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Maternal Health, Test 1
Maternal Health, Test 1
369
Medical
Undergraduate 3
03/24/2009

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Term
__________ is the # of live births per 1000 people
Definition
birth rate
Term
_________ ___________ is the # of deaths of infants under 1 year of age per 1000 live births in a given population.
Definition
infant mortality
Term
___________ ___________ is the # of deaths of infants less than 28 days of age per 1000 live births.
Definition
neonatal mortality
Term
_________ ____________ number of deaths during the pregnancy cycle (including the 42 day postpartal period) per *100,000* live births.
Definition
maternal mortality. This is higher in african americans
Term
What are some risk factors to pregnancy?
Definition
age (if person is too young or too old), SES - "urban poor", have pre-existing medical disorders, obstetric (previous pregnancy, current pregnancy) others on chart: poor diet, living at high altitude, multiparity >3, mom is too skinny or too fat, smoking, drugs, alcohol, DM, cardiac disease, anemia, HTN, thyroid disorders, renal disease, still born, abortion, cesarean birth, Rh or blood group sensitization, large baby, rubella, cytomegalovirus, Herpes type 2, syphilis, UTI, preeclampsia, multiple gestation, elevated Hct, spontaneous rupture of membranes.
Term
The HC does want to know the mom's MOTIVATION FOR PREGNANCY. Why do people have babies??
Definition
* self-concept... self-esteem, *masculinity.... femininity *generativity... creating the next generation
Term
We do view pregnancy as a CRISIS situation. The body is under going stress. why?
Definition
physiologic changes are happening, there is emotional liability, role transition (increased responsibility), cultural expectations, social climate (Social climate refers to atmosphere of pregnancy. Part relates to was the pregnancy wanted or unwanted? We do ask this in prenatal records. It asks planned or unplanned. If it is unplanned, do not just and assume it’s unwanted. The involvement of the father of the baby is a huge factor in social climate. If he’s involved it’s much more of a positive, supportive event for the mother’s feelings.)
Term
women who are older (above 35) having their first babies are esp at risk. they're called _________.
Definition
primapara
Term
how is SES a risk factor for pregnancy?
Definition
low income has lack of knowledge, education & even awareness of prenatal care. Also, lack of access. There are several counties that do not have OBGYN or prenatal care facilities in MO. There are areas where women have significant difficulty accessing HC. Even in KC, some of this. Urban poor still struggles w/ resources to access care.
Term
What obstetric events are a risk factor?
Definition
o Problems in previous pg like preterm labor it prevents higher risk.
o Anything occurring w/ current pg will of course present higher risk.
Term
How can a nurse help with the 'crisis resolution' of a pregnancy. what does she want to know?
Definition
Want to know their PERCEPTION OF THE EVENT. How do they see the event? Are their perceptions realistic? Their health, age, education level will help with crisis resolution. Being able to handle the stressors that occur in pregnancy.
Term
What interventions help with crisis resolution of pregnancy??
Definition
support them through EDUCATION. Teaching, teaching… esp in pregnancy we’re very focused on “anticipatory” guidelines.
Term
What are the 2 primary tasks of pregnancy?
Definition
• Acceptance (throughout the pregnancy) and
• Safe Passage
Term
What is a very common 'feeling' during the first trimester of a pregnancy?
Definition
Disbelief… feeling “AMBIVALENT” feelings are VERY normal in the first semester. Do I really want a baby? When pregnancy is actually achieved there is some degree of anxiety. “Am I going to be okay?” is common. “Is my baby going to be okay?”
Term
Where is the concern at for the first trimester?
Definition
Self-concern happens b/c baby is “non-event” at this point.
Term
What teaching is appropriate from nursing during the first trimester of pregnancy?
Definition
Teaching is on physiologic changes of early pregnancy. How to take care of your health for the pregnancy. More concerned with woman & not the fetus as much. (not teaching labor & delivery here! ☺ )
Term
_____________ is a common theme to the 2nd trimester of pregnancy. As the baby grows & women start to show… your pregnancy is more evident to other people.
Definition
Acceptance… mom is not feeling as tired in the 2nd trimester
Term
_______________ is the first perceived fetal movement.
Definition
Quickening - baby becomes real with “quickening.”
Term
During the second trimester, the date when the mom feels quickening is important. why?
Definition
quickening date helps give data for due date estimation.
Term
During the 2nd trimester and once the fetus is moving, the pregnancy is established, mom is okay & feeling better… the concern is more ....
Definition
focus is on the baby now in the 2nd trimester. The mom will seek information about the baby & fantasize about it..
Term
What happens during the 3rd trimester? What is the mom feeling?
Definition
More anxiety returns, approaching labor & delivery. More fatigue d/t not being able to sleep well. Concern – am I going to be ok? Is the baby going to be ok? There is concern for LABOR & DELIVERY. concern for "SAFE PASSAGE."
Term
What is the mom preparing for in the 3rd trimester?
Definition
emotional separation from baby. Some women feel a loss in a way.
Term
What behavior by the mom (if shown during pregnancy) shows potential risk?
Definition
* Denial of pregnancy
* Absence of response to quickening – they’re not really connecting/accepting.
* Lack of preparation for delivery/baby “Is the babies room ready yet?” Need to look at pt’s particular situation. Ex/ parents who have lost a child previously, are they going to get prepared again? Significant problems w/ premature baby, they will not pick a name yet? Nurses push for a chosen name b/c they want that connection & accepted reality that this is a live baby.. there is a hesitancy in extreme critical care situations.
* Excessive physical complaints
* Excessive emotional withdrawal
Term
What is the duration of gestation? "9 months is not completely correct" A full-term is ___ weeks. Or ___ lunar months.
Definition
40 weeks. 10 lunar months.
Term
The definition of pre-mature is __ weeks or less.
Definition
37
Term
How many weeks are in the 3 trimesters then?
Definition
o 1-12th wk=1st trimester
o 13-26 wks=2nd trimester
o 27-39 wks=3rd trimester
(know this in general, she will not ask something on the border)
Term
What are some physiologic changes of pregnancy?
Definition
Virtually ALL systems are impacted to some degree by the pregnancy. Normally uterus is nonpalpable & can’t even feel in a pelvic exam. At the end of gestation, the uterus is huge & encroaches on the xiphoid process.
Term
The uterus grows to _____ - ______ times its capacity due to hypertrophy of the _______________ cells. the growth is related to what hormone?
Definition
500 - 1000 times. myometrial cells. hormone = estrogen.
Term
What other changes occur due to growing fetus?
Definition
Distention by growing fetus, Fibrous tissue increases … adds to strength & elasticity, Walls thicken… thinning with distention, Circulatory requirements increase
Term
Do contractions occur before birth?
Definition
Painless/irregular contractions do occur – may not be perceived at all by the woman. If they are then we call it “false labor” & hear term Braxton hicks contractions
Term
Why can a woman who has had babies (multigravida) feel the contractions more than a 1st time pregnancy mom?
Definition
Because she has felt them before. Also, the uterus loses tone & so it's likely working harder.
Term
what happens to the ovaries during pregnancy?
Definition
Cease ovum production. Once pregnant, can’t get pregnant for awhile.
Term
Corpus Luteum is what?
Definition
endocrine structure that secretes progesterone until it can be produced by the placenta. Does this until 10th-12th week.
Term
What does progesterone do?
Definition
Progesterone maintains the pregnancy. Low progesterone levels = higher loss of pregnancy. Multiple miscarriages? Going to assess progesterone levels early into pregnancy.
Term
The cervix has mucosal changes during pregnancy. what happens?
Definition
increase glandular tissue & secretions… it forms “mucous plug.” It seals off the cervical canal to prevent any pathogens or entry into uterus. Want fetus in this sterile environment. Gives us the protective mechanism.
Term
The cervix also has an "Increase in vascularization & congestion of tissues" (there is a different consistency!) What is Goodell's sign?
Definition
Know that “Softening” of the cervix is Goodell’s Sign. This is not usually charted, but what it is called & is used for test Q's
Term
What is Chadwick's sign?
Definition
Discoloration - cervix gets a bit darker. This is Chadwick’s sign.
Term
The Vagina's Epithelium undergoes hypertrophy & hyperplasia. This is due to ___________ being induced.
Definition
Estrogen
Term
During pregnancy, the vagina will have a thickening of mucosa, loosening of connective tissue & increase in secretions... what is the whitish discharge from the vagina during pregnancy? is it normal???
Definition
whitish discharge called "LEUKORRHEA." It’s normal. The secretions are thick, white & acidic (pH 3.5-6.0).
Term
What is the point of leukorrhea/white discharge?
Definition
it's a protective against invasive pathogens
Term
Unfortunately, leukorrhea favors the growth of:
Definition
candadiasis (monoliasis)… “vaginal yeast infections are common in pregnancy. They’re treated same as in non-pg. use OTC meds. Problem is they’re not totally treatable & tend to recur.
Term
Are more lumps felt in the breasts normal?
Definition
it’s a normal change in breasts, there is an increase in nodularity… glandular hypertrophy & hyperplasia. That is influenced by estrogen & progesterone
Term
What else becomes more prominent in breasts normally during pregnancy? What are Montgomery Follicles?
