Exam 3 Mom/baby
Describe each menstrual disorder and its care
AMENORRHEA The absence of menstruation Normal before menarche, during pregnancy, and after menopause Primary-hasn't gotten it yet Secondary-getting period, then stops (decreased eating patterns) Treatment depends on cause identified ABNORMAL UTERINE BLEEDING Three types Too frequent Too long in duration Excessive in amount Common causes Pregnancy complications Lesions of the vagina, cervix, or uterus Breakthrough bleeding when on contraceptives Endocrine disorders Failure to ovulate Menstrual Cycle Pain-DYSMENORRHEA Primary—no evidence of pelvic abnormality Secondary—a pathologic condition is identified-cysts Vasopressins and prostaglandins from the endometrium contribute Potent stimulants of painful uterine contractions ENDOMETRIOSIS The presence of tissue that resembles the endometrium outside of the uterus Can cause pain, pressure, and inflammation (constipation pressure) More constant than spasmodic Can cause dyspareunia (painful sexual intercourse) PREMENSTRUAL DYSPHORIC DISORDER Associated with abnormal serotonin response to normal changes in estrogen levels Symptoms occur between ovulation and the onset of menstruation Are not present the week after menstruation has occurred reduce cafeeine, simple sugars/salty foods, exercise
Diferentiate between cleft lip and cleft palate
CLEFT LIP Result from maxilarry sinus and median nasal process-failed to grow together adequately during amniotic period CAUSED from smoking and diabetes higher risk in boys than girls Surgical treatment-chelioplasty Wait 6 months-well established pattern of weight gain and free of infection After surgery-will not be able to suck a couple weeks after-don't want tension on suture line-dropper to feed baby for 1-2 weeks-elbow restraints used clean mouth with water CLEFT PALATE The failure of the hard palates to fuse at the midline during the 7th to 12th weeks of gestation Forms a passageway between the nasopharynx and the nose-POTENTIALLY LIFE THREATENING Increases risk of infections of the respiratory tract and middle ears Visualizing the hard palate—can be easy to miss Easily aspirating milk Hearing loss Surgery-unite cleft-hard palate Improve speech and nutrition, dental development, self image
Explain the medical and nursing care of women who are nearing of have completed menopause
Cessation of menstrual periods for a 12-month period because of decreased estrogen production hot flashes, lose moisture, increased desire of sexual intercourse Treatment: excercise, increase fiber, calcium, and magnesium soy , gingsing, vitamin E High risk for osteoporosis Determine woman's understanding of risk/benefits of HRT Teach signs and symptoms to report; i.e., vaginal bleeding that recurs after cessation of menses, vaginal irritation, signs of UTI Teach woman how to take prescribed medications correctly and to report specific side effects Teach value of weight-bearing exercises
What would the nurse include when instructing parents about positioning their toddler who has just had a body spica cast applied?
Change the child's position frequently.
In the week before her menstrual period, a woman experiences irritability, anxiety, and difficulty concentrating. What suggestion from the nurse is most appropriate to relieve these symptoms?
Include complex carbohydrates and fiber in the diet.
The nurse bathing an infant would recognize which of the following as a sign of developmental hip dysplasia?
One leg appears shorter than the other (rolls on baby's legs are asymmetrical)
metabolic defects screening
PKU s/s Lethargy Poor feeding Hypotonia Unique odor to body or urine Tachypnea Vomiting Within 48 hours- Extremely important- vast ray of disorders that can cause death in newborns RARE-vague or no symptoms at all
Demonstrate the details of the physical assessment of the newborn
Stage 3-reactivity Movements-shakey, jerky Head-sutures-misshapen head-soft spot caput-crosses suture lines-cone head cephalohematoma-doesn't cross suture lines-on one side of head-lump of collection of blood (JAUNDICE) Eyes-cross eyed-poor muscle tone-black and white preferred and holding baby to feed -LOVE SEEING FACES Ears-hearing screening-sensor of sound wave to tympanic membrane-some babies refer because of amniotic fluid Sleep-alert 30-1 hr -then deep sleep (shots done) Newborns feel pain-watch behaviors-NIPS scale coiled tight respiratory -first hour of life is crucial circulatory-placental profusion-cord clamped-pressure changes-MURMUR may be normal length and weight-loses 5-10% is okay 19-21.4 in/6-9 lbs head circumference-at discharge -ICP document OUTPUT-6 wet diapers a day-hydration first stool-black/tarry in appearance
A nurse is teaching a new mother about signs of effective breastfeeding of her newborn. Which of the following information should the nurse include in the teaching?
