1
Q
what are ways to help the parents respond to perinatal loss
A
- inform them as soon as possible
- provide privacy
- keep same nursing staff
- prepare them for the appearance of the child
- allow unlimited time with infant
- dress the infant
- take pictures and offer them to the parents
- support cultural practices
- send anniversary cards
2
Q
What classifies SGA
A
Birth weight less than the 10th percentile. Typically less than 5 lbs. 8 oz. at birth
3
Q
What does the SGA infant look like
A
Loose dry skin(indicates loss of weight) Little fat or muscle(malnourishment) Sunken abd Thin cord Wide skull sutures Weak cry Hypoglycemia Development delay
4
Q
What classifies LGA
A
Hey newborn with the weight above the 90th percentile. Greater than 9 pounds at birth
5
Q
Can result from LGA
A
Difficult vaginal birth, shoulder dystocia, clavicle fractures, and facial palsies
6
Q
What is LGA related to
A
Maternal diabetes, post date, large parents
7
Q
What physiological problems may you see in an LGA infant
A
Hypoglycemia caused from maternal diabetes because the fetus sucks up the maternal extra glucose in utero so they produce excess insulin and when they’re born the glucose supply has diminished so they become hypoglycemic
Respiratory distress
Birth trauma
8
Q
Signs of hypoglycemia in an infant
A
Lethargy, apathy, drowsiness, irritability, tachypnea, weak cry, temperature and stability, jitteriness, seizures, apnea, bradycardia, cyanosis or pallor, weak suck and poor feeding
9
Q
When is an infant postterm
A
After 42 weeks
they may be SGA, LGA, or AGA
10
Q
What may a post term infant look like
A
- wasted appearance due to the placenta not functioning optimally,
- lack of vernix because it is getting absorbed while the baby is in utero —lack of subcutaneous fat due to placenta declining and function.
- dry cracked skin
11
Q
What are complications of a post term infant
A
-Asphyxia caused from placental aging
-Hypoglycemia
Meconium aspiration
Birth trauma
Hypothermia
Polycythemia caused by an increase production of RBC to compensate for reduced oxygen environment
12
Q
When is preterm birth and what causes it
A
- infection
- ATOD
- trauma
- preeclampsia
- malnutrition
- diabetes
- multiple pregnancy
13
Q
What characteristics do you see in preterm
A
Lack of subcutaneous fat, lack of surfactant, weak lungs, weak suck, weak gag, fragile capillaries Weak muscle tone poorly formed pinna of ear fused eyelids matted hair absent/few creases is soles and palms lax posture barely visible nipple At risk for respiratory distress
14
Q
What Care do we want to provide for preterm infant
A
Mimic the uterine environment by keeping them flexed in a quiet dark warm nest
Avoid overstimulation
Supply nutrition
15
Q
What type of feeding is provided for preterm infant care
A
TPN
Gavage -tube inserted to stomach to stimulate gi on no effort of the fetus
Nipple supplementation
16
Q
What do we assess for in a preterm infant
A
- Cerebral bleed d/t the thin skin and fragile capillaries
- hypothermia
- hypoglycemia
- retinopathy
- respiratory distress
- cerebral palsy
17
Q
what is necrotizing enterocolitis
A
an inflammatory disease of the bowel that can cause ischemic and necrotic injury
abx, parenteral fluids, human milk corticosteroids and probiotics help this condition
18
Q
when and what symptoms will we see with respiratory distress
A
about 1-2 hours after birth s/s tachypnea, retractions nasal flaring grunting crackles diminished breath sounds decreased O2 cyanosis tachycardia
19
Q
what can we do to help an infant in respiratory distress
A
- intratracheal surfactant replacement
- supply O2 by bubble, CPAP oscillator, Ventilator, hood or NC
- suction as needed- when mucous secretions blocking the airway
- monitor O2 sats and ABGs
20
Q
when would you not give an infant a feeding
A
if they are in respiratory distress and their Respiratory rate is greater than 60 because they are now at an increased risk for respiration
21
Q
what is kangaroo care & benefits
A
when the infant is placed chest to chest with parent over the heart. the parent is encouraged to rock the infant.
