NUR 141 - Exam 1

latent phase labor stage 1

- slow early phase - lasts appx 9hrs primi moms or 6hrs multi moms - cervix 0-4cm dilated with mild contractions q 5-15min, 10-30 sec long

tocolysis

procedure using meds to delay the delivery of a fetus from women in preterm labor

ataxia (ataxia telangiectosa)

progressive degenerative disease that ultimately involves most body systems

protuberant

protruding, bulging

tonic neck reflex

- birth to 6mos - lay baby supine & turn head over to the side - baby should assume a fencing position

postpartum bleeding

- bleeding from the uterus after birth - causes: distended bladder placental abruption, placenta previa, preeclampsia, prolonged labor

moro reflex

- birth to 6mos - startle reflex - hold baby in semi-siting position & let the head drop back - baby will extend arms, flex legs, against trunk, & make c-shape with finger/thumb

puerperal phases

- 3 maternal phases - taking in, taking hold, letting go

small for gestational age (SGA)

- NB weighing below 2500g (5lb 8oz) at term - weight below 10th percentile

large for gestational age (LGA)

- NB weighting above 4000g (8lb 13oz) at term - weight above 90th percentile

Rh isoimmunization I: obs mom for 20mins after drug admin for adverse reactions

- RhoGAM or Rhophylac - given to Rh neg women at 28 wks & after birth of a Rh pos baby - prevents the production of anti-Rh (D) antibodies & from mom becoming sensitized

imperforate anus I: perineal anoplasty, may need colostomy if baby too small for surgery yet, high-fiber diet

- absence of abn location of the anus - requires surgical repair - requires high-fiber diet & checkups throughout childhood A: no anal opening, anal opening in the wrong place, no stool in 1st 24-48hrs after birth, stool passing from wrong place, swollen ABD D: x-rays, spinal ultrasound, ECG, MRI

gestational age

- age of the fetus btwn conception & birth - assessed using physical & neuromuscular maturity markers - based on mom's menstrual hx, ultrasound, & NB maturational exam

decerebrate posture

- arms & legs are straight out with toes pointed downward & head/neck are arched backward - indicates severe brain damage

fetal tachycardia (non-reassuring FHR pattern)

- baseline HR > 160bpm for 10+ mins - HR 200-220 causes fetal demise

Babinski reflex (sign)

- birth to 12mos - stroke lateral surface of foot in upward motion - baby hyperextends & fans toes

grasping reflex

- birth to 4mos - place a finger in the palm of baby's hand - baby grasps finger tightly

stepping reflex

- birth to 4wks - hold baby upright with feet touching flat surface - baby steps up & down in place

rooting reflex

- birth to 6mos - brush the side of baby's cheek near the corner of the mouth - baby will turn head towards stimulus & open mouth

Hirschsprung's disease I: enema, IV therapy, warm saline irrigation of rectum

- blockage of intestine r/t lack of nerves in the bottom segment of the colon - congenital A: no meconium in 1st 24hrs, constipation, RIBBON-LIKE STOOLS, watery stool, ABD distension, vomiting D: empty rectum, ABD x-ray, barium enema, rectal biopsy

Coomb's test I: phototherapy (jaundice), folic acid to increase RBCs (anemia)

- blood test to diagnose hemolytic anemias & antibodies - if pos, baby may develop jaundice or anemia

transition phase labor stage 1

- cervix 8-10cm dilated with intense contractions, q 1-2min, 40-60 sex long - complete effacement & intense contractions A: N/V, back pain, trembling, diaphoresis

bonding

- close emotional attachment to baby by the parents - develops in the 1st 30-60 mins PP

group B strep (GBS) I: IV abx when in labor

- common bacteria found in the vagina - harmless to adults, but can cause morbidity/mortality in babies

ductus arteriosus

- connects pulm artery with the descending aorta - usually closes 15hrs post-birth

ductus venosus

- connects umb vein to inferior vena cava - closes by 3 days post-birth & becomes a ligament

signs of impending labor

- contractions increasing in frequency, time, & duration - vaginal pressure from fundus downward - unable to relieve discomfort with activity - exam presents cervical dilation & effacement - lightening (descent into pelvis) - Braxton-Hicks - nesting - low backache, sacroiliac discomfort, bloody show

lochia rubra

- dark or bright red color - 1-3 days PP - mod to heavy flow with small clots

labor stage 3 I: uterotonic meds, assess mom's VS q15 min, encourage relaxation btwn UCs, give immediate NB contact, explain any upcoming procedures, give pain meds, stay with mom & fam, document