Definition
• Veins>prominent nipples_erectile, increase in pigmentation of areola, hypertrophy of montgomery’s follicles (these are nodules on areola that will enlarge, this is normal), striae may develop (stretch marks)
Term
What happens to the mom's heart during pregnancy?
Definition
Becomes displaced upward & to the left. pulse increases slightly (not something we usually identify), BP remains the same & may decrease slightly in 2nd trimester – this is normal.
Term
the increase in BLOOD VOLUME is a major change in pregnancy! How much does it increase? When does it peak?
Definition
30-50%. peaks at 36 weeks. (the increase in Blood Volume is really good & helps protect mom from blood loss at birth, among other necessities)
Term
With the increase in blood volume, comes an increase in _________ ____________.
Definition
cardiac output
Term
So the blood volume increases. and the cardiac output increases. How is it possible that Blood Pressure remains unaltered?
Definition
*VASODILATION* due to the smooth muscle contraction. There is an increase in vascular "space" so you don't have the real increase in pressure.
Term
The total red blood cells increase significantly. This is because of the increased ____________ needs.
Definition
oxygen
Term
The hemodilution that occurs during pregnancy is referring to a decrease in ____________.
Definition
hematocrit
Term
The "whole products" increases less than the plasma volume increases. There is an increase in Hgb, but it is LESS than the increase in plasma volume. This is the physiological _________ of pregnancy. Requires supplemental ____ needed to meet the increase of RBC's and the fetal needs.
Definition
anemia. supplement iron. (really going to check up front if mom's anemic b/c it will get even worse in pregnancy. XT iron is given to MANY pregnant women!)
Term
When is a pregnant mom most hemodiluted? (low on the Hgb & Hct and really need the iron?)
Definition
36 weeks
Term
What happens to clotting factors during pregnancy?
Definition
luckily, there is an INCREASE in clotting factors. Reflected in labs as an increase in "FIBRIN" levels and increase in "PLASMA FIBRINOGEN" levels. <-- help with clotting.
Term
THe downside of have the INCREASE in CLOTTING FACTORS is the pregnant mom is at an increased risk for:
Definition
blood clots
Term
What happens to the peripheral circulation during pregnancy?
Definition
There is DECREASED VENOUS RETURN.
Term
What kind of things happen to the pregnant woman b/c of the 'decreased venous return'?
Definition
postural hypotension (dizziness, recommend sitting & resting more & non standing for long periods d/t this), variscosities, dependent edema happens at end of pregnancy, vena caval syndrome.
Term
What is Vena Caval Syndrome?
Definition
During the 2nd trimester, do not lay a pregnant woman on her back or she will pass out on you! The fetus lays on the vena cava and obstructs flow. DO NOT WANT PREGNANT WOMAN TO LAY FLAT ON HER BACK. HOB at 30 degrees+ if on her back. Having C-section? wedge under hip. CPR on pregnant mom? put something under her hip.
Term
The respiratory system change when a person is pregnant. There is a small degree of _____________________.
Definition
hyperventilation
Term
What happens to the respiratory rate and tidal volume (lung volume & amt of air inhaled & exhaled)?
Definition
they both increase
Term
What happens to women who have asthma when they get pregnant?
Definition
They may show improvement b/c of the DECREASE IN AIRWAY RESISTANCE B/C OF "SMOOTH MUSCLE RELAXATION."
Term
Oxygen consumption __________ in a pregnant woman about 14%.
Definition
increases
Term
The diaphragm becomes elevated and causes an __________ in the substernal angle.
Definition
increase
Term
The rib cage flares when pregnant. What happens to the length of the rib cage (vertical diameter) and the diameter around?
Definition
The vertical diameter decreases. There is an increase in the Anteroposterior and transverse diameters... the circumference of chest may increase 6 inches around! There's a widening of the chest & they are larger around and may need to increase that + cup size for bras.
Term
What happens to the nasal area during pregnancy?
Definition
It's stuffy, there is edema and vascular congestion in nasal mucosa. "epistaxis" nosebleeds are more common in pregnancy. Want to teach them to avoid URI b/c they're experiencing more congestion in general.
Term
The pregnant woman has increased oxygen requirements. The volume of breathed air each minute _________ 30-40%. In addition, progesterone decreases airway resistance, permitting a 15-20% ________ in oxygen consumption, as well as increases in carbon dioxide production and in the respiratory functional reserve.
Definition
increase, increase
Term
As the uterus enlarges, it presses upward & elevates the diaphragm. The subcostal angle increases, so that the rib cage flares. the anteroposterior diameter increases and the chest circumference expands by as much as 6 cm, as a result, what happens to the intrathoracic voume?
Definition
there is no significant loss in intrathoracic volume
Term
Do pregnant women breathe with abd or thoracic as the pregnancy progresses?
Definition
breathing changes from abdominal to thoracic as pregnancy progresses. Descent of the diaphragm on inspiration becomes less possible & some hyperventilation and difficulty breathing may occur.
Term
How can superior vena caval syndrome be corrected?
Definition
have the woman lay on her left side or place a pillow or wedge under her right hip.
Term
The total erythrocyte (RBC) volume increases by about 30% in women who take iron supplements. The increase in erythrocytes is necessary to transport the additional oxygen required for pregnancy. However, increase in plasma volume is 50%. Because plasma volume increase (50%) is greater than the erythrocyte increase (30%) the hematocrit, which measures the concentration of red blood cells in the plasma, decreases slightly. The decrease of hematocrit/RBCs in the plasma is referred to as...
Definition
the physiologic anemia of pregnancy.
Term
Iron is necessary for hemoglobin formation, and hemoglobin is the oxygen-carrying component of erythrocytes. Thus the increase in erythrocyte levels results in an increased need for _____ by the pregnant woman.
Definition
Iron
Term
What are leukocytes?
Definition
White blood cells
Term
What happens to leukocytes in a pregnant woman?
Definition
Leukocytes increase slightly to an average of 5000-12000, some women develop as high as 15,000. Dueing labor and the early postpartum period, these levels may reach 25,000 or higher.
Term
Both the fibrin and plasma fibrinogen levels increase during pregnancy. Although the blood-clotting time of the pregnant woman does differ significantly from that of the nonpregnant woman, clotting factors 7,8,9 and 10 increase. Thus, pregnancy is somewhat hypercoagulable state. these changes, coupled with venous stasis in late pregnancy, increase the pregnant woman's risk of developing....
Definition
venous thrombosis (blood clots)
Term
nausea and vomiting are common during the first trimester because of elevated __________ ______________ ______________ levels and changed carbohydrate metabolism.
Definition
human chorionic gonadotropin (HCG) levels
Term
There is smooth muscle relaxation happening, resulting in ____________ gastric emptying and decreased peristalsis. As a result, the pregnant woman may complain of bloating and constipation.
Definition
delayed
Term
These symptoms are aggravated as the enlarging uterus displaces the stomach upward and the intestines laterally and posteriorly. The __________ sphincter also relaxes, and heartburn may occur d/t reflux of acidic secretions into the lower esophagus.
Definition
cardiac
Term
___________ frequently develop in late pregnancy from constipation (DECREASE IN INTESTINAL MOTILITY) and from pressure on vessels below the level of the uterus.
Definition
Hemorrhoids
Term
The emptying time of the ____________ is slower & prolonged during pregnancy, also as a result of smooth muscle relaxation. This coupled with elevated levels of cholesterol in the blood (during pregnancy, not long-term worry), can predispose the woman to gallstone formation.
Definition
gallbladder
Term
Urinary frequency on the bladder is common during pregnancy due to pressure on the bladder. What trimesters will urinary frequency be the worst?
Definition
1st & 3rd trimesters
Term
The ureters dilate during pregnancy. There is an increased potential for ______________ infections.
Definition
urinary tract infections
Term
____________________ is sometimes seen during pregnancy b/c the kidneys cannot absorb all the glucose filtered by the glomeruli. Happens episodic and it's due to a DECREASE in the RENAL THRESHOLD.
Definition
Glycosuria. - it may be normal or it may indicate gestational diabetes, so it always warrants further testing.
Term
During pregnancy, many hormone levels are changes and there are changes in their skin. What areas become hyperpigmented?
Definition
primarily pigmentation increases in areas that are already hyperpigmented: the areola, the nipples, the vulva, and the perianal area.
Term
The skin in the abdomen may develop a pigmented line, the ______ ________, which usually extends from the umbulicus or above to the pubic area.
Definition
linea negra
Term
Chloasma is also known as the "________ of _________." due to darkening where?
Definition
mask of pregnancy. darkening over cheeks, nose and forehead may develop. Chloasma is more prominent in dark-haired women and is aggravated by exposure to the sun. Fortunately, the condition fades or becomes less prominent soon after childbirth when the hormonal influence of pregnancy subsides.
Term
____________ __________ ________ are small, bright red elevations of the skin radiating from a central body, may develop on the chest, neck, face, arms, and legs. They're just little red dots - that may scare women, but they're capillaries and it is normal, nothing significant.
Definition
vascular spider nevi
Term
What happens to the sweat and sebaceous glands during pregnancy?
Definition
they're hyperactive
Term
Striae may develop during pregnancy. what is this?
Definition
stretch marks. they're normal and will decrease after awhile.
