OB Exam 4
Trunk assessment
nipple buds should be 5-10 mm--firm and raised. belly is distended with veins present. listen to the bowels and heart. xiphoid process is prominent.
Breast feeding latch
nipple to nose, wait for wide open mouth and place nipple in the baby's mouth
Nose assessment
no nasal flaring, monitor for respiratory distress. cover mouth and press on side of the nose and then the other to determine if they are able to breathe out of their nose.
Ear assessment
not low-set, instant recoil of ears, assess kidneys with the ears (develops at the same time so defects are often linked)
Transient tachypnea interventions
oxygen, continuous positive airway pressure, ABGs, IV fluids, tube feedings
Respiratory distress syndrome interventions
oxygen, surfactant, IV fluids, antibiotics, keep warm, blood sugar stable
Circumcision nursing care
petroleum jelly on gauze, tented over the penis
Interventions to decrease hyperbilirubinemia
phototherapy (cover eyes for this); exchanged transfusion (removes sensitized RBCs, maternal antibodies and unconjugated bilirubin)
Erythema toxicum
pink rash that appears suddenly anywhere on the body of a term baby during the first 3 weeks, most common on the abdomen
Caput
poorly demarcated soft tissue swelling/localized edema. crosses suture lines.
Conduction interventions
pre warm surfaces or place warm blanket in between baby and cold surfaces, scale, stethoscope, exam table
Newborn risk factors for respiratory distress syndrome (RDS)
prematurity, infection, cold stress, hypothermia, hypoglycemia, lack of adequate surfactant, septic babies (pneumonia cause)
BPD interventions
prevention, oxygen, surfactant replacement
Risk factors for pathologic jaundice
previous antibodies from the mother kill off red blood cells in the baby. an ABO or Rh incompatibility
Risk factors for IUGR
problems with blood flow and nutrient flow to the placenta, uterus issues, multiple gestations, alcohol, drugs, diabetes, renal issues, infections, chronic hypertension.
Communication techniques for a mom of a preterm infant
quiet and understanding environment
Respiratory distress syndrome
rapid respiratory failure due to surfactant deficiency
Phototherapy
repeated exposure under special fluorescent lights, eyes must be covered, exposure of as much skin as possible, keep the skin hydrated (bottle feed q2 hours)
Pre-eclampsia
residual hypertension--monitor seizures--seizures mean mom has progressed to preeclampsia
Expected outcomes with Beractant
respiratory rate 30-60, clear lung sounds, no nasal flaring, grunting, retractions, normal oxygen saturation
Male genitalia assessment
scrotum should be pendulous, may be darker than surround skin. palpation to determine if testes have descended
Transient tachypnea
self-limiting (usually disappears within 72 hours), delay in the clearance of the fetal lung fluid--may need CPAP help
Molding
shaping of the fetal head during movement through the birth canal. will return to normal
Recognize cues of pathologic jaundice
shows up before 24 hours, significantly elevated bilirubin levels, yellowing of the skin and eyes, crying and irritable (too much bilirubin in the brain)
Hypothermia interventions
skin to skin, placing on mother's abdomen or radiant warmer, make sure they are not experiencing heat loss, dry them, double wrap and make sure they have a hat on, check their blood sugar!
SGA
small for gestational age, below the 10th percentile, small head and body, can cause hyperglycemia and hypothermia.
Risk factors for uterine atony
soft and weak uterus without tone retained placental fragments, prolonged labor, augmented labor, over distention of the uterine muscle, birth trauma, macrosomia, high parity multiple gestation
Moro reflex
startled or feels like they are falling, arms fling out sideways
What type of touch is used with a 26 week premature infant
steady, gentle, hands-on, or skin-skin contact
S/sx of apnea prematurity
stop breathing for short periods of time; abrupt pallor; hypotonia; cyanosis, bradycardia, O2 desaturation
Benefits for the baby with breastfeeding
strengthens immune system, protects from infection, decreases allergies, easily digestible, protects against obesity, helps with long term brain development, adapts to the baby's needs
Babinski reflex
stroked sole of the foot, big toe bends back toward the top of the foot and the other toe fans out
Stork bite
superficial vascular pink areas found at nape of neck and eyelids
Low oxygen level interventions
supplemental oxygenation, warm and humidified, protect eyes, find the cause, CPAP, check temp and glucose levels to help find the cause of hypoxia
Caput succedaneum
swelling that can cross suture lines. pressure at the cervix is the cause. at birth and does not increase in size
Eye assessment
symmetrical, may be puffy at first, slate blue color
Transient tachypnea assessment
tachypnea (>60 bpm), hypoxemia, grunting, nasal flaring, retractions
Respiratory distress syndrome assessment
tachypnea, grunting, nasal flaring, cyanosis, retractions, low oxygen saturation
BPD assessment
tachypnea, nasal flaring, retractions, grunting
Support for families with a child in NICU for discharge
teaching
acrocyanosis
temporary cyanotic condition. bluish color around the lips, hands, and fingernails, feet, and toenails. lasts 1-2 days
What happens when the umbilical cord is clamped?