- delivery of placenta - cramping, mild contractions

breastfeeding

- encourage frequently (q 2-3 hrs)

hyperbilirubinemia

- excessive bilirubin - total serum > 5 mg/dL

postpartum hemorrhage (PPH) primary causes: uterine atony, lacerations, hematoma secondary causes: hematoma, subinvolution, retained placental tissue

- excessive bleeding after childbirth - risk factors: placenta previa or placenta accreta, mult gestation, hx. c/s or uterine surgery, forceps or vacuum vag delivery, precipitous labor or birth - primary: 1st 24 hours after birth - secondary: 24hrs to 12wks after birth

cold stress I: dry NB immediately, remove wet blankets, skin to skin contact with blanket, prewarmed objects, keep away from vents & windows

- excessive heat loss that leads to hypothermia - results in compensatory mechanisms to maintain NBs temp - complications: hypoglycemia, metabolic acidosis, decreased surfactant production, resp distress, hypoxemia, increased indirect bilirubin, delayed transition from fetal to NB circulation A: axillary temp < 97.7 F, cool skin, lethargy, pallor, tachypnea, grunting, hypoglycemia, hypotonia, jitteriness, weak sucking

tachysystole

- excessive uterine atony - over 5 UCs in 10mins over a 30min window, lasting 2+ mins

uteroplacental insufficency

- failure of the placenta to deliver sufficient nutrients to the fetus during pregnancy - often results in insufficient blood flow to the placenta

malpresentation

- fetus is in the wrong position - any position other than the head against the cervix

spina bifida I: surgical closure of sac, place baby in prone position with hips flexed & legs abducted, apply sterile/moist dressing over sac, avoid pressure

- general term for neural tube defects affecting the spinal region - vertebrae fails to infuse, may be caused by inadequate folic acid intake - risk factors: inadequate folic acid intake (mom), malnutrition, drug use during pregnancy - complications: pressure injuries, increased ICP, bladder issues A: protruding sac from the spine, lumbosacral dimpling

cerebral palsy I: provide safety, assess for aspiration, coordinate with speech therapy/PT/OT, skeletal muscle relaxants

- group of conditions that affect motor development - can cause vision, hearing, speech, & cognitive impairments - requires continual lifelong adjustments A: persistent moro/tonic neck reflex, choking when feeding, poor head control, rigid/abnormal posture, seizures D: not meeting milestones, hypertonia, CNA trauma

GERD I: I&O, daily wt, mom's feeding style (breastfeeding), r/o overactive letdown with excessive milk, admin meds as ordered, H2 histamines

- immaturity of the lower esophageal sphincter with retrograde flow of gastric contents into the esophagus - surgical fix with nissen fundopilication A: recurrent vomiting, irritability, heartburn, chronic cough, mid-sternal discomfort, sleep interruption, sore throat, eating unpleasant & painful, apnea, slow/no wt gain

celiac disease I: may require IV fluids Diet: - avoid oats, wheat, barley, rye, & malt - OK to eat dairy, rice, corn, potatoes, eggs, fruits & veggies

- inability to digest gluten, causing damage to the cells in the bowel - immune-mediated systemic disease A: distended ABD, D/V, wt loss, foul-smelling stools, bloating, flatulence, B12 deficiency D: CBC, IgA, stool sample, endoscopy with tissue biopsy

subinvolution

- incomplete involution of the uterus after birth - causes excess blood loss - complications: hemorrhage, pelvic peritonitis, salpingitis, abscess formation

decorticate posture

- indicates severe brain damage - legs are straight out, fists clenched, & arms bend to hold hands on chest

uterine atony (boggy uterus) I: massage fundus (2 hands), oxytocin, oxygen 10L/min, turn on L side

- indicates the uterus isn't contracting - places mom at risk for PPH (by going soft) - risk factors: multiparous

mastitis I: apply moist heat to breast before feeding

- infection of the breast - typically occurs 3-4 wks PP A: fever, chills, malaise, flu-like symptoms, unilateral breast pain, redness/tenderness in infected area

anastomosis

cross-connection btwn adjacent channels, tubes, fibers, or other parts of a network

meningitis I: droplet precautions, NPO for decreased LOC, provide dark & quiet environment

