1
Q
What are 4 sources of labor pain
A
- Tissue Ischemia
- Cervical Dilation
- Pressure and pulling on pelvic structures
- Distention of Vagina and Perineum
2
Q
Factors influencing perception or tolerance of pain?
A
- labor intensity
- Cervical readiness
- Fetal Position
- Pelvic readiness
- Fatigue & hunger
- Caregiver interventions
3
Q
Advantages to non-pharmacologic pain management
A
- Non systemic
- Doesn’t effect fetus
- Doesn’t effect labor
- ## Non allergy contraindications
4
Q
Psychosocial factors that influence labor pain include
A
- culture
- anxiety and fear
- previous experiences
- preparation for childbirth
- mother’s support system.
5
Q
Excessive pain can heighten a woman’s fear and anxiety, which stimulates an increased secretion of ___________________.
A
Catecholamines
6
Q
Catecholamines act on what two receptors?
A
- Alpha
- Beta
7
Q
Stimulation of the ______ receptors relaxes the uterine muscle and cause __________
A
- Beta
- Vasodilation
8
Q
Stimulation of the _________ receptors causes uterine and generalized ____________.
A
- Alpha
- Vasocontriction
9
Q
What are the effects of excessive catecholamine secretion?
A
- Reduced blood flow to and from the placenta,
* Reduced effectiveness of uterine contractions, slowing labor progress
10
Q
Pain is both physiologic and psychological. The Physiological pain can be affected by increased secretion of _____________
A
Catecholamines
11
Q
Labor _______ a woman’s metabolic rate and her demand for __________.
A
- increases
- oxygen
12
Q
How do pain and anxiety affect a woman’s already high metabolic rate.
A
Increase
13
Q
How does an increase in metabolic rate affect the fetus?
A
- significantly alter placental exchange causing less oxygen to be available for the fetus
14
Q
The fetus shifts to _____________ when it does not have enough oxygen available for uptake
A
Anaerobic Metabolism
15
Q
The fetus may shift to _____________ when it does not have enough oxygen available for uptake
A
Anaerobic Metabolism
16
Q
___________ acidosis and does not resolve as quickly after birth as __________ acidosis, which results from shorter periods of ___________.
A
- Metabolic
- Respiratory
- hypoxia
17
Q
What are the psychological effects of poorly relieved pain?
A
- affect the mothers interaction with newborn as she is so depleted/tired
- Poor memories of
- Affect her response to sexual activity
18
Q
What are 3 causes of pain in labor in stage 1?
A
- Stretching of the cervix
- Uterine Anoxia - Tissue ischemia
- Stretching of the uterine ligaments
19
Q
What are 4 causes of pain in labor in stage 2 ?
A
- Traction on the stretching of perineum
- Distention of the vagina and perineum
- Compression of the nerve ganglia in cervix and lower uterus
- Pressure on urethra, bladder & rectum during fetus decent
20
Q
What factors that influence perception and tolerance of pain
A
- Labor intensity
- Cervix that is not ready results in longer labor which leads to lowered level of pain tolerance
- Fetal position such as posterior is more painful
- Pelvic readiness - abnormal pelvis
- Fatigue and Hunger reduce a woman’s ability to tolerate pain
- Interventions by medical personnel
21
Q
Goal of pain management?
A
- Help ease the anxiety in the moment of labor
22
Q
Sedatives are given to …
A
- promote sedation and relaxation
23
Q
Benefits of Sedatives
A
- promote sedation and relaxation
- Decrease release of catecholamines
24
Q
Adverse effects of Epidural block
A
- Maternal hypotension
- Bladder distention
- Catheter migration
- Cesarean Birth
25
If you have a mom with a history of drug addiction, she is on heroin or she is on a drug treatment program such as methadone, what drugs should be avoided?
Stadol
Nubain
26
Advantages of pharmacological Interventions
- Increases women's ability to cope
| - Medication may be administered by the nurse
27
Disdvantages of pharmacological Interventions
- Side affects - itching, vomiting, pruritus, drowsiness, and neonatal depression
- Pain is not eliminated completely
- The fetus can be effected by medicatiosn
28
What is local anesthesia used for ?
- Anesthetizes the lower vagina and part of the perineum
- Provides anesthesia for an episiotomy and vaginal birth
- Mother feels pressure.
29
A spinal anesthesia is typically given for a ___________ birth
Cesarean
30
Pudendal Anesthesia
Provides pain relief for episiotomy and delivery
31
How is Pudendal Anesthesia administered?
transvaginally
32
How often do you monitor vital signs after an epidural is placed?
Every 3 Min
33
Because the medication given during an epidural/spinal causes vasodilation, a nurse must watch for
Hypotension
34
A mother who is going to receive an epidural should receive a bolus of _______ ml normal saline prior to the procedure to prevent hypotension
1000
35
Medicine used to counteract hypotension
Ephedrine
36
Complications associated with Epidural and Spinal Anesthesia
- Hypotension
- Maternal fever
- Shivering
- Pruritus
- Inadvertent injection into the blood stream
- Spinal headache
- Fetal distress
37
A person with a spinal headache severe head pain in what position?
