Maternity Exam 2 Review

apnea in newborn

If cessation is 20 seconds or more then its concerning. shorter periods less than 20 seconds are expected and normal

After C section patient should not lift anything heavier than the _________?

Infant for 4-6 weeks.

pathological jaundice occurs when?

occurs before 24 hours after birth and may indicate early hemolysis

Changes in oxygen saturation of neonate indicates ________.

pain

Expected urinary output for a postpartum woman is at least ______ with each void on a regular basis.

100 mL

Dressing over a C section is generally removed after ____ hours

24 hours.

A nurse is assessing a postterm newborn. Which finding would the nurse correlate with this gestational age variation? 1 moist, supple, plum skin appearance 2 abundant lanugo and vernix 3 thin umbilical cord 4 absence of sole creases

3

Large Gestational Age (LGA) are above what _____ percentile.

>90th percentile

Turner Syndrome

A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted.

Polycythemia is ? it can lead to?

A disorder characterized by an abnormal increase in the number of red blood cells in the blood Jaundice

The uterus should be like what after delivery?

Firm not boggy Fundal height= days postpartum (3days= 3cm below naval) Midline- if not catheterize

Pinkish/brown, serosanguineous. Lasts day 4-10 postpartum

Lochia Serosa

The __________ phase is characterized by the woman's dependency on and passivity with others. Maternal needs are dominant, and talking about the birth is an important task. The new mother follows suggestions, is hesitant about making decisions, and is still preoccupied with her needs. The __________ phase is characterized by the woman becoming more independent and interested in learning how to care for her infant. Learning how to be a competent parent is an important task. The __________ phase is an interdependent phase after birth in which the mother and family move forward as a family system, interacting together. The binding-in phase is a distractor for this question.

The Taking-in phase The taking- hold phase The letting go phase

The nurse is preparing a new mother to be discharged home after an uncomplicated delivery. Which type of lochia pattern should the nurse point out needs to be reported to her primary care provider immediately during the discharge teaching? 1 moderate lochia serosa on day 4 postpartum, increasing in volume and changing to rubra on day 5 2 moderate flow of lochia rubra on day 3 postpartum, changing to serosa on day 5 3 lochia progresses from rubra to serosa to alba within 10 days 4 moderate lochia rubra on day 3, mixed serosa and rubra on day 4, light serosa on day 5

1

The nurse is teaching new parents the best way to prevent hypothermia. Which mechanism would the nurse include when explaining about the newborn's primary method of heat production? 1 nonshivering thermogenesis 2 thermoregulation 3 thermoconduction 4 shivering thermogenesis

1

While making a follow-up home visit to a client in her first week postpartum, the nurse notes that she has lost 5 pounds. Which reason for this loss would be the most likely? 1 diuresis 2 lactation 3 blood loss 4 nausea

1

Cold stress can cause hypoglycemia, increased respiratory distress and apnea, and metabolic ___________

metabolic acidosis.

breastfeeding jaundice occurs when

occurs during first week, due to suboptimal milk intake

When assessing a newborn, the nurse determines that the newborn is most likely experiencing respiratory distress syndrome (RDS) based on which finding? 1 peripheral cyanosis 2 slightly diminished breath sounds 3 see-saw respirations 4 respiratory distress occurring by 6 hours of age

3

umbilical cord prolapse is what?

Protrusion of the umbilical cord alongside or ahead of the presenting part of the fetus. Umbilical cord prolapse is a complication that occurs prior to or during delivery of the baby. In a prolapse, the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby.

The woman who is Rh-negative and whose infant is Rh-positive should be given _________ within 72 hours after birth to prevent sensitization.

The woman who is Rh-negative and whose infant is Rh-positive should be given Rho(D) immune globulin within 72 hours after birth to prevent sensitization.

_______________ = occurs due to prolonged pressure against the maternal pelvis or due to forceps delivery. The result is reduced movement on the side of the injury and generally begins to resolve in a few hours but complete recovery may take months. Facial nerve trauma may cause feeding difficulties.

facial nerve trauma

Scant voiding can be a sign of?

infection

Secondary postpartum hemorrhage occurs when?

is after the first 24 hours and up to 12 weeks

__________ therapy is the first-line treatment for brachial plexus injuries and typically starts at the end of the first week after birth. Physical therapy is used to promote muscle strength and function. Splints may be used to prevent contractures of the elbow and fingers

physical therapy

uterine involution

the process of the uterus returning to normal size

involution of the uterus means what?

the uterus returns to its normal nonpregnant size

Nevi simplex is?

