Current 312 Exam 4

After receiving a change-of-shift report in the normal newborn nursery, the nurse should see which neonate first?

6-hour-old neonate with a blood glucose of 25 mg/dL (1.38 mmol/L)

Fibroids: Signs & Symptoms

dysmenorrhea heavy bleeding painful sex fertility issues enlarged lower abdominal pain preg. complications

A septic preterm neonate's IV was removed due to infiltration. The nurse prioritizes restarting the IV to help which complication?

hypoglycemia

Sick and preterm neonates who experience continuity of nursing care directly benefit from

nursing recognition of subtle changes in high-risk neonates' conditions.

What should the nurse expect to find in a premature female neonate born at 30 weeks' gestation who is small for gestational age?

fine, downy hair over the upper arms and back

Clinical Manifestations of NEC:

Abdominal distention Vomiting (bile or blood) Bloody stools Abdominal tenderness Erythema of abdominal wall Generalized symptoms such as hypotonia

*Risk Reduction Measures*

Abstinence of activities with fluid exchange Avoid: Practices that increase tissue damage Direct contact with lesions Increased # of partners Knowledge of partner's sexual history Vaccinations

Potential Gastrointestinal Complication:Necrotizing Enterocolitis (NEC)

Acute inflammatory disease of gastrointestinal mucosa May result in ulcerations & perforation May occur in 2 - 5 % of NB in NICU's May have up to a 40% mortality rate

The nurse explains to the mother of a neonate diagnosed with erythroblastosis fetalis that the exchange transfusion is necessary to prevent damage primarily to which organ in the neonate?

brain

Uterus: Reduction in Size

"After pains" are also effective in helping to return uterus to pre-pregnancy size Involution Term used to describe reduction in size of uterus postpartum Immediately postpartum uterus is about size of a __*grapefruit*__ Uterus will never return "all the way" to pre-pregnancy size

Factors effecting Parent-Infant Attachment

"Maternal-fetal" attachment behaviors—impact of a difficult pregnancy and/or birth experience Cultural beliefs or practices Family structure & functioning Contact during early "sensitive" period Prolonged contact after birth

While the nurse is caring for a neonate at 32 weeks' gestation in an isolette with continuous oxygen administration, the neonate's mother asks why the neonate's oxygen is humidified. What should the nurse should tell the mother?

"Oxygen is drying to the mucous membranes unless it is humidified."

A nurse places a neonate with hyperbilirubinemia under a phototherapy lamp, covering the eyes and gonads for protection. The parents asked the nurse to tell them how their baby will benefit from having phototherapy done. Which statement by the nurse is the most appropriate response about phototherapy?

"Phototherapy decreases the serum unconjugated bilirubin level."

syphilis Secondary Stage

*Systemic* 6 wks - 6 mo after chancre is seen Maculopapular rash on palms & soles Fever Alopecia Headache Lymphadenopathy

Urinary System

- continued 🡹 risk for infection due to 🡻 tone & dilated ureters; - postpartal _*diuresis* (reversal of water metabolism of pregnancy), occurs within 12 hrs postpartum; also diaphoresis esp. at night. Body works to eliminate excess fluid voiding difficulties common

endometriosis diagnosis

1. painful intercource 2.heavy menstration 3.infertility Tissue responds with changes in hormone levels Bleeds into surrounding structures Causes: Unknown but some theories Retrograde blood flow out of uterus and thru fallopian tubes Immature cells from embryonic development persist into adulthood, lying dormant until eventually developing into ectopic endometrial tissue Metastasis thru lymph and vascular systems Diagnosis of Endometriosis: Accurate diagnosis only possible thru laparoscope to visualize pelvic organs

A newborn diagnosed with phenylketonuria (PKU) is placed on a low-phenylalanine formula. The mother asks the nurse how long her infant will need to have dietary restriction. Which response would be most appropriate?

A newborn diagnosed with phenylketonuria (PKU) is placed on a low-phenylalanine formula. The mother asks the nurse how long her infant will need to have dietary restriction. Which response would be most appropriate?

Effects of Substance Abuse:

Alcohol Tobacco Marijuana Cocaine Heroin Methadone See Table 35-4 on pg. 869 Summary of Neonatal Effects of Commonly Abused Substances

RH Immune Globulin

All RH negative moms should receive RhoGAM within 72 hours after delivery of a RH positive baby. If pregnancy ended in a miscarriage, ectopic pregnancy..., she will also need to receive RhoGAM. Rh + blood has a particular antigen that Rh- blood does not have If mom's blood is exposed to that antigen, it will create antibodies in defense Just as it would with any other foreign object Antibodies will cause hemolysis of fetal RBCs Causing Hemolytic Anemia

CNS Anomalies

Anencephaly Encephalocele Meningomyelocele Hydrocephalus

Recurrence of Ovulation/ Menstruation

As soon as placenta is delivered, estrogen & progesterone will decrease Hormone levels will be at pre-pregnant levels within one week Decrease in estrogen & progesterone stimulates FSH release & return of ovulation Ovulation will likely precede menstruation Therefore a lack of menstrual return does not mean the woman cannot become __*PRegnant again!

PP Contraception

Assess knowledge of & past use; (Note: Breast feeding is not considered a very effective method of birth control!!) - "mini" pill preferred if client is breast feeding & desires oral contraception

EXTREMITIES

Assess legs for edema, warmth, redness and pain (+ _Homans*_ SIGN) Clotting factors remain elevated during postpartum ↑ risk Thromboembolism due to: Hypercoagulable state Immobility Vessel damage Sepsis

Clinical/Nursing Management of Sepsis

Assessments Blood cultures, CBC, vital signs Treatments IV antibiotics Oxygen or other respiratory aids Breast feeding encouraged for protective antibodies Patient education/Discharge Planning

PP Activity

Avoid: Heavy lifting Excessive stair climbing Strenuous activity Encourage mom to sleep when baby sleeps Encourage ambulation

pp OVULATION

BOTTLE FEEDING ↓ Prolactin levels Menses return Average is ______ wks pp, usually by 3 months Ovulation occurs _before__ the menses BREASTFEEDING ↑ PROLACTIN levels suppress ovulation in breastfeeding Levels effected by frequency, duration of feeds, as well as supplement use Menses return-highly variable

Neonatal Infections: Group B Streptococcus

Bacterial Infection Treated with antibiotics such as Gentamycin, Ampicillin or Penicillin If detected or suspected in the pregnant/ laboring woman, she will be treated with PCN _*during labor*__ Contracted by: Birth canal Baby to baby in nursery If staff is not washing their hands between caring for babies Babies who contract this infection are categorized into: Early onset Illness Late onset Illness

Uterine Fibroids

Benign neoplasms of smooth muscle origin Most common form of pelvic tumor 1/ 4-5 women > 35 yrs of age

Differentiating bruises from Mongolian spots:

Blanch skin with 2 fingers If skin color blanches, it is Mongolian Spots If skin doesn't blanch, it is petechiae or bruising

Cardiovascular System

Blood that was shunting through uterus & placenta will suddenly go into maternal systemic circulation immediately after birth of placenta CO is increased Would this be difficult on woman with heart issues? Decreases rapidly for first 2 weeks postpartum Returns to normal within 6 weeks

Gastrointestinal System

Bowel movements may be difficult due to: Sluggish peristalsis Episiotomy Edematous perineal area Hemorrhoids Stool softeners are often prescribed.