Term
Talk about the physiological leukocytosis that occurs w/ pregnancy. Is the immune system intact for pregnancy & birth?
Definition
Yes, the immune defense system is definitely intact during pregnancy and esp delivery. During pregnancy, the body increases WBC's (called leukocytosis) & this is related to the pregnancy, not infection! A woman will increase her WBC's from 5,000-12,000 on average. This may go as high as 15,000. During labor "activation" the WBCs go as high as 25,000!
Term
The joints of the pelvis relax somewhat b/c of hormonal influences. The result is often a ____________ gait. The symphisis pubis bones may "separate".
Definition
waddling gait.
Term
As the pregnant woman's center of gravity gradually changes, the lumbar spinal curve becomes more accentuated, and her posture changes. This posture change compensates for the increased weight of the uterus anteriorly and frequently results in:
Definition
back aches
Term
A pregnant womans postural changes during pregnancy are increasing lordosis of the __________________ spinal curve and a posture change d/t the increasing curvature of the thoracic area.
Definition
lubosacral or lumbodorsal spine curves
Term
Why might a pregnant woman experience facial nerve paralysis or an exacerbation in her carpal tunnel syndrome?
Definition
There is pressure on the nerves due to congestion in the tissues. the facial nerve paralysis is r/t pregnancy & then goes away. The carpel tunnel syndrome may be exacerbated during pregnancy & then it will go away. Surgery is not done during pregnancy, just do a splint.
Term
There is an increase in CALCIUM & PHOSPHORUS requirements during pregnancy. Do the bones & teeth demineralize to provide CA for the pregnancy? Why do women have more dental caries during pregnancy?
Definition
No, a pregnant woman's bones AND teeth do NOT demineralize to provide calcium for the fetus! The increased risk of dental caries is due to changes in pH of the saliva and increase in circulating LACTOSE.
Term
The basal metabolic rate increases by 25%. (why pregnant women are warm). This provides for the increased needs of...
Definition
the fetus and maternal tissue growth
Term
What happens with the thyroid in a pregnant woman?
Definition
The thyroid function increases and often the thyroid gland enlarges slightly.
Term
There are changes in carboydrate metabolism during pregnancy. There is an ______________ in free fatty acids for maternal use. There is a __________ in the maternal metabolism of glucose.
Definition
increase in fatty acids for the mom to use. decrease in mom metabolizing glucose. (First half pregnancy, increase maternal need for glucose. second half of pregnancy, increase in fetal need for glucose)
Term
What is the recommended weight gain during pregnancy for a normal weight woman?
Definition
25 to 35 lbs.
Term
We know the weight should be put on gradually. about how much should be gained in the 1st, 2nd and 3rd trimesters?
Definition
1st: 4 lbs. 2nd: 11 lbs. 3rd: 11 lbs.
Term
A sudden excessive weight gain during pregnancy (more than 2 lbs. a week) is a symptom of:
Definition
pregnancy induced hypertension
Term
Is wt gain the same for all pregnancies?
Definition
No, weight gain is specific to maternal weight and pregnancy individually. Heavier women actually should gain less weight. Underweight women should gain up to their ideal wt + 25-35 lbs. The concern is whether babies have enough weight for development, not concerned with mom being overweight.
Term
What is the recommended increase in calories for a pregnant woman?
Definition
increase of 300 kcal's over RDA.
Term
a woman has increased needs for PROTEINS and CARBOHYDRATES during pregnancy. When are the maternal and tissue demands highest? When are the fetal demands greatest?
Definition
moms tissue demands: highest in 1st & 2nd trimesters. Fetal demands: highest in 3rd trimester
Term
There is increase need for calcium & iron. The mom's will be receiving oral supplements, but what foods need to be recommended?
Definition
IRON: lean meats, dark green leafy veggies, egg and whole grain and enriched breads and cereals are the usual sources of iron. Other iron sources: dried fruits, legumes, shellfish nd molasses. Calcium: really important in last 2-3 months. 4 cups of milk is adequate or calcium fortified soymilk or orange juice. Smaller amts of Ca are in: legumes, nuts, dried fruits, and dark green leafy vegs (kale, cabbage, collards and turnip greens-this calcium is absorbed more efficiently than calcium in dairy foods.
Term
What are the 3 main dangers in food that pregnant women need to avoid?
Definition
Listeria (bacteria even in refrigerator), Mercury (harmful metal found in some fish) and Toxoplasma (parasite i undercooked meat and unwashed fruits & vegetables)
Term
A new mom can NOT eat raw or undercooked meat, poultry, fish or shellfish. So NO
Definition
sushi or sashimi
Term
What fish is not allowed for pg mom?
Definition
no swordfish, tilefish, king mackerel or shark. no refrigerated smoked seafood. Like whitefish, salmon or mackarel. It is usually labeled "Nova-style," lox, kippered or jerky.
Term
what meats are not recommeneded?
Definition
obviously undercooked. Also, no refrigerated pates or meat spreads. Do NOT eat hot dogs or lunch meats (unless they're reheated until steaming hot)
Term
What cheeses must be avoided when pregnant?
Definition
Soft cheeses & unpasteurized. (ok if label says they are pasteurized or made from pasteurized milk)
Term
What does a pregnant woman need to do to her fruits & veggies?
Definition
Wash them! Or she is at risk for toxoplasma
Term
Increased water retention is a basic chemical alteration of pregnancy. This is due to the increased levels of ____________ sex hormones.
Definition
steroid
Term
We do have water retention in pregnancy & we want it! why?
Definition
The increased fluid demands are necessary for: blood volume, amniotic fluid, fetus and placenta.
Term
A pregnant woman needs adequate fluid intake. how much? Do we ever restrict water intake in pg moms?
Definition
8-10 oz glasses of water or other fluid daily is really necessary! We NEVER restrict water intake. Do not let them decrease their water intake because of increased urination or whatever they say...
Term
What are the 4 hormones of pregnancy?
Definition
estrogen, progesterone, hCG (human chorionic gonadotropin) and relaxin
Term
Which hormone maintains the pregnancy?
Definition
progesterone
Term
which hormone is the basis of the pregnancy test?
Definition
hCG. This is the first hormone that will secrete estrogen & progesterone to maintain the pregnancy.
Term
What is relaxin?
Definition
it's another hormone of pregnancy that is associated with fatigue and pregnancy. it diminishes contractions, softens the cervix, relaxes joints, things like this... it is in the blood /urine by the time the 1st menstrual period is missed
Term
The mom has ______________ demands for insulin during pregnancy.
Definition
increased
Term
What is hPL? What does it have to do with insulin?
Definition
hPL is a hormone. HPL is an anti-insulin. (hPL antagonizes insulin) and does not let her use glucose easily. Not included, but to help understand: HPL decreases maternal insulin sensitivity, and therefore raises maternal blood glucose levels, whilst decreasing maternal glucose utilization, which helps ensure adequate fetal nutrition.
Term
The subjective changes of pregnancy are the symptoms a woman experiences and reports. Because they can be caused by other conditions, they cannot be considered proof of pregnancy. These presumptive signs can be diagnostic "clues" when other s/s are pregnant though. what are some?
Definition
amenorrhea, nausea and vomiting, urinary frequency, breast tenderness, quickening.
Term
An examiner can perceive the objective changes that occur in pregnancy. The objective (probable) signs can also have other causes, they do not confirm pregnancy. Examples of Probable signs are:
Definition
abdominal enlargement (not necessarily pregnancy), ballotement (palpating floating object in body, think it's head, but could be tumor or fibroid), and pregnancy tests (they are NOT an absolute test!)
Term
Pregnancy testing is done in urine or serum. They may have false-negatives (usually b/c done too early) & false-positives (infection of tube may give false+) happen. Pregnancy tests are based on what hormone?
Definition
hCG... the pregnancy test is not a positive sign because other conditions can cause elevated hCG levels.
Term
There are only 3 diagnostic POSITIVE signs of pregnancy. what are they?
Definition
audible fetal heartbeat (can NOT usually be found in 1st trimester, but can see the heart beat at 5 weeks), the fetal movement felt by an EXAMINER, visualization by an ultrasound.
Term
What are the key nursing interventions antepartal (before the babies born)?
Definition
explain the normal changes of pregnancy to the childbearing family, specifying those s/s that indicate a problem may be developing, providing appropriate info about self-care measures the pregnant woman may employ to relieve the common discomforts of pregnancy, answer Q's about the common concerns that arise during pregnancy, referring the woman for additional or more specialized assistance when necessary.
Term
What trimesters is fatigue highest? what's recommended?
Definition
1st & 3rd trimesters. promote adequate periods every day.
Term
When is nausea/vomiting expected for pregnancy? what to do?
Definition
first trimester. eat dry carb foods... like crackers in the am & before she gets up.
Term
Frequent urination is worst in what trimesters? what to do?
Definition
1st & 3rd trimesters. encourage to maintain fluid intake. Frequent urination is "normal," but should assess for other symptoms of a UTI like dysuria, burning, urgency, little amounts constantly.
Term
When is heartburn bad? what to do?
Definition
last half of pregnancy. Take antacids in moderation. eat small, more frequent meals, avoid lying down after a meal.