(salmon patches, stork bites, angel kisses, telangiectatic nevi)

A group of nurses are reviewing information about the changes in the newborn's lungs that must occur to maintain respiratory function. The nurses demonstrate understanding of this information when they identify which event as occurring first? 1 expansion of the lungs 2 increased pulmonary blood flow 3 initiation of respiratory movement 4 redistribution of cardiac output

1

A nurse is assessing a client's lochia every 15 minutes for the first hour during the fourth stage of labor. Which finding would the nurse expect to assess? 1 moderate lochia rubra with a fleshy odor 2 lochia alba saturating at least 3 pads 3 lochia rubra with large clots 4 lochia rubra saturating two pads

1

A nurse is aware that the newborn's neuromuscular maturity is typically completed within 24 hours after birth. Which assessment would the nurse be least likely to complete to determine the newborn's degree of maturity? 1 Moro reflex 2 square window 3 popliteal angle 4 scarf sign

1

A nurse is providing care to a postpartum woman who gave birth about 2 days ago. The client asks the nurse, "I haven't moved my bowels yet. Is this a problem?" Which response by the nurse would be most appropriate? 1 "It might take up to a week for your bowels return to their normal pattern." 2 "I'll get a laxative prescribed so that you can move your bowels." 3 "That's unusual. Are you making sure to eat enough?" 4 "Let me call your healthcare provider about this problem."

1

A premature infant develops respiratory distress syndrome. With this condition, circulatory impairment is likely to occur because with increased lung tension, the: 1 ductus arteriosus remains open. 2 foramen ovale closes prematurely. 3 aorta or aortic valve strictures. 4 pulmonary artery closes.

1

A woman who gave birth to a healthy newborn several hours ago asks the nurse, "Why am I perspiring so much?" The nurse integrates knowledge that a decrease in which hormone plays a role in this occurrence? 1 estrogen 2 hCG 3 hPL 4 progesterone

1

During a routine assessment the nurse notes the client is tachycardic. Which possible cause should be ruled out? 1 delayed hemorrhage 2 bladder distention 3 extreme diaphoresis 4 uterine atony

1

In the neonate, the "red reflex" is a test for: 1. cataracts 2. congential dislocation of the hip 3. CF 4. phenylketonuria 5. sickle cell

1

One thing a new mother does is to adapt to the new baby psychologically. The woman takes on her new role as mother by going through a series of four developmental stages. What is one of them? 1 Achieving a maternal identity 2 Finding a way to get the new baby to conform to existing family interrelationships 3 Physical restoration and learning to get help in caring for the infant 4 Preparing for the infant before she conceives

1

The nurse has admitted a small for gestational age infant (SGA) to the observation nursery from the birth room. Which action would the nurse prioritize in the newborn's care plan? 1 Closely monitor temperature. 2 Assess for hyperglycemia. 3 Monitor intake and output. 4 Observe feeding tolerance.

1

The nurse is assisting a postpartum woman out of bed to the bathroom for a sitz bath. Which action would be a priority? 1 placing the call light within her reach 2 teaching her how the sitz bath works 3 telling her to use the sitz bath for 30 minutes 4 cleaning the perineum with the peri-bottle

1

The nurse is concerned that a new mother is developing a postpartum complication. What did the nurse most likely assess in this patient? 1 Absence of lochia 2 Red-colored lochia for the first 24 hours 3 Lochia that is the color of menstrual blood 4 Lochia appearing pinkish-brown on the fourth day

1 Lochia should never be absent during the first 1 to 3 weeks because absence of lochia may indicate postpartal infection. Red-colored lochia for the first 24 hours is normal. Lochia that is the color of menstrual blood is normal. Lochia appearing pinkish-brown on the fourth postpartum day is normal.

A woman arrives at the office for her 4-week postpartal visit. Her uterus is still enlarged and soft, and lochial discharge is still present. Which nursing diagnosis is most likely for this client? 1 Risk for fatigue related to chronic bleeding due to subinvolution 2 Risk for infection related to microorganism invasion of episiotomy 3 Risk for impaired breastfeeding related to development of mastitis 4 Ineffective peripheral tissue perfusion related to interference with circulation secondary to development of thrombophlebitis

1 Subinvolution is incomplete return of the uterus to its prepregnant size and shape. With subinvolution, at a 4- or 6-week postpartal visit, the uterus is still enlarged and soft. Lochial discharge usually is still present. The symptoms in the scenario are closest to those of subinvolution.

During the first few days after birth, the uterus typically descends downward from the level of the umbilicus at a rate of __ cm (___ fingerbreadth) every ____ hours so that by day 2, it would be ______?

1 cm (1 fingerbreadth) every 24 hours so that by day 2 (48 hours) it would be 2 fingerbreadths under the umbilicus.

A nurse is assessing a client with postpartal hemorrhage; the client is presently on IV oxytocin. Which interventions should the nurse perform to evaluate the efficacy of the drug treatment? Select all that apply. 1 Assess the client's uterine tone. 2 Monitor the client's vital signs. 3 Assess the client's skin turgor. 4 Get a pad count. 5 Assess deep tendon reflexes.