Peripheral Nervous System Injuries: Erb-Duchenne Paralysis

Brachial paralysis of upper arm Most common type of paralysis associated with difficult birth Caused from: Stretching or pulling _*head*_ away from shoulder

Mom's Breast Milk Preferred

Breast milk can be provided via bottle, OG or G- tube OG-Tube is preferred over NG b/c infants are nose breathers

Prevention of NEC:

Breastfeeding Nonnutritive Sucking Reversal of perinatal asphyxia within 30 minutes After 30 minutes of hypoxia, body compensates by redistributing blood to essential organs

Exposure to Cocaine

CNS Stimulant Acts as a peripheral sympathomimetic Effects to fetus are secondary to maternal effects High blood pressure Vasoconstriction Infants may exhibit: Poor suck, high pitched cry, rigidity, irritability, irregular sleep patterns, inability to be consoled, hypersensitivity to sound/noise

Signs of Bilirubin Encephalopathy

CNS depression or excitation, which will include: Decreased activity Lethargy Irritability Hypotonia Seizures

Facial Palsy

Caused by pressure on facial nerve during birth Clinical Manifestations: Side remains "flattened" Eye remains open Forehead will not wrinkle Mouth will appear distorted with crying Permanent paralysis is rare Will usually resolve in few days after birth Treatment: Assist with feeding Prevent damage to cornea as result of an open eye

PP Cervical Changes

Cervix remains open Allows about two finger insertion during first 4-6 days By end of 1st week, will allow insertion of about a fingertip Appearance & shape of cervix will be forever changed Slit appearance, instead of round

Perineum

Check perineum when checking lochia May be best to have her lay on her side & look from back Check for: Swelling Hematoma formation Episiotomy (REEDA) Presence of hemorrhoids Apply ice bag to perineum after delivery Apply ice for 20 minutes, off for 10 minutes Usually need to do this for first 24 hours Encourage use of Peri bottle Use after voiding to keep clean & to promote comfort

Skeletal Injuries: Fractured Clavicle

Clavicle is bone most often fractured during birth Frequent Cause: Shoulder Dystocia

Common Complications: IDM

Congenital Anomaly/ Cardiomyopathies Macrosomia Birth Trauma Perinatal Asphyxia/ RDS Hypoglycemia Polyhydramnios Polycythemia Hyperbilirubinemia

Other proven effects of Cigarette Smoking

Deficits in growth Deficits in intellect & emotional development Poor auditory responsiveness Increased fine motor tremors Hypertonicity Increase incidence of SIDS deaths

Rubin's Phases

Dependent: taking-in first 1-2 days focus: self & own needs dependent excited, talkative desires to review birth experience

Management of Dysmenorrhea

Depends on severity Treatment alternatives include: Heating pads/Hot baths Massaging lower back Pelvic Rock Exercises/ Yoga Increases vasodilation Releases endogenous opiates Suppresses prostaglandins Meditation Decrease salt & refined sugar intake 7 - 10 days before expected menses May reduce fluid retention Natural diuretics Asparagus, cranberry juice, peaches, watermelon Medications: Prostaglandin Inhibitors Oral Contraceptive agents Decreases prostaglandin release

Cardiovascular

Due to increase in blood volume, signs of hypovolemic shock are not usually evident in women with normal amount of blood loss after delivery Signs may be delayed in women who have a heavy blood loss

Potential Hematologic Complication: Anemia

Due to: Slower production of RBC's due to immature bone marrow Will improve with maturation Fragile capillaries Impaired coagulation, including prolonged prothrombin & partial thromboplastin time Loss of blood due to frequent blood sampling

Location of the Fundus

Each day fundus will lower about 1 finger breadth Approximately 1 cm By 2nd week, uterus will be below symphysis pubis Uterus will be approximately at it's pre-pregnant size by 6th week postpartum _*breastfeeding*__ feeding woman contract more due to oxytocin release, so involution may be more rapid.

PP Perineal Changes

Edema & tenderness of perineum is to be expected Assess episiotomy incision Edges should be together Assess for signs of infection Healing should occur in 2-3 weeks

Breasts

Encourage a support bra Are breasts soft? Are nipples inverted, cracked...? Is colostrum present?

Non-Nursing Mothers

Encourage a supportive, well-fitting *bra*_, continuously until lactation is suppressed: Usually within 5 - 7 days Ice packs applied to axillary area bilaterally for 20 minutes, 4x a day Avoid any _*stimulation*__ of her breast Avoid heat to breasts Avoid having shower water hit her front side Cabbage leaves

Management of Fibroids

Exogenous estrogen makes it worse Size will regress with menopause Leuprolide (Lupron) Gonadotropin releasing hormone May be used to shrink size of fibroid Hysterectomy (?BSO also)

Temperature

First 24 hours: There may be a slight rise in temperature due to dehydration from labor Should not exceed 100.4F 3rd or 4th day postpartum: Expect temp to rise due to increase in vascular activity when milk comes in This fever should not last more than a few hours >100.4F after first 24 hours should be investigated According to Joint Commission on Maternal Welfare Postpartum infection is a major cause of postpartum mortality

Erb-Duchenne Paralysis: Clinical Manifestations

Flaccid arm with elbow extended & hand rotated inward Absence of Moro reflex on affected side Intact grasp reflex Loss of sensation over lateral aspect of arm

Urinary Elimination

Following birth, woman should void within 4 hours Encourage her to void every 4 - 6 hours Palpate for bladder distention upon fundal & perineal checks May need to straight cath to empty bladder if she is unable May need to insert a foley catheter if she continues to have difficulty voiding

Extracorporeal Membrane Oxygenation (ECMO)

For infants with severe pulmonary dysfunction Cardiopulmonary bypass to oxygenate infant's blood Outside body through membrane oxygenator

Exposure to Tobacco

Frequent cause of low birth weight infants Maternal cigarette smoking is implicated in 21-39% of LBW infants Second hand smoke: also leads to low birth weight infants Nicotine will be found in breast milk for two hours after mom has smoked

pp Documentation of Fundal Assessment

Fundus Firm, location Ex: FF@ -1 or FF@ u/1 Fundus boggy, firm with massage, location... Fundus boggy, does not firm with massage... Is bladder full? Is medication being administered? Amount of lochia? Any clots?