- Sitting up
38
Intervention for a spinal headache includes the use of __________ & Tylenol first and then a __________.
- Alot Caffeine
| - blood patch
39
Life-threatening complications occurring with general anesthesia
- Failed intubation
- Aspiration
- Malignant hyperthermia
40
What is malignant hyperthermia?
Condition that causes sustained muscle contractions in the presence of certain anesthetic agents?
41
________ is a general term that describes any difficult labor or birth.
Dystocia
42
What are problems with the powers of labor?
- Ineffective Contractions (hypotonic/hypertonic)
| - Ineffective maternal pushing
43
Possible causes of ineffective contractions include the following:
- Early or excessive use of analgesia
- Overdistention of the uterus _ (polyhydramnios, twins etc)
- Excessive cervical rigidity
- Grand multiparity
- Mild pelvic contraction
- Postmature and large infants - CPD
44
What are problems with the passage of labor?
- Shape of pelvis
| - Maternal soft tissue obstructions
45
What are problems with the passenger of labor?
- fetal size
- presentation or position
- multifetal pregnancy
- fetal anomalies
46
What are problems with the Psyche of labor?
- Catecholamines release inhibits contractionscan
47
The 2 combined effects of excessive catecholamine secretion are as follows:
* Reduced blood flow to and from the placenta, restricting fetal oxygen supply and waste removal
* Reduced effectiveness of uterine contractions, slowing labor progress
48
what is an amniotomy?
artificial rupture of amniotic sac
49
what are some indications for an amniotomy?
- induce labor
- augment labor
- allow internal fetal monitoring
50
What is a major risk for an amniotomy? What are other risks?
MAJOR = prolapsed cord
- Infection
- Abruptio placenta
51
What are three major risks for an amniotomy?
- prolapsed cord
- placental abruption
- infections
52
What are the things you would do as a nurse for an amniotomy?
- obtain baseline fetal heart rate (20-30 mins before procedure)
- assist with the amniotomy (place absorbent pads under buttocks)
- provide after care
53
What type of after care is provided after an amniotomy?
- FHR is assessed for at least one full minute
- quantity, color and odor of amniotic fluid are charted
- the woman's temp should be assess at least every 2-4 hours after the membranes rupture
- provide comfort
54
what are the artificial methods to stimulate uterine contractions?
induction and augmentation
55
___ is performed when a continued pregnancy may jeopardize the health of the woman or fetus and labor and vaginal birth are considered safe.
induction of labor
56
What are some contraindications for induction of labor?
- placenta previa
- vasa previa
- umbilical cord prolapse
- abnormal fetal presentation
- fetal presenting part above the pelvic inlet
- previous surgery in the upper uterus
57
what are some indications for induction of labor?
- hostile intrauterine environment
- post-term pregnancy
- SROM
- chorioamnionitis (inflammation of the amniotic sac)
- HTN
- abruptio placentae
- maternal medical conditions that worsen with continuation of the pregnancy
- fetal death
58
What are the risks to induction and augmentation of labor?
- hypertonic uterine activity
- uterine rupture
- maternal water intoxication
- greater risk for chorioamnionitis
- greater risk for cesarean birth
59
labor is ____ induced if term gestation, fetal lung maturity, or both are not established unless a compelling reason exists
not
60
What are techniques to induction and augmentation of labor?
- cervical ripening
- oxytocin administration
- serial induction of labor
61
What are some medical methods to cervical ripening?
- prostaglandin
- cervidal
- cytotec
62
What are some mechanical methods to cervical ripening?
-foley balloon
63
Oxytocin Administration:
- dilute in isotonic solution
- secondary (piggyback) infusion
- insert oxytocin into the primary IV line
- start slowly, increase gradually
- monitor uterine activity, FHR, and fetal heart patterns frequently
64
Nursing considerations for induction and augmentation of labor:
- observe the woman and fetus for complication and takes corrective actions if abnormalities are noted
- observe fetal response
- observe the mothers response
65
What are the two types of versions?
- external
| - internal
66
The goal of __ is to change the fetal position from a breech, shoulder (traverse lie), or oblique presentation
external cephalic version
67
___ change the position of a second twin a vaginal birth
internal version
68
Contraindications for performing a Version
- Uterine malformations
- Previous cesarean
- Fetal size ≥4000 g
- Cephalopelvic disproportion
- Multifetal gestation
- Oligohydramnios
69
What is a precipitate labor and what is a precipitate birth?