1, 2, 4

A newborn is experiencing cold stress. Which findings would the nurse expect to assess? Select all that apply. 1 respiratory distress 2 decreased oxygen needs 3 hypoglycemia 4 metabolic alkalosis 5 jaundice

1, 3, 5,

A 26-year-old new mother says to her nurse, "I am so disappointed. I gained 25 pounds with my baby. Just what the doctor said I should gain. But after I had my baby I only lost 12 pounds." What is the best response by the nurse? 1 "I see that you are bottle-feeding your baby. You would lose your weight faster if you were breast-feeding." 2 "It is normal to lose between 12 and 14 pounds after the baby delivers. You should be back to your pre-pregnancy weight by the time your baby is about 6 months old." 3 "I know you are anxious to lose all your 'baby fat.' Get yourself on a good diet and you will be down to your original weight in no time." 4 "Remember, it took 9 months for you to gain all this weight. It won't disappear in just a couple of days."

2

Many clients experience a slight fever after birth especially during the first 24 hours. To what should the nurse attribute this elevated temperature? 1 infection 2 dehydration 3 change in the temperature from the birth room 4 fluid volume overload

2

A nurse is caring for a client who has had a cesarean birth. Which of the following interventions is most important for such a client? 1 Discouraging early ambulation 2 Providing the client only clear fluids 3 Offering the client extra pillows 4 Administering calcium supplements

2 A client who has had a cesarean birth should be given only clear fluids until bowel sounds are present. Once present, intake can progress to solid foods. The client may be prescribed iron supplements if there has been an excess loss of blood; however, the client need not immediately be given calcium supplements. Early ambulation is encouraged to prevent DVT and to stimulate peristalsis. Although extra pillows may be comforting, they are not necessary.

The nurse is assessing a client who is 14 hours postpartum and notes very heavy lochia flow with large clots. Which action should the nurse prioritize? 1 Assess her blood pressure. 2 Palpate her fundus. 3 Have her turn to her left side. 4 Assess her perineum.

2 The nurse should assess the status of the uterus by palpating the fundus and determining its condition. If it is boggy, the nurse would then initiate fundal massage to help it contract and encourage the passage of the lochia and any potential clots that may be in the uterus. Assessing the blood pressure and assessing her perineum would follow if indicated. It would be best if the woman is in the semi-Fowler's position to allow gravity to help the lochia to drain from the uterus. The nurse would also ensure the bladder was not distended.

The nurse is teaching a postpartum woman and her spouse about postpartum blues. The nurse would instruct the couple to seek further care if the client's symptoms persist beyond which time frame? 1 week 2 weeks 3 weeks 4 weeks.

2 weeks

A nurse is developing a teaching plan about sexuality and contraception for a postpartum woman who is breastfeeding. Which information would the nurse most likely include? Select all that apply. 1 resumption of sexual intercourse about two weeks after birth 2 possible experience of fluctuations in sexual interest 3 use of a water-based lubricant to ease vaginal discomfort 4 use of combined hormonal contraceptives for the first three weeks 5 possibility of increased breast sensitivity during sexual activity

2, 3, 5,

Blood loss during vaginal delivery is how many mL? During C section?

200-500 mL can be up to 1,000 mL

A nurse is caring for a client who has just given birth. What is the best method for the nurse to assess this client for postpartum hemorrhage? 1 by assessing skin turgor 2 by assessing blood pressure 3 by frequently assessing uterine involution 4 by monitoring hCG titers

3

A nurse is caring for a client who is nursing her baby boy. The client reports afterpains. Secretion of which substance would the nurse identify as the cause of afterpains? 1 prolactin 2 progesterone 3 oxytocin 4 estrogen

3

A primipara client gave birth vaginally to a healthy newborn girl 48 hours ago. The nurse palpates the client's fundus and documents which finding as normal? 1 two fingerbreadths above the umbilicus 2 at the level of the umbilicus 3 two fingerbreadths below the umbilicus 4 four fingerbreadths below the umbilicus

3

In recording a postpartum mother's urinary output, the nurse notes that she is voiding between 100 to 200 mL with each void. How would the nurse interpret this finding? 1 The urinary output is inadequate and the mother needs to drinks more fluids. 2 The urinary output is inadequate suggestive of urinary retention. 3 The urinary output is normal. 4 The urinary output is above expected levels.