Your baby can lose 5% of body weight during the first 3 days of life. The nurse should instruct the mother that the baby can have a weight loss between 5% and 6% of their birth weight during the first 3 days of life. Breastfed infants usually regain birth weight by their second or third week of life. The nurse should instruct the mother that ineffective breastfeeding is indicated by the infant having less than six wet diapers per day after the fourth day of life, and to notify the provider. The nurse should instruct the mother the baby should gain at least 0.5 oz (14 g) per day after the fourth day of life. The nurse should instruct the mother that if the baby is feeding constantly, breast feeding may be ineffective and should notify the provider.
Vernix caseosa
cheesy substance covering the skin of the fetus protectant from amniotic fluid
caput succedaneum
crosses different suture lines-cone head, molding from delivery
Outline the nursing care for the newborn with hydrocephalus
dilated scalp veins, tight shiny scalp, unequal response to light in eyes gaping between staples and bulging sutures CT SCAN, MRI Treatment: medications, surgery, ventriculoperitoneal shunt to relieve pressure and remove fluid
Problems associated with postterm delivery
fetal distress in utero because of lack of placental nutrition Macrosomnia Asphyxia Meconium aspiration-RDS Poor nutritional status-poor placental nutrition Increase in red blood cell production-in utero not enough oxygen Difficult delivery due to increased size of fetus Birth defects Seizures High risk for jaundice because of the increased in RBCs HIGH RISK for seizures-lack of oxygen
Lanugo
fine, soft hair, especially that which covers the body and limbs of a human fetus or newborn.
A nurse is caring for a client who is breastfeeding and tells the nurse that she is concerned about her newborn's hydration. Which of the following nursing observations is appropriate to use in evaluating the adequacy of the newborn's hydration?
the number of wet diapers per day
Newborn should be positioned on the back or side
to help maintain a patent airway reinforce that there shouldn't be so many extra stuff in crib/bassinet because of risk for suffocation First hour is critical period of life
A nurse is reinforcing teaching with a client who is postpartum about bathing her newborn. Which of the following statements by the client indicates a need for further teaching?
Baby powder will prevent a diaper rash Lotions, creams, oils, or powders can alter a newborn's skin and provide a medium for bacterial growth or cause an allergic response. Powders can be inhaled, leading to respiratory distress.
Circumcisions
Benefits Decrease risk of penile cancer Fewer UTIs Fewer STIs Disadvantages Infection Hemorrhage Care- Vaseline gauze on tip of penis as barrier so skin doesn't grow onto diaper
Describe selected problems and needs of preterm newborns and the nursing goals associated with each problem
RDS-corticosteroids (betamethozone) Cluster Cares dehydration/overhydrations VS O2 Apnea-stimulate-bulb syringe Neonatal hypoxia-flexible sensors on outer side of hand or feet for Oxygen level (earlobe) 92 or above-NOT 100% Sepsis-increased risk for infection because of decreased immune system and increased interventions s/s-Low temperature Lethargy or irritability Poor feeding Respiratory distress-grunting, nasal flaring, cyanosis Therapy-antibiotics; precautions/hand hygiene-non latex gloves Poor control of body temperature -result in cold stress-hat, rewrapping Hypoglycemia-lower than 30-intervene s/s -tremors, weak cry, lethargy, convulsions Increased tendency to bleed-posturing and fontanelles retinopathy-oxygen sat too high-can affect blood vessels in vision sufficient levels of vitamin E- monitoring of pulse ox Poor nutrition-high risk for aspiration-poor suckling reflex-poor strength and energy Mom's can't nurse-pacifier for needing to suck with feeding tube Immature kidneys-I/O-weigh diapers fontannelles, turgor, weight 1 gram=1 mL Jaundice-don't have much oxygen-extra RBCs in utero-immature liver to filter out extra RBCs now that in room air -prevent brain damage sclera, blanch on fourhead, hard palate for yellowing bilirubin tests patho jaundice-BAD-1st 24 hours of life (infection, mom/baby blood type, etc.) physiological jaundice-benign-treat same way BREASTFED-get rid of bilirubin in first meconium High bilirubin-epilepsy can occur Phototherapy-bili lights-cover eyes Reposition every 2 hours at least-diaper changes important-risk for skin breakdown (bile)
Discuss the care of the newborn with Down syndrome
chromosomal abnormality-mild to severe blood screening/amniocitentrisis (most accurate) around 15 weeks-to determine to continue pregnancy or terminate characteristics-flatter fourhead, smaller nose, smaller ears, short pinup, short neck, palmar creases straight across, shorter stature, heart abnormalities, hyperreflex ability -hypertonia -higher risk for respiratory infections (less developed-poor drainage of mucous, underdevelloped nasal fold) --constipation -decreased muscle tone early onset of alzheimers
Cephalohematoma
collection of blow between cranial bone and membrane; looks like lump on side of head
Describe the symptoms of increased intracranial pressure MAA
high pitched cry, bulging fontanelles, irritable, sleepy baby, lethargy, changing in feeding pattern, changes in vitals hydrocephalus-dilated scalp veins, tight shiny scalp, unequal response to light in eyes gaping between staples and bulging sutures Changes of behavior-to assess pain how they are laying, crying when needs are met?