Precipitate labor - birth occurs within 3 hrs of its onset
Precipitate birth - Occurs after a labor of any length, when a trained attendant is not present to assist
70
Induction and Augmentation of Labor: Indications
- Hostile intrauterine environment
- Spontaneous rupture of the membranes (SROM)
- Post-term pregnancy
- Chorioamnionitis (inflammation of the amniotic sac)
- Hypertension
- Abruptio placentae
- Maternal medical conditions that worsen with continuation of the pregnancy
- Fetal death
71
When the water bag breaks before
| ___ weeks of pregnancy and labor has not started, it is considered a Preterm Premature Rupture of Membranes (PPROM)
37
72
What is a Premature Rupture of Membranes?
When a woman's water breaks before the start of labor
73
How long after a woman's water breaks do providers give them to got into labor without interventions?
12hrs
74
Risk factors associated with PPROM?
- Infection
- Previous
- Polyhydramnios
- Incompetent cervix
- Multiple gestation
- Abruptio placentae
75
The _______ test is more diagnostic of true rupture of membranes because it is less likely to be affected by vaginal infections, recent intercourse, or other factors.
fern
76
How can a provider determine true membrane rupture?
- Perform a sterile speculum exam to look for a pool of fluid near the cervix
- Ph swab (amniotic fluid is alkali/ urine is acidic)
- Fern test
- Amnisure test (99% accurate)
77
What 2 kind of drugs are given to dcrease the severity of respiratory distress syndrom in the premature neonate?
- Tocolytics
| - Corticosteroids
78
Management of PROM at 37 weeks gestation or greater focuses on ________
Delivery
79
How often do you change the pads of a woman who had a PROM ?
Every 2 hours (more frequently if needed)
80
A complication of PROM is Chorioamnionitis which is characterized by Chorioamnionitis, characterized by ___________ & ___________
- maternal fever
| - uterine tenderness.
81
3 Types of prolapsed umbilical cord?
- COMPLETE cord can be seen protruding from the vagina
- An OCCULT (Hidden) prolapse of the cord is one in which the cord slips alongside the fetal head or shoulders.
- FORELYING - The cord cannot be seen but can probably be felt as a pulsating mass during vaginal examination.
82
Predisposing factors for a Prolapsed of cord
- ROM
- Shoulder and foot presentations
- Prematurity
- Polyhydraminos
- CPD (large head)
- Breach presentation
- Placenta previa
83
Priority nursing interventions of a Prolapsed cord?
1. Position -
a. Knee-chest position - on her knees and lying on her chest, elevate buttocks
b. Trendelenburg position -
c. Hips elevated with pillows, with side-lying position maintained
2. Push the presenting fetal part off the cord
3. Minimize manual palpation or handling of the cord as much as possible to minimize cord vessel vasospasm.
- Cover wet gauze on the prolapsed cord
4. Ultrasound examination may be used to confirm presence of fetal heart activity before cesarean delivery.
84
Why can terbutaline be used during a cord prolapse?
to stop or slow the contractions and stop pushing the head down on the cord
85
Maternal Complications of a prolapsed cord
1. infection
2. Risk for increased blood loss from emergency delivery
3. Fear and anxiety
86
Fetal Complications of a prolapsed cord
1. Prematurity
2. Complications resulting from hypoxia
3. Fetal death
87
What is the appropriate oxygen administration for a women with a prolapsed cord?
Face mask at 8 to 10L/min
88
Definition of Preterm labor includes what 4 manifestations?
1. 20 to 37 weeks of pregnancy
2. Uterine contractions
3. 8-% thinning of the cervix
4. Cervical dilation > 1cm
89
Risks factors for preterm birth
More than one fetus
- Hx of preterm birth
- Abnormal uterus or incompetent cervix
90
Management of preterm labor?
Detect early and adminster medications to stop contractions
91
If preterm birth is suspected, the mother is given _________ to help the baby breath after birth at least ______ before birth.
- Steroids (betamethasone)
| - 48 hrs
92
Steroids (betamethasone) is give to premature fetus less than _____ weeks gestation.
37
93
Treatment approaches for preterm labor include?
- bedrest
- hydration
- Medications
94
Medications used for preterm labor include?
- terbutaline
- toradol
- mag sulfate
95
How can mag given to a mother in preterm labor help the fetus after birth?
improve neurological outcomes of premature fetus
96
Risks to the fetus in a prolonged pregnancy?
1. Placental insufficiency
2. Reduced amniotic fluid
3. Meconium aspiration
4. Post date growth retardation
97
How are post term babies affected by poor placental perfusion?
- hyperbilirubinemia
- Meconium (baby is stressed - craps its fluid)
- Decrease in nutrition - decreased fat stores
- decreased amniotic fluid
98
Why are post term babies at risk for hyperbilirubinemia ?
When baby becomes hypoxic, it makes more RBC to hold on to more oxygen. When these extra rbc are broken down, bilirubin is a byproduct which can accumulate
99
What are some contraindications for Version?
- uterine malformation
- previous cesarean
- fetal size >4000g
- cephalopelvic disproportion
- multifetal gestation
- oligohydraminos
- ruptured membranes
- cord around the fetal body
- engagement of the fetal head
- placenta previa
100
What are some risks to version?