3

On an Apgar evaluation, how is reflex irritability tested? 1 tightly flexing the infant's trunk and then releasing it 2 dorsiflexing a foot against pressure resistance 3 flicking the soles of the feet and observing the response 4 raising the infant's head and letting it fall back

3

One of the primary assessments a nurse makes every day is for postpartum hemorrhage. What does the nurse assess the fundus for? 1 Content, lochia, place 2 Location, shape, and content 3 Consistency, shape, and location 4 Consistency, location, and place

3

The nurse is monitoring several postpartum women for potential complications related to the birthing process. Which assessment should a nurse prioritize on an hourly basis? 1 Complete blood count 2 Vital signs 3 Pad count 4 Urine volume excreted

3

The nurse is performing an assessment on a 2-day postpartum client and discovers a boggy fundus at the umbilicus and slightly to the right. The nurse determines that this is most likely related to which situation? 1 Uteruine atony 2 Full bowel 3 Bladder distention 4 Poor bladder tone

3

The nurse is preparing a nursing care plan for an immediate postpartum client. Which nursing diagnosis should the nurse prioritize? 1 pain related to afterpains or episiotomy discomfort 2 Risk for infection related to multiple portals of entry for pathogens 3 Risk for injury: postpartum hemorrhage related to uterine atony 4 Risk for injury: falls related to postural hypotension and fainting

3

The nurse is teaching a prenatal class and illustrating some of the basic events that will happen right after the birth. The nurse should point out which action will best help the infant maintain an adequate body temperature? 1 Bathe the infant immediately after birth. 2 Place the infant on the mother's abdomen after birth. 3 Wrap the infant in a warm, dry blanket. 4 Turn the temperature up in the birth room.

3

The nurse palpates a postpartal woman's fundus 2 hours after birth and finds it located to the right of midline and somewhat soft. What is the correct interpretation of this finding? 1 The uterine placement is normal. 2 The soft fundus indicates that the woman's uterus is filling up with blood. 3 The clien's bladder is distended and is causing the uterus to deviate to the right. 4 The uterus is soft because there is an infection inside the uterus.

3

Bilirubin typically peaks around babies ____ to ____ days of life

3-7 days

When does the ductus venosus close?

3-7 days after birth

Following delivery, a newborn has a large amount of mucus coming out of his mouth and nose. What would be the nurse's first action? 1 Suction the mouth and then the nose with a suction catheter. 2 Place the newborn on its stomach with the head down and gently pat its back. 3 Suction the nose first and then the mouth with a bulb syringe. 4 Using a bulb syringe, suction the mouth then the nose.

4

The nurse is assessing a newborn's vital signs and notes the following: HR 138, RR 42, temperature 97.7oF (36.5oC), and blood pressure 78/40 mm Hg. Which action should the nurse prioritize? 1 Report tachypnea. 2 Recheck blood pressure in 15 minutes. 3 Put warming blanket over infant. 4 Document normal findings.

4

The nurse is inspecting a male newborn's genitalia. Which action should the nurse avoid when conducting this assessment? 1 Inspecting if the urethral opening appears circular 2 Palpating if testes are descended into the scrotal sac 3 inspecting the genital area for irritated skin 4 Retracting the foreskin over the glans to assess for secretions

4

The nurse, assessing the lochia of a client, attempts to separate a clot and identifies the presence of tissue. Which observation would indicate the presence of tissue? 1 yellowish-white lochia 2 foul-smelling lochia 3 easy to separate clots 4 difficult to separate clots

4

Which action would be priority for the nurse to complete immediately after the delivery of a 40-week gestation newborn? 1 Swaddle the infant and place in the bassinet. 2 Complete a full head-to-toe assessment. 3 Assess the newborn's glucose level. 4 Dry the newborn and place it skin-to-skin on mother.

4

x A client who gave birth about 12 hours ago informs the nurse that she has been voiding small amounts of urine frequently. The nurse examines the client and notes the displacement of the uterus from the midline to the right. What intervention would the nurse perform next? 1 Insert a 20 gauge IV. 2 Administer oxytocin IV. 3 Notify the healthcare provider. 4 Perform urinary catheterization.

4

normal Newborn Glucose range?

40-60 mg/dL

Normal WBC count

5,000-10,000. After delivery however it is expected to be elevated for the first 24 weeks. should remain normal after 1 week or so.

Newborn Blood Pressure

80/40 Varies with birth weight. Not always taken in newborns. If a significant murmur is heard, the doctor may ask to get a BP.

Normal newborn temperature ranges?

97.7 F to 99.3 F (36.5 C to 37.3 C)

Oxytocin is released by the ______________. Stimulates _______ during childbirth and milk ejection during breastfeeding.

A hormone released by the posterior pituitary that stimulates uterine contractions during childbirth and milk ejection during breastfeeding. Can be given as a medication to stimulate uterine contractions during labor and postpartum (contractions to prevent uterine atony)

Harlequin sign

A rare color change that occurs between the longitudinal halves of the newborn's body, such that the dependent half is noticeably pinker than the superior half when the newborn is placed on one side; it is of no pathologic significance. (normal finding)

Chest general assessment—should be symmetrical and ____________

Barrel chested.