Term
When is constipation common? want to do what to help?
Definition
2nd & 3rd trimesters. increase fiber & prunes in diet, increase fluids, exercise, stool softeners (mild ones that are safe & appropriate).
Term
When are hemorrhoids most common?
Definition
the LAST HALF of pregnancy. Tell to avoid constipation and straining. They will be exacerbated by delivery. hemorrhoids are a routine expectation & will improve after pregnancy.
Term
When do variscosities appear? why? what can help?
Definition
last half of pregnancy. they happen because of decreased venous return and increased abd pressure. Want to avoid constrictive clothing & crossing legs. Elevate legs when possible (this may even mean really laying on side to help return).
Term
When is edema bad? where is it worst & why? what can help?
Definition
last trimester. the lower extremities get the decreased venous return. So, elevate legs when possible.
Term
When is backaches worst? what helps?
Definition
last half of pregnancy. good posture helps. (avoiding high heeled shoes!) Doing exercises like the pelvic tilt helps.
Term
When are leg cramps bad? what needs to be assessed? what exercise helps?
Definition
they can be bad in the first few weeks and then the last half. Assess intake of CA... are they getting excessive milk? If LOTS of milk or drink LOTS of sodapop (the phosphorus) can interfere with the calcium. Extend the legs and dorsiflex the foot. (massaging? some DVT risk, may advise another strategy)
Term
What is advised for exercise during pregnancy?
Definition
generally, there are NO contraindications, may continue with your previous exercise routine. However, it is not the time to start a new sport or strenuous exercise program. Even some mild to moderate exercise is beneficial (WALKING is best). After the 1st trimester, you want to avoid the supine position for exercise (avoid vena caval syndrome). Modify the intensity of the workout, pulse rate should not be greater than 140 bpm. There may be balance issues in the 3rd trimester. Want to be concerned & avoid any abdominal trauma (no snow skiing, no water skiing, etc...) Also avoid Hyperthermia (pregnant moms should not be in hot tubs)
Term
More exercise recommendations:
Definition
mild to moderate exercise is beneficial during pregnancy. regular exercise-at least 30 minutes of moderate exercise daily or at least most days is preferred. pulse rate should not exceed 140 bpm.
Term
Is their contraindications for sexual activity, dental care and alternative therapies when pregnant?
Definition
There are no contraindications for sex during pregnancy unless there are concerns of preterm labor. Because sex stimulates uterine contractions. Also, there are contraindications of premature rupture of membrane. There are no contraindications for dental care. Check-ups are encouraged during early pregnancy. Repair and extractions can be done during pregnancy, preferable under local anesthetic. The 2nd trimester is best for treatment. The dentist should no she is pregnant so that she is not exposed to any teratogenic substances. Dental x-ray exams and extensive work should be delayed until after the birth when possible.
Term
What immunizations are ok & what are avoided?
Definition
Immunizations with attenuated live viruses, such as rubella vaccine, should not be given in pregnancy because of the teratogenic effect of the live viruses on the development of the embryo. Vaccinations using killed viruses may be used, however.
Term
Many women choose to use alternative approaches/therapies, what should they do?
Definition
They often do not report the use of these to their HC provider, but they should. It is important for them to talk to someone who is very knowledgable and trained. "Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care." The thing is we do not know a lot about alternative therapies & they need more study! She mentioned St. Johns Wort in class
Term
What are some immunizations that are safe & recommended during pregnancy?
Definition
killed viruses - like the Influenza vaccine is recommended. Toxoids are safe.
Term
CDC on immunizing pregnant women:
Definition
No evidence exists of risk from vaccinating pregnant women with inactivated virus or bacterial vaccines or toxoids. Live vaccines pose a theoretical risk to the fetus. Benefits of vaccinating pregnant women usually outweigh potential risks when the likelihood of disease exposure is high, when infection would pose a risk to the mother or fetus, and when the vaccine is unlikely to cause harm.1 Generally, live-virus vaccines are contraindicated for pregnant women because of the theoretical risk of transmission of the vaccine virus to the fetus. If a live-virus vaccine is inadvertently given to a pregnant woman, or if a woman becomes pregnant within 4 weeks after vaccination, she should be counseled about the potential effects on the fetus.
Term
Inactivated Influenza was the only one listed as recommended. Some immunizations that are contraindicated are:
Definition
Rubella, Measles, Mumps, Live attenuated virus (LAIV) influenza vaccine, Varicella
Term
Substances that adversely affect the normal growth and development of the fetus are called Teratogens. It is essential to provide pregnant women with info about avoiding these recognized teratogens:
Definition
X-rays, pesticides, smoking - causes low birth weight. can't quit? cut down as much as possible, alcohol - safe limit? unknown so air on the side of safety & say no alcohol, but this varies, caffeine: concern is when it is excessive & baby withdraws when born. The first term is the critical period for teratogenesis. Tetracycline in late pregnancy stains teeth in children. Sulfonamides compete with bilirubin and increase risk of jaundice.
Term
Pregnant women need to avoid all medication-prescribed, homeopathic, or OTC-if possible. what is some good advice from a nurse?
Definition
If no alternative exists, it is wisest to select a well known med rather than a new one When possible, the oral form of a drug should be used & the lowest possible therapeutic dose for the shortest amt of time as possible. The advantage of using a particular med must outweigh the risks. Asthma medication? May need to consider benefits with risks. All pg women should check with physician/nurse midwife about herbs or meds they considering or any nonprescription drugs.
Term
Alcohol & pregnancy...
Definition
altho an occasional drink during pregnancy does not carry any known risk, no safe level of drinking during pregnancy has been identified. Thus caregivers recommend that pregnant women abstain from all alcohol during pregnancy. The effects of moderate intake of alcohol are unclear.
Term
Current research reveals no evidence that moderate caffeine intake has teratogenic effects in humans nor is it linked to low birth wt or preterm birth. An increased risk of decreased birth wt has been found in mom's who drink, how many cups of coffee or other caffeine sources (chocolate, tea, cola, etc...)
Definition
6 cups of coffee at 10 ounces each.
Term
Effects of marijuana with pregnancy are...
Definition
no teratogenic effects have been documented. the research is difficult on this though. likely low birth weight like smoking.
Term
Using cocaine during pregnancy has been related to:
Definition
abruptio placentae, preterm birth, fetal distress, low birth weight, neonatal withdrawal, SIDS, several congenital abnormalities in the GU system, the hear, limb defects, CNS anomalies.
Term
The # of women of childbearing age using cocaine & meth increases. So, HC providers should be alert to early signs of use. They should be alert, open & nonjudgmental approach for early dtection. Urine screening for cocaine is valuable, but cocaine is metabolized rapidly and the screen will be negative within...
Definition
24-48 hrs. Thus, many moms who use cocaine are not identified.
Term
What are TORCH infections?
Definition
5 congenital infections passed from mom to new baby. They are generally mild in an adult, but significant consequences to the embryo/fetus. T=Toxoplasmosis, O=other (Varicella/Chk pox-it's similar to Rubella, Beta Strep, R=Rubella, C=CMV (cytomegalovirus), Herpes (Type 1 & 2)
Term
Toxoplasmosis is a _____________ infection.
Definition
protozoan
Term
Where is toxoplasmosis contracted from?
Definition
raw or undercooked meat (esp Pork) or cat feces. It is innocuous (produces no harm) to the parent, but can profoundly afect the fetus.
Term
Is there a test for toxoplasmosis?
Definition
Yes, serologic testing of antibody, specifically IgG and IgM fluorescent antibody tests.
Term
Nurses instructions to avoid toxoplasmosis:
Definition
avoid poor cooked or raw meat (esp pork, beef, lamb). Wash fruits & vegetables. Avoid the cat litter box and have someone else clean it frequently since it takes 48 hrs for a cat's feces to become infectious. Also discuss the importance of wearing gloves when gardening and of avoiding garden areas frequented by cats.
Term
What happens when a pregnant woman is exposed to Varicella?
Definition
Varicella is CHICKEN POX. Most pregnant women are immune to chickenpox, due to either immunization or a childhood bout with chickenpox. If chickenpox develops during pregnancy, the risks depend on the timing. If exposed during the first 20 weeks, risk of Congenital varicella syndrome — a rare group of serious birth defects. A baby who has congenital varicella syndrome may experience: Scars on the skin, Muscle and bone defects, Malformed limbs, Vision problems, Mental retardation. If you're considering pregnancy and you're not immune to chickenpox, ask your doctor about the chickenpox vaccine. It's safe for adults, although you'll need to wait at least one month after vaccination before trying to conceive.
Term
Beta Strep is present normally in the vagina of about 35% of women. Why is it so dangerous to a pregnant woman?
Definition
All pregnant women are screened for this. Women identified as carriers should receive antibiotic prophylaxis for the baby (not for the mom). The infection in infants causes a severe, invasive disease... they can get in in their lungs & have severe cases of pneumonia and overwhelming sepsis. Can even manifest as meningitis.
Term
Fortunately the success of the Rubella (German Measles) vaccine in US has led to dramatic decrease in the incidence. There are still 10-20% moms at risk and consequently so are their fetuses for congenital rubella syndrome. The period of greatest risk for the teratogenic effects of rubella on the fetus in the first trimester. the most common clinical signs of congenital infection include:
Definition
congenital cataracts, mental retardation, sensorineural deafness, congenital heart disease, IUGR=intrauterine growth restriction.