- few risks are present and few serious risk to fetus
- fetus may become entangled in the umbilical cord
- abruptio placentae may occur
- mixing of fetal and maternal blood
101
What is the technique for external version?
- non stress test to evaluate fetal well-being
- determine gestational age beyond 37 weeks
- administer tocolytic drug to relax uterus
- use ultrasound to guide manipulations
- Rho(D) immune globulin (RhoGAM) given if indicated
102
What do you do as a nurse to prepare a patient for version?
- provide information
- promote maternal and fetal health (vitals, women should be NPO at least 4 hours before procedure)
- reduce anxiety
103
what are some indications for an operative vaginal birth?
- shortened second stage of labor
- maternal indications (exhaustion, inability to push effectively, and cardiac and pulmonary disease)
- fetal indications (nonreassuring FHR)
104
Risks to operative vaginal birth:
- trauma to maternal and fetal tissues
- hematoma of the vagina
- fetus may have bruising, facial nerve injury, clavicular fractures, cephlahematoma
105
Technique to operative vaginal birth:
- preparation of woman (empty bladder, cervix completely dilated and membranes ruptured, adequate anesthesia)
- classification of techniques (outlet: fetal head on perineum, Low: leading edge of fetal skull at station +2, mid: leading edge of fetal skull between 0 and +2)
- forceps: locking blades applied to fetal head
- vacuum extraction: cup attached to fetal head and traction applied
106
what does the nurse during and after an operative vaginal birth?
- observe mother for trauma (bright red bleeding with firm fundus)
- observe neonate for trauma after birth (facial asymmetry)
107
Commonly infants that are stressed in utero have a _________ lung maturation
increased
108
Initiation of respirations includes what four factors?
LECTURE
- Chemical Factors
- Mechanical Factors
- Thermal Factors
- Sensory Factors
109
What role do Chemoreceptors play in the First breath?
The chemoreceptors in the carotid arteries and the aorta respond to changes in blood chemistry, partial pressure of oxygen and pH and partial pressure of carbon dioxide all help to stimulate the respiratory center in the medulla
110
The fetus begins to produce surfactant at ___-___ weeks in small amounts and by ___-___ weeks of gestation sufficient Surfactant is produced to prevent respiratory distress syndrome.
- 24-25
| - 34 - 36
111
If the mother has diabetes, how will the infants lungs be affected?
- slower lung maturation
112
When a women is at risk for a preterm birth, when and what medication is given to help the lungs begin to increase surfactant production and speed maturation
- betamethasone is given prior to 34 weeks
113
Four causes of initial respiration of a new born?
Chemical Factors
Mechanical Factors
Thermal Factors
Sensory Factors
114
What are the 3 shunts in the fetal cardiovascular system and what do they do?
- Ductus Venosus- Directs blood away from liver to inferior vena cava
- Foramen Ovale - a flap valve in the septum between the right and left atria of the fetal heart. As blood flows into the right atrium, 50% to 60% crosses the foramen ovale to the left atrium
- Ductus Arteriosus - Connects the pulmonary artery and the descending aorta
115
How does chest compression in the narrow birth canal support the first breath?
- Helps force fluid out of the lungs into the upper air passages during birth.
- When the pressure against the chest is released at birth, recoil of the chest draws a small amount of air into the lungs and helps remove some of the viscous fluid in the airways.
- This reduces the amount of negative pressure needed for the first breath after birth
116
How do thermal factors support the first breath?
Sensors in the skin respond to a sudden change in temperature by sending impulses to the medulla that stimulate the respiratory center and breathing.
117
How does a new born crying affect the respiratory process?
As the infant cries, pressure within the lungs increases, causing remaining fetal lung fluid to move into the interstitial spaces, where it is absorbed by the pulmonary circulatory and lymphatic systems.
118
What is the most frequent cause of respiratory difficulty in the first few hours of birth ?
-Use of sedatives, tranquilizers, analgesics and anesthetics
119
What are the 3 shunts in the fetal cardiovascular system and what do they do?
- Ductus Venosus- Directs blood away from liver to inferior vena cava
- Foramen Ovale - a flap valve in the septum between the right and left atria of the fetal heart. As blood flows into the right atrium, 50% to 60% crosses the foramen ovale to the left atrium
- Ductus Arteriosus - Connects the pulmonary artery and the descendin aorta
120
Why can cyanosis be seen in the hands and feet for 1 -2 hours after birth?
- Because the oxygenated blood is shunted to vital organs immediately after birth (heart, lungs, brain)
121
What changes in blood flow occurs after the umbilical cord is clamped and the newborn takes its first breath?
- increase blood flow to the liver and lungs
| - Decrease blood flow through the shunts
122
Clamping of the umbilical cord closes which shunt?
- Ductus Venosus
123
When does the foramen ovale’s flap valve close?
