVIC REST 3. monitor VS, esp temp |
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what is salpingitis? what is oophortis?
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salpingitis: infx of tubes
oophoritis: infx of ovaries |
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what is the most common cause of salpingitis and oophoritis?
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gonorrhea infx
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a women has lower ab pain, high temp, and tachycardia 10 days PP....what would you suspect?
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salphingitis or oophoritis
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when does salphinigitis or oophoritis occur and how does it manifest? (3)
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occurs about 9-15 days pp
and s/s are 1. unilateral/bilateral ab pain 2. high temp 3. tachycardia |
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what is the mgmt of salphingitis/oophoritis? (2)
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1. meds
2. pelvic rest |
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a women has a high spiking fever, chills, flushing, sweating, tachycardic, SOB, increasing uterine tenderness, waht would tou suspect?
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peritonitis
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what are the s/s of peritonitis? (8)
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1. high spiking fever
2. chills 3. sob 4. flushing 5. sweating 6. tachycardia 7. sob 8. uterine tenderness |
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what is the tx for peritonitis?
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aggressive abx tx IV
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what is the assessment acronym for infx?
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REEDA
a. redness b. ecchymosis c. edema d. discharge/drainage 3. approximation |
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why are pregnant/l&d women at risk for UTI? (5)
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1. edema from birth trauma
2. urinary retention 3. decreased bladder sensation 4. epidural 5. catheterization |
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what is cystitis?
when does it usually occur? how does it manifest? |
inflammation of bladder
occurs a few days PP freq, urgency, dysuria, nocturia, hematuria, suprapubic pain |
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a pregnant women comes to you with a spiking temp, shaking, chills, n/v, urgency, freq, dysuria, back pain....what should you do?
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evaluate if this is pyelonephritis (since it sounds like preterm)
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pyelonephritis: what are the s/s? (7)
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1. spiking temp
2. shaking/chills 3. n/v 4. urgency 5. freq 6. dysuria 7. back pain |
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what are the urine lab workup for pyelonephritis? (4)
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presence of:
wbc rbc protein bacteria |
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when does baby blues resolves? what is the tx?
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resolves in 5-10 days and NO TX is needed
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how to prevent thrombloplebitis?
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1. evluate need for support hose for a women with varicosities
2. early ambulation before development of thromboplebitis is encouraged |
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what should the nurse do if woman has thromboplebitis? (7)
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1. warm moist soaks
2. legs elevated 3. bedrest/don't cross legs 4. incr fluid intake 5. wear support stocking 6. analgesic (non-aspirin) for pain 7. measure legs |
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how is pp blues and pp depression different?
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pp blues may feel blue/episodic tearing occasionally without reason
depression will manifest as freq crying, insomnia, appetite changes, has a slow onset |
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what are the r/f of pp depression? (6)
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1. first baby
2. ambivalence about maintaining pregnancy 3. hx of ppd 4. lack of social support 5. lack of stable relationship with parents or partner 6. body image/eating disorders |
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in PPD, what should you worry about?
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suicide
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when may pp psychosis occur?
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within the first 3 months
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what should you do to help a person with psychosis or depression? (4)
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1. observe client and baby
2. recognize and seek referral 3. support positve parenting behaviors 4. discuss clients plans for her baby and herself |
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what is premature baby?
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an infant that is born before the completion of the 37th week of pregnancy
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when is the earliest age of viability?
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23-24 weeks
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what can cause prematurity? (6)
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1. young age/old age
2. smoking 3. poor nutrition 4. placental problems 5. previous preterm 6. incompetent cervix |
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what are fetal risk factors for prematurity? (2)
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1. multiple gestation
2. infx |
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explain how to teach parents with a preterm infant? (6)
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1. assess bonding
2. explain equipment and infant condition 3. present positive attitude and establish trust 4. encourage parents to touch infant 5. encourage parents to verbalize feelings 6. teach care of infant |
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explain how the RR, cardio, immunity, GI, hepatic, renal, and neuromuscular of a preterm baby
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RR: immature alveoli, may not be able to hold head
cardio: PDA may cause pulm congestion, increased RR, and bounding pulses immunity: no iga until 3rd trimester GI: incr hyperbilirubenia from immature liver, prone to low bs, weak suck (until 33-34 wks), immature clotting factors incr risk of necrotizing enterocolitis renal: risk for dehydration, prolonged excretion time and neuromuscular: incr risk for apnea, poor muscle tone, weak cry, at risk for IVH |
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what is RDS resulted from?