- inflammation of the meninges & CSF - can be viral or bacterial, but viral is most common A: photophobia, headache, N/V, irritability, high-pitched cry, poor feeding, fever, bulging fontanels (late sign), seizures, positive Brudzinski's & Kernig's signs, petechiae D: elevated WBCs, lumbar puncture

intussusception I: begin IV therapy, barium enema

- intestine slides into itself, "telescoping" - cuts off blood supply to adjacent intestine A: severe interval ABD pain, sausage-shaped ABD mass, CURRANT JELLY STOOLS, fever, vomiting, lethargy, wt loss D: ultrasound, CBC, barium enema

hydrocephalus communicating: no blockage in ventricular system non-communicating: blockage in ventricular system I: reposition frequently for comfort

- involves the buildup of too much CSF, leading to enlargement of the ventricles - congenital or acquired - requires draining excess CSF with a shunt to the ABD cavity A: rapid increase in head size, bulging fontanels (baby), lethargy, irritability, high-pitched cry, seizures, double vision, bradycardia

labor stage 2 I: more freq maternal/fetal asmt, review prenatal record, assess FHR & UC, ongoing asmt, communication with interdisciplinary team, prep paperwork for delivery

- labor stage - from 10cm dilated to delivery of baby - contractions mild, q 1-2min, 50-90 sec

active phase labor stage 1

- lasts 5hrs primi moms or 2-3hrs multi moms - 4-8cm dilated with mod contractions, q 3-5min, 30-45 sec long

newborn thermoregulation

- little thermal insulation - blood vessels closer to the skin - small layers of SC fat - decrease BAT in premies, large body surface area, evaporation, conduction, convection, radiation

melasma

- mask of pregnancy - brownish pigmentation that appears over the cheeks, nose, & forehead

postpartum depression (PPD)

- mood disorder characterized by severe depression that occurs within 1st 6-12 mos PP - risk factors: social support, low self-esteem, life stress, fatigue, prenatal depression, prenatal anxiety, poor marital relations, hx. depression, difficult infant A: depressed mood, loss of interest/pleasure, sig wt loss/gain, insomnia/hypersomnia, changes in psychomotor activity, low energy or fatigue

living (GTPAL)

- number of living children - each child counted individually

term births (GTPAL)

- number of pregnancies delivered at or over 37 weeks gestation - includes alive & stillborn babies

pre-term births (GTPAL)

- number of pregnancies delivered btwn 20 - 36 6/7 wks gestation

steatorrhea

- oily, smelly stools - excretion of fat when the intestines can't absorb it

gastroenteritis I: IV therapy, abx, NPO 2-3hrs, start with clear liquid diet, may continue to breastfeed

- onset diarrhea without chronic diseases - with/without ABD pain, fever, N/V - risks: metabolic acidosis, hypovolemic shock A: D/V, ABD cramps, fever, chills, stools with blood/pus, dehydration D: CBC & electrolytes (dehydration)

labor stage 1 I: diet, hydration, activity & rest, elimination, comfort, support & family involvement, education, safety, document, assess pain, I&O, pain mgmt

- onset of labor to complete cervical dilation - progression of cervical changes

foramen ovale

- opening btwn the L & R atrium - closes when L arterial pressure is higher than R arterial pressure

gastroschisis I: decide delivery type (most c/s), support fluid needs, surgical closure of defect, parenteral nutrition, IV abx, support non-nutritive sucking, may have TPN for several mos

- opening on the R side of the umb cord that affects the stomach, intestines, & liver - intestine at risk for vascular compromise (matted with exudate) - normally developed ABD musculature D: increased AFP, prenatal ultrasounds, amniocentesis

Puerperium period

- period after childbirth where the body undergoes changes to return to its pre-pregnant state - first 6 wks after childbirth

lochia serosa

- pinkish, brown - 4-10 days PP - less blood, more discharge, no clots

labor stage 4 I: uterotonic meds, monitor bladder, BUBBLEHE, ice to perineum, provide opportunity for support person to interact with NB