Rebella is not given during pregnancy but should be given when?

Before discharge.

__________ ____________may contribute to the uterus not contracting as expected. (can push the uterus to the left of right)

Bladder Distension

______________-typically unilateral nerve damage that occurs from stretching and traction on the brachial plexus. May recover spontaneously over a few months or may require more extensive treatment.

Brachial plexus injury

BUBBLE-EE Mnemonic for Postpartum Nursing Care

Breast, Uterus, Bladder, Bowels, Lochia, Episiotomy (perineum and for hemorrhoids), Extremities, Emotional status

A neonatal intensive care nurse monitors patients for what signs of respiratory distress syndrome? A. Nasal flaring B. Expiratory grunting C. Use of accessory muscles to breathe D. All of the above

D

Many clients experience a slight fever ( up to 100.4*F) after birth especially during the first 24 hours. To what should the nurse attribute this elevated temperature?

Dehydration.

The umbilical cord should be _____ and without redness

Dry.

NEC treatment

Early: TPN, antibiotics, cessation of oral feeding. Complicated: emergence surgery or bowel sparing percutaneous drainage Recovery: evaluate for strictures, most common complication

Caput Succedaneum is?

Edematous swelling on the scalp caused by pressure during birth. This swelling may cross suture line. It usually disappears in a few day. (normal)

infants with ____________ have an upper arm that is adducted and internally rotated

Erb palsy

Ophthalmia Neonatorum treatment

Erythromycin or tetracycline

vExcess blood volume resolves over the first few days after delivery through blood loss, _____________, and ___________. (normal findings to get rid of fluid)

Excess blood volume resolves over the first few days after delivery through blood loss, diuresis, and diaphoresis. (normal findings to get rid of fluid)

___________ - The neonate sticks out the tongue if the tip of the tongue is touched or pushed.

Extrusion

tonic head reflex is also called ?

Fencing

WBC counts are elevated right after labor so check for other signs of infection would include?

Fever over 100.4, foul odor, etc.

hole between the two atrium's in a fetal heart?

Foramen Ovale

For neonates Hemoglobin typically ranges from ___ to ____ g/dL. White blood cells are initially elevated soon after birth as a result of birth trauma, typically ranging from ______ to _______/mm3. The newborn's platelet count is the same as that for an adult, ranging between 100,000 and 300,000/uL. However, clotting factors are low during the first days of extrauterine life due to a low level of vitamin K After birth, the red blood cell count gradually increases as the cell size decreases. Normal count ranges from 5,100,000 to 5,800,000/uL.

Hemoglobin typically ranges from 14 to 24 g/dL. White blood cells are initially elevated soon after birth as a result of birth trauma, typically ranging from 10,000 to 30,000/mm3. The newborn's platelet count is the same as that for an adult, ranging between 150,000 and 300,000/uL. After birth, the red blood cell count gradually increases as the cell size decreases. Normal count ranges from 5,100,000 to 5,800,000/uL.

which immunoglobulin as having crossed the placenta for immunity status?

IgG

Common Cesarean complicationos include: ___________(loss of bowel function), ___________(inflammation of the lining of uterus), Blood clots, hemmorrhage, surgical injury

Ileus, Endometritis

____________ babies are at higher risk for birth injury.

LGA

Late preterm- _____& _______ weeks Early term-37 to 38 &6 weeks Full term is 39 to 40 & 6 weeks Late term is 41 weeks Postterm- _____ weeks or later.

Late Preterm- 34 to 36 &6 weeks Early term-37 to 38 &6 weeks Full term is 39 to 40 & 6 weeks Late term is 41 weeks Postterm- 42 weeks or later.

Newborn heart sounds stethoscope should be placed where?

Left sternal boarder above the nipple line.

Whitish/yellowish discharge - lasts 10-14 days, may last 3-6 weeks and remain normal.

Lochia Alba

Bright red, may contain small clots, transient flow increases during breastfeeding and upon rising. Lasts 1-3 days

Lochia Rubra

________ is more common in infants of mothers with obesity, diabetes, and excessive weight gain in pregnancy.

Macrosomia

exceptionally large infant with excessive fat deposition in the subcutaneous tissue; most frequently seen in fetuses of diabetic mothers

Macrosomia

For a soft not flaccid fundus the nurse should do what to prevent uterine atony?

Massage it

__________- is typically passed within the first 24 hours and is thick, dark green, and tarry

Meconium

Small white sebaceous glands = __________

Milia (normal finding) Typically resolve in 2-4 wk without treatment.