Term
The best therapy for rubella is prevention. live attenuated virus is available & should be given to all children. When a woman becomes pregnant, a prenatal lab screen is done to determine the mom's maternal AB titer. The presence of a positive titer 1:16 or greater is evidence of immunity. A negative titer indicates susceptibility to rubella, what is this?
Definition
Maternal AB titer < 1:8 = susceptibility
Term
Once a woman is pregnant, can she get the rubella vaccine?
Definition
No, mom can NOT be vaccinated DURING pregnancy for Rubella. It is a live attenuated virus. All women of childbearing age who receive the rubella vaccine should carefully avoid pregnancy for at least 3 months. It is considered safe for newly vaccinated children to have contact with pregnant women.
Term
Infants who are born with congenital rubella syndrome are infectious & should be _____________. What are these infants long-term effects?
Definition
isolated. these infants continue to shed the virus for months. Long-term effects on these infants are increased incidence of insulin-dependent DM, sudden hearing loss, glaucoma, and a slow, progressive form of encephalitis.
Term
Cytomegalovisurs (CMV) belongs to the herpes virus group... the significance of this virus in pregnancy is related to its ability to be transmitted by asymptomatic women ACROSS THE PLACENTA or the CERVICAL ROUTE DURING BIRTH. It is the most __________.
Definition
common
Term
CMV (Cytomegalovirus) is in over 1/2 of the adults in the US. It a chronic, persistent infection. CMV is the most frequent cause of viral infection in the human fetus, infecting 0.5%-2.5% of all newborns. Of these, what is the mortality rate for a symptomatic newborn with CMV?
Definition
30%
Term
What effects can CMV have on an infant? At present, no treatment exists for maternal CMV or for the congenital disease in the neonate.
Definition
FETAL DEATH, MICROCEPHALY, MENTAL RETARDATION
Term
_____________ infection of Herpes (Type 1 & 2) presents the greatest risk to newborns.
Definition
Primary (they have a high viral load in blood & the baby is born herpetic)
Term
Primary infection has been associated with:
Definition
spontaneous abortion, low birth weight, and preterm birth.
Term
50% of infants are infected born vaginally to a mother who is a experiencing a primary genital infection will develop some form of a herpes infection. Of these, there is a ___% mortality rate
Definition
60
Term
If the children do survive, 50% will have high risk of:
Definition
microcephaly, mental retardation, seizures, retinal dysplasia
Term
If the mother has active herpes (type 1 & 2) lesions, what is done?
Definition
deliver by C-section asap after rupture of membranes. If there is not active lesions, they will deliver vaginally.
Term
An infection that puts a risk on pregnancy is a Urinary Tract Infection. When should Cystitis (lower UTI) be treated?
Definition
ASAP
Term
Cystitis (lower UTI) needs to be treated ASAP to prevent an ascending infection that causes PYELONEPHRITIS in the kidneys. What may happen if pyelonephritis is developed? how should it be treated?
Definition
Pyelonephritis may cause preterm labor. It is difficult to treat... give IV antibiotics.
Term
Bacterial Vaginosis may be a cause of ____-_______ labor.
Definition
pre-term.
Term
What is bacterial vaginosis?
Definition
overgrowth of bacteria in vagina (thin, watery, yellow, grey discharge that is "fishy") Treatment Flagyl or Metronidazole. These may cause teratogenic effects in the 1st TM, she said & some HC providers will not prescribe. Book says there are no teratogenic effects to Metronidazole.
Term
HIV is an infection that we know perinatal (mother to child) transmission usually occurs. It CAn be transmitted via breast milk. What drug significantly reduces the transmission rate of HIV from mom to baby?
Definition
zidovudine (ZDV) given to pregnant women infected with HIV and their newborns reduced the risk of HIV infection from 25% to 5%. KNOW... if treated with ZDV therapy in pregnancy it significantly reduces impact to the fetus! It doesn't even have to be long-term, the 1st few weeks before delivery helps...
Term
Does a c-section increase or decrease the risk of vertical (mother to baby) transmission?
Definition
C-section will decrease the risk of HIV tranmission
Term
Anemia indicates inadequate levels of hemoglobin in the blood. During pregnancy, anemia is defined as hemoglobin less than ___.
Definition
10
Term
Having low hemoglobin (iron deficiency anemia) less than 10 will increase susceptibility to what during pregnancy?
Definition
increased risk for infection, fatigue, there is less reserve for blood loss at delivery.
Term
Anemia is Hemoglobin less than 10. Iron deficiency anemia is hemoglobin less than __.
Definition
11
Term
Anemias during pregnancy are due to either insufficient hemoglobin production related to nutritional deficiency in iron or folic acid during pregnancy or to hemoglobin destruction in an inherited disorder such as ________ ________ anemia.
Definition
sickle cell
Term
What may happen to a person who has sickle cell anemia during pregnancy?
Definition
they may see an increase in a sickle cell crisis. (Increased destruction of Hemoglobin?) The mom is at increased risk for infection, especially URINARY TRACT INFECTIONS.
Term
What are the DANGER SIGNS IN PREGNANCY? (The woman should report these danger signs asap)
Definition
Dizziness, blurring of vision, double vision, spots before eyes (scotoma), severe persistent headache, edema of HANDS, FACE, legs & feet, RUQ pain (eigastric), oliguria (decreased or absent urine), muscular irritability or convulsions (all previous are signs of preeclampsia=hypertension). Other signs to report: persistent vomiting beyond first trimester or severe vomiting at any time, sudden gush of fluid from vagina, vaginal bleeding, chills or fever (greater than 38.3/101), burning on urination, abd pain that persistent or intermittent could be preterm labor or abruptio placentae, the absence of fetal movement.
Term
Adolescent Pregnancy, what is it like in US?
Definition
although there has been a decline in adolescent birth rates in the US, we still have one of the highest adolescent birth rates among industrialized countries. It doubles the adolescent birth rates in Canada & England, it is 10 times higher than in Japan.
Term
The incidence of sexual activity statistics are very similar (decline, but it's still really high) in adolescents. Research suggests the differences are due to:
Definition
Family influence (whether it is present), openness about sexual activity, access to contraceptives, comprehensive sexual education.
Term
_____________ is a major risk factor for adolescent pregnancy. (what SES?) What is their educational level?
Definition
Poverty & low educational achievement are big risk factors for adolescent pregnancy. In the US, the adolescent birth rate is higher among African Americans and Hispanic teens than among white teens. However, pregnancy rates in these groups are declining and, since 1991, the rate for black teens ages 15-17 has been cut in half. To some degree the higher teen pregnancy rate in these groups reflects the impact of poverty, as a disproportionately higher number of african americans and hispanic youths live in poverty.
Term
Among Adolescents there is tremendous peer pressure to become sexually active during the teen years & this high risk behavior contributes to higher adolescent birth rates. What other high risk behavior is a concern?
Definition
It's not uncommon to have multiple partners and lack contraceptive use. Many teens lack accurate & adequate knowledge about contraceptive options. This is common topic of sex education programs, but there is debate about the appropriateness of such programs in schools. Does sex education promote sexual actitity? No, research on sex education reveals it does not increase initiation of sexual activity at an earlier age.
Term
When do teens begin prenatal care?
Definition
Teens tend to begin prenatal care later in pregnancy
Term
Therefore, teens are at an increased risk for:
Definition
pre-term birth, low-birth weight babies, cephalopelvic disproportion (head will not fit through mom's pelvis), iron deficiency anema, preeclampsia (HTN) - eclampsia (seizures)
Term
There are higher incidences of sexually transmitted infections in adolescence & this presents an increased risk for the _________.
Definition
fetus
Term
The rate of adolescent pregnancy in the US is among the highest of all the developed countries of the world. true or false?
Definition
true
Term
What is an emancipated minor?
Definition
minors that assume the rights of adults. the pregnant adolescent, even if very young, is generally considered emancipated and has the RIGHT TO MAKE HEALTHCARE DECISIONS FOR HERSELF AND THE BABY. she has a right to CONFIDENTIALITY. ONLY WITH HER AGREEMENT CAN OTHER ADULTS, INCLUDING HER PARENTS, BE INCLUDED IN COMMUNICATION.
Term
If they are unwed, does the father's name on the birth certificate establish paternity rights or responsibility?
Definition
NO! The father of the baby needs to sign a witnessed/notarized affidavit accepting paternity.
Term
What is the general schedule for prenatal care?
Definition
First visit by 3 months, Every 4 weeks for 28 weeks, every 2 weeks until 36 weeks, Then, every week until delivery. There are 12 to 13 visits in a full-term pregnancy.
Term
What info is obtained in the initial maternal visit?
Definition
General health history, Obstetrical History (current pregnancy, past pregnancies, determination of due date), Physical exam & lab tests
Term
It is important to find out the date of the last normal menstrual period (LNMP). why?
Definition
it's an imp piece of information b/c it helps determine due date. USE the "FIRST DAY" of the LNMP. It's also important to assess for a "normal" period (is it usually light or heavy?), assess for presence of spotting or bleeding.