A preterm neonate admitted to the neonatal intensive care unit at about 30 weeks' gestation is placed in an oxygenated isolette. The neonate's mother tells the nurse that she was planning to breastfeed the neonate. Which instructions about breastfeeding would be most appropriate?

Gavage feedings using breast milk can be given until the neonate can coordinate sucking and swallowing.

*non-nutritive*_ Sucking

Gavage or parenterally fed Pacifier is provided during feeding times May improve oxygenation & decrease energy expenditure (less restlessness)

*Human Papillomavirus (HPV)*

Genital warts (condylomata acuminata) Most prevalent viral STI Incubation period 1-6 months Linked with cervical & vulvar cancer Typically from 1-10 warts at a time Cauliflower-like Most commonly seen in posterior part of introitus

Treatment of Fractured Clavicle

Gentle handling No other treatment Figure-eight bandage is appropriate for older children, but not recommended for NB

Clinical/Nursing Management: Apnea

Gentle stimulation O2 via bag & mask Apnea monitors Theophylline or Caffeine Sodium Benzoate May need to be on ventilator

reproductive Bacterial Infections

Gonorrhea—often asymptomatic Chlamydia—often asymptomatic Syphilis Bacterial Vaginosis All are reportable communicable disease (except Bacterial Vaginosis) Healthcare providers are legally responsible for reporting all cases

After pains

Good thing! Usually will give Tylenol or Ibuprofen Will usually diminish in 2 to 3 days _*breastfeeding*__ will increase incidence

Chlamydia

Gram negative bacterium Chlamydia trachomatis Most prevalent STD in USA Occurring at a rate of 3 million new cases per yr Difficult to diagnose & complications are highly destructive Often asymptomatic Expensive to culture If not diagnosed or treated 40% will develop PID 1 in 5 become infertile

PP Collaborative interventions

HELP PARENTS: integrate birth experience: increases self-esteem meet their own needs (Maslow); include support systems, baby-sitting, etc. develop successful infant care skills & satisfying interactions by teaching (specific concrete demonstrations & suggestions), Role Model, reinforce positive behaviors

fundal massage

Have bed flat to assess location Press "in & down" to find fundus Check often for firmness & location Should feel like a hard ball If boggy ---- _*massage it*_ it. When massaging fundus, provide support to lower segment To avoid inverting uterus.

Exposure to Heroin

Heroin crosses placenta Increase incidence of stillbirth, premature births, low birth weight, meconium aspiration, neurobehavioral problems, high pitched cry, seizures... No increase in congenital anomalies The baby will experience "withdrawal symptoms" If the mom stops using while pregnant, fetus will go through withdrawal Can lead to miscarriage or fetal death

Viral Infections

Herpes Virus Human Papilloma Virus (HPV) Hepatitis B Human Immunodeficiency Virus (HIV) Heb B & HIV are reportable communicable disease No curative treatments available treat only symptoms

Prognosis of Erb Duchenne Paralysis

If cause is edema or hemorrhage: Prognosis is good Recovery expected in @ 3 weeks If cause is tear of nerve: Prognosis is poor to fair Healing, if it does occur, will occur within 3-6 months If healing doesn't occur within 2 years, prognosis is poor Little of no function will return

Preterm Infant

Infant born before completion of 37th week of gestation Regardless of birth weight Organ systems are immature Responsible for 2/3 of all infant deaths Preterm babies have not had trouble adjusting in utero, they are just delivered early

Alcohol Related Neurodevelopmental Disorder (ARND)

Infants who are exposed to alcohol, but do not meet the criterion for ARBD Effects of ARND may include: Learning disabilities Behavioral problems Speech/ language problems Hyperactivity

Sexually Transmitted Infections (STI)

Infections primarily transmitted by sexual contact One of most common health problems in USA STI's --cause reproductive morbidity Complications--Preterm labor & low birth weight

Fourth Stage of Labor

Initial 1-2 hours after birth of placenta Body systems begin to stabilize Maternal organs undergo initial readjustments to non-pregnant state VS Q 15 min X1 hour, frequent physical assessment Tremors/ "shakes" ; Hungry & Thirsty GREATEST RISK FOR _*postpartum hemmorrage*

Late Onset Illness: strep b group

Instead of Respiratory distress, meningitis tends to be more common Symptoms start about 1 week to 3 months after birth 50% have long term neurological consequences

Treatment: Erb Duchenne Paralysis

Intermittent Immobilization With use of brace, splint, pinning infants sleeve to mattress Should immobilize infants arm for 2-3 hours, then release. Proper positioning ROM exercises Not to start until after 10 days so that you won't further aggravate brachial plexus nerve

Clinical Manifestation: Fractured Clavicle

Limited movement of arm on affected side Crepitus over bone Absence of Moro Reflex on affected side

Prevention: Apnea

Maintain body temperature Gentle handling-- to avoid fatigue Avoid vagal stimulation Observe after feedings Full stomach will put pressure on diaphragm

Clinical/Nursing Management: respiratory distress

Maintenance of _warmth __ Oxygen prn Via ET tube/ventilator, mask, incubator, NC, blow-by Warmed & humidified Carefully monitor O2 concentration & delivery Too much O2 can lead to retinopathy of prematurity (ROP) Administration of synthetic surfactant ABG's & O2 sats O2 sat 88- 93% & not >95%

Potential Complication: Heat Loss

Major problem for Preterm infant due to: Immature temperature regulating center in brain Minimal stores of glycogen in liver Minimal insulating subcutaneous fat Limited stores of brown fat No shiver response Due to absent reflex in capillaries

Exposure to Marijuana

Marijuana crosses placenta Has been associated with: Increase incidence of Meconium Staining Low birth weight Tremors More studies are needed

Diagnosis & Clinical Management

Maternal Antibodies are present after 32nd week of gestation If newborn is tested right away, positive antibody result could be mom's antibodies—not infants