___________ is an elongated head shape caused by overlapping of the cranial bones as the fetus moves through the birth canal. This will also resolve in a few days without treatment. ___________ sign is characterized by a clown-suit-like appearance of the newborn where the skin is dark red on one side of the body and the other side is pale. This is a harmless condition which occurs most frequently with vigorous crying or with the infant lying on his or her side.

Molding is an elongated head shape caused by overlapping of the cranial bones as the fetus moves through the birth canal. This will also resolve in a few days without treatment. The Harlequin sign is characterized by a clown-suit-like appearance of the newborn where the skin is dark red on one side of the body and the other side is pale. This is a harmless condition which occurs most frequently with vigorous crying or with the infant lying on his or her side.

Startle reflex is also called what?

Moro Reflex.

Necrosis of intestinal mucosa and possible perforation. Colon is usually involved, but can involve entire GI tract. In neonates, more common in premies (decreased immunity)

Necrotizing enterocolitis (NEC)

_______________- is an inflammation in the intestines and usually occurs in premature babies. The damage that NEC causes to the intestinal tissues can cause a hole in the intestines that allows bacteria leak out into the abdomen and cause infection

Necrotizing enterocolitis (NEC)

scant voiding

Not enough or barely enough. infrequency

physiological jaundice

Occurs after 24-48 hours after birth

jaundice and feeding difficulties are also higher risk for _________ infants

Preterm

A hormone that stimulates lactation and suppresses ovulation

Prolactin

Brazelton's Neonatal Behavioral Assessment Scale says the best time to interact with new babies is during which state?

Quiet alert state.

Lochia rubra

Reddish or red-brown vaginal discharge that occurs immediately after childbirth; composed mostly of blood.

REEDA assessment can be helpful for perineum assessment. What does REEDA stand for?

Redness Edema Ecchymosis Discharge Approximation

The biggest concern with cold stress and the newborn is ______________ and ____________?

Respiratory distress and hypoglycemia

See Saw Respirations is a sign of?

Respiratory distress syndrome.

_____________occurs because of abnormal vascular growth of the blood vessels of the retina in infants born prematurely. The abnormal blood vessels are more permeable and leak, leading to edema and hemorrhage of the retina. This causes scarring that pulls on the retina, leading to distortion or even detachment.

Retinopathy of Prematurity

The use of artificial ventilation for more than a week and surfactant therapy are the most prominent intervention-related risk factors, although hyperglycemia, insulin therapy, poor caloric intake, early use of erythropoietin for anemia, and high-volume blood transfusion can also contribute to ______________

Retinopathy of prematurity.

If a mother is Rh negative and her infant is Rh positive, _____________ should be administered within 72 hours via IM injection.

Rho(D) immune globulin (Rogan)

_________-Folds within the vagina that allow it to stretch during childbirth and that re-form postpartum

Rugae

____________ babies Having a birth weight that is below the 10th percentile on intrauterine growth charts. There is a concern for malnutrition and hypoglycemia.

SGA (small gestational age)

Apnea over 20 seconds can indicate ______,____________,___________ or another issue.

Sepsis, hypothermia, hypoglycemia.

__________ hemorrhage—looks alarming (ocular bleed) but are very common in neonates and resolve spontaneously within 2 weeks. Make sure red reflex is intact

Subconjunctival hemorrhage.

IUGR-Intrauterine growth restriction (IUGR) refers to a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb. Measured by ultra sound. SGA (small gestation age) AGA, LGA __________- is more concerning. Head and body are the same size. Associated with malunion, infection, exposure to teratogens. (stillbirth, morbility) _____________- head is normal, but body is less. Typically occurs after 30 weeks gestation. Decrease oxygen, can have material hypertension, preeclampsia, diabetes

Symmetric- is more concerning. Head and body are the same size. Associated with malunion, infection, exposure to teratogens. (stillbirth, morbility) Asymmetric- head is normal, but body is less. Typically occurs after 30 weeks gestation. Decrease oxygen, can have material hypertension, preeclampsia, diabetes

Preterm infant: Anticipated problems—"TRIES"

Temperature regulation (poor) Resistance to infections (poor) Immature liver (jaundice) Elimination problems (necrotizing enterocolitis [NEC]) Sensory-perceptual functions (retinopathy of prematurity [ROP])

The _________ is the most commonly fractured bone of the neonate. Can by asymtamatic. Risk factors is big babies and _____________ babies

The clavicle is the most commonly fractured bone of the neonate. Big babies and vacuum babies.

kangaroo care involves?

Treatment for preterm infants that involves skin-to-skin contact.

Webbed neck, short stature indicates ________syndrome.

Turner syndrome

When does the foramen ovale close?

Within the first hour of birth

By the end of the first week, the stool of breastfed infants is __________ and ___________ and is passed 4 to 8 times per day.