- postpartum stage of delivery - cramping

neuromuscular maturity

- posture - square window (wrist) - arm recoil - popliteal angle - scarf sign - heel to ear

5 P's factors affecting labor

- powers (contractions) - passage (pelvis & vagina) - passenger (fetus) - psyche (response) - position (maternal posture, physical positions)

taking hold

- puerperal phase - can last several weeks - mom beginning to be independent, eager to learn, may show s/s baby blues & fatigue, starts to like the role of mother, may feel inadequate & overwhelmed

taking in

- puerperal phase - first 24-48 hrs - focused on own needs, relives birth experience, dependent on others for own needs & NBs needs, decreased ability to make decisions

letting go

- puerperal phase - fluid & interchangeable with the taking-hold place - incorporating baby into her life, full independence

dehydration

- reduction in water content - 3 types based on osmolality & serum Na content Mild: cap refill > 2sec, slight thirst, 3-5% wt loss Mod: cap refill 2-4sec, 6-9% wt loss, irritability, slight increase in HR, slight tachypnea, dry mucous membranes, decreased skin turgor Severe: cap refill > 4sec, >10% wt loss, tachycardia, tachypnea, orthostatic hypotension, extreme thirst, no tears, sunken eyeballs, sunken anterior fontanel (babies), tented skin, oliguria/anuria

APGAR scale

- scale assigning 0-2 points per category - assesses NB appearance, pulse, grimace, activity, & respirations - done at 1min & 5min

lactation

- secretion of milk by the breasts - results of progesterone, estrogen, prolactin & oxytocin - suppresses menses - typically starts 3 days PP

physical maturity

- skin - lanugo - plantar surface - breast - eye/ear - genitals

omphalacele

- stomach & intestines are contained within a sac of amino, peritoneum, & Wharton's jelly outside the ABD - malrotation present, defect varies from 4-12cm, sac may rupture in utero - liver, spleen, gonads, & bladder may be contained in the sac - commonly associated with cardiac defects, neural tube defects, exstrophy of the bladder, & Beckman Wiedemann syndrome)

Nissen fundoplication I: I&O, NGT suction, gradually increase feedings, pain meds PRN

- surgical technique used to suture the fundus of the stomach around the distal esophagus - used for GERD

hypoglycemia

- suseptible (premie, SGA, LGA) - BG < 40 mg/dL (NB) - risk factors: mom with DM, NB > 4000g (LGA), post-term & premie NBs, SGA, hypothermia, infection, resp distress, NB resuscitation, birth trauma A: temp instability, hypotonia, jitteriness, & seizures

EFM (electronic fetal monitoring)

- technique used for fetal asmt based on the fact that FHR reflects fetal oxygenation - goal is to interpret & continually assess fetal oxygenation

postpartum blues "baby blues"

- transient emotional disturbance - causes: hormonal changes, stress, fatigue - symptoms disappear without meds - able to care for self & baby - typically starts 2-4 days after birth & resolves by day 8 A: anxiety, irritability, insomnia, crying, loss of appetite, sadness, anger, mood swings

spina bifida occulta

- type of spina bifida - characterized by dark hair growth over the area

meningocele

- type of spina bifida - fluid filled sac protrudes & membrane surrounding spinal cord enlarged

myelomeningocele AKA. spina bifida cystica

- type of spina bifida - tissue floats to surface of fluid-filled sac - section of spinal cord & nerves are exposed & visible on the outside of the body - most common type of spina bifida

seizures I: antiseizure drugs

- uncontrolled electrical discharge of neurons in brain - safety is number one! - risk factors: fever, cerebral edema, infection, toxin exposure, brain tumor, hypoxia, lead poisoning, electrolyte imbalance, hypoglycemia, hemorrhage D: EEG

postpartum psychosis (PPP)

- variant type of bipolar disorder - medical emergency - risk factors: hormonal shifts, OB complications, sleep deprivation, increased environmental stress continues to the onset of symptoms A: frank psychosis, cognitive impairment, grossly disorganized behavior, hallucinations, sleep disturbances, fatigue, hypersomnia

lochia alba

- yellow to white discharge - 10+ days PP - very little blood (if any) - some discharge, no clots

d) all of the above

Analgesics used during labor include: a) morphine sulfate b) butorphanol c) sublimaze d) all of the above

attachment

dev of a strong affection btwn baby & significant other (mom, dad, sibling, etc.)