- when the pressure in the left atrium is higher than that in the right atrium.
124
The babies temp should be maintained at ____F or ____ - ___ C
98.6 F 36.4 -37.2C
125
Methods of heat loss
TEST
- Evaporation
- Conduction
- Convection -
- Radiation
126
What occurs when heat is lost through evaporation
TEST
Air drying of the skin that results in cooling. Water loss from skin and respiratory tract increases heat loss.
127
What occurs when heat is lost through conduction
TEST
Placing infants on cold surfaces or toughting them with cool objects.
Placing warm objects on them or skin to skin can warm them
128
What occurs when heat is lost through convection
TEST
Transfer of heat to cooler surrounding air. *Keep them in a draft free area
129
What occurs when heat is lost through radiation
TEST
Heat is lost to surrounding coller areas. Or heat from radiant warmer can warm the infant
130
What is Non shivering thermogenesis?
Metabolism of brown fat to produce heat
131
What are the hazards of cold stress?
1. Increased oxygen need
2. Decreased surfactant production
3. Respiratory distress
4. Hypoglycemia
5. Metabolic acidosis
6. Jaundice
132
Manifestations of hyperthermia
- metabolic rate rises, causing an increased need for oxygen and glucose and possible metabolic acidosis.
- peripheral vasodilation leads to increased insensible fluid losses.
- Tachypnea
133
What can be the result of Metabolism of brown fat ?
- Releases fatty acids which can result in metabolic acidosis
- Elevated fatty acids in the blood can interfere with transport of bilirubin to the liver, increasing the risk of jaundice
134
Infants have brown fat primarily located
- around the back of the neck
- axillae
- around the heart, kidneys and adrenals,
- between the scapullae
- along the abdominal aorta.
- Around the sternum
135
How should an infant be dressed to maintain proper thermoregulation
Dressed in an outfit with one more layer
136
This brown fat is mainly accumulated in the __________ , thus infants that are born prematurely have less brown fat and are unable to keep themselves warm.
third trimester
137
What are some indications for an episiotomy?
- shoulder dystocia
- vacuum or forceps-assisted births
- face presentation
- preterm fetus
138
Risks for an episiotomy?
- infection
| - perineal pain
139
Name the two techniques for an episiotomy?
- median
| - mediolateral
140
What does the nurse do during and after an episiotomy?
- promote gradual stretching of perineum during second stage (perineum massage)
- delay pushing until the urge is felt
- push with an open glottis
- observe for hematoma and edema
141
What are the indications for a cesarean birth?
- dystocia
- cephalopelvic disproportion
- HTN
- maternal diseases
- active genital herpes
- fetal distress
- umbilical cord prolapse
- some previous uterine surgical procedures
- persistent non reassuring FHR pattersn
- prolapsed umbilical cord
- fetal malpresentations
- hemorrhagic conditions
142
What are contraindications to a C-section?
- fetal death
- immature fetus
- maternal coagulation defects
143
name maternal risks associated with a C-section?
- infection
- hemorrhage
- urinary tract infection or trauma
- thrombophlebits
- paralytic ileus
- atelectasis
- anesthesia complications
144
name fetal risk associated with a C-section?
- lung immaturity
- inadvertent preterm birth
- transient tachypnea
- persistent pulmonary HTN of the newborn
- traumatic injury
145
What is done in preparation for a c-section?
- anesthesia
- medication
- lab studies
- prophylactic antibiotics
- skin prep
- foley catheter
- IV insertion
- trim pubic hair
146
Name the type of incisions used for a c-section?
- low transverse (can have VBAC)
- low vertical
- classical (not likely to have VBAC)
147
Nursing considerations for a c-section?
- provide emotional support
- teach
- promote safety
- provide post-op care (vitals, fundal checks, care of incision, monitor i/o, assessment of bowel sounds)
148
At birth the stomach holds __ml/kg
6ml/kg
149
Peristalsis in newborns is _______
rapid - twice as fast
150
Initial feedings should be about ____ ml and then increase very slowly
Lecture
20 - 25ml
151
Peristalsis is rapid in newborns especially after the ingestion of _________
- humane milk
152
What occurs anatomically in newborns that makes them more prone to regurgitation
Cardiac sphincter is relaxed
153
The intestines are long in proportion to infants size thus there is more surface space for absorption making infants more prone to ________
Rapid water loss with diarrhea
154
When are bowel sounds heard in a newborn?
within the first hour
155
Why are newborns unable to synthesize vitamin K?
- B/c Vitamin K is synthesized in the intestines, but food and normal intestinal flora are necessary for this process. At birth the intestines are sterile and therefore unable to produce vitamin K
156
What shot is given to newborns in order to help activate several clotting factors thus preventing hemorrhagic disease?
- Vitamin K
157
Newborns cannot digest complex carbs & has a hard time with fatsa but can easily digest _______ and ________.