Yellow and seedy

boggy uterus is? It an cause ?

a uterus that feels soft and spongy, rather than firm and well contracted. (not a good sign) can cause uterine atony

boggy uterus feels?

a uterus that feels soft and spongy, rather than firm and well contracted. Indicates uterine atony (risk for hemorrhage)

Integument of the newborn. inspect for color, bruising, birth marks, lanugo, vernix, or rashes. Expect skin to be centrally pink but may have bluish hands and feet (_____________).

acrocyanosis.

Apgar scale stands for? It is done at ____ and ____ minutes after birth.

appearance, pulse, grimace, activity, respiration 1 and 5

A __________ is typically characterized by asymmetrical movement.

birth injury

central cyanosis

bluish discoloration of the skin or mucous membranes (lips) due to hemoglobin carrying reduced amounts of oxygen (abnormal)

Mongolian spots are ?

bluish purple spots of pigmentation (normal)

Stretching and traction on the _________ is the most common cause of injury; the compression of the nerves, hemorrhage, and oxygen deprivation of the neonate may also contribute

brachial plexus injury

Why should the uterus not be palpated with two hands?

can cause uterine prolapse

The "Red Reflex" is an indication of ___

clear media. Absence of red reflex is bad.

ophthalmia neonatorum is?

conjunctivitis of the newborn (pink eye)

___________ ____________= a blood vessel in a fetus that bypasses pulmonary circulation by connecting the pulmonary artery directly to the ascending aorta

ductus arteriosus

Clamping of the umbilical cord causes decreased blood flow to the ___________, which will then begin to atrophy.

ductus venosus

____________ ________= connects the umbilical vein to the inferior vena cava, bypassing the liver

ductus venosus

Although hCG, hPL, and progesterone decline rapidly after birth, decreased __________ levels are associated with breast engorgement and with the diuresis of excess extracellular fluid accumulated during pregnancy.

estrogen

What is cold stress?

exposure to temperatures cooler than normal body temperature so that the newborn must use energy to maintain heat

Subinvolution means ?

failure of uterus to return to non-pregnant state

endometritis treatment includes what antibiotics?

gentamicin + clindamycin +/- ampicillin

to assess a women perineum what position should she be in.

have her lay on her side with her knees bent

The signs and symptoms of IVH include a sudden decrease in __________, a severe and sudden unexplained deterioration of vital signs, bulging fontanels, changes in activity level, and sudden lethargy. The diagnosis is confirmed by cranial ultrasonography.

hematocrit

Temperature instability, seizures, and feeble sucking suggest ____________

hypoglycemia

Infants born to women who are morbidly obese are at a greater risk for developing _______. Early signs of hypoglycemia in the newborn include jitteriness, poor feeding, listlessness (not frequent activity), irritability, low temperature (not fever), weak or high-pitched cry, and hypotonia (not hypertonia).

hypoglycemia.

For preterm infants the main three things to assess cause of higher risk are __________, ____________ and ____________ because they go hand in hand

hypothermia, hypoglycemia, respiratory distress.

hypoglycemia in newborn

hypothermia/ cold stress, twitching, tachypnea (respiratory distress), jitterness, shakiness. Blood sugar lower than 60. normal BS for baby is 70-100

Although __________________ is rare, its risk of occurrence increases with forceps and vacuum-assisted delivery.

intracranial hemorrhage (ICH)

The primary risk factors for ROP (retinopathy of prematurity) are ______________ and _____________

low gestational age and weight

Phimosis means

narrowing of the opening of the prepuce over the glans penis

Increased intracranial pressure Change in heart rate variability Change in pupil size can all be parameters for __________ assessment.

neonatal pain

Postpartum WBC are normally ___________after delivery.

normally elevated after delivery 25,000-30,000

Primary postpartum hemorrhage occurs when?

occurs in the first 24 hours after delivery

The rooting reflex refers to a baby's tendency to

open the mouth in search of a nipple when touched on the cheek

after pains are

pain after birth with uterine contraction. Felt more with more babies.

subluxation means?

partial dislocation

When the cord is clamped and the _______ cannot provide gas exchange, a mild state of hypoxia is created, which stimulates breathing.

plancenta

__________ infants may be macrosomic or small for gestational age (SGA) because of the aging placenta.

postterm infants

movement of chest and abdomens in oppsite direction. a sign of respiratory distress.

seesaw breathing

Grunting and nasal flaring are signs of? Grunting is heard on __________?

signs of respiratory distress Expiration

____________ injury is rare but may be caused by forceps or vaginal breech delivery. Prognosis depends on the location and severity of the injury.

spinal cord injury

Nonnutritive sucking

sucking fingers, thumb, pacifiers, or other objects for comfort. not bottle feeding.