the pulmonary resistance decreases so the lungs can fill up with air. clamped at birth. dries up and falls off in 1-2 weeks. teach about signs/symptoms of infection--red, drainage, warmth at the umbilical site benefits for the first 30 seconds-5 minutes and can help with increased blood flow for the baby.
Vernix caseosa
thick white substance that provides protection for the newborns skin in utero
How to give erythromycin eye ointment?
tip the head back slightly and pull your lower eyelid down to form a pouch. apply to inside of the lower eyelid. cover the entire area
Abdomen assessment
umbilical cord, veiny skin
Phototherapy
undress the baby completely, place the eye shield over the baby's eyes (completely cover the eyes but prevent any occlusion of the nares)
Milia
unopened sebaceous glands many times found on the infant's nose
Nursing assessment of client prior to the induction of labor using oxytocin
want to avoid excessive stimulation to uterus or fetus. monitor FHR, contraction pattern, maternal vital signs, and intensity Q15 minutes. fetal presentation and station. placental prevue and placenta abruption and uterine tachysystole (do not give with these conditions). check for fetal distress (HR <90 >160). look for decelerations of marked variability. check for frequency, duration, and intensity used to induce and/or augment labor and postpartum for hemorrhage
Cold stress interventions
warm the room, dry the infant, swaddle in warm blankets, warm oxygen, kangaroo care and skin-skin, use radiant warmer, monitor Q1-4hrs, avoid heat loss, less than 29 weeks--put in a bag, maintain blood sugar
Cephalohematoma
well demarcated swelling. collection of blood that does not cross suture lines.
Cause of afterpains
when the uterus contracts and shrinks back to pre-pregnancy size. breastfeeding releases oxytocin which makes these afterpains more painful. lasts 2-3 days.
First period of reactivity
wide awake, alert, and seems interested in his or her surroundings
A newborn in the nursery is exhibiting signs of neonatal abstinence syndrome. Which of the following signs/symptoms is the nurse observing? A) Hyperphagia B) Lethargy C) Hyporeflexia D) Persistent shrill cry
A) Hyperphagia D) Persistent shrill cry
Normal newborn assessment
-plantar creases (the more creases the more mature the neonate) -Babinski reflex (toes fan out when sole of foot is stroked) until 1 year of age -Epstein's pearls (white pearl like cysts) are benign and should disappear in a few weeks -opaque/whitish blue umbilical cord with 2 arteries & 1 vein (should turn black then detach from body in 2 weeks--do not use alcohol to clean) -acrocyanosis: bluish color of hands and feet, place skin to skin with mother, normal during first 24 hours -mongolian spots: benign discoloration of skin that fades in 1-2 years of life, document size and location -2-6 wet diapers expected first 24 hours, by 3-4 days 6-8 wet diapers -positive Moro reflex (startle) -swollen labia with thin white discharge -milia: pinpoint papules -diamond shaped anterior fontanel -triangular shaped posterior fontanel smaller than anterior -rales d/t transitioning to extrauterine life
Normal newborn head circumference
13.5 inches. measure from right above the eyebrows and around the head.
Normal newborn length
17-22 inches, can drastically change from week to week
A neonate is found to have choanal atresia on admission to the nursery. Which of the following physiological actions will be hampered by this diagnosis? A) Feeding. B) Digestion. C) Immune response. D) Glomerular filtration.
A) Feeding.
What are normal blood glucose levels for a term infant
40-60 mg/dL
How many weeks is considered post-term
42
Normal newborn weight
5.8-8.13 pounds (2500-4000 grams). normal to lose up to 7% in the first few days.