Other signs/symptoms that might indicate sepsis

Maternal fever during labor Foul smelling amniotic fluid Prolonged ROM Prolonged labor

PP Medications

Medications are often given after delivery to facilitate uterine contractions Pitocin IV Methergine IM Do not give with hypertension Hemabate IM Prostaglandin F Contraindicated in patients with asthma

ECMO

Membrane Oxygenator serves as a artificial lung Allows infants lungs to mature and/or heal ECMO requires anticoagulation therapy so that blood does not clot in tubing

Congenital Anomalies: In General

Most common congenital anomalies: Cardiac, Musculoskeletal, Neurologic Incidence of congenital anomalies is greatest among LGA babies IUGR/LGA infants occur in Diabetic moms with what? Uncontrolled blood glucose levels

Infants of Diabetic Mothers (IDM):

Most complications caused by uncontrolled blood glucose levels Most congenital anomalies occur during first 8 weeks after conception Occur in 7 - 10% of all IDM

Continuous Positive Airway Pressure

Needed if incubator or cannula are not sufficient Preset level of pressure is applied Can be administered via nasal prongs, face mask or ET tube An orogastric tube should be inserted for decompression of the stomach

*The 5 P's for Sexual History*

Nurse needs to identify women at risk... Include questions about sexual history using 5 P's: Partners Prevention of Pregnancy Protection from STIs Practices Past History of STIs

Breast Feeding Mothers

Observe feeding technique with mother Assist as needed Encourage her to wear a well-fitting supportive bra continuously Keep breasts clean - no _*soaps*__! Educate!!

dysmenorrhea (menstrual cramps)

Occurs a day before onset of menses & disappears by end of menses Prostaglandins are primary cause of pain Increases uterine contractility & decreases uterine blood flow (ischemia) More common in women: who smoke (possibly due to vasoconstriction) are obese (unknown)

Potential Complications: Retinopathy of Prematurity (ROP)

Ocular disease that can lead to blindness Due to vasoconstriction of immature retinal blood vessels High oxygen concentrations cause vasoconstriction When oxygen is d/c'd, then dilation of vessels takes place Causes capillary hemorrhages, scarring & retinal detachment in some cases Process may take 5 months

LOCHIA

Odor is "fleshy", like menses If offensive odor → may indicate __*infection*__ Less amount after C/S May ↑ with activity or ambulation May pool in vagina if woman lies down, then "gush" RUBRA (red) day 3-4 SEROSA (pink) until day 10-14 ALBA (white) 2-6 weeks after birth When the lochia flow stops, cervix is considered closed Usually about 3- 6 weeks This is when risk of infection is considered to be decreased. Sexual intercourse...

A neonate was admitted to the pediatric unit with an unexpected congenital defect. What is the best way to involve the parents in the neonate's care?

Offer the parents opportunities to be involved with the neonate's care while they adjust to his unexpected condition.

Clinical Manifestations: gonorrhea

Often asymptomatic: Diagnose? Diagnosis cannot be based on symptoms Diagnosis requires a culture Menstrual irregularities Greenish-yellow *purulent* endocervical discharge Chronic or acute severe pelvic or lower abdominal pain Vaginitis

Musculoskeletal

Only permanent change from pregnancy may be an increase in _*shoe*_size!!!! Abdomen protrudes when standing up due to relaxation Diastasis recti abdominis: separation of muscles Striae

Oxytocin.

Oxytocin stimulates "let down" reflex Milk ejection Let Down Reflex Causes? Tingling sensation Increased uterine cramping Increased lochia Release of milk out of both breasts

Nutritional Complication:

PT NB have an accelerated metabolism rate Due to stress, repair & growth Need more calories/kg in diet Preterm: 115 - 140 calories per Kg Term: 100 - 110 calories per Kg Often unable to breast or bottle feed Gavage, gastrostomy or parenteral feedings

Anemia: Clinical Manifestations

Pale skin Increase in apneic periods Lethargy Tachycardia Poor weight gain Low H/H levels

Siblings & Extended Family

Parental education and preparation Key for sibling: "Parents should continue to show love, concern & include the sibling in care of the baby" Formal classes for siblings & grandparents

RhoGAM

Passive Immunization Provides passive antibodies, so that mom's body won't create it's own This will protect "future" pregnancies.

Potential Respiratory Complication: Apnea

Pause in respirations longer than 20 seconds with accompanying bradycardia Common in preterm babies due to: Fatigue Immature respiratory mechanisms

Potential Neurologic Complications: Intracranial _*hemorrhage*_

Periventricular-Intraventricular Hemorrhage (PV-IVH) Fragile capillaries rupture whenever there is a change in cerebral BP 15% of infants < 32 wks develop hemorrhages

Birth Trauma

Physical Injury sustained by neonate during L&D May be avoided if high risk infants were identified during pregnancy Macrosomia, Hydrocephalus, CPD, Abnormal Presentation

Petechiae

Pinpoint hemorrhages Possibly from tight NC Good assessment & monitoring are critical!! Petechiae Benign if: "No new" petechiae appear Petechiae disappear within 2 days Danger Sign if: New Petechiae keep "cropping up" They do not disappear in 2 days May be Thrombocytopenia

A newborn who is 20 hours old has a respiratory rate of 66 breaths/min, is grunting when exhaling, and has occasional nasal flaring. The newborn's temperature is 98° F (36.6° C); he is breathing room air and is pink with acrocyanosis. The mother had membranes that were ruptured 26 hours before birth. What nursing actions are most indicated?

Place a pulse oximeter, and contact the health care provider (HCP) for a prescription to draw blood cultures.