-
- Simple carbs
- Proteins
158
Saliva production is limited until ___ month
3rd
159
The first meconium stool is usually passed within ___hours of life, and 99% of neonates pass meconium within 48 hours
12
160
How does initially breastfeeding an infant help with the first meconium stools?
colostrum has a laxative property which helps infant pass initial meconium
161
Describe a breastfed infant stool vs a formula fed infant stool
BREAST FED- Stools are seedy and mustard colored and have a sweet-sour smell. Mor
FORMULA - Pale yellow to light brown, firmer consistency
162
What is the principal source of bilirubin?
- The hemolysis of erythrocytes.
163
When hemolysis of RBC's occur, bilirubin is released in an ________ form.
unconjugated
164
Why must bilirubin go through the conjugation process?
Unconjugated bilirubin, also called indirect bilirubin, is soluble in fat but not in water. Before excretion can occur, the liver must change it to a water-soluble form by a process called conjugation.
165
Where is bilirubin excreted and how is it eliminated?
- Duodenum
| - Stool
166
The liver is responsible for what functions?
- Blood glucose maintenance
- Conjugation of Bilirubin
- Factors produced to help with blood clotting
- Storage of iron
- Metabolism of drugs
167
What is the kernicterus?
Permanent neurologic injury caused by chronic bilirubin toxicity
168
In the term infant, glucose levels should be ___-___ mg/dL on the first day and ____ - ____ mg/dL thereafter
- 40 to 60
| - 50 to 90
169
Factors that increase risk for increased bilirubin?
- Excess production
- Red blood cell life
- Liver immaturity
- Intestinal factors
- Delayed feeding
- Trauma can result in increased hemolysis of
red blood cells.
- Fatty acids are released when brown fat is used
170
______________ is a transient hyperbilirubinemia (excess bilirubin in the blood) and is considered normal.
Physiologic Jaundice
171
Whats the main defining factors between Physiologic Jaundice vs Nonphysiologic Jaundice?
Nonphysiologic jaundice may occur in the first 24 hours while physiologic Jaundice never occurs before 24 hours
172
Physiologic Jaundice becomes visible when the bilirubin level is greater than
___ mg/dL. and Peaks between the 2nd and 4th day of life.
5
173
Breastfeeding or Early-Onset Jaundice presents with bilirubin levels greater than ___ mg/dL develops in 13% of breastfed infants by 1 week of age
12
174
The most common cause of jaundice in breastfed infants is _____________.
Insufficient intake
175
_______________ may give a reddish color to the urine that is sometimes mistaken for blood.
Uric acid crystals
176
What immunoglobulin crosses the placenta and provides temporary immunity?
Lecture
IgG
177
What is the first immunoglobulin produced when exposed to infection?
Lecture
IgM
178
How does an infant receive IgA ?
Lecture
- Some from colostrum and breast milk
| - Must be produced by infant
179
Daily intake and output in the newborn for the First 3-5 Days of Life
INTAKE
- 60 to 100 mL/kg (27 to 45 mL/lb)
OUTTAKE
- At least 1 to 2 voidings
180
Daily intake and output in the newborn AFTER First 3-5 Days of Life
INTAKE:
- 150 to 175 mL/kg (68 to 80 mL/lb)
OUTPUT:
- At least 6 voidings by the fourth day
181
First period of reactivity
Lecture
- first period of reactivity begins at birth and lasts for 30 minutes.
- Infants are active at this time and appear wide awake, alert, and interested in their surroundings.
182
Second Period of Reactivity
Lecture
The second period of reactivity lasts 4 to 6 hours. Infants have alert periods, and parents may enjoy the opportunity to get to know their infant at this time. Infants become interested in feeding and may pass meconium.
183
Because an infant is less effective to fighting infection due to their immature immune system, typical responses such as fever is sometimes not present. Only subtle signs such as _________, ____________, ___________ may be the only signs of sepsis. .
- change in color,
- tone
- feeding
184
When is the optimum time of discharge?
- usually 24-48 hours after delivery
- based on individuals needs
- follow-up essential with early discharge
- nurses maintain phone contact with family at home
- variety of services available after discharge
185
Home visits are usually schedule _____ after discharge
24-72 hrs
186
a ___ is observed during a home visit
feeding session
187
car safety seat considerations:
- current recommendation is that rear-facing seats be used for infants until they are 2 years of age or have reached the highest weight or height allowed by the car seat manufacturer
- shoulder straps should be at lowest position
- restraint clip should be placed at mid-chest
- seats should be tightly secured in car
188
What are some early problems with infants?
- infant crying
- colic
- shaken baby syndrome
- sleep
- concerns of working mothers
- concerns of adoptive parents
189
infant crying peaks at ____ weeks and decreases at __ months
6 weeks
| 3 months
190
colic is irritable crying for no reason lasting about ___ hours a day, __ days a week, and for ____ weeks.
