Exam 4

Acrocyanosis vs cyanosis

- Acrocyanosis: feet and hands - Cyanosis: heart problem

Asymmetric vs symmetrical

- Asymmetric: Extrinsic - Symmetrical: Congenital

What are some Issues babies with diabetics mothers can have ?

- Big - Hypoglycemia (relying on moms sugar so can't regulate own sugar so it drops) - Hypocalcemia (may have seizures) - Cardiac issues

Placenta Abruption

- Detaches from wall - Cramping

What maternal factors put newborn at risk?

- Diabetes - drugs/alcohol - STDS - Hypertension - Maternal infant separation

How can a nurse assist a family with a newborn who has significant problems?

- Educate them (expect/do) - Attitude of NICU nurse so responsible in helping them be parents

What are some characteristics of FAS?

- Flat nose - Lower ears - Farther apart eyes

When the above patient/client does get up with help to the bathroom, she has a sudden gush of lochia. Her fundus is firm and midline. How would you explain this occurrence?

- Lochia is a type of discharge that can almost represent a period. It can come out in gushes during the first 6-12 hours postpartum. It will even contain blood clots. This is a normal occurance and will subside with rest. Getting up will cause some gushes of blood to fall. - If larger than orange that is a concern

What are some characteristics of IUGR?

- Long - Skinny

A patient is admitted to the L & D floor with spontaneous rupture of membranes 25 hours earlier. The fluid is clear and the fetal heart rate is 124 with moderate variability. Which assessment is the most important for the nurse to make at this time and why?

- Maternal temperature. -This is because when a membrane ruptures it gives pathogens the ability to enter the uterine cavity and cause infection since the uterine cavity is no longer sterile. The maternal temperature will help us monitor for any increases which can point towards infection.

What is PDA?

- Patent ductus arteriosus - hole between right/left ventricle and when born that hole closes. - If that doesn't happen causes cyanosis

What are stork Bites?

- Rash looking - Often temporary

Which of the following situations should the nurse conclude is a vaginal delivery emergency and why?

- Shoulder dystocia. - Shoulder Dystocia is considered an emergency because the baby's anterior shoulder is caught on the mother's pubic bone. This can cause neonatal brachial plexus, hypoxia, injury, and maternal trauma (bladder, anal sphincter, rectum and hemorrhage\.

What are vascular birthmarks?

- caused by abnormal growth or formation of blood vessels and vessel cells - There are two main types of vascular birthmarks: hemangiomas (strawberry birthmarks) or vascular malformations. - Haemangiomas are caused by overgrowth of the cells providing the lining for vessels in the affected area. - Vascular malformations are caused when vessels are formed with an abnormal or weak wall structure.

What should you assess for the next 4 hours after epidural?

- heart rate - respiratory rate - pain score - Blood pressure -temperature

What are Angel kisses?

- pink to red marks that may appear anywhere on the body - Usually temporary

What are Capillary Birthmarks?

- sometimes called a "port-wine stain" - enlarge and darken as a child grows older

What is a Pudendal block?

- used when epidural is not working or didn't have one - numbs perineum (helps with episiotomy) - done right before mother starts crowning

What is Pneumothorax?

A collapsed lung

What is a clubbed foot?

Babies foot is twisted out of position. This include bones. ligaments, joints, skin, muscle, nerves etc.

Discuss the differences in anesthesia and analgesia used in obstetrics, labor and delivery.

Analgesia is the epidural side of labor and delivery. This help reduce the pain felt without loss of consciousness and without loss of function. Aesthesia is the reduction of pain and loss of function. Level of consciousness is typically intact during this.

What is the Difference between 22 & 35 week baby?

At 22 weeks: - your baby's eyelids are still fused shut, but the eyes themselves are starting to move. -Tear ducts are also forming and your baby now has eyebrows -little tufts of fine white hair. - Babies lungs havent started producing surfactant At 35: - Lungs are still not fully developed

What is DIC?

Disseminated Intravascular Coagulation

What is Meconium aspiration?

Feces are inhaled when 42+ weeks gestation causing lungs to stick together

What is FAS?

Fetal Alcohol syndrome

What is FAE?

Fetal alcohol effected

What is IUGR?

Intrauterine growth restriction

How do you test for Hyperbilirubinemia/jaundice

Lab tests and push down on nose

What is LGA?

Large Gestational Age -

Can a baby be circumcised if they have Hypospadias?

No because the foreskin is used to repair this.

What is another cause of respiratory problems in 42+ gestational fetuses besides meconium aspiration?

Placenta is starting to break down and those materials are inhaled

What does REEDA stand for and what is it?

Redness Edema Ecchymosis of perineum Discharge from episiotomy Approx- imitation of skin at edges 5 components to the healing process

What is a side effect of hypoxia (low o2) in babies

Seizures

What is SGA?

Small Gestational Age - Baby is smaller than expected at it's gestational age

What are babies given before birth if premature and why?

Steroids and it helps mature the lungs so they don't stick

For a cleft lip how does the nurse assess for a cleft palate?

Takes a gloved finger and feels the roof of mouth

Why do babies get Hyperbilirubinemia/jaundice?

They produce red blood cells way faster than older people but those blood cells also don't last as long so liver can't keep up

How do nurses asses for Developmental dysplasia of hip?

They push out hips and look to see if they hear a click

When is Hyperbilirubinemia/jaundice directly after birth?

This is a pathological issue and is caused by blood incompatibility

Why do we use Magnesium Sulfate?

To prevent seizures

What is Hypospadias?

Urethra is located on the side of the penis

What is Transient ticipnia?

When a newborn stops breathing randomly - babies are sent home with apnea blankets

How does a nurse assess an umbilical hernia?

When baby cries it's belly sticks out and you can physically see the hernia

When does Hyperbilirubinemia/jaundice show up on the skin?

When levels reach 6

What are two things shoulder dystocia can cause?

brachial plexus palsy (nerve damage) and fractured clavicles

What makes babies more at risk with Hyperbilirubinemia/jaundice

cephalohematoma (bruise on skull)

What is HELLP syndrome?

hemolysis, elevated liver enzymes, low platelets

The lumbar epidural is used to cause sensation to be lost in the following areas

relieve neck, arm, back, abdomen, and leg pain caused by inflamed spinal nerves due to spinal stenosis or disc herniation.

What is placenta previa?

- The placenta partially or completely covered - Painless bleeding

when is the viability point?

20 weeks

What is Necrotizing enterocolitis?

Affects intestines of premature baby. Infection occurs killing the walls

What is shoulder dystocia?

Head is born, but anterior shoulder cannot pass under pubic arch

What is Erythroblastosis fetalis?

Hemolytic anemia in the fetus caused by transplacental transmission of maternal antibodies to fetal RBCs.

What is the most dangerous thing to occur postpartum?

Hemorrhage