Carboprost / Hemabate

Class: abortifacients, oxytocics, prostaglandins Uses: uterine atony, control unresponsive PPH, termination O: reproductive C: acute PID, pulm disease, renal/hepatic disease, asthma S: N/V/D, dizziness K: monitor s/s anaphylaxis *complete abortion, control PPH

diazepam / Valium

Class: antianxiety agents, anticonvulsants, sedatives/hypnotics, skeletal muscle relaxants, benzos Uses: anxiety, pre-op sedation, seizures, skeletal muscle relaxant, etoh withdrawal O: neuro C: resp distress (br/min < 10) S: dizziness, drowsiness, lethargy, resp depression, headache K: assess resp before admin *decrease anxiety, muscle spasms, tremors *control seizures

carbamazepine / Tegretol lamotrigine / Lamictal

Class: anticonvulsant Uses: seizures, trigeminal neuralgia O: neuro C: S: suicidal thoughts, ataxia, drowsiness, fatigue, HTN, wt gain, aplastic anemia, thrombocytopenia K: avoid grapefruit *reduce/cease seizures *decrease neuralgia pain, manic depressive symptoms

topiramate / Topamax

Class: anticonvulsant, mood stabilizer Uses: seizures, migraine headaches O: neuro C: S: cognitive disorders, dizziness, speech problems, sedation, diplopia, acidosis, N, wt loss, paresthesia K: avoid alcohol or CNS depressants *reduce/cease seizures, migraines

phenytoin / Dilantin

Class: anticonvulsants Uses: seizures, ventricular arrhythmias O: neuro, cardiac C: S: ataxia, hypotension, rash, diplopia, N/V, suicidal thoughts, hepatic failure K: avoid alcohol & CNS depressants *reduce/cease seizures, neuropathic pain *suppress arrhythmias

levetiracetam / Keppra

Class: anticonvulsants, pyrrolidines Uses: seizures O: neuro C: S: suicidal thoughts, aggression, anxiety, apathy, depression, psychosis, weakness, HTN K: watch for DRESS syndrome *reduce/cease seizures

famotidine / Pepcid rantidine / Zantac

Class: antiulcer agent, H2 histamine blocker Uses: gastric ulcers, GERD, heartburn, avid indigestion, sour stomach, prevent GI bleed O: GI C: S: confusion, dizziness, drowsiness, headache, constipation, N/V, agranulocytosis, aplastic anemia K: avoid alcohol *decrease pain, indigestion, heartburn, GERD symptoms

esomeprazole / Nexium pantoprazole / Protonix lansoprazole / Prevacid omeprazole / Prilosec

Class: antiulcer agents, PPI Uses: GERD, esophagitis, decrease gastric ulcer risk, heartburn O: GI C: S: c.diff, N/D, headache, constipation, dizziness

Misoprostol / Cytotec

Class: antiulcer agents, cytoprotective agents, prostaglandins Uses: control PPH, prevent gastric mucosal injury from NSAIDs, cervical ripening, labor induction, termination O: reproductive C: hypersensitivity to prostaglandins S: ABD pain, diarrhea, miscarriage, headache K: avoid alcohol & GI irritating foods *prevent NSAID related gastric ulcers *termination, cervical ripening, labor induction

Oxytocin / Pitocin

Class: hormones, oxytocics Uses: control PPH, induce labor O: reproductive C: anticipated c/s S: increased uterine motility, painful contractions K: afterpains will be worse if this drug is given *onset of effective UCs, increase uterine tone, reduce PP bleeding

Calcium carbonate / Tums, Rolaids

Class: mineral & electrolyte replacements, antacids Uses: hypocalcemia, acid indigestion, heartburn, hyperphosphatemia in ESRD O: GI C: S: arrythmias, constipation, N/V, headache K: don't take with enteric coated meds within 1hr *resolve indigestion *increase calcium, control hyperphosphatemia

Methylergonovine / Methergine

Class: oxytocics, ergot alkaloids Uses: stim smooth/vascular muscle & sustains contractions, prevents/treats PPH O: reproductive C: HTN, labor induction, hepatic/renal disease S: N/V, cramps, dizziness K: can't breastfeed for 12hrs after last dose of drug *UCs that maintain uterine tone & prevent PPH

b) lochia the amount & appearance of the lochia tells us about the progress of endometrial shedding & regeneration