3,3,3
191
infants sleep ___ hours a day
16-17
192
infants should be placed _____ for sleeping
on their backs
193
by ___ weeks infants sleep ___ a night
12 weeks
| 5 hours
194
by __ months infants take ____ naps a day and sleep _____ hours a night
12 months
2 naps
10 hours
195
the ____ should be checked to see if the infant is warm enough
abdomen
196
formula fed infants generally pass ______ a day
one stool
197
breastfed babies may pass a stool ____or, in older infants, _____
- after every feeding
| - every 2-3 days
198
the infants should have ____ wet diapers by the fourth day of life
6
199
the mother should be nursing ____ times a day and a formula fed infants should be fed __ a day
8-12 (breastfeeding)
| 6-8 (formula)
200
transient strabismus is normal the first __ months of life
2-3
201
______, or prickly heat, develops in infants who are too warmly dressed in any weather
miliaria
202
_________ is a chronic inflammation of the scalp or other areas of the skin characterized by yellow, scaly, oily lesions
seborrheic dermatitis
203
infants do not need solid food until _______ months of age
4-6
204
the ______, in which infants push the tongue out against anything that touches it, continues until about ____.
extrusion reflex
| 4-6 months of age
205
in the first 3 months, the average infant gains about ____ each day and ___ per month
1oz
| 2lb
206
each month infants grow__ and have a head circumference of __
1. 4"
| 0. 8"
207
a social smile begins___
1-3 months
208
infants "coo" at ____ and laugh at ________
1-4 months
| 3-6 months
209
well-baby check-ups are done____
48hrs-2weeks after discharge from hospital and then 1,2,4,6,9, and 12 months of age
210
what are common signs of illness in infants:
- axillary temp above 100.4F
- vomiting all of a feeding more than once or twice in a day
- watery stools or a significant increase in the number of stools
- blister, sores, or rashes that are unusual
- unusual changes in behavior
- coughing, frequent sneezing, runny nose
- pulling or rubbing at the ear, drainage from the ear
211
breastfed babies need ___kcal/kg daily and formula fed babies need ____kcal/kg daily
85-100
| 100-110
212
babies may lose less than ____ of birth weight but should be evaluated after a _____ loss of weight.
10%
| 7%
213
lactogenesis is defined as:
the composition of breast milk that changes in three phases
214
begins during pregnancy and continues during the early days after giving birth, contains colostrum.
lactogenesis I
215
begins 2-3 days after birth and last about 10 days, usually called transitional milk
lactogenesis II
216
beings 10 days after birth and called mature milk
lactogenesis III
217
what are the infection-promoting benefits of breast milk?
- promotes growth of intestinal flora
- protects against common intestinal pathogens
- leukocytes
- immunoglobulins high in colostrum
218
What is the effect of the maternal diet on breast milk?
- fatty acid content influenced by maternal diet
- protein, carbs, and mineral content are the same in a malnourished mother
- vitamins levels are affected by maternal intake and stores
- balanced diet important for breastfeeding women.
219
what are the hormonal changes at birth in relation to breast milk production?
- prolactin is secreted after the delivery of the placenta and it activates milk production
- oxytocin increases in response to nipple stimulation
220
what are common infant problems that could interfere with breastfeeding?
- sleepiness
- nipple confusion
- suckling problems
- infant complications such as jaundice, prematurity, illness and congenital defects.
221
common breastfeeding maternal concerns:
- breast problems
- illness in mother
- medications
- breast surgery
- employment
- milk expression
- storing milk
- multiple births
- weaning
- home care
222
_____ is given IM to infants right after birth because they cannot synthesize it in the intestines without bacterial flora.
vitamin K
223
infants also receive a prophylactic eye treatment to prevent ______.
ophthalmia neonatroum
224
the normal newborn has little difficulty clearing the airway after the first few hours of life. the expected outcomes are met if:
- the RR is between 30-60 breaths per minute
| - the infant shows no signs of respiratory distress
225
generally, the newborn's temperature & respiratory rate are assessed every ____ until it has been stable for 2 hours.
30 mins
226
the normal axillary temperature range for newborns is ____
between 97.7 - 99.5
227
a common practice is to feed the newborn if the glucose screening shows __ or less to prevent further depletion of glucose.
40-45 mg/dl
228
assess for jaundice every _____ hours along with vital signs
8-12
229
what are some interventions for bilirubin?
- identify infants at risk for hyperbilirubinemia
- explain the importance of adequate feedings
- explain the significance of skin color changes
- continue to monitor during home or clinic visits.
230
What are ongoing assessments and care of a newborn?
- assess every 8 hours
- provide skin care
- bathing
- cord care
- cleansing the diaper area
- feedings
- positioning
- protecting the infant
231
what are primary ways nurses protect newborns:
- ensuring that infants always go to the correct parents
- taking precautions to prevent infant abductions
- preventing infections or recognizing early signs
- preventing infant falls
232
what are the major benefits to circumcision?