Neonatal Infections: Sepsis

Presence of microorganisms or toxins in blood Major cause of neonatal morbidity/ mortality Sepsis May be Acquired: In-utero During birth During resuscitation Nosocomial

Potential Nutritional Complication: Difficulties with Intake

Preterm Infants Have Difficulty due to: Lack of coordinated suck/ swallow reflex Until 32 - 34 weeks Inability to suck due to congenital anomaly Respiratory Distress requiring ventilator Lack of O2 reserves Tendency for Necrotizing Entercolitis

Surfactant Administration

Prior to 32 - 34 weeks of gestation, NB lack surfactant Lack of surfactant causes: Atelectasis, decreased lung compliance & decrease in gas exchange Administered via ET tube Usually requires several doses Use of exogenous surfactant has proven to: Decrease time on ventilator Decrease O2 needed Increase survival rate

POSTPARTUM DIURESIS

Profuse diaphoresis, usually @ night for first 2-3 days after birth Caused by↓ estrogen levels Improved venous circulation of lower extremities Increased __*urinary output*_ Birth trauma to urethra Effects of conductive anesthesia

ROP

ROP is Not reversible Prevention is key Preterm babies need frequent ophthalmologist visits Treatments that are tried: Laser photocoagulation Vitamin E therapy Decreasing ambient light

PV-IVH: Common Precipitating Events

Rapid birth Hypoxia IV infusions Ventilation Pneumothorax

Prevention of PV-IVH

Recognize events that may *precipitate*__ hemorrhage Maintain O2 levels Avoid rapid IV infusions Monitor BP closely Monitor for pneumothorax Position infant with HOB elevated slightly

Treatment: Bacterial Vaginosis

Recommended antibiotic: Metronidazole (Flagyl) Sexual partners do NOT need to be treated Patient Education Avoid douching Avoid hot tubs Change wet bathing suits soon Avoid tight clothing

Exposure to Alcohol

Referred to as "Alcohol Related Birth Defects (ARBD)" Previously referred to as FAS ARBD is based on three criterion: Prenatal /Postnatal growth retardation CNS malfunctions Some degree of IQ deficit, ADD, diminished fine motor skills, poor speech Craniofacial features Microcephaly, small eyes, short palpebral fissures, thin upper lip, flat midface

The charge nurse observes that a nurse caring for a very sick infant is making inappropriate remarks and acting bizarrely. What is the first action the charge nurse should take?

Remove this nurse from the client assignment.

Premi Potential Complications

Respiratory Distress, Apnea, ROP Hematologic Anemia Cardiovascular PDA Temperature Heat Loss/Temp Maintenance Neurologic PV-IVH Nutritional Feeding Difficulties Gastrointestinal/ Hepatic Necrotizing Entercolitis Hyperbilirubinemia

Clinical Manifestations: Sepsis

Respiratory: Apnea/ Tachypnea/ Grunting Nasal Flaring/ Retractions Decreased oxygen saturation Metabolic Acidosis Cardiovascular: Tachycardia Hypotension Decreased Perfusion Central Nervous System: Temperature instability Lethargy/ Hypotonia Irritability/ Seizures Gastrointestinal: Decreased suck strength Increased residual/ abdominal distention Integumentary: Jaundice Pallor/ Mottling Petechiae

pelvic inflammatory disease: risk factors

Risk Factors: STI's Partner with untreated urethritis Recent IUD insertion Douching Multiple sex partners

PP Immunizations

Rubella Vaccine Administered to mom's whose rubella titer is less than 1:10 Must not become pregnant for 3 months following the vaccine Tdap

Colostrum

Secreted during pregnancy & for 2-4 days after birth Yellow, creamy appearing fluid Thicker than mature milk Contains more protein, fat-soluble vitamins & minerals High levels of immunoglobulin

Treatment of Neonatal Abstinence Syndrome

See textbook for Care of NAS Infant Interventions: __*decrease*__ stimuli Provide adequate nutrition Weigh daily Promote positive maternal-infant bonding Correct hydration/ electrolyte imbalances Pharmacologic Treatment to include... Phenobarbital, Diazepam, Methadone, Morphine

Neonatal Infections

Sepsis Torch Bacterial

pp Blood Pressure

Should be same as in the THIRD trimester BP associated with hemorrhage or hypovolemia (late sign) BP pp onset of PIH or from excessive oxytocin Watch for _orthostatic hypotension_

Breasts:

Should be soft & non-tender after delivery Will usually "fill-up" in 3rd or 4th day postpartum May become "Engorged"

A term neonate's mother is O-negative, and cord studies indicate that the neonate is A-positive. Which finding indicates that the neonate developed hemolytic disease?

Signs of kernicterus

What would you do for the patient with hemorrhoids?

Sitz Baths, Adequate fluid intake Stool softeners, Rectal Suppositories Topical Anesthetic Tucks Pads Topical ointment Avoid prolonged sitting Lay on her side as much as possible

Kangaroo Care

Skin to Skin Holding Provides an "external heat" source Studies have proven that Kangaroo Care: Enhances temperature regulation Maintains oxygen levels better Leads to fewer episodes of crying & apnea Increases heart rate Encourages developmental tasks

Birth Trauma may include:

Skin/ Hemorrhagic Problems Petechiae Skeletal Injuries Fractured Clavicle Peripheral Nervous System Injuries Erb Duchenne Paralysis Facial Palsy

Clinical/Nursing Management: NEC

Supportive __*NPO*_______ Rest GI tract (give Parenteral Nutrition) OG tube for decompression Strict infection control Antibiotics Surgical resection may be necessary

Early Onset Illness: group b strep

Symptoms occur usually within 24 hours after birth Usually caused from maternal transmission during birth Results in severe respiratory distress

A male neonate born at 36 weeks' gestation is admitted to the neonatal intensive care nursery with a diagnosis of probable fetal alcohol syndrome (FAS). The mother visits the nursery soon after the neonate is admitted. Which instructions should the nurse expect to include when developing the teaching plan for the mother about FAS?

Symptoms of withdrawal include tremors, sleeplessness, and seizures.

PDA: Clinical Manifestations

Systolic murmur Bounding peripheral pulses Tachycardia Crackles/Pulmonary Edema Hepatomegaly Enlarged heart

PP Vital Signs

Temperature: 97.1˚ (36.2˚) - 100.4˚ (38˚) Pulse: 50 - 70 b/m Respirations: normal or 🡻 Blood pressure: normal or slight 🡻

Neonatal Abstinence Syndrome

Term used to describe a set of behaviors exhibited by newborn who was exposed to chemical substances in-utero May have been exposed to substances such as... Amphetamines, Barbiturates, Benzodiazepines, Cocaine, Opiates/Narcotics (including heroin and methadone) Will occur during the first 24 - 48 hours See textbook: Signs of Neonatal Abstinence Syndrome Symptoms include: Jitteriness & Hyperactivity Shrill & persistent cry Yawn or sneeze frequently Hyperactive tendon reflexes Poor feeding & sucking Abnormal sleep cycles

Methadone

Therapy for heroin addiction Synthetic Opiate Questionable regarding benefit in pregnancy: Methadone withdrawal resembles heroin withdrawal, but tends to be more severe & prolonged Incidence of seizures is higher with Methadone withdrawal

endometriosis

Tissue responds with changes in hormone levels Bleeds into surrounding structures Causes: Unknown but some theories Retrograde blood flow out of uterus and thru fallopian tubes Immature cells from embryonic development persist into adulthood, lying dormant until eventually developing into ectopic endometrial tissue Metastasis thru lymph and vascular systems Diagnosis of Endometriosis:

Neonatal Infections: HIV/ AIDS

Transmission can occur from: Prenatal Transmission, During Birth, Through Lactation Rate of transmission can be decreased from 12-40% to <1%: Treating HIV infected pregnant woman with AZT (Zidovudine) during pregnancy & intrapartum Treating infant for first 6 weeks of life with AZT Schedule an elective C/S

PP Uterus

Two main goals for uterus postpartum: Sealing of _*placental* site _*reduction*_in size Sealing of Placental Site: After delivery of Placenta, bleeding will occur by large uterine vessels at placental site Uterus will begin to contract immediately after delivery of placenta. These contractions are called "__*after*-pains" Contractions cause retraction of uterine muscle fibers This clamps down on blood vessels & controls bleeding Thrombi form over vessels First _*hour*_ postpartum is most dangerous for hemorrhage b/c _*thrombi*_ have not formed over placental site yet The part of endometrial lining that was NOT under placenta will slough off This endometrial tissue will be ready for implantation in _*3*_ weeks! Endometrial tissue under placental site will be ready for implantation in _*6*_ weeks

Physiologic Jaundice

Type of Jaundice that is due to liver immaturity Occurs in about 50 - 60% of all full-term newborns 80% of all pre-term infants Usually a benign condition, but can become dangerous!

Lochia Assessment

Type, amount & consistency of lochia is important to assess to determine: Early postpartal hemorrhage-within 24 hours of birth Late postpartal hemorrhage-> 24 hour, < 6 weeks PP Subinvolution of uterus Watch for persisting or re-occuring Lochia Rubra May need to weigh perineal pads: 1 gram = 1 ml of blood See Box 20-1 on pg. 475 Ways to distinguish between lochia & nonlochia discharge See Emergency Box, page 487 Hypovolemic Shock; signs/symptoms & interventions

BONDING

Unidirectional parent 🡺 infant Develops rapidly hours after birth Facilitated by physical contact "Falling in love"

Which assessment finding would lead a nurse to suspect dehydration in a preterm neonate?

Urine output below 1 ml/hour

Mechanical Ventilation

Used for severe hypoxemia or severe hypercapnia Ventilator settings are individualized to infants needs May be set to deliver a specific amount of O2 Or, to initiate ventilation if baby has periods of apnea

Expected Blood Loss

Vaginal delivery _300-400__ml Cesarean Delivery _600-800_ml

PDA: Clinical/Nursing Management

Ventilator Support Fluid restriction Diuretics Indomethacin Prostaglandin Inhibitor Causes PDA to constrict Surgical closure of PDA

A newborn admitted with pyloric stenosis is lethargic and has poor skin turgor. The health care provider (HCP) has prescribed IV fluids of dextrose water with sodium and potassium. The baby's admission potassium level is 3.4 mEq/L (3.4 mmol/L). What should the nurse do first?

Verify that the infant has urinated.

Blood Values:

WBC count: @ 20,000 - 25,000 postpartum Hemoglobin & Hematocrit: Difficult to interpret during first 48 hours due to shifting of blood volume Values should be approximate to pre-pregnancy values within 2 - 6 weeks

Musculoskeletal Anomalies

Weakness & deformity of lower extremities Malformation of hip joint

Weaning from Oxygen Therapy

Weaning will occur in a slow, step format For example: ECMO - Mechanical - CPAP - hood - nasal cannula Many preterm infants are d/c'd home on O2 via NC

Potential Cardiovascular Complication: Patent Ductus Artiosus

What causes the ductus arteriosus to close? May not be able to close due to inadequate pressure PDA increased blood volume to lungs pulmonary congestion, increased respiratory effort & carbon dioxide retention

Assessment of Lochia Discharge

What if there are clots? What if there is a foul odor? What if there is blood pooling under the patient' s buttocks?

PP Vaginal Changes

Will be bruised & edematous immediately after delivery May have small superficial lacerations Diameter will return to "almost" the prepregnant diameter within 6-8 weeks Kegel's exercise may help!

Weight Loss

Will lose about 12 pounds with delivery Additional five pounds due to rapid diuresis & diaphoresis first 5 days At six weeks she will not usually lose anymore Except with effort!

Diagnosis: PDA

X ray: Pulmonary Edema Enlarged Heart Hepatomegaly Echocardiography: View blood shunting across PDA

The nurse determines that a newborn is experiencing hypoglycemia based on which findings? Select all that apply.

a blood glucose reading of less than 30 mg/dL (1.7 mmol/L) or less at 1 hour irregular respirations, tremors, and hypothermia

What should the nurse assess in a newborn diagnosed with an anorectal malformation? Select all that apply.

abdominal distension vomiting meconium in the urine

A nurse caring for a preterm neonate knows that positioning can benefit high-risk neonates. Which position is appropriate for a preterm neonate?

adduction and flexion of the extremities with gently rounded shoulders

A preterm neonate is having frequent blood draws for laboratory specimens. What is most important for the nurse to document about the blood draws?

amount of blood drawn for each specimen

For an infant who's about to undergo a lumbar puncture, the nurse should place the infant in:

an arched, side-lying position, avoiding flexion of the neck onto the chest.

The nurse should assess a newborn with esophageal atresia and tracheoesophageal fistula (TEF) for which complications? Select all that apply.

copious frothy mucus episodes of cyanosis distended abdomen

The nurse provides a neonate with an initial feeding. The nurse would suspect a tracheoesophageal fistula if the neonate demonstrated which behavior?

coughing, choking, and cyanosis that occur after several swallows of formula

A mother with a history of gestational hypertension gives birth to a neonate at 26 weeks' gestation. After the neonate receives surfactant through an endotracheal tube in the delivery room, a nurse takes the neonate to the neonatal intensive care unit (NICU), places the neonate on an overbed warmer, and provides mechanical ventilation. When the mother arrives in the NICU for the first time, the nurse's priority should be to

enhance bonding by pointing out the neonate's features.