Discuss two ways to help facilitate maternal infant bonding for preterm newborn
kangaroo care place baby on side or prone position help with tube feedings Encourage participation in any way Help build confidence
s/s of cold stress
•Decreased skin temperature •Increased respiratory rate with periods of apnea •Bradycardia •Mottling of skin •Lethargy
ACHES
Abdominal pain (severe) Chest pain, dyspnea, bloody sputum Headache (severe), weakness, or numbness of extremities Eye problems Severe leg pain or swelling, speech disturbance Abdominal, or chest pain, dyspnea, double vision (eye issue), leg or swelling pain REPORT these things Hypertension, CVD, thrombo-smoking risks
A nurse is preparing to examine a post-term newborn immediately following delivery. Which of the following findings should she expect to observe? Select all that apply.
Absence of vernix-except in armpits or groin area (creases) Moro reflex Cracked, peeling skin
What would the woman correctly using a diaphragm tell the nurse?
"I should leave it in place for at least 6 hours after intercourse." and no longer than 24 hours.
The mother of a 4-month-old infant, born prematurely, asks the nurse if her daughter will always be small for her age. What is the most appropriate nursing response?
"It takes about two years for the preterm infant to catch up to a full-term infant."
The mother states that her newborn has white pinpoint "pimples" on his nose and chin and she plans to squeeze them to make them disappear. What is the best nursing response?
"These pimples are called 'milia' and will disappear on their own in a week or two."
A nurse is caring for a newborn who was delivered by vacuum extraction and has swelling on his head that crosses the suture line. The newborn's mother asks about the swelling on her newborn's head. Which of the following responses should the nurse make?
"This is a caput succedaneum, which is a collection of fluid from pressure of the vacuum extractor."
Devise a plan of care for a newborn receiving phototherapy
-PHOTOTHERAPY-billi lights converts to water soluble in liver and can be excreted eyes are protected-genital covered with diaper-gauze over genital areas-repositioned from front to back frequently-frequent diaper changing sclera, push fourhead (blanch yellow) assess hard palate for jaundice billi blanket does not need to be turned and rotated-hits whole core-can still nurse and hold baby (not quite effective)
Vital signs for a newborn
-Temperature: 97.7-98.6-want 97.7 -Pulse: 120-160 bpm -Respirations: 30-60 SHOULD REPORT: 97.6-stimulate baby, make sure hat is on, kangeroo care, reswaddle 99.8-99.9 TEMP-should never have temperature ----REASSESS TEMP 15-30 MINUTES cyanosis of anywhere but hands and feet (lips) tachypnea NOISY RESPIRATIONS-GRUTNING NASAL FLARING-CHEST RETRACTIONS
milia
Benign, keratin-filled cysts that can appear just under the epidermis and have no visible opening. no interventions needed
acrocyanosis
Blue condition of the extremities
A nurse is collecting data from a newborn 1 hour after delivery. Which of the following respiratory rates is within the expected reference range for a newborn?
48/min
What would the nurse assess for in a preterm infant receiving an intravenous infusion containing calcium gluconate?