- reduces penile cancer
- reduces UTI's in the first year of life
- reduces HIV infections
- reduces the risk of transmission of other sexually transmitted diseases
233
how is hep b administered to a newborn whose mother is infected?
- give hep b vaccine
- give hep b immune globulin
- give te globulin within 12 hours of birth
234
what are some newborn screening tests?
- hearing
- phenylketonuria
- hypothyroidism
- galactosemia
- hemoglobinopathies
- congenital adrenal hyperplasia
235
In order for newborns to qualify for early discharge they must:
- be appropriate for gestational age
- VS wnl
- feeding successfully
- making transition from fetal to neonatal life
- passed urine and stool
- mother able to care for infant
236
How do thermal factors support respiration of a newborn at birth?
Lecture
The temperature change that occurs with birth also stimulates the initiation of respirations.
237
How do the sensory factors help stimulate the first breaths ?
Lecture
The stimulation of the light, sound, smell, and pain at delivery may also aid in initiating respirations.
238
What role do Chemical factors play in initial respirations of a newborn?
Lecture
Chemoreceptors in the carotid arteries and the aorta respond to changes in blood chemistry caused by the hypoxia that occurs with normal birth. A decrease in the partial pressure of oxygen (Po2) and pH and an increase in the partial pressure of carbon dioxide (Pco2) in the blood cause impulses from these receptors to stimulate the respiratory center in the medulla.
239
What is an APGAR SCORE ?
Lecture
The Apgar score is a method for rapid evaluation of the infant’s cardiorespiratory adaptation after birth.
240
The nurse scores the infant at __ minute and __minutes in each of five areas.
Lecture
- 1
| - 5
241
When assessing a newborn you work in a certain direction. _____ to ____.
Lecture
Head to feet
242
Blood sugars are monitored for babies below the ___ percentile and above the ___ percentile.
Lecture
- 10th
| - 90th
243
During APGAR scoring, the infant is assigned a score of ___ to ___ in each of the five areas, and the scores are totaled.
Lecture
- 0
| - 2
244
What are the 5 areas of assessed during an APGAR SCORE?
Lecture
1. Heart Rate
2. Respiratory effort
3. Muscle tone
4. Reflex response
5. Color
245
What do you do for APGAR score of 0 - 2
Lecture
Infant needs resuscitation
246
What do you do for APGAR score of 3 - 6
Lecture
- Gently stimulate by rubbing infant’s back while administering oxygen.
- Determine whether mother received narcotics, which may have depressed infant’s respirations.
-Have naloxone (Narcan) available for administration.
247
APGAR scores from ___ to ___ don't require any interventions.
Lecture
7 - 10
248
___________ is blockage or narrowing of one or both nasal passages by bone or tissue.
Lecture
Choanal atresia
249
Central cyanosis involves the lips, tongue, mucous membranes, and trunk and indicates true hypoxia which could indicate ____________ problems
Lecture
Cardiovascular
250
What is the difference between Caput and a Cephalhematoma?
Lecture
Caput - localized edema, pitting, crosses suture lines, disappears within 12-48hrs
Cephalhematoma - bleeding between the periosteum & skull, does not cross suture lines, may take 2-3 months to resolved
251
________ may be present on the hard palate or gums. These small, white, hard, inclusion cysts are accumulations of epithelial cells and disappear without treatment within a few weeks.
Lecture
Epstein’s pearls
252
A murmur in a newborn is normal and maybe heard bc ________
Lecture
A murmur may be heard as a result of blood flow through the partially open vessel.
253
First __hours is the best time to interact and breastfeed?
Lecture
2
254
How does Oxytocin affect breastfeeding?
Lecture
- stimulates milk let down
| - tells body to release prolactin thus increasing milk production
255
Breastfeeding moms need to eat _____ extra calories per day and drink ___ glasses of water?
Lecture
- 500
| - 10
256
In physiologic jaundice, the bilirubin peaks at between the second and fourth days of life and falls to normal levels by ___ - ___ days
Lecture
- 5 to 7
257
Pathologic jaundice can show up ______ or within _____
Lecture
- at birth
| - within 24 hrs
258
___________ jaundice is not present during the first 24 hours of life in term infants but appears on the second or third day after birth.
Lecture
Physiologic
259
What is important to know when cleaning an uncirumsized babies foreskin?
DON'T PULL BACK SKIN... ITS ATTACHED TO THE GLAND
260
Screening tests should be performed between ___ - ____ hrs for more accurate results
24 to 48
261
Fresh unrefrigerated breast milk should generally be used within __ to ___ hours of pumping. Under very clean conditions using it within 6 to 8 hours is acceptable.
3 - 4
262
Breast milk may be stored in a refrigerator at 4°C (39°F) or below for ___ hours in usual circumstances or for 5 to 8 days under very clean situations (ABM, 2010).
- 72
263
If the milk is to be frozen, it should optimally be used by ___ - ____
6 - 12
Perinatal test
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