Term
What are some terms used that mean the same thing as the "estimated due date"?
Definition
estimated date of confinement, estimated date of delivery, estimated date of birth
Term
the due date is "estimated!" true or false?
Definition
true - it is an estimation
Term
a Gestation Calculator is used to calculate the due date. where do you put the arrow for 1st day of last period?
Definition
on the date of the woman's LMP... then read the EDB at the arrow labeled 40.
Term
How would you calculate Nagele's Rule to get the EDB? (not used in practice, but is in test questions)
Definition
Begin with the first day of the LMP & subtract 3 months. Add 7 days & that is the estimated date of birth. (Always give February 28 days) - It is simpler to turn months into numeric terms
Term
___________ is the number of pregnancies regardless of outcome. (ALWAYS COUNT THE CURRENT PREGNANCY AS ONE, students ALWAYS FORGET THIS!)
Definition
GRAVIDA
Term
________ is the number of births AFTER 20 WEEKS of gestation. (This includes stillbirths and live births.)
Definition
Para
Term
_____________ are any birth BEFORE 20 WEEKS of gestation.
Definition
Abortions
Term
LIVING CHILDREN (LC) may also be included in some assessments. true or false/
Definition
true
Term
What is SAB?
Definition
Spontaneous Abortion. (In lay terms it is a miscarriage)
Term
A useful acronym for OB history/past pregnancies is TPAL. what does it stand for?
Definition
Term, Preterm, Abortion, Living Children
Term
What does EAB, TAB and VIP mean?
Definition
They all mean the same thing - Elective Abortion, Therapeutic Abortion & Voluntary interruption in pregnancy.
Term
If the mom is having twins, triplets... how are they counted in gravida & para?
Definition
they are counted as ONE PREGNANCY and ONE BIRTH.
Term
What are normal findings for mucosa during pregnancy?
Definition
It's normal for it to be redder, in pregnancy nasal mucosa is edematous in response to increased estrogen, resulting in nasal stuffiness (rhinitis of pregnancy) and nose bleeds are normal findings
Term
The pregnant woman may have palpitation occuring in her heart and short systolic murmurs - its this normal or need to be reported?
Definition
this is normal (thrills, thrusts, gross irregularity, skipped beats, extra sounds are not)
Term
A Pelvic Exam is done at the first visit. some things assessed are...
Definition
Uterine size assessed in relation to gestational dating, a pap smear is usually done, cultures are obtained for sexually transmitted infections and vaginal infections
Term
Lab tests done on the first visit are a CBC... what H & H indicates anemia?
Definition
Hgb less than 12 = anemia (this is a concern b/c anemia & hemodilution happen w/ pregnancy already - so below 12 is a concern!)
Term
Want to assess the mothers blood type & Rh. Note if the mom is Rh ___________.
Definition
negative
Term
What other tests are we going to do for labs on the first visit?
Definition
Urinalysis (to id alterations in the urine), Rubella titer (HAI titer of 1:10 indicates immunity, anything less is a concern), Hep B screen, HIV screen (w/ pt approval), Sickle-cell screen as indicated
Term
What is assessed at subsequent antepartum assessments?
Definition
Weight (want mom gaining so baby has enough for development), Vitals Signs (this is usually just BP!), Urine Test for Glucose, Protein & possibly Ketones. Going to look for Fetal Heart Tones at 10-12 weeks, Fetal Activity (date of quickening, "kick counts"... fetal activity monitoring (have woman keep track at home sometimes & bring report back next visit)
Term
How much weight is gained total for a normal/healthy pregnancy?
Definition
25-35 lbs
Term
During the first trimester, second & third trimesters - how much weight is gained?
Definition
1st: 0-4 lbs, 2nd: ~12 lbs, 3rd: ~12 lbs (1 lb/week is normal)
Term
Sudden, excessive weight gain is a sign of...
Definition
PIH (Pregnancy Induced Hytpertension)
Term
What VS is most critical? What is normal?
Definition
BP. It is normal for BP to decrease slightly in the second trimester
Term
BP greater than _________ or an increase of 30 systolic and 15 diastolic may indicate PIH.
Definition
140/90+
Term
What is the deal with glucose on the urine dipstick during pregnancy?
Definition
Glycosuria may be present due to physiologic alterations of pregnancy, but persistent glycosuria (seen 1/2 way through pregnancy) is a sign of gestational diabetes.
Term
What if proteins are found on the urine dipstick?
Definition
Never normal, Proteinuria (albuminuria) is a sign of PIH
Term
What about ketones on a urine dipstick?
Definition
This could be associated with the changes in CHO metabolism or "not having eaten". If the mom does not eat then ketones will show up in her urine.
Term
Can Fetal Heart Tones be "heard" in the first trimester?
Definition
No, they are difficult to hear prior to 10-12 weeks of gestation. Fetal Heart Activity can be seen by sonogram as early as 5 weeks though.
Term
When does Quickening (1st fetal movement perceived by mom) occurs differently for a multigravida (had a baby before) and a primigravida (1st baby)... at what week?
Definition
14-16 weeks for multigravida (earlier). At 18-20 weeks for primigravida (little bit later)
Term
Fundal height is an indicator of _________ size
Definition
uterine - the cm's will correlate with weeks of pregnancy
Term
The fundal height adds to assessment data about the estimated date of delivery. McDonald's method measures from where to where?
Definition
a cm tape measures the distance abdominally from the top of the symphisis pubis to the top of the uterine fundus. Fundal height in cm's correlates well with weeks of gestation between 22 to 24 weeks and 34 weeks. Thus at 26 weeks gestation, the fundal height is about 26 cm's. The woman should void 30 min's prior to exam. In the 3rd trimester, the fundal height measurements are not accurate b/c of the fetal weight. NOTES SAID: FUNDAL HEIGHT CORRELATES WITH WEEKS OF GESTATION BETWEEN 22 TO 24 WEEKS TO 34 WEEKS. (McDONALDS METHOD)
Term
If the fundal height is greater than expected... what are 3 possibilities?
Definition
multiple pregnancy, hydraminos (increased amniotic fluid), molar pregnancy (an overgrowth of tissue that results in uterus being larger than expected)
Term
At 16 weeks, where should the fundal height be? this is a landmark...
Definition
expect 1/2 way between symphis pubis and umbilicus. that's a landmark - after that we can start measuring.
Term
What labs are evaluated later?
Definition
Hgb & Hct are assessed at 36 weeks b/c it's when blood volume peaks & have greatest hemodilution, may do a triple screen/multiple screen marker which tests 3 factors: MSAFP (maternal seruma alpha-fetoprotein), Estriol and hCG - tests for neural tube defects, downs syndrome, etc... not mandatory, but may be done. A 50 g, 1 hr. Glucose Screen is routine. This is done between 24-28 weeks to id gestational diabetes. Antibody screen - looking for any atypical antibodies.
Term
Teach about the common discomforts of pregnancy in the 2nd & 3rd trimester & what to do... pg. 233
Definition
heartburn/pyrosis (eat small, more frequent meals, antacids, avoid lying down right after eating), ankle edema (practice dorsiflexion of feet when prolonged sitting or standing is necessary, elevate legs when sitting or resting, avoid tight bands around legs), Varicose Veins (elevate legs frequently, wear support hose, avoid crossing legs at knees), hemorrhoids (avoid constipation, apply ice packs, warms soaks/sitz baths helps), constipation (increase fluids, fiber in diet and exercise, use stool softeners), Backache (practice pelvic tilt exercise, avoid high heels), leg cramps (imbalance of calcium/phosphorus ratio, practice dorsiflexion of feet to stretch affected muscle)
Term
The antibody screening test (Coomb's test) is important for the Rh negative woman who may be pregnant with an Rh-positive fetus bc it indicates whether the woman is sensitized to the Rh antigen. The test measure the # of antibodies in the _____________ blood.
Definition
maternal
Term
There is an antibody screen at 28 weeks. If the mm is Rh negative, the woman is given ____________ intramuscularly as a prophylactic preventative measure.
Definition
Rhogam - provides a passive antibody protection against Rh antigens. This "tricks" the body, which does not then produce antibodies of its own (active immunity).
Term
What is done if an Rh - woman (father is Rh+ or unknown) and she has an abortion... ?
Definition
She needs to be treated with Rhogam
Term
The Rh- mom gives birth to an Rh+ fetus... what should be done
Definition
Rhogam IM within 72 hours of birth (so she doesn't have time to produce antibodies to the fetal cells)
Term
If the mom's indirect Coomb's test is negative and the infant's direct Coomb's test is negative (confirming that sensitization has not occured)... what is done?
Definition
the mom is given Rh immune globulin within 72 hours of birth
Term
If the mom's indirect Coomb's test is positive and her Rh positive infant has a positive direct Coomb's test... what is done?
Definition
Rh immune globulin is NOT given, in this case, the infant is carefully monitored for hemolytic disease.
Term
When should Rh immune globulin be given prenatally?
Definition
at 28 weeks
Term
How do we prevent Rh sensitiation?
Definition
administer Rhogam (Rh immune globulin)
Term
Is Rh immune globulin administered after an abortion?