Bradycardia
The nurse instructs a woman taking oral contraceptives to report which possible serious side effects? Select all that apply.
Abdominal pain Headache Eye or visual problems Speech disturbances
The nurse warns that the effectiveness of oral contraceptives is decreased in women who are taking which medication?
Anticonvulsants for treatment of epilepsy
The client who has been dealing with urge incontinence tells the nurse that the symptoms have gotten worse lately. The nurse reminds the client that which food(s) and drug(s) can increase incontinence? Select all that apply.
Antihypertensive drugs Coffee Alcohol Diuretics
APGAR
Appearance (all pink, pink and blue, blue (pale) Pulse (>100, <100, absent) Grimace (cough, grimace, no response) Activity (flexed, flaccid, limp) Respirations (strong cry, weak cry, absent) done 1 min and 5 min after birth want 9-10-acrocyanosis
The nurse explains to a client in preterm labor that what may be ordered by the health care provider to accelerate fetal lung maturity?
Corticosterioids Prostaglandins are used to induce labor. Oxytocin is used to induce or augment labor; as well as to prevent or treat postpartum hemorrhage. Magnesium Sulfate is used to stop preterm labor, or for preeclampsia. Corticosteroids, such as betamethasone, can increase surfactant production. Corticosteroids may also be administered via ET tube.
symptoms/diagnosis of Premenstrual dysphoric disorder FIVE OR MORE MUST OCCUR REGULARLY
Depressed mood Anxiety, tension, feeling "on edge" Increased sensitivity to rejection Irritability Decreased interest in usual activities Difficulty in concentrating Lethargy Change in appetite Change in sleep habits Feeling overwhelmed Physical symptoms; i.e., breast tenderness, bloating, weight gain, headaches
The nurse is providing education to parents of a child with cleft palate. What will the nurse instruct the parents to report immediately?
Ear infections
The nurse is discussing cervical mucus changes with a woman who wishes to use natural family planning methods. The nurse determines the woman understands the information presented when she says the changes in cervical mucus at ovulation serve what function?
Enhance the motility of sperm
A nurse is reinforcing teaching with the parents of a newborn about caring for the umbilical cord stump. Which of the following instructions should the nurse include?
Give the newborn a sponge bath until the cord stump falls off.
Preterm Characteristics
Extremities-lack of muscle tone, shorter, short fingernails, fewer creases in feet on plantar surface (check first hour-quick way to find out gestational age) Skin-gelantinis, thin, lack of subcutaneous fat, loose, transparent, can see superficial veins Vernix & lanugo-covering fourhead, shoulders and arm with hair-abundance of both Genetalia -undestended tesicles, scrotum is small and smooth (no rugae), clitoris is prominate as well as minora with open majora (not fully developed) HIGH RISK FOR APNEA Gag reflex not well developed-sleep on side because of risk for aspiration
Phases of sleep-wake cycle
First reactive (fiirst 30 min-hour to offer the breast) sleep second reactive-stability stability-waking up to eat and then getting into cycle of sleeping through the night
The nurse must handle the preterm infant gentley because capillaries are:
Fragile and prone to bleeding spontaneously
An Apgar score of 9 at 5 minutes indicates the neonate is in: Good condition Fair condition--score of 7 can lead to something Poor condition Critical condition
Good condition STABLE BABY
Briefly describe three normal reflexes of the newborn, including the approximate age of their disappearance
Grasp reflex-3 months replaced-plantar and palmer Moro reflex-startle reflex-loud noise Rooting reflex-related to feeding (early sign of hunger) Tonic neck reflex-turned head one way and that extremities side will extend Dancing reflex-pressure on one foot, the other goes down
Outline the causes and treatment of hemolytic disease of the new born (erythroblastosis fetalis)
Happens when mom was not desensitized with RhoGAM Rh-negative mother and Rh-positive father produce Rh-positive fetus fetus will have issues with anemia/heart failure-difficulty with baby in utero blood transfusion with baby in utero Indirect Coombs' test will indicate previous exposure to Rh-positive antigens Direct Coombs on NEWBORN- antibody sensitized in newborn-if positive-higher risk for jaundice Hyper bilirubin levels -amniocentesis Pathological-BAD JAUNDICE Physiological jaundice-don't need to treat an underlying cause-breastfeeding Treatment:don't want toxic level of high bilirubin levels-PHOTOTHERAPY-billi lights converts to water soluble in liver and can be excreted
Five objective signs measured APGAR-1 min and 5 min after birth
Heart rate Respiration Muscle tone Reflexes Color
A 48-year old woman tells the nurse, "I missed my period last month, am I in menopause?" The nurse knows that at which point is a women considered menopausal?