Reason premature babies have a harder time breathing is because of lack of ___________?

surfactant

_________ and expiratory grunting occur early in respiratory distress syndrome to help improve oxygenation.

tachypnea

_____________ is priority immediately following delivery and is best achieved by keeping the newborn warm and dry. This can be accomplished by drying the newborn and placing it skin-to-skin with the mother.

thermoregulation

Postpartum nursing care includes assessment of involution, uterine ________, ________ and ___________

tone and position, and lochia

____________ reflex- when baby is lying on her back, depending on the direction of the head- that arm will straighten while the other hand raises up at the head

tonic head

inability of the uterus to contract effectively and causes postpartum hemorrhage. Blood vessels from where the placenta detached are not being compressed allowing for blood to go freely and increases risk of hemorrhage.

uterine atony

During the bath, all blood and products from the delivery need to be washed off and the _________ should be left in place to allow it to gradual absorb into the infant's body

vernix.

The nurse is making a home visit to a woman who is 5 days postpartum and has no reports. Which finding would concern the nurse and warrant further investigation? 1 uterus 5 cm below umbilicus 2 lochia rubra 3 edematous vagina 4 diaphoresis

2

The partner of a woman who has given birth to a healthy newborn says to the nurse, "I want to be involved, but I'm not sure that I'm able to care for such a little baby." The nurse interprets this as indicating which stage? 1 expectations 2 reality 3 transition to mastery 4 taking-hold

2

Not treating neonatal pain adequately can have long-term effects on how the neonate responds to pain throughout his or her life. Infants admitted to the NICU experience an average of ____ to ____ painful procedures every day.

5 to 15

_____ more calories a day increase if you are breast feeding.

500 more

A woman who gave birth 24 hours ago tells the nurse, "I've been urinating so much over the past several hours." Which response by the nurse would be most appropriate? 1 "You must have an infection, so let me get a urine specimen." 2 "Your body is undergoing many changes that cause your bladder to fill quickly." 3 "Your uterus is not contracting as quickly as it should." 4 "The anesthesia that you received is wearing off and your bladder is working again."

2

During the second day postpartum, a nurse notices that a client is initiating breastfeeding with her infant and changing her infant's diapers with some assistance from her partner. Which phase does the nurse recognize that the woman is experiencing? 1 the taking-in phase 2 the taking-hold phase 3 the binding-in phase 4 the letting-go phase

2

Elevation of a client's temperature is a crucial first sign of infection. However, when is elevated temperature not a warning sign of impending infection? 1 when the white blood cell count is less than 10,000/mm³ 2 during the first 24 hours after birth owing to dehydration from exertion 3 after any period of decreased intake 4 when the elevated temperature exceeds 100.4° F (38° C)

2

An extremely low-birth-weight newborn weighs less than _______ g. A very-low-birth-weight newborn weighs less than ________ g. A large-for-gestational-age newborn typically weighs more than ______ g. A small-for-gestational-age newborn or a low-birth-weight newborn typically weighs about _________ g.

1,000 1,500 4,000 2,500

The LVN/LPN will be assessing a postpartum client for danger signs after a vaginal birth. What assessment finding would the nurse assess as a danger sign for this client? 1 presence of lochia rubra 2 fever more than 100.4° F (38° C) 3 fundus is above the umbilicus 4 fundus is firm

2

A new mother asks the nurse what she is allowed to do when she goes home from the hospital. Which statement by the nurse would be correct? 1 You should be able to resume normal activities after 2 weeks. 2 You should not lift anything heavier than your infant in its carrier. 3 Only clean half of the house per day to allow yourself more rest. 4 You need to hire a maid for the first month after delivery to help out around the house.

2

A postpartum client comes to the clinic for her routine 6-week visit. The nurse assesses the client and suspects that she is experiencing subinvolution based on which finding? 1 nonpalpable fundus 2 moderate lochia serosa 3 bruising on arms and legs 4 fever

2

The poor muscle tone, low temperature, and jitteriness are signs and symptoms indicative of ___________.

hypoglycemia

Where is the brachial plexus located?

C5-T1

A central nervous system stimulant medication used for neonates

Caffeine Citrate

There is a increase risk of _______ or ______ during postpartum period due to increase clotting ability and immobility. Encourage patients to ambulate early to decrease risk.

DVT and PE

Acrocyanosis is?

Normal cyanosis of the babys hands and feet which appears intermittently over the 1st 7-10 days.

For perineal pain _________ and _______ are commonly ordered for childbirth pain

Tylenol and Ibuprofen (Motrin)

Weight loss after birth includes _________lbs at the time of birth. ___-___ lbs lost with fluids and uterine involution.

Weight loss- 12lbs at the time of birth. 5-8 lbs is lost with fluids and uterine involution

When does the ductus arteriosus close?

Within 10-15 hours of birth