When performing an assessment on a one-day old newborn, which finding would be most suggestive of an imperforate anus?

failure to pass a meconium stool

A primigravid client has completed her first prenatal visit and blood work. Her laboratory test for the hepatitis B surface antigen (HBsAg) is positive. The nurse can advise the client that the plan of care for this newborn will include which interventions? Select all that apply.

hepatitis B immune globulin at birth series of three hepatitis B vaccinations per recommended schedule standard/routine precautions for mother and infant

While assessing a neonate weighing 3,175 g (7 lb) who was born at 39 weeks' gestation to a primiparous client who admits to opiate use during pregnancy, which finding would alert the nurse to possible opiate withdrawal?

high pitched cry

What conditions would the nurse expect to find in in a preterm neonate suffering from cold stress?

hyperactivity and twitching

The nurse is caring for a newborn of a primiparous woman with insulin-dependent diabetes. When the mother visits the neonate at 1 hour after birth, the nurse explains to the mother that the neonate is being closely monitored for symptoms of hypoglycemia because of which reason?

interrupted supply of maternal glucose and continued high neonatal insulin production

While assessing a 4-day-old neonate born at 28 weeks' gestation, the nurse cannot elicit the neonate's Moro reflex, which was present 1 hour after birth. The nurse notifies the health care provider (HCP) because this may indicate which complication?

intracranial hemorrhage

A viable neonate born to a 28-year-old multiparous client by cesarean birth because of placenta previa is diagnosed with respiratory distress syndrome (RDS). Which factor would the nurse explain as the factor placing the neonate at the greatest risk for this syndrome?

neonate born preterm

Major Causes of NEC:

ntestinal Ischemia From hypoxia at birth Bacterial or viral infection Due to immature immune response Immature gut Decreased amount of gastric acid & underdeveloped protective intestinal mucin layer

While caring for several preterm infants in the special care nursery, which action is most important for preventing nosocomial infections in these neonates?

performing thorough handwashing before giving infant care

A neonate born at 28 weeks' gestation has been receiving 80% to 100% oxygen via mechanical ventilation for the past 2 weeks. The neonate also has received multiple blood transfusions to treat anemia and has experienced several episodes of apnea. The nurse caring for the neonate should anticipate which iatrogenic complication?

retinopathy of prematurity

The nurse carefully documents the premature neonate's response to oxygen therapy, delivering only as much oxygen as is necessary to prevent the development of which complication?

retinopathy of prematurity

What would the nurse expect to find during the physical examination of a preterm male neonate born at 28 weeks' gestation?

thin wasted apperence

A client has admitted use of cocaine prior to beginning labor. After the infant is born, the nurse should anticipate the need to include which action in the infant's plan of care?

urine toxicology screening

Common Diagnostic Test: reproductive

vaginal culture

Increased Cardiac Output:

🡻 pressure on Inferior Vena Cava 🡹 vasoconstriction from 🡻 progesterone 🡻 vascular bed (start of ) water reversal Extravascular water enters CV system Reason why woman can withstand an EBL of _*1000-2000*__ml!

Treatment of Hyperbilirubinemia

Early feeding: Facilitates removal of bilirubin through stools Breastfed infants have increased incidence of jaundice Begins 2-4 days after birth Thought to result from decreased caloric & fluid intake before milk supply is well established Recommend breastfeeding within 1st few hours after birth then 10- 12 times per day

When developing the plan of care for an infant diagnosed with myelomeningocele and the parents who have just been informed of the infant's diagnosis, the nurse should include which action as the priority when the parents visit the infant for the first time?

Emphasize the infant's normal and positive features.

Endometeriosis Treatment

Goserelin (Zoladex) Gonadotropin-releasing hormone agonist Suppresses pituitary gonadotropin secretion FSH & LH stimulation declines Women may experience _*menopause*_ symptoms Zoledex initially causes increase of FSH & LH (Lupron is another GnRH) Endometrial Ablation: Procedure that destroys (ablates) the endometrium Ablation can be done by multiple ways, such as... Radiofrequency A balloon filled with saline solution that has been heated to 185'F Normal saline (heated free fluid) Electricity, using a resectoscope with a loop or rolling ball electrode Freezing

Viral STI's - Hepatitis

Hepatitis A virus (HAV) Acquired primarily through fecal-oral route Influenza-like symptoms Vaccination is most effective means of preventing HAV transmission Hepatitis B virus **Most threatening to fetus & neonate Transmitted parenterally, perinatally, orally (rarely), & through intimate contact vaccination series Hepatitis C virus Most common blood-borne infection in USA Responsible for 50% of cases of hepatitis 2.7 million people are now chronically infected New curative drug approved in 2017--Mavyret Risk factor for pregnant women is history of injecting intravenous drugs

Viral STI's - HIV

Human immunodeficiency virus (HIV) Heterosexual transmission now most common means of transmission in women Estimated that 26% of new infections occur in women Transmission of HIV occurs primarily through exchange of body fluids Seroconversion in 6 to 12 weeks Severe depression of cellular immune system associated with HIV infection characterizes AIDS

*Herpes & Pregnancy*

If initial infection happens near time of delivery, there is high risk of transmitting virus to neonate Because it is systemic If tingling is felt, or lesions are present near time of delivery, a *C/S will be performed* If they have a history of herpes: May deliver vaginally if no tingling/ lesions Do not forget Standard Precautions

syphilis Tertiary Stage

If left undiagnosed & untreated, will result in tertiary (latent) syphilis Asymptomatic 1/3 of patients will develop multiple organ complications *Cardiovascular, neurological, musculoskeletal*

*Reproductive Infections*

Include > 25 infectious organisms transmitted sexually Causes--personal & financial burdens Prevention Education? Identify risk factors Change risky behaviors Reduce # of partners Use condoms

Criteria for Physiologic Jaundice

Jaundice appears after 24 hours Disappears by end of 7th day Level should not exceed 12 mg/100ml If the above criteria does not fit, the jaundice may be due to a more serious "pathologic" problem

Pathologic Jaundice

Jaundice that does not meet expectations of normal "physiologic jaundice" Physiologic Jaundice... Appears after 24 hours & disappears within 7 days Bilirubin level does NOT exceed 12mg/dl in term infants or 15md/dl in preterm infant If pathologic jaundice is left untreated, can result in... Sensorineural hearing loss Mild cognitive delays Kernicterus

Preterm Infant: Appearance

Little subcutaneous fat Head disproportionately large compared with chest Skin is ruddy looking Minimal vernix Lanugo is abundant Few or no sole creases Ear cartilage is immature Reflexes may be absent sucking & swallowing Cry is weak & high pitched

Herpetic Infection

Localized symptoms Painful lesions that progress from macules to papules to vesicles... Typically last 4-15 days before crusting *Systemic* Symptoms: Typically appear 3-4 days after lesions Fever, malaise, headache & photophobia *Suppressive therapy* Famvir, Valtrex, Zovirax (Acyclovir)