A full term infant admitted to the newborn nursery has a blood glucose level of 35mg/dl. Which of the following actions should the nurse perform at this time? A) Feed the baby formula or breastmilk. B) Assess the baby's blood pressure. C) Tightly swaddle the baby. D) Monitor the baby's urinary output.
A) Feed the baby formula or breastmilk.
Fontanelles
areas where the infant's skull has not fused together; should not be bulging or sunken in, usually disappear at approximately 18 months of age
A neonate is being assessed for necrotizing enterocolitis (NEC). Which of the following actions by the nurse is appropriate? Select all that apply. A) Perform hemoccult test on stools. B) Monitor for an increase in abdominal girth. C) Measure gastric contents before each feed. D) Assess bowel sounds before each feed. E) Maintain a strict every 3 hour feeding schedule.
A) Perform hemoccult test on stools. B) Monitor for an increase in abdominal girth. C) Measure gastric contents before each feed. D) Assess bowel sounds before each feed.
Four full-term babies were admitted to the neonatal nursery. The mothers of each of the babies had labors of 4 hours or less. The nursery nurse should carefully monitor which of the babies for hypothermia? A) The baby whose mother cultured positive for group B strep during her third trimester. B) The baby whose mother had gestational diabetes C) The baby whose mother was hospitalized for 3 months with complete placenta previa. D) The baby whose mother previously had a stillbirth.
A) The baby whose mother cultured positive for group B strep during her third trimester.
A baby is in the NICU whose mother is addicted to heroin during the pregnancy. Which of the following nursing actions would be appropriate? A) Tightly swaddle the baby. B) Place the baby prone in the crib. C) Provide needed stimulation to the baby. D) Feed the baby half-strength formula.
A) Tightly swaddle the baby.
A baby was born 24 hours ago to a mother who received no prenatal care. The infant has tremors, sneezes excessively, constantly mouths for food, and has a shrill, high-pitched cry. The baby's serum glucose levels are normal. For which of the following should the nurse request an order from the pediatrician? A) Urine drug toxicology. B) Biophysical profile test. C) Chest and abdominal ultrasound evaluations. D) Oxygen saturation and blood gas assessments.
A) Urine drug toxicology.
A 42-week gravida is delivering her baby. A nurse and a pediatrician are present at the birth. The amniotic fluid is green and thick. The baby fails to breathe spontaneously. Which of the following actions should the nurse take next? A) Stimulate the baby to breathe. B) Assist with intubation. C) Place the baby in the prone position.
B) Assist with intubation.
A 1000 gram neonate is being admitted to the NICU. The surfactant Survanta (beractant) has just been prescribed to prevent respiratory distress syndrome. Which of the following actions should the nurse take while administering this medication? A) Flush the intravenous line with normal saline solution. B) Assist the neonatologist during the intubation procedure. C) Inject the medication deep into the vastus lateralis muscle. D) Administer the reconstituted liquid via an oral syringe.
B) Assist the neonatologist during the intubation procedure.
A newborn nursery nurse notes that a 36-hour-old baby's body is jaundiced. Which of the following nursing interventions will be most therapeutic? A) Maintain a warm ambient environment. B) Have the mother feed the baby frequently. C) Have the mother hold the baby skin to skin. D) Place the baby naked by a closed, but sunlit window.
B) Have the mother feed the baby frequently.
Thirty seconds after birth a baby, who appears preterm, has exhibited no effort to breathe even after being stimulated. The heart rate is assessed at 68 bpm. Which of the following actions should the nurse perform first? A) Perform a gestational age assessment. B) Inflate the lungs with positive pressure. C) Provide external chest compressions. D) Assess the oxygen saturation level.
B) Inflate the lungs with positive pressure.
Which of the following neonates is at highest risk for cold stress syndrome? A) Infant of diabetic mother. B) Infant with Rh incompatibility. C) Postdates neonate. D) Down syndrome neonate.
C) Postdates neonate.
A baby has been admitted to the NICU with a diagnosis of intrauterine growth restriction (IUGR). Which of the following maternal factors would predispose the baby to this diagnosis. Select all that apply. A) Hyperopia B) Gestational diabetes. C) Substance abuse. D) Chronic hypertension. E) Advanced maternal age.
C) Substance abuse. D) Chronic hypertension. E) Advanced maternal age.