Benefits-increase sleep time for infant
regulates HR
decreased O2 demands
mothers body temp senses what infant needs and regulates temp for infant.
better weight gain
nurse better
22
Q
what can happen to the infant of a diabetic mother
A
- the baby gets too big d/t all the extra glucose and can have birth trauma
- the babys pancreas produces excess insulin to meet the demands of the excess glucose and then when the baby is born the glucose diminishes but the pancreas still secretes a bunch of insulin to hypoglycemia results
- also resulting in hyperinsulinemia
- Resp distress d/t the hyperglycemic environment- delays the maturation of fetal lungs so therefore surfactant is not as quickly made.
- cardiac or spinal anomalies
- polycythemia- causes baby to have a red appearance
23
Q
what interventions are performed for an infant of a diabetic mother
A
-check glucose @ 30 minutes, 1,2,4,6,9,12,24 hours
treat hypoglycemia
24
Q
what is the neonatal hypoglycemia level
A
anything less than <40mg/dL
25
what do we do to treat hypoglycemia in infants
assess glucose before feedings
<40 we give them breast milk
<20 we give IV D10W
26
what is the issue with meconium aspiration
creates an emphysema like action
| once meconium is inhaled it stops the alveoli from being able to exhale. -it blocks the airway
27
s/s of meconium aspiration syndrome
APGAR score of <6
respiratory distress(grunting, retractions etc)
barrel shaped chest
diminished breath sounds
meconium staining- the water may have a golden yellow/greenish color- worry some when there are chunks in the fluid
cord may be yellow/green
28
what can meconium aspiration lead to
aspirational pneumonia
29
what interventions do we do when an infant has meconium aspriation
suction the mouth and nose after head is born
| -if the airway seems to be obstructed the baby will be intubated and the trachea will be suctioned
30
when does ABO incompatibility occur and what happens
when mom is type O and has a type A or B fetus
the mom develops antibodies against A and B that can cross the placenta
this will cause mild neonatal hemolysis and jaundice
31
when does jaundice begin to appear and bilirubin level
approx 24 hours after birth
| < or equal to 15
32
what are the causes of jaundice
the result of increased RBC level and an immature liver that cannot filter out the excess RBC breakdown
and
the Rh or ABO incompatibility of mother and fetus
or infection
33
what can be complications of hyperbilirubinemia
-Kernicterus-unconjugated bilirubin deposited into the brain tissue causing neurological damage
(motor function, developmental delay, vision, hearing issues, -permanent conditions)
-Rh isoimmunization & erythroblastosis details- the moms antibodies are breaking down the infants RBC resulting in anemia and jaundice and the baby is producing immature RBCs to try to compensate
-Hydrops fetalis- severe anemia
so severe will develop while fetus is still in utero- causes multi-organ system failure, edema, ascites, hypoxia and fetal death
34
what are assessments for hyperbilirubinemia
- blanch the skin to see the color (be in normal light)
- inspect conjunctiva/sclera
- check bili levels
35
what bili level indicates treatment is needed
in a term infant >15
| in a preterm >10
36
what helps clear the excess bilirubin
- feeding- will help excrete the excess
- phototherapy-blue/green spectrum
- exchange transfusion- if phototherapy not working, positive direct coombs OR baby hgb <12--5-20mLs blood removed and replaced with donor blood.