Definition
Rh Immune globulin is also administered after each abortion (spontaneous or therapeutic), ectopic pregnancy (egg implants in fallopian tube instead of uterus), amniocentesis (amniotic fluid test)
Term
Tests are done to provide information about...
Definition
growth of the fetus... this relates to gestational age, presence of congenital abnormalities, location of the placenta, and fetal lung maturity
Term
What does vigorous activity and marked decrease in activity of the fetus indicate?
Definition
vigorous activity generally provides reassurance of fetal well-being while a marked decrease in activity or cessation of movement may indicate possible fetal compromise that requires immediate evaluation.
Term
one method to tracking fetal activity is the "Cardiff count-to-ten method." how would you teach a woman to do this?
Definition
Beginning at 27 weeks gestation, keep a daily record of fetal movement. Try to begin counting at about the same time each day, about 1 hour after a meal if possible. Lie quietly in a side lying position. Using the Cardiff card, have the woman place an X for each fetal movement until she has recorded 10. Movement varies considerably, but most women feel fetal movement at least 10 times in 3 hours. (remember, the fetus sleeps 20-22 hrs day)
Term
Ultrasounds can be done transabdominal or endovaginal. She needs to have her bladder full for a TRANSABDOMINAL ultrasound. what are the multiple uses of an ultrasound?
Definition
early identification of pregnancy, observation of fetal heartbeat and fetal breathing movements, identifying more than one embryo or fetus, measurement of the bipareietal diameter of the fetal head or the fetal femur length, clinical esitmations of birth weight, detection of fetal anomalies such as anencehaly and hydrocephalus, exam of nuchal translucency in the first trimester to assess for Down syndrome ad other fetal anomalies, exam of fetal cardiac structures, id the amniotic fluid index, location of the placenta, placental grading, detection of fetal death, determination of fetal position and presentation.
Term
Is an ultrasound "routine?"
Definition
NO, an ultrasound is NOT a routine test
Term
Is an ultrasound medically indicated to determine gender?
Definition
NO, an ultrasound is NOT medically indicated for gender determination.
Term
The Nonstress Test (NST) is used alone or as part of the biophysical profile. What is the test based on?
Definition
Based on accelerations of the fetal heart rate with fetal movement in a "healthy" fetus. This requires electronic fetal monitoring. (book said:the nonstress test is based on the knowledge that when the fetus has adequate oxygenation and an intact CNS, there are accelerations of the fetal heart rate w/ fetal movement. An NSR requires an electronic fetal monitor to observe & record these fetal heart accelerations
Term
A __________ test: shows accelerations (at least 2) of 15 bpm above the baseline, lasting 15 sec or more in a 20-min window, are present, indicating fetal well-being.
Definition
reactive (this is good-you want this)
Term
A __________ test: does not meet the reactive criteria. The accelerations are not present indicating the fetus is at risk or asleep.
Definition
nonreactive
Term
If a nonreactive test happens, what is done to stimulate the fetus?
Definition
stimulate the fetus by sound or vibration. these measures often wake a fetus so a reactive NST can be obtained. If it is not, further tests are done.
Term
A biophysical profile (BPP) is an NST plus...
Definition
an ultrasound. The ultrasound is done to measure: fetal breathing movements, gross body movements, fetal tone (this is good, don't want flaccid/limp), amniotic fluid volume
Term
The complete Biophysical Profile looks at 1)Reactive FHR w/ activity (reactive NST) 2)Fetal Breathing movement 3)fetal movement of body or limbs 4)amniotic fluid volume 5)fetal tone. How is this scored?
Definition
Each of the 5 measures has a maximum score of two. A score of 8 to 10 indicates a healthy fetus.
Term
The contraction stress test (CST) is a means of evaluating...
Definition
respiratory function of the placenta. If contractions are not present, they will stimulate contraction with IV pitocin or breast stimulation (BST). Fetal monitoring is done to evaluate the FHR in response to uterine contractions. During a uterine contraction, the blood and oxygen supply to your baby drops for a short time. This is not a problem for most babies. But the heart rate of some babies gets slower. This change in heart rate can be seen on the external fetal monitoring device. Look for "LATE DECELERATIONS" that are a sign of fetal distress. These are evaluated as negative or positive.
Term
What is an amniocentesis?
Definition
obtaining amniotic fluid for testing. The bladder should be EMPTY. This is not w/o risk, it is optional. Done to test for anomalies.
Term
What does the amniocentesis provide info about?
Definition
genetic disorders, fetal health, fetal lung maturity (LS ratio and PG level).
Term
What is the LS ratio and PG level?
Definition
(Found online: The lecithin/sphingomyelin (l/s) ratio and phosphatidyl glycerol (pg) tests are two ways of measuring the fetal maturity of your baby's lungs. Used in combination, they give the doctor a unique ability to determine whether a baby will be able to breathe after delivery, or whether it will need the aid of a respirator.)
Term
A Contraction Stress Test demonstrates reaction of FHR to stress of uterine contractions. Results are either:
Definition
Negative or Positive. A negative test shows 3 contractions of good quality lasting 40 or more seconds in 10 minutes without evidence of late decelerations. This is the desired result. It implies the fetus can handle the hypoxic stress of the uterine contractions. (Don't need to know all details, just about the test & "negative" is what's desired)
Term
The triple test marker is a triple marker. It is commonly used by taking ....
Definition
maternal blood
Term
What does the triple test marker test for?
Definition
It identifies substances in the amniotic fluid that provide info about the health status of the fetus. Specifically, it looks at Alpha-fetoprotein (AFP), Human chorionic gonadotropin (hCG), Unconjugated estriol (UE3). THE TRIPLE TEST MARKER IS THE OST WIDELY USED TO SCREEN FOR DOWNS SYNDROME, TRISOMY 18 AND NEURAL TUBE DEFECTS. (all this info was on the outline)
Term
The first few hours of life when the newborn stabilizes respiratory and circulatory functions is called the _______________ transition.
Definition
neonatal
Term
The nursing goals during the neonatal transition are to identify actual or potential problems that may require immediate or emergency attention. true or false?
Definition
true - identify any resuscitative measures asap
Term
The initiation of respiration in the newborn requires 2 radical changes for the lungs to function:
Definition
1) pulmonary ventilation must be established through lung expansion following birth 2) a marked increase in the pulmonary circulation must occur
Term
The first breath of life-the gasp is in response to mechanical, sensory and thermal stimuli initiates the opening of the alveoli. give examples...
Definition
mechanical stimulation: vaginal canal is compressing & squeezes the fetus. sensory stimulation: dry w/ warm towel, soles of feet to cry. thermal stimulation: put under warmer.
Term
WHat are the 3 factors opposing the babies first breath?
Definition
1) alveolar surface tension 2) viscosity of lung fluid within the respiratory tract, and 3) degree of lung compliance.
Term
The alveolar surface tension would cause the alveoli to collapse between each inspiration were it not for the presence of ________________.
Definition
surfactant
Term
Lecithin/Sphingomyelin (L/S Ratio must be __:__ to support breathing and oppose the alveolar surface tension.
Definition
a ratio used to determine fetal pulmonary maturity, found by testing the amniotic fluid; when the lungs are mature, lecithin exceeds sphingomyelin by 2 to 1.
Term
The greater _________ volume contributes to the conversion of fetal circulation to newborn circulation... a successful transition to extrauterine life.
Definition
blood
Term
Is shunting of blood common in a newborn? (bidirectional blood flow, or right-to-left shunting?)
Definition
Yes, this is common in the newborn period
Term
The cardiovascular system adapts in a newborn. The onset of ________________ triggers increases blood flow to the lungs after birth.
Definition
respiration
Term
Where are the major areas of change in the cardiopulmonary adaptation?
Definition
1) INCREASED AORTIC PRESSURE AND decreased venous pressure 2) INCREASED SYSTEMIC PRESSURE and decreased pulmonary artery pressure 3) closure of foramen ovale 4) closure of ductus arteriosus 5) closure of ductus venosus READ pg. 567-568 AGAIN!
Term
Who has greater oxygen saturation, a newborn or an adult?
Definition
The oxygen saturation is greater in a NEWBORN than an adult. (fetal Hgb is still attached to RBC's & has an increased affinity for the oxygen molecule)
Term
The oxygen saturation is better in a newborn's blood, but what is the catch with newborns?
Definition
The amount of oxygen that is available for the tissues is LESS. (this is why you can't rely on oxygen though. Look at the pt, not just the monitor!)
Term
What is the average newborn resting heart rate (when they are in a quiet & alert state)?
Definition
120-160 beats/min
Term
What is the average BP for a full-term, resting newborn that is over 3 kg during the first 12 hours of life?
Definition
50 to 55 mm Hg
Term
__% of murmurs in newborns are transient and not associated w/ anomalies.
Definition
90
Term
What is the normal newborn RR?
Definition
30 to 60 breaths per minute
Term
The baby is displaying a breathing pattern that has pauses lasting 5-15 seconds. What is this? Is the baby okay?
Definition
Periodic Breathing - it is rarely associated skin color or heart rate changes, and it has no prognostic significance. (Cessation of breathing for more than 20 seconds is apnea & is abnormal)
Term
Is some cyanosis or acrocyanosis normal at birth?
Definition
Yes, it's normal for several hours, thereafter the infants color improves steadily.