An infant in the neonatal nursery has low-set ears and Simian creases. The nurse should monitor this infant for which of the following signs/symptoms? A) Blood-tinged urine. B) Hemispheric paralysis. C) Cardiac murmurs. D) Hemolytic jaundice.
C) Cardiac murmurs.
There is a baby in the neonatal intensive care unit (NICU) who is exhibiting signs of neonatal abstinence syndrome. Which of the following medications is contraindicated for this neonate? A) Morphine. B) Opium. C) Narcan. D) Phenobarbital.
C) Narcan
A baby is born with esophageal atresia and tracheoesophageal fistula. Which of the following complications of pregnancy would the nurse expect to note in the mother's history? A) Preeclampsia. B) Idiopathic thrombocytopenia. C) Polyhydramnios. D) Severe iron deficiency anemia.
C) Polyhydramnios.
A 1-day old neonate, 32 weeks gestation, is in an overhead warmer. The nurse assesses the morning axillary temperature as 96.9 F. Which of the following could explain this assessment finding? A) This is a normal temperature for a preterm neonate. B) Axillary temperatures are not valid for preterm babies. C) The supply of brown adipose tissue is incomplete. D) Conduction heat loss is pronounced in the baby.
C) The supply of brown adipose tissue is incomplete.
A baby born by vacuum extraction has been admitted to the well-baby nursery. The nurse should assess this baby for which of the following? A) Pedal abrasions. B) Hypobilirubinemia. C) Hyperglycemia. D) Cephalohematoma.
D) Cephalohematoma.
A macrosomic infant of a non-insulin dependent diabetic mother has been admitted to the neonatal nursery. The baby's glucose level on admission to the nursery is 25mg/dl and after a feeding of mother's expressed breastmilk is 35mg/dl. Which of the following actions should the nurse take at this time? A) Nothing, because the glucose level is normal for an infant of a diabetic mother. B) Administer intravenous glucagon slowly over five minutes C) Feed the baby a bottle of dextrose and water and reassess the glucose level. D) Notify the neonatologist of the abnormal glucose levels.
D) Notify the neonatologist of the abnormal glucose levels.
The staff on the maternity unit is developing a protocol for nurses to follow after a baby is delivered who fails to breathe spontaneously. Which of the following should be included in the protocol as the first action for the nurse to take? A) Prepare epinephrine for administration. B) Provide positive pressure oxygen. C) Administer chest compressions. D) Rub the back and feet of the baby.
D) Rub the back and feet of the baby.
How do maternal pregnancy and labor issues cause potential newborn problems?
Diabetes- puts the baby at risk for hypoglycemia, macrosomia, and potentially broken clavicles. If mom has poor control--baby is used to having a constant supply of sugar and now their body is still pushing out high levels of insulin (hypo or hyperglycemia reactions) Macrosomia- extra glucose in the fetus is stored as body fat Potentially broken clavicle- shoulder gets stuck in the birth canal, too large in size. makes feeding difficult.
Mouth assessment
Epstein pearls, tongue ability to suck, hard and soft palate, presence of teeth.
Normal lab values for the term newborn
Hematocrit- 44-70% Hemoglobin- 14-24
Beractant
MOA--helps with preterm lung maturity.
Medications for postpartum hemorrhage (Oh My Hemorrhage)
Oxytocin- given post delivery to control contractions and contract uterus. Methergine- causes vasoconstriction. Hemabate- give fluids and keep HOB flat.
Normal newborn vital signs
RR: 30 to 60 per minute (70-80 if crying, 50s if sleeping) HR: 120 to 160 per minute (100 sleeping, 180 crying) BP: 60 to 80 / over 40 to 50 Temp: 36.5 to 37.3 Celcius or 97.7 to 98.9 Farenhiet
Premature infant's physical characteristics that affect thermoregulation
Skin thin with blood vessels near surface; less brown fat (thermogenesis); little white fat (insulation); large surface area; extended extremities; immature temperature control center
Infection
UTI, mastitis, incisional infections, endometritis
Where is Vitamin K administered?
Vastus lateralis within the first 24 hours
Vernix
a greasy, lipid-rich substance that protects the fetus in utero and can still be present at birth. helps with water loss and temperature control
A 2-day old breastfeeding baby born via normal spontaneous vaginal delivery has just been weighed in the newborn nursery. The nurse determines that the baby has lost 3.5% of the birth weight. Which of the following nursing actions is appropriate? a) Continue to monitor, as this is a normal weight loss. b) Notify the neonatologist of the significant weight loss. c) Advise the mother to bottle feed the baby at the next feed. d) Assess the baby for hypoglycemia with a glucose monitor.
a) Continue to monitor, as this is a normal weight loss.