37
what is normal baby hgb after birht
16,18-20
| <12 the baby has anemia
38
what effects does caffeine have on an infant
may cause heart defects if large amounts consumed
| may contribute to SGA
39
what effects does cocaine and methamphetamines have on infant
they are vasoconstrictors so they constrict the blood supply to the fetus resulting in SGA, Prematurity, cardiac anomalies and cleft palates
40
what effects does marijuana have on an infant
causes FGR, SGA, abnormal sleep pattern, impaired executive functioning (impulse control issues)
41
what effects does tobacco have on the infant
it is a vasoconstrictor so constricts the blood supply to the fetus leading to SGA, causes impaired respiratory function, ADD, developmental delay, gastrochisis (abd organs develop outside the body) SID and cleft lip/palate
42
what effects does opioids have on the infant
SGA, neonatal abstinence syndrome
| -the infant develops dependency of the drug- withdrawal symptoms
43
```
what are s/s of neonatal abstinence syndrome (NAS)
neuro
Gi
metabolic
respriatory
```
* neuro problems- abnormal cry, sleep probs, tremors, hyperactive reflexes
* GI-excessive sucking, poor feeding, diarrhea, slow weight gain, regurgitation
* metabolic- fever, sweating (very abnormal), yawning excessively
* Respiratory- sneezing, nasal congestion, tachypnea
44
what are things we do to manage NAS
- do a toxicology screen to see what drug is in the infants system
- swaddle tightly
- reduce noise and stimuli
- feed on demand
- finnegan score > or equal to 8- we need pharmacological therapy
45
what are the pharmacological therapies we have to manage NAS
Morphine
phenobarbital
breast feeding- if the mother has the drug in her system it readily passess through the breast milk and onto the baby decreasing the withdrawal symptoms
46
what does alcohol do to a fetus
it is a teratogen and causes brain damage and results in fetal alcohol spectrum disorders
47
what does fetal alcohol syndrome look like in brain damage and in features
- microcephaly
- impaired executive function (impulse control issues)
- intellectual disability (retardation)
- small eyes
- epicanthal folds
- thin upper lip
- smooth philtrum
- flat mid face
- narrow forehead
48
what is the fertility awareness contraceptive measure
the woman checks the cervical mucosa- when not fertile the mucous is very sticky- when fertile the mucous is less sticky and the cervix moves forward.
body temp checks- when your fertile your body temp drops slightly and raises after ovulation (about a 10th of a degree- take in AM)
49
how do you avoid pregnancy when using the fertility awareness contraceptive measure
abstain from intercourse 7 days before expected ovulation and 3 days after ovulation
50
how long is the longest possible fertile period
8 days
| the sperm live for 7 days and the ovum survives 24 hours
51
how does the pill prevent pregnancy
it inhibits ovum release and thickens cervical mucous to prevent sperm motility
52
what hormones are in the pill
there are estrogen and progestin
| and ones with only progestin
53
what would cause a pt to not be a candidate for the pill or vaginal ring
if she has a hx of a thromboembolism because the pill causes the pt to be at an increased risk for thromboembolisms
54
how effective is the pill
92%
55
what does the vaginal ring do
continuously secretes estrogen and progestin
| it is in for 3 weeks and out the period week and new ring then inserted.