Term
The newborn's initial respirations are largely diaphragmatic and shallow. They're irregular in depth & rhythm.... what are you going to do as the nurse?
Definition
Nothing, this is normal
Term
What happens to a newborns hematocrit? why?
Definition
it may RISE 1 to 2 g/dL above fetal levels. Happens as a result of placental transfusion, low oral fluid intake, and diminished extracellular fluid volume.
Term
What happens to a newborns hemoglobin?
Definition
it declines progressively over the first 2 months of life. (This is why it's imp for babies to be on iron fortified cereals)
Term
Why is a leukocytosis a normal finding in a newborn if they are not sick?
Definition
The increase in WBC is normal b/c the STRESS OF BIRTH stimulates production of neutrophils in the babies first few days.
Term
How much blood volume is in a term infant?
Definition
An infants blood volume is estimated to be 80 mL/kg of body weight. (There is not a lot of blood in new babies! Why we must accurately measure blood withdrawals.)
Term
Answer: What is the blood volume of an 8 lb. (3.6 kg) newborn?
Definition
80 mL : 1 kg = X mL : 3.63 kg x=290.4 290 mL blood volume in the infant
Term
Blood volume varies for the newborn depending on: (pg. 570)
Definition
1) DELAYED CORD CLAMPING AND THE NORMAL SHIFT OF PLASMA TO THE EXTRAVASCULAR SPACES (hold baby below level of placenta & delayed clamping of the cord increases blood volume 50%) 2) GESTATIONAL AGE (positive correlation for age, RBCs and Hgb) 3) A SIGNIFICANT PRENATAL OR PERINATAL HEMORRHAGE decreases blood volume 4)THE SITE OF THE BLOOD SAMPLE (venous blood sites are more accurate)
Term
A newborn is at a distinct disadvantage in maintaining a normal temperature. A newborn has poor thermal stability due to excessive _______ _______ (rather than having impaired production).
Definition
heat loss
Term
The newborn's impaired thermoregulation is closely related to ..
Definition
their high rate of METABOLISM, OXYGEN CONSUMPTION, AMOUNT OF BROWN FAT AND SUBCUTANEOUS TISSUE. Book says: the transfer of heat in a NB from core to skin is transferred by increasing oxygen consumption, depleting glycogen stores and metabolizing brown fat). Brown fat is the primary source of heat in the cold newborn (it's located on the babies upper chest/shoulders, down trachea/esophagus, on back in chunk on mid spine & 2 other spot - picture pg. 573)
Term
How else does a baby thermoregulate?
Definition
increases metabolic demands and/or increased oxygen demands can quickly deplete glycogen stores leading to hypoglycemia.
Term
So, is it important to keep babies in a normal temperature range?
Definition
Yes, very important
Term
A newborns blood sugar should be maintained about ___ mg/dl.
Definition
50
Term
Neonatal hypoglycemia is defined as a blood sugar below __ mg/dl.
Definition
40
Term
What are the 1st s/s of neonatal hypoglycemia?
Definition
jitteriness, lethargy (baby won't wake to eat), feeding problems, temperature instability
Term
what should you do if a newborn is hypoglycemic?
Definition
institute the hospital's protocol.. usually it is formula feed, there is no time to breastfeed
Term
Heat is lost from the body in 4 ways: Convection, Radiation, Evaporation & Conduction. Explain CONVECTION...
Definition
Is the loss of hear from warm body surface to the cooler air currents. ex/ mom has a fan, being in air conditioned rooms, removal form incubator
Term
explain RADIATION:
Definition
Heat loss occurs when next to a colder surface. Ex/ placed next to a wall or window are potential causes of heat loss by radiation.
Term
Explain Evaporation:
Definition
loss of heat when water is converted to vapor. Ex/ heat loss is quick right after birth and during baths - drying the newborn is critical.
Term
The newborn has several mechanisms to produce heat (thermogenesis). what are they?
Definition
** Mechanisms to increase heat are: 1) increased basal metabolic rate 2) muscular activity 3) nonshivering thermogenesis - this chemical process converts brown fat into heat energy.** (shivering/muscular activity does little to produce heat & means their metabolic rate has already doubled. nonshivering thermogenesis is the primary source of heat in newborns.
Term
What characteristics predispose newborns to heat loss:
Definition
BLOOD VESSELS CLOSE TO SKIN, NO SHIVERING ABILITY, LARGE BODY SURFACE AREA (BSA) RELATIVE TO THEIR WEIGHT, LACK OF SUBCUTANEOUS FAT, CAN'T ADJUST THEIR OWN CLOTHING OR BLANKETS WHEN THEY ARE COLD, CAN'T COMMUNICATE WHEN THEY ARE COLD.
Term
how can we prevent hypothermia in newborns?
Definition
bring blanket warmers, put baby in 'radiant' warmer/warm bed, turn off fans in delivery room, dry baby asap to avoid evaporation, skin to skin contact helps, early breast feeding, ensure that oxygen is warm/humidified if used, don't bathe until temp is stabilized at 98.6, swaddle in blankets
Term
When is physiologic jaundice normal in a newborn?
Definition
It is normal AFTER THE FIRST 24 HOURS of LIFE. (it's never normal in the 1st 24 hrs)
Term
why does natural physiologic jaundice occur?
Definition
accelerated destruction of fetal RBC's, impaired conjugation of bilirubin, increased bilirubin reabsorption from intestinal tract.
Term
What is the definition of the conjugation of bilirubin?
Definition
it's the conversion of yellow lipid soluble pigment into water-soluble pigment (conjugated form-Direct billi)
Term
Unconjugated (indirect) bilirubin is breakdown product that is:
Definition
derived from hemoglobin, released primarily from destroyed RBCs, unconjugated bilirubin is not an excretable form in utero and crosses placenta to be broken down by mother's liver
Term
Conjugated (direct) + Unconjugated (indirect) bilirubin = Total serum bilirubin. What are the levels shortly after birth? Levels should not be greater than...
Definition
Total serum bilirubin is less than 3 mg/dl shortly after birth. Levels should not be greater than 12. Levels of 20 or greater ae considered knicterus and may cause permanent CNS damage.
Term
What is conjugated (direct) bilirubin again?
Definition
conversion of yellow lipid soluble pigment into water-soluble pigment
Term
what is unconjugated (indirect) bilirubin?
Definition
it's a breakdown product. Derived from Hemoglobin. Released primarily from destroyed RBCs (unconjugated bilirubin is not in excretable form in utero & crosses and crosses placenta to be broken down by the mom's liver.)
Term
What newborn care is necessary to decrease the probability of high bilirubin levels?
Definition
maintain newborns skin temp at 36.5 C (97.8 F) or above. Monitor stool for amount and characteristics (not stooling keeps bilirubin in). Encourage early and frequent feedings. Sunlight helps to conjugate bilirubin.
Term
What is breastfeeding jaundice?
Definition
jaundice that occurs in the first days of life in breastfed newborns. This is associated with poor feeding practices. Encourage feeding! may be feeding every 1.5-2 hrs
Term
How do we prevent breastfeeding jaundice?
Definition
encourage frequent breast feeding, avoid supplementation if you can, access maternal lactation counseling
Term
Know normal bilirubin. What is it?
Definition
Anything 12+ is NOT normal.
Term
The LIVER plays an important part in blood coagulation during the fetal life and continues this function to some degree during the first few months after birth. Coagulation factors II, VII, IX, and X (are synthesized in the liver) and are activated under the influence of _______________.
Definition
Vitamin K (the blood coagulation factors 2, 7, 9, & 10 are considered dependent on vitamin K to develop)
Term
Why is Vitamin K levels naturally low at birth?
Definition
The ABSENCE OF NORMAL FLORA NEEDED TO SYNTHESIZE VITAMIN K IN THE NEWBORN GUT RESULTS IN THE LOW LEVELS OF VIT K AND CREATES A TRANSIENT BLOOD COAGULATION ALTERATION BETWEEN THE 2ND AND 5TH DAY OF LIFE.
Term
When is Vit K given to the newborn & why?
Definition
Vit K is given prophylactically on the day of birth to combat potential clinical bleeding problems. Vit K PREVENTS HEMMORHAGIC DISEASE OF THE NEWBORN.
Term
By __ to __ weeks gestation, the gastrointestinal system is adequately mature, with enzymatic activity and the ability to transport nutrients.
Definition
36-38 weeks gestation (So, the full-term newborn has sufficient intestinal and pancreatic enzymes to digest most simple carbohydrates, proteins & fats)
Term
The only enzyme lacking is pancreatic _____________ in the newborn.
Definition
amylase (it will remain deficient during the first few months of life)
Term
B/c of the lacking enzyme (pancreatic amylase), Newborns have trouble digesting __________________.
Definition
Starches
Term
Newborns also digest & absorb _______ less efficiently.
Definition
fats
Term
However, ___________ are well digested and absorbed by the newborn intestine.
Definition
proteins
Term
_______ enters the stomach immediately after birth.
Definition
air
Term
How big is the newborn's stomach capacity? not very big...
Definition
50-60 mL (IMPORTANT to know that, it's not very large.
Term
Considering the size of a babies stomach, how much should be fed & how often burped?
Definition
Feed 30-50 