A 40 week gestation neonate is in the first period of reactivity. Which of the following actions should the nurse take at this time? (Select all that apply). a) Encourage the parents to bond with their baby. b) Notify the neonatologist of the finding. c) Encourage and support parents in feeding their baby. d) Perform the gestational age assessment. e) Place the baby under the overhead warmer. f) Swaddle the infant snuggly and sway, hoping to help settle the infant to sleep. g) Encourage extended family to visit so they can see the baby while awake.
a) Encourage the parents to bond with their baby. c) Encourage and support parents in feeding their baby.
Which of the following are important topics to educate parents on prior to discharge? (Select all that apply). a) Feeding, Bathing, and Elimination b) Introduction of infant cereal c) Cord and Circ (if applicable) care d) Safe Infant Travel in appropriate care seat e) Holding and Positioning f) Sleep Patterns g) Follow-up care and Danger Signs
a) Feeding, Bathing, and Elimination c) Cord and Circ (if applicable) care d) Safe Infant Travel in appropriate care seat e) Holding and Positioning f) Sleep Patterns g) Follow-up care and Danger Signs
The nurse is discussing the neonatal blood screening test with a new mother. The nurse knows that the teaching was successful when the mother states that the test screens for the presence of which of the following diseases in the newborn? (Select all that apply). a) Hypothyroidism b) Sickle cell disease c) Galactosemia d) Cerebral palsy e) Cystic fibrosis
a) Hypothyroidism b) Sickle cell disease c) Galactosemia e) Cystic fibrosis
To reduce the risk of hypoglycemia in a full-term newborn weighing 2900 grams, what should the nurse do? a) Maintain the infant's temperature above 97.7 degrees F. b) Feed the infant glucose water every 3 hours until breastfeeding well. c) Assess blood glucose levels every 3 hours for the first 12 hours. d) Encourage the mother to breastfeed every 4 hours.
a) Maintain the infant's temperature above 97.7 degrees F.
A full-term newborn was just born. Which nursing intervention is important for the nurse to perform first? a) Remove wet blankets b) Assess APGAR score c) Insert eye prophylaxis d) Elicit the Moro reflex
a) Remove wet blankets
What are the 4 consequences of Cold Stress? (Select all that apply). a) Respiratory distress and Hypoxemia b) Hypoglycemia c) Hyperglycemia d) Babinski e) Hyperbilirubinemia f) Erythema toxicum neonatorum g) Metabolic acidosis
a) Respiratory distress and Hypoxemia b) Hypoglycemia e) Hyperbilirubinemia g) Metabolic acidosis
Potential complications after meconium aspiration
atelectasis--trapped air can lead to pneumothorax, respiratory distress
Extremity assessment
acrocyanosis (lasts 1-2 days). extremities should be flexed toward the body
What is the purpose of clustering care
allows them to work on healing and growing instead of dealing with constant stimulation (allows for periods of rest). improves tissue perfusion
How do we treat pathologic jaundice
an exchange transfusion to get new healthy blood cells into the body
Mongolian spots
areas of deep bluish-gray pigmentation most commonly on the sacral aspect, usually will disappear in a few years, do not hurt, change shape and color
A mother questions why the ophthalmic medication is given to the baby. Which of the following responses by the nurse would be appropriate to make at this time? a) "I am required by law to give the medicine." b) "The medication is given to prevent eye infections." c) "The medicine promotes neonatal health." d) "All babies receive the medicine at delivery."
b) "The medication is given to prevent eye infections."
Which of the following behaviors should nurses know are characteristic of infant abductors? (Select all that apply). a) Act on the spur of the moment. b) Create a diversion on the unit. c) Ask questions about the routine of the unit. d) Choose rooms near stairwells. e) Wear over-sized clothing.
b) Create a diversion on the unit. c) Ask questions about the routine of the unit. d) Choose rooms near stairwells. e) Wear over-sized clothing.