56
what is the issue with the transdermal contraceptive patch
it causes significant irritation at the site and also causes stroke
it only works up to a certain weight. a heavy person has more tissue and causes the patch to be less effective
57
what does the progestin IM ind do
an injury q12wks
it inhibits ovulation and causes thick mucous
it is 97% effective
58
what is an issue with long term use of the progestin IM inj
should only be used for 2 years because longer increases the risk of bone loss
bone loss may not be revirsable
59
when will you be able to conceive after stopping the IM inj of progestin
it can take up to 1.5 years for the fertility cycle to begin
60
what are the intrauterine device contraceptives
Paraguard and the mirena
can remain from 5-10 years
both cause inflammation of endometrium inhibiting fertilization and implatation
the mirena secretes progestin which inhibits ovulation
99% effective
61
what does the morning after pill do
if given within 72 hours and doses 12 hrs apart
it may prevent ovulation, fertilization and implantation
it is 80% effective
62
when can a therapeutic abortion take place
before 20 wks
63
when can a surgical abortion take place
up to 16 wks gestation- can be vacuum aspiration
| or dilation and evacuation at 16-20 weeks
64
what is a complication of surgical abortions
perforation/hemorrhage
lacerations
infections
65
what are the medical abortions
medications by mouth within 7 wks of last menstrual period
(mifepristone within 7 wks of LMP and misoprostol 2 days later)
need to come back to have confirmation
66
what is a hypotonic uterus and the causes
a boggy uterus that feels mushy
its not contracting properly
causes include over sedation of the uterus
macrocosmic baby, multiple gestation, polyhydramnios, multiple births, transverse lie, use of mag sulfate, oxytocin and a full bladder
67
if the post partum pt has a firm uterus but is still having continuous bleeding what can be the cause
a laceration of the genital tract or d/t retained placental fragments
68
how long after birth is the woman mostly hemodynamically stable
the first 46 hours after birht
69
if a post partum pt is bleeding what meds can be given
-oxytocin first to stimulate uterine contractions
if she has already had that the move to
METHERGINE IM/PO which is usually ordered in 4-6 doses- you want to finish out the doses even if she stops bleeding
if she is still bleeding we can give her prostaglandins
Misoprostol(cytotec) rectally which will stimulate uterine contractions
Carboprost IM
70
what is something we can insert to stop a woman from actively bleeding post partum
a balloon tamponade- done by midwife or MD
| it puts pressure on the uterus from the inside
71
what are side effects of methergine
shivering- makes sure she is warm and have blankets
| fever- make sure these sxs are not from infection
72
what are side effects of Carbropost
severe cramping, diarrhea, nausea, vomiting, chills and fever
73
when is methergine contraindicated
you cannot give methergine if the BP is elevated. the reassessment for this drug is to take BP prior to. anything of 140/90 or above HOLD the med
the med will further raise her BP and put her at risk
74
what is endometritis
the infection of the uterine lining
| may occur 2ndary to c/s vaginal delivery SAB or TAB
75
what are the s/s of endometritis
- temp >100.4
- abnormal amount and odor of lochia
- pelvic /abd pain
- malaise, nausea, fatigue
- increased WBC (high wbc is usually normal but associated with these other symptoms is not)
- increased ESR (which rises with infalmmation in the body)
- positive blood cultures
76
what is the treatment for endometritis
```
C&S
IV abx asap
analgesics for the pain
antipyretics for fever
hydration and rest
```
77
what are the s/s of wound infection
```
temp >100.4
tacky
chills
malaise
nausea
fatigue
pain at inc
REEDA
```
78
if a woman is chilling (shivering d/t chills) when is the best time to take her temp
after she stops chilling because at this point her body has a new set point
79
what are the risk factors for developing mastitis
```
milk stasis
bacteria promotion
nipple trauma
blocked ducts
fatigue
stress
```
80
how to avoid mastitis
- continue to breast feed- infection not spread in milk
- empty breast before switching
- reposition the baby to have a good latch to promote emptying
- maintain nipple integrity
- avoid pressure on breast
- massage while child feeding to empty breast
81
s/s of post partum blues
```
mood swings
anger
tearfulness
insomnia
resolves around 1-2 wks
```
82
s/s of postpartum depression
```
more intense than post partum blues
persists longer than 2 weeks
decreased interest in surroundings
loss of emotional response
guilty feeling
unworthy
fatigue
difficulty concentrating
weight changes
sleep problems
panic attacks
suicidal thoughts
obsessive thoughts
```
83
s/s of postpartum psychosis
```
present 3 wks after birth
may look like bipolar illness, schizophrenia, depression
irritability
hyperactive
euphoria
poor judgment
confusion
tearful
guilt
sleep and appetite disturbances
hallucinations
delusions
increased risk of suicide/infanticide
```
202A
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