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ineffective pulmonary surfactant
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when does RDS occur usually?
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first 24-48 hours and peaks around 3 days.
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what are some r/f for RDS? (5)
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1. fetal hypoxia
2. postnantal hypothermia 3. prematurity 4. MAS 5. TTN |
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how to help a baby with RDS? (5)
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1. maintain neutral environment
2. admin warm humidified oxygen, attempting to keep o2 sat above 90% and pa02 between 50-70 3. position baby in SIDE LYING or neck slightly extended with arms at side 4. suction 5. monitor o2 |
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what is TTN and who is at risk
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TTN: failure to clear airway of excess lung fluid at delivery, usually occurs in term infants
risk: c-section b/c they didn't get the squeeze of the vagina |
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how to assess TTN?
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1. expiratory grunting
2. nasal flaring 3. mild cyanosis 4. tachypnea that lasts by 6 hours and can go as high as 100-140 bpm |
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how to care for baby with TTN (2)
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1. give o2 and monitor
2. usually resolves within 72 hours |
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where would you assess jaundice?
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sternum or forehead
or sclera, palms, and soles of black babies |
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bilirubin levels greater than ___indicate hyperbili
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13-15
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other than jaundice, what might you see in a baby? (r/t jaundice) (3)
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1. enlarged liver/spleen
2. anemia 3. concentrated dark urine |
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what is indirect combs?
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dtermines presence of maternal antibodies
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what is direct combs?
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determines presence of maternal antibodies in fetal blood
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how can you help remove jaundice?
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1. early freq feedings
2. phototherapy 3. assess for green stools (which is bilirubin) 4. increase fluid intake 5. assess temp q2h |
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when does pathologica jaundice occur?
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within the first 24 hrs of life
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what to assess for in IDM? (9)
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1. s/s of birth trauma d/t LGA
2. assess for shoulder dystoica 3. enlarged organs 4. cardiomegaly 5. hyperbilirubinemia 6. RDS 7. false positive L/S ratio 8. increased risk of congenital anomalies 9. hypocalcemia |
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how to help a IDM baby?
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1. assess for birth trauma
2. assess bs at 30 min and then 1, 2, 4, 6, 9, 12, and 24 hours |
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what can cause sga? (5)
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1. placental insufficiency
2. infx 3. smoking 4. htn 5. malnutrition |
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what may u find in SGA? (4)
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1. loose skin
2. little scalp hair 3. hypoglycemia 4. weak cry |
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what should a nurse do for SGA? (4)
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1. assess for presence of meconium
2. assess temp 3. assess for signs of low bs 4. take wt |
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how would a baby going thru withdrawals look like? (7)
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1. hyperactive/jittery
2. absence of step reflex 3. shrill persistent crying 4. freq yawning/sneezing 5. respiratory distress 6. sweating 7. feeding difficulties |
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babies with feeding difficulties 2dary to withdrawal syndrome are at increased need for?
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non-nutrititve sucking
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how to help baby with w/drawals? (6)
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1. position baby on side to faciliate drainage
2. suction 3. decrease stimuli 4. swaddle for comfort 5. i&0/daily wt 6. get tox screen |
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what factors increase risk for jaundice?
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1. enclosed hemorrhage (cephalhematoma)
2. infx 3. dehydration 4. sepsis |
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why might postterm baby be at risk for birth injury?
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from dystocia
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what is happening to the placenta in postterm pregnancy?
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aging placenta less able to supply o2 so at risk for RELEASE OF meconium and meconium ASPIRATION
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what might you see in a post term baby?
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1. absence of vernix/lanugo
2. dry cracked skin 3. hypoglycemia 4. minimal subq fat 5. cord yellow 6. long fingernails |