Endometrial changes are asserted by examining which of the following? a) vital signs b) lochia c) fundal height d) all of the above

c) ice to the breasts

For a woman who isn't breastfeeding, which measure would be most appropriate to relieve engorgement? a) warm showers b) nipple stim c) ice to the breasts d) manually expressing milk

b) 12 hours acrocyanosis is normal up to 12 hours, but after 24 hours we need to determine the cause

How long is acrocyanosis considered normal? a) 6 hours b) 12 hours c) 18 hours d) 24 hours

c) start of one UC to the start of another UC

The frequency of UCs measure from: a) time btwn UCs b) length of the UC c) start of one UC to the start of another UC d) all of the above

shoulder dystocia

NB's anterior shoulder is stuck above mom's pubic bone after vag delivery of the head

B & E fundus can rise slightly above or below the umbilicus in first 24hrs & mod saturation of 2/3 peripad is appropriate

SATA: Given that the first 24hrs after delivery is a time for return to homeostasis, which PP findings are considered acceptable during this time? a) inverted nipples after breastfeeding b) fundus one fingerbreath below umbilicus c) hypotonic bowel sounds d) urination of 50mL/hr e) mod saturation of peripad every 3 hrs

d) all of the above

The first stage of labor includes which of the following? a) latent phase b) active phase c) transitional phase d) all of the above

c) bacteria that synthesizes vitamin K aren't present in the NB's intestine tract

The nurse administers vitamin K to the NB for what reason? a) most moms are vitamin K deficient b) vitamin K prevents the synthesis of prothrombin in the liver c) bacteria that synthesizes vitamin K aren't present in the NB's intestine tract d) supply of vitamin K is inadequate for 3-4 mos

dysphagia

difficulty swallowing

d) retained placental fragments & infection

To provide optimum care for the PP woman, the nurse understands that the most common causes of subinvolution are: a) PPH & infection b) multiple gestation & PPH c) uterine atony & overproduction of oxytocin d) retained placental fragments & infection

b) false a premie NB more easily digests breastmilk than formula

True/False: A premie NB will more easily digest formula than breastmilk. a) true b) false

b) false a deviated uterus may indicate a distended bladder, which interferes with UCs

True/False: Uterine contractions can be effective with a deviated uterus a) true b) false

b) false arm recoil measures neuromuscular maturity

True/false: Arm recoil is one measure of assessing a NB's physical maturity a) true b) false

a) true a slight elevation of temp is normal, up to 100.4 F

True/false: During the first 24 hours PP, a slight elevation in temp is considered normal a) true b) false

3000mL fluids

We can prophylactically prevent PP UTIs by encouraging ____ mL of fluids daily

Temp elevated up to 100.4 (first 24hrs) HR 40-80 (puerperium/relative bradycardia) Resp 16-20 BP 100/60 - 119/79

What are the normal vital signs for a PP mom?

Breasts Uterus Bowels Bladder Lochia Episiotomy / Lacerations Homan's Sign Edema

What does BUBBLEHE stand for?

500-1000mL

What is the normal EBL for a c-section delivery?

250-500mL

What is the normal EBL for a vaginal delivery?

a) at the umbilicus

What is the normal location of the fundus 2 hours post-delivery? a) at the umbilicus b) 1cm above the umb c) 1cm below the umb d) 2cm below the umb

b) few palmar creases premie babies have none to few creases on their foot soles & palms of their hands

When assessing a preterm (31 wk) NB, which would you expect to find? a) limited lanugo b) few palmar creases c) wrinkled, thick skin d) wide-eyed expression

c) yellow-gold loose stool

When assessing the stools of a 1wk old NB who is breastfed, which would you expect to find? a) greenish-black tarry stool b) seedy greenish-brown stool c) yellow-gold loose stool d) yellow-green formed stool

a) category 1

Which of the following FHR patterns are normal? a) category 1 b) category 2 c) category 3 d) none of the above

encopresis

a childhood disorder characterized by repeated defecating in inappropriate places, such as one's clothing

kernicterus

abnormal accumulation of unconjugated bilirubin in the brain cells

hemorrhage

blood loss of >500mL following a vag delivery or > 1000mL following a c/s

transient tachypnea of the newborn (TTN)

breathing disorder seen shortly after delivery in early or late term babies

increased ICP

bulging fontanels, high-pitched cry, increase in head circumference, irritability, bradycardia, headache, seizures, resp changes, diplopia, vomiting (early sign)