A neonate has an elevated bilirubin and is slightly jaundiced on day 3 of life. What is the probable reason for these changes? a) Hemolysis of neonatal red blood cells by the maternal antibodies. b) Physiological destruction of fetal red blood cells during the extrauterine period. c) Pathological liver function resulting from hypoxemia during the birthing process. d) Delayed meconium excretion resulting in the production of direct bilirubin.
b) Physiological destruction of fetal red blood cells during the extrauterine period.
A full-term neonate has brown adipose fat tissue (BAT) stores that were deposited during the latter part of the third trimester. What does the nurse understand is the function of BAT stores? a) To promote melanin production in the neonatal period. b) To provide heat production when the baby is hypothermic. c) To protect the bony structures of the body from injury. d) To provide calories for neonatal growth between feedings.
b) To provide heat production when the baby is hypothermic.
Reasons to give vitamin K
babies are not born with Vitamin K (cannot synthesize). We give them this in order to help the blood clot
Breastfeeding positions
baby should be placed on tummy to tummy and well supported, may use a pillow, football, cradle, cross cradle, laid back, and side-lying positions. baby's nose to the mother's nipple. most of the areola in the baby's mouth.
Nonreactive stress test
bad, FHR does not accelerate adequately with fetal movement if non-reactive--let the healthcare provider know, change mother's positioning to increase placental perfusion, evaluate if the mother needs a biophysical profile, intervene, give mom fluids variability is good--tells us that the baby has good oxygenation and is neurologically intact
Hair assessment
bald, or a full head, depending on ethnicity--it will be longer, darker, and thicker with a lower hairline. lanugo may be present (all over the body--more lanugo if the baby is preterm)
Second period of reactivity
becomes interested in feeding
Cephalohematoma
blood collected that does not cross suture lines. pressure of vacuum during delivery is the main cause. after birth and increases for 2-3 days. disappears in several weeks to months. risks for jaundice, skull fracture, anemia, and infection
Hemangioma
blood vessel collection which appears as a birthmark. this is normal
Normal assessment of a newborn (screenings)
blood-done at 24 hours hearing- prior to discharge congenital heart screening- before discharge
Mongolian spot
blue or purple areas found on the buttocks or lower extremities
Four newborns are in the nursery, none of whom are crying or in distress. Which of the babies should the nurse report to the neonatologist? a) 16 hour old baby who has yet to pass meconium. b) 16 hour old baby whose blood glucose is 50 mg/dL. c) 2 day old baby who is breathing irregularly at 70 breaths per minute. d) 2 day old baby who is excreting a milky discharge from both nipples.
c) 2 day old baby who is breathing irregularly at 70 breaths per minute.
A neonate is being admitted to the well-baby nursery. Which of the following findings should be reported to the neonatologist? a) Umbilical cord with three vessels b) Diamond-shaped anterior fontanelle c) Cryptorchidism d) A café au lait spot
c) Cryptorchidism
A nurse is assessing the bonding of the father with his newborn baby. Which of the following actions by the father would be of concern to the nurse? a) He holds the baby in the en face position. b) He calls the baby by a full name rather than a nickname. c) He tells the mother to pick up the crying baby. d) He falls asleep in the chair with the baby on his chest.
c) He tells the mother to pick up the crying baby.
A nurse notes that a 6 hour old neonate has cyanotic hands and feet. Which of the following actions by the nurse is appropriate? a) place child in an isolette b) administer oxygen c) swaddle baby in a blanket d) apply pulse oximeter
c) swaddle baby in a blanket
S/sx of postpartum blues
mood swings, crying, irritability, appetite problems, fatigued, insomnia, mood instability, anxiety, typically lasts 2 weeks
Urinary retention
can lead to hemorrhage, uterine displacement, can lead to uterine infection, can lead to hemorrhage
Evaporation
can occur during birth or bathing from moisture on skin, wet linens, and insensible water loss
Hypoglycemia interventions
check temperature, feeding, dextrose and insulin, notify the provider, recheck glucose as needed, follow hypoglycemic protocol
Risk factors for SGA
chromosomal abnormalities, maternal infections, disease, malnutrition, smoking, drugs, alcohol use, multiple gestations, anything that impairs placental blood flow.
Gomco clamp
clamp is placed around the cone and foreskin is tightened to provide enough pressure to crush the blood vessels, remove foreskin after 3-5 minutes
Conduction
contact with cooler surface and lose body heat
A 2 day old infant received a vitamin K injection at birth. Which of the following signs/symptoms in the baby would indicate that the treatment was effective? a) Skin color is pink. b) Vital signs are normal. c) Glucose levels are stable. d) Blood clots after heel sticks.
d) Blood clots after heel sticks.