Syphilis

Organism Treponema pallidum Pathophysiology Enters body thru small breaks in skin or mucous membranes Kissing, biting, oral-genital sex.... *Can be spread to a fetus via transplacental transmission during pregnancy*

Management of PID

Prevention is most important factor Education regarding STI prevention & management Broad spectrum antibiotic Bed rest in semi-fowlers position during acute stage Comfort measures Abstain from intercourse until treatment finished

Which finding provides the most evidence that a fetus might have a gastrointestinal tract anomaly?

increased amount of amniotic fluid

A nurse is assessing a neonate born 1 day ago to a client who smoked one pack of cigarettes daily during pregnancy. Which finding is most common in neonates whose mothers smoked during pregnancy?

small for gestational age

Nursing Care: Phototherapy

yes must be protected by an opaque mask Eyes should be closed under mask Mask should not occlude nares Infants' temp should be closely monitored Feedings should be adequate to prevent dehydration Amount of urine output & number of stools should be monitored Baby may go home with phototherapy

Ammorrhea

Needs thorough physical examination May be caused from: Pregnancy (most common cause of secondary) Congenital anomalies Hormone imbalances Hypothyroidism/Hyperthyroidism... Eating disorders Excessive exercise Emotional stress Medications

Gonorrhea

Neisseria gonorrhoea (Gram negative organism) Primarily spread by genital to genital contact Also be spread by oral-genital & anal-genital May be transmitted to newborn during birth

Vaginal Infection--Bacterial Vaginosis

Not always sexually transmitted Most common type of vaginitis **Associated with preterm labor & birth* Symptoms: Thin grayish-white discharge Woman complains of a *fishy odor*

Pelvic Inflammatory Disease

Can lead to serious consequences including: Infertility Ectopic pregnancy Abscess formation Chronic pelvic pain Large # of ectopic pregnancies occurring every year are due to PID Diagnosis Difficult to diagnose Laparoscopy would confirm diagnosis

Preterm Complication: Respiratory Distress

Causes: _Lower_____ # of functional alveoli Deficient Surfactant Levels Smaller lumen in respiratory tracts Weak or absent gag reflex Immature capillaries in lungs

Twenty-four hours after cesarean birth, a neonate at 30 weeks' gestation is diagnosed with respiratory distress syndrome (RDS). When explaining to the parents about the cause of this syndrome, the nurse should include a discussion about an alteration in the body's secretion of which substance?

surfactant

The nurse is making clinical rounds on a group of clients in a newborn nursery. Which infant is at greatest risk of developing respiratory distress syndrome (RDS)?

a neonate born at 36 weeks' gestation

Immediately after the first oral feeding after corrective surgery for pyloric stenosis, a 4-week-old infant is fussy and restless. What action would be most appropriate at this time?

Give the infant a pacifier to suck on.

Herpes Simplex Virus

*One of most common STI's* 50 million persons in USA HSV has 2 subtypes HSV1 Transmitted non-sexually Fever blisters HSV2 Usually transmitted sexually Usually vaginal

A newborn weighing 6.5 lb (2,950 g) is to be given naloxone due to respiratory depression as a result of a narcotic given to the mother shortly before birth. The drug is to be given 0.01 mg/kg into the umbilical vein. The vial is marked 0.4 mg/mL. How many milligrams would the newborn receive? Record your answer using two decimal places.

0.03

While caring for a neonate of a woman with diabetes soon after birth, the nurse has fed the newborn formula to prevent hypoglycemia. The nurse checks the neonate's blood glucose level, and it is 60 mg/dL (3.3 mmol/L), but the neonate continues to exhibit jitteriness and tremors. What should the nurse do first?

Request a prescription for a blood calcium level.

The mother of a newborn is concerned about the number of persons with heart disease in her family. She asks the nurse when she should start her baby on a low-fat, low-cholesterol diet to lower the risk of heart disease. At what age does the nurse should tell the client to start modifying her child's diet?

2 years of age

Vaginal Infections--Yeast/Candidiasis Infection

2nd most common type of vaginal infection Not an STI Can be transmitted to a partner thru sexual activity only if partner has a favorable environment for growth Such as in Diabetic patients

Kernicterus

Also called Bilirubin encephalopathy Caused by deposits of bilirubin in brain Indirect bilirubin is highly fat soluble Will pass blood brain barrier May cause necrosis of brain neurons Exact level of serum bilirubin required to cause damage is not known Some texts will say that levels above 20 -25 mg/dl places full term infant at risk Preterm babies will develop problems with much lower levels (12mg/dl)

*Common Treatments for ALL Bacterial Infections*

Antibiotics *Both partners* must be *treated* even if asymptomatic (except bacterial vaginosis) Abstinence during treatment

Hyperbilirubinemia

Bilirubin level in blood is increased Characterized by jaundice of the skin, sclera.. May be categorized as: "physiological" "pathological"

Which measure would be most effective in helping the infant with a cleft lip and palate to retain oral feedings?

Burp the infant at frequent intervals.

syphilis Primary Stage

Characterized by primary lesion Primary lesion is called a Chancre Painless, indurated lesion of penis, vulva, lips, mouth, vagina, and/or rectum Appears 5 - 90 days after initial infection Lasts 3-6 weeks Heals spontaneously

Vaginal infection—Group Beta Streptococci (GBS)

Considered normal flora in non-pregnant woman A concern in pregnancy Increased risk for preterm labor & transmission to newborn Screening in pregnancy Treat MOM with antibiotics during labor to prevent transmission to newborn during vaginal delivery

The nurse plans the discharge of a newborn diagnosed with torticollis (wry neck). Which action should the nurse take?

Coordinate outpatient physical therapy.

HPV Treatment

Difficult to treat Topical Treatment: Trichloracetic Acid (TCA) Cryotherapy Electrocautery Laser Therapy *Vaccine—Gardasil* Approved by FDA for males & females ages 9-26 *Ideally, vaccination should occur before youth become sexually active*

Pharmacological Treatment of PMS/PMDD

Diuretics Progesterone replacement SSRI's Prostaglandin inhibitors Low dose BCP's If not planning a pregnancy

Phototherapy

May use... Bili-lights Phototherapy blanket Bili-bed All types use systems use light therapy that will breaks down bilirubin in skin into substances that can be excreted in feces & urine

Respiratory Distress: Clinical Manifestations

Wheezing Effort Tachypnea Flaring (nasal) Retractions Oxygenation Grunting __hypothermia/hypoglycemia____________ Respiratory Distress