Engorgement I: apply ice for relief (if not breastfeeding)

caused by an increase in the vascular & lymphatic systems within breast & milk accumulation

Kernig's sign

extension of the knee is painful or limited in extension

lanugo

fine hair on the back, shoulders & forehead

mongolian spots

flat, bluish area on the lower back/buttocks

deep vein thrombosis (DVT)

formation of a clot in a deep vein of the body, occurring most often in the femoral and iliac veins A: redness, sharp/sudden pain, warmth in leg

icteric

having jaundice

appendicitis I: NPO, monitor VS, position for comfort, IV fluids, NGT may be used post-op to prevent ABD distension (suction), assess pain, incentive spirometer, amb with ABD binder

inflammation of the appendix A: low-grade fever, RLQ pain (McBurney's point), sm volume of stool, decreased bowel sounds, rebound tenderness, tachycardia D: CBC, urinalysis, ultrasound, CT scan

amnioinfusion

injection of LR or NS infused transcervically into the uterus via IUPC to increase amniotic fluid

amniotomy

intentional rupture of the amniotic sac

dystocia

labor characterized by abnormally slow labor progress

respiratory distress syndrome (RDS)

life threatening lung disorder that results in small, underdeveloped alveoli & insufficient pulm surfactant levels A: expiratory grunting, nasal flaring, chest wall retractions, see-saw retractions, generalized cyanosis, HR 150-180, fine inspiratory crackles, tachypnea

contraction duration

measured in seconds by counting from the beginning to end of one contraction

clonus

neuro condition that creates involuntary muscle contractions

abortion (GTPAL)

number of abortions or miscarriages under 20 wks gestation

gravidity (GTPAL)

number of times a woman has been pregnant

pylorus

opening btwn the stomach & small intestine

atresia

orifice or passage in the body that's (abnormally) closed

nevus flammerus

port wine stain skin mark

encephalocele

portion of the brain protrudes through an opening in the skull

pyloric stenosis I: begin small freq feedings 4-6 hrs post-op, provide IV therapy with isotonic solution, electrolytes PRN, prep pt & fam for surgery

pylorus blocks foods from entering the small intestine A: forceful vomiting, dehydration, wt loss, babies may seem constantly hungry D: pyloric mass in mid-epigastrium, upper GI series, CBC, LFTs

fetal attitude

relationship of the fetal parts to one another, noted by fetal joint flexion/extension

fetal lie

relationship of the spine (long axis) of the fetus to the spine of mom

physiological jaundice

results from hyperbilirubinemia that commonly occurs after the first 24 hrs A: jaundice moves from head to trunk & lower extremities

stork bites

salmon colored skin patch

anal fissure

small tear in the lining of the anal mucosa

contraction intensity

strength of the uterine contraction & measured by palpation

tetanic contraction

sustained muscle contraction evoked when the motor nerve that innervates a skeletal muscle emits action potentials at a very high rate

contraction frequency

timing from the start of one contraction to the start of another

droplet precautions

used for pathogens spread via large droplets in the air

VEAL CHOP MINE

variable decels early decels accelerations late decels cord compression head compression okay placental insufficency mom changes positions intervention not needed no intervention emergency delivery

prolonged decelerations

visually apparent abrupt or gradual decrease in FHR below baseline that is equal to or greater than 15 bpm lasting 2-10 mins

variable decelerations

visually apparent decrease in the FHR from baseline to nadir taking less than 30sec

early decelerations

visually apparent gradual decrease in FHR from baseline to nadir taking more than 30 sec

late decelerations

visually apparent gradual decrease of FHR from baseline to nadir taking more than 30sec

accelerations

visually apparent, abrupt increase in FHR above the baseline

regurgitation

vomiting

Brudzinski's sign

when flexing the head the knees & hips flex spontaneously

milia

white papules on the face

primipara

woman who has given birth after 20 wks gestation 1 time

multipara

woman who has given birth after 20 wks gestation multiple times

nullipara

woman who has never given birth after 20wks