Her periods have stopped for 1 year
What manifestations of increasing ICP in the hydrocephalic newborn should the nurse be aware of? Select all that apply.
High-pitched cry Inequality of pupils Bulging fontanelles
Postterm careful observation for
Hyperbilirubin Respiratory distress-meconium aspiration hypoglycemia-use storage of fat and glycogen cold stress-use adipose tissue from storage of fat
The nurse caring for an infant born at 36 weeks of gestation assesses tremors and a weak cry. The nurse is aware that these are symptoms of what condition?
Hypoglycemia
Nursing Goals for the Preterm Newborn
Improve respiration Maintain body heat (large body surface for weight) (kangaroo care-skin to skin with blanket over back of newborn and hat and diaper, radiant heat warmer with sensor) Conserve energy Prevent infection Provide proper nutrition and hydration Give good skin care Observe infant carefully and record observations Support and encourage the parents
The nurse observes that the infant's anterior fontanelle is bulging after placement of a ventriculoperitoneal shunt. How should the nurse position this infant?
In a semi-Fowler's position Positioning of the infant depends on several factors and may vary with the infant's progress. If the fontanelles are sunken, the infant is kept flat because too rapid a reduction of fluid may lead to seizures or cortical bleeding. If the fontanelles are bulging, the infant is usually placed in the semi-Fowler's position to promote drainage of the ventricles through the shunt.
What symptoms of cold stress might the nurse recognize in a preterm infant?
Increased respiratory rate and periods of apnea
The nurse explains that which Rh-negative mother should receive RhoGAM?
Is a primipara with an O positive child
Phototherapy is instituted for an infant. What is the most important nursing action for the infant having phototherapy?
Keep the infant's eyes covered
What factors contribute to poor control of body temperature in the preterm infant, and how can a nurse promote a neutral thermal environment?
Lack of fat aidpose tissue-hypoglycemia Spralled out, body surface area is larger Effictiveness of shivering is not there Posture is poor-lack of tone and losing body heat STIMULATE baby-kangaroo care-under warmer Symptoms of cold stress- lethargy, bradycardia, tapychnea, check blood sugar for hypoglycemia
What nursing action will the nurse implement after feeding an infant with hydrocephalus?
Leave the infant in a side-lying position.
The nurse is caring for an infant born at 35-weeks of gestation. What physical characteristic might the nurse expect this infant to exhibit?
Loose, transparent skin
What complication is more likely for an infant of a diabetic mother within the first few hours after birth?
Low blood glucose levels
intracranial hemorrhage
MOST COMMON type of birth injury Not getting enough oxygen-anoxia Lethargy- poor muscle tone- poor sucking, cyanosis, respiratory distress seizure- look at second hand -time frame and what parts of body were moving -VS, color before occured high pitched cry-something neurological Treatment Oxygen Gentle handling Elevated head Medications may be prescribed Care with feeding because sucking reflex may be affected
Describe the various methods of birth control, including indications, side effects, and contraindications of each MAA
Monthly-contradicted in women who smoke-blood clotting-antibiotics can stop effectiveness Extended Implants-3 years -doesn't affect bone density-rapid return for fertility Injections-depraprovera-teens not used because affect of bone density-side effects like weight gain and can cause infertility for a year or over IUD-check string every month-can get dislodged Transdermal patch-not used in women over 198 lbs-every week put on Vaginal ring-insert at home-rests at vaginal canal-releases estrogen and prostegen daily at a local level rather than systemically
neural tube defects
Most often caused by failure of neural tube to close at either the cranial or the caudal end of the spinal cord Hydrocephalus Spina bifida women to take with child bearing to prevent neural tube defects-FOLLIC ACID
Causes of Preterm Labor MAA
Multiple births Maternal illness Hazards of actual pregnancy (e.g., GH) smoking Placental abnormalities Placenta previa Premature separation of the placenta from uterine wall
List three characteristics of the postterm infant
POSTterm----Little lanugo or vernix caseosa -some in creases in neck, groin, armpits Skin is dry, cracks and peels skin is loose around buttocks and thighs Nails are long and may be stained from meconium Genetalia-deep rugae present on testicles, distended; labia majora will fully cover the minora and clitoris Skin-stained meconium, loose skin around buttocks, dry peeling skin, fat stores used in utero for nourishment-hypoglycemia Extremities-fingernails long, stained with meconium, creases and wrinkles covered in, long and thin
acrocynaosis usually the reason for the 8/9 out of 10 on APGAR score
Persisitent cyanosis of fingers, hands, toes & feet w/mottled blue or red discoloration & coldness. May be seen during first couple days as response to cold. Normal and intermittent.