Four newborns were admitted into the neonatal nursery 1 hour ago. They are all sleeping in overhead warmers. Which of the babies should the nurse ask the neonatologist to evaluate? a) The neonate with T 98.9 degrees F and weight of 3000 grams. b) The neonate with white spots on the bridge of the nose. c) The neonate with raised white specks on the gums. d) The neonate with respirations of 72 and heartrate of 166.
d) The neonate with respirations of 72 and heartrate of 166.
When a baby is born and takes its first breath, the change in pulmonary pressure causes embryonic vessel to constrict? a) umbilical vein b) umbilical artery c) ductus venosis d) ductus arteriosus
d) ductus arteriosus
How to manage engorgement
day 3 milk starts to come in, feed often, wear well-fitting and supportive bras, apply cold compresses between feedings, alternate breasts at feedings. do not stimulate during periods of rest. breast feed by mouth 6 months to 2 years.
Milia
distended sebaceous glands which appear as tiny white spots on the baby's face. DO NOT POP. can cause infection
APGAR
done at 1 minute and 5 minutes after birth. 8-10 is good. assessment of appearance, pulse, grimace, activity, and respiration.
Evaporation interventions
dry infant immediately after birth, place smaller infants in plastic bags, change wet clothes, remove wet blankets, keep them dry, change their diaper.
Pathological hyperbilirubinemia
due to Rh incompatibility between mother and baby, extreme breakdown in RBCs, occurs within the first 24 hours
Physiological hyperbilirubinemia
due to immature liver or polycythemia (high RBC count), occurs between days 1-7, late in passing meconium
Molding
elongated shaping of the infant's head to allow for passage through the birth canal
Behaviors to encourage bonding with a child who has a congenital anomaly
encourage the mother to actively participate in the newborns care. nurse demonstrates positive behavior (speaking to the baby, holding the baby close). treat them as you would treat any other baby. talk to the baby in your mom voice, tell them how beautiful the baby is, help the parent to create a bond (they have your nose/eyes), use nurturing types of behaviors.
Jaundice interventions
enhanced nutrition and phototherapy (jaundice before 24 hours is abnormal
What are the four components of heat loss?
evaporation, conduction, convection, radiation
Hyperbilirubinemia
excessive bilirubin in the blood, causes jaundice
Cold stress
excessive loss of heat that results in increased respirations and non-shivering thermogenesis to maintain core body temperature
Definition of SGA
falls below 10th percentile; symmetric growth restriction; asymmetric growth restriction (head and length are normal, body is thin)
Period of sleep or decreased activity
falls into a deep sleep
Hypoglycemia interventions
feeding, oral dextrose, IV with 10% dextrose, notify provider, check temperature.
Assessment for postpartum complications
fever, abnormal discharge, recognize postpartum blues are normal, fungus should be at the umbilicus, descending 1 cm every day, if funds is to either side there is urinary distention
Signs of endometritis
fever, amount of bleeding, purulent or malodorous discharge, tenderness, pain
Lanugo
fine, unpigmented hair that appears on the fetus in the last 3 months of development. dissipates near term. helps with warmth and protection
Newborn behaviors
first period of reactivity, period of sleep or decreased activity, second period of reactivity eat, sleep, cry (you will learn what their cry means), and poop. will not sleep more than 2 hours at a time--their stomach is not large enough to keep fluids and food in their body) watch for feeding cues--licking lips, sucking fingers--try to feed before they start to cry
Plastibell
fitted over the glans, a suture is tied around the bell's rim, the excess is prepuce is cut away and the plastic rim remains in place until it falls off in approximately 5 to 7 days
Stork bite
flat, irregularly shaped red or pink patch found on the face or back, cluster of capillaries, will typically disappear
Characteristics of TTN
fluid in the lungs, tachypnea, hypoxemia, grunting, nasal flaring, retractions
How often do newborns produce stool
formula fed babies will stool every 1-2 days. breast fed babies will stool more often because breast milk is easier to digest.
Hyperbilirubinemia interventions
frequent feedings, kangaroo care, phototherapy, exchange transfusions when nothing else is working, fluids
Hemorrhage
fundal firmness, midline, 1 finger breadth per day decreasing, bleeding--weigh and quantify the blood on the periods, assess vital signs, tachycardia is an issue--should be bradycardic
Erythema toxicum
general transient rash that looks like flea bites
Hip assessment
move legs up and down and out from hip, should not hear any clicking (dislocation). gluteal fold creases should be equal
Reasons to give erythromycin eye ointment
given for unknown gonorrhea or chlamydia infection during the first 24 hours after birth. prevents eye infection during the passage through the mother's birth canal.
Reactive stress test
good, 2 or more accelerations of 15 bpm above baseline for at least 15 seconds within a 15 minute time period
S/sx of respiratory distress
grunting, nasal flaring, increase in breaths per minute, cyanosis
Infection prevention for an infant in the NICU
hand washing--prevent infection from hospital staff or contaminated equipment
Why are newborn hearing screenings completed before discharge?
hearing loss is the most common congenital abnormality early treatment can help to prevent a delay in speech
Normal term gestation (38-40 weeks) newborn assessment
heart, respiratory, muscle tone, reflexes, and color
Radiation
heat loss through electromagnetic waves emanating from surfaces with temperature higher than surrounding air, occurs when infant is near cold surfaces
Convection
heat lost from the infant's skin to moving air
What are the safety precautions used for newborns in the OB unit
identification bands are on the infant, mom, and another birth parent. bring the infant to the nursery if she is going to shower or nap. prevent/recognize early signs of infections (washing hands)
Cause of Bronchopulmonary Dysplasia (BPD)
imbalance between lung injury and repair in the developing lung usually in a baby who has been on chronic ventilator or oxygen. chronic lung injury--low birth weight and young gestation age are risk factors affected infants are usually oxygen dependent after 36 weeks
Benefits for the mother with breastfeeding
increase bonding and relaxation, saves money, more convenient, quicker recovery post-pregnancy, reduces chances of breast/ovarian/and endometrial cancer, reductase risk of obesity and hypertension
IUGR
intrauterine growth restriction, an infant with slower than expected intrauterine growth, normal head but a smaller body.
Hyperbilirubinemia assessment
jaundice, elevated serum bilirubin levels, enlarged liver, poor muscle tone, lethargy, poor sucking reflex
Umbilical cord care
keep cord clean and dry, keep the top of the diaper fold underneath it, the cord falls off around 10-14 days after birth, give sponge baths and avoid submerging newborn until cord falls off, could cause infection
Convection interventions
keep doors closed, move baby away from air conditioning or drafts, no extra moving, keep a blanket on, radiant heater if possible
Radiation interventions
keep infant away from cold surfaces, windows, walls, doorway
Trickle of blood
lacerations of the birth canal
LGA
large for gestational age, above 90th percentile, can cause hypoglycemia, fractures or bruising, nerve damage.
Teen pregnancies are at risk for
low birth weight, perinatal death, C-section, CPD, preeclampsia, iron deficient anemia, pre-term labor, lack of prenatal care, education, emotional, physical, financial immaturity, hide pregnancies--preterm labor risk increases, IUGR, lack of nutrition
Hypoglycemia
low blood sugar (below <40)
Cold stress assessment
low temperature, increased respirations, respiratory distress, metabolic distress, tachypnea, hypothermia, hypoglycemia, weak cry, lethargic
Neuro assessment
major reflexes--Gag, Babinski, Moro, Galant. minor reflexes--palmar grasp, plantar grasp, rooting and sucking, head righting, stepping, tonic neck)
Teach about bottle-feeding
make sure the nipples are full of milk, air will cause an upset stomach, do not prop bottles, risk for aspiration and overfeeding. must discard unused formula, increase amount with age. follow diluting instructions on the formula bottle. no microwaves to heat up formula or breast milk (will create hot spots which will scald the baby's mouth).
Risk factors for LGA
maternal diabetes mellitus, maltiparity, prior history of a macrocosmic infant, postdates gestation, maternal obesity, genetics, large parent.
Female genitalia assessment
may have breast discharge. labia major should be large and completely cover everything, may be darker than surround skin. small amount of vaginal discharge is normal due to the mother's hormones. bloody white discharge is normal due to hormonal changes
Head assessment
molding, flat fontanelles, 13.5 inches in circumference
Circumcision risks
monitor for bleeding, no more than a few drops with the first diaper changes, failure to urinate, signs of infection including fever and drainage