A nurse is assessing a preterm infant of 38 weeks gestation who was born 72 hours ago and notes a yellow tinge to the infant's sclera and skin. What condition does this finding indicate, and how should the nurse respond?
Physiological jaundice -72 hours after birth Encourage breastfeeding because of bilirubin -to increase frequent stools Serum bilirubin level and how many days old will tell us what interventions need to be implemented Billi lights or blanket-fibroctick cabel-flat plastic around newborn's abdomen -can swaddle baby around that
Nursing care for spina bifida
Prevent infection of, or injury to, the sac Correct positioning to prevent pressure on sac Prevent development of contractures Good skin care Adequate nutrition Accurate observations and charting Education of the parents Continued medical supervision and habilitation Upon delivery, the newborn is placed in an incubator Moist, sterile dressing of saline or an antibiotic solution may be ordered to prevent drying of the sac Protection from injury and maintenance of a sterile environment for the open lesion are essential Size and area of sac are checked for any tears or leakage Extremities are observed for deformities and movement Head circumference is measured Fontanelles are observed to provide a baseline for future assessments Complications that can be life-threatening must be monitored Meningitis Pneumonia UTI Urological monitoring Skin care-prone position in warmer-awaiting surgery-and after surgery-repositioning-splints possible Feeding Potential for latex allergy -frequent exposure
CLUSTER CARE
RDS-baby needs adequate periods of rest oxygen does not need to be at 100%-can cause damage
A nurse is assisting a client with breastfeeding her newborn. The nurse should explain that which of the following reflexes will initiate sucking?
Rooting
apnea in newborn-what's the first thing you do?
STIMULATE back and feet suction with bulb syringe-mouth first Positive pressure-amboo bag
Interpret discharge teaching for the mother and her newborn
Safe sleep-don't add extra stuff in crib or fluffy blankets Have the babies sleep on back Skin care-dry skin doesn't need lotions, Feeding- Clothing Furnishing
The nurse knows that a postterm infant may experience which potential problems? Select all that apply.
Seizures Asphyxia Polycythemia
desquamation
Shedding of epithelial elements; chiefly of the skin in scales or sheets
The nurse is instructing a man considering a vasectomy. What instruction will the nurse provide to address the postoperative time period?
Sperm will still be ejaculated for up to a month.
State four methods of maintaining the body temperature of a newborn
Stimulation Dry and/or warm blankets to rub back swaddling-hat under warmer prevent drafts-convention radiation-near a cold surface do not place on cold surface-conduction evaporation-keep dry Assess temperature axillary
The nurse is advising parents about feeding their infant with phenylketonuria. What formula and/or diet should the nurse suggest?
Substitute Lofenalac for some protein foods
A nurse is assisting in the care of a newborn immediately following birth. The nurse notes mucus bubbling out of the newborn's mouth and nose. Which of the following actions should the nurse take first?
Suction the newborn's mouth with a bulb syringe. LMNOP-mouth first then nose do not push air into baby -squeeze bulb syringe before
What deficiency causes preterm infant respiratory distress syndrome?
Surfactant Respiratory distress syndrome (RDS), is a result of lung immaturity, which leads to decreased gas exchange. In this disease, there is a deficient synthesis or release of surfactant, a chemical in the lungs. Surfactant is high in lecithin, a fatty protein necessary for the absorption of oxygen by the lungs.
Which statement made by the nurse would teach an adolescent using tampons how to prevent toxic shock syndrome (TSS)?
Tampons should be changed at least every 4 hours.
The nurse should report
Temperature elevations >99.8° F or <97.1° F Pulse rates >160 or <110 beats/min Respirations >60 or <30 breaths/min Noisy respirations-grunting-shouldn't make noise when breathing Nasal flaring or chest retraction Reassess after intervention in 15 min-document reassessment
spina bifida occulta
most common and least severe form of spina bifida without protrusion of the spinal cord or meninges Defect in the bone-don't have an actual protrusion May see a dimple BEST CASE SCENARIO FOR SPINA BIFIDA May have trouble with foot drop or gait Long term can function well
Discuss the early signs of developmental hip dysplasia
newborn's hip dislocates and head of femur is displaced Constant flexion and abduction -4 to 8 weeks multiple folds on one leg-don't match asymetrical leg may be shorter than the other Pavlik harness, body cast, traction Care of spica cast-keep dry-ensure toys aren't stuck in there for skin breakdown
spina bifida cystica
Two different degrees: Meningocele-meninges protruding-spinal column is normal-default in bone-sac protrudes from the back of baby-containing spinal fluid and meninges Meningomyelocele- meninges protruding-also have the spinal chord protruding Prevention----folic acid Mother takes folic acid 0.4 mg per day prior to becoming pregnant and/or continues to take the folic acid supplement until the 12th week of pregnancy Treatment-surgical closure of spinal canal Protecting that sac-nerve damage can occur-place in prone position moist sterile saline dressing-antibiotic on tissue while awaiting for surgery-HIGH RISK FOR INFECTION behaviors- irritablity, fever or low temp, lethargy assessing for reflexes, fontannelles pnemonia, infection in spinal bladder surgery, spasms-infection risk prone position in warmer while awaiting for surgery-repositioning-splints
Discuss the dietary needs of a newborn with phenylketonuria
Unable to metabolzes phenylphaline-in protein foods-breast milk and formula Accumulates in blood-mental retardation if not caught obtain blood 48-72 hours after birth-want the baby to retain milk before testing Management: Dietician-special formula special additive special diet to break down amino acids throughout life meats and dairy products are restricted AVOID nutrasweet-sweetener asp (Diet soft drinks)
The nurse reminds new parents that newborns must be protected from environments that are too cold or too hot because of which aspects of the newborn's physiology? Select all that apply.
Very little subcutaneous fat Ineffective sweat glands
A neonate's vital signs are assessed as follows: axillary temperature 98.5° F, pulse 170 bpm, respirations 44. The nurse is aware that: these are within normal limits. pulse is elevated. respirations and temperature are normal. temperature is decreased.
pulse is elevated respirations and temp are normal
Club foot
a congenital deformity involving one foot or both the affected foot appears to have been rotated internally at the ankle tightly wrapping in certain way (splinting/casting)-lot of stretching techniques physical and occupational therapy involved Cast care: allow to dry-elevated on pillow so we don't create imprints -decrease swelling -use palm of hand to raise cast check on area distal to cast-cap refill, edema, swelling, redness-check toes Swelling, cap refill, acrocyanosis, redness, edema Intermittent random movement CMS-cap refill, movement, swelling Bleeding-outline and report
Mongolian spots
areas of deep bluish-gray pigmentation most commonly on the sacral aspect of a newborn
Kernicterus
bilirubin has reached toxic levels
psudomenstration female genitalia
blood tinged mucous Normal-change of lack of hormones as withdrawn from mom's hormones
Contrast the techniques for feeding preterm and ful term newborns
can't nurse at breast may syringe with formula or feeding tube May require Parenteral feedings Gavage feedings May use bottles for Breast milk Formula Early initiation of feedings reduces the risk of hypoglycemia, hyperbilirubinemia, and dehydration
A 21 year old college student has come to see the nurse practitioner for treatment of a vaginal infection. Physical assessment reveals inflammation of the vagina and vulva, and vaginal discharge has a cottage cheese appearance. What are these findings are consistent with?
candidiasis
respiratory distress related to can find out how much there is with amniocitesis
surfactant corticosteroids-betamethozone-two doses to mom-increases level of surfactant in baby's lungs to help mature lungs can give it through an ET tube if there was no time to give medication beforehand
Ballard Score
test used to estimate gestational age, Most accurate at 12-20 hrs and is based on sum of neuromuscular and physical maturity score the higher the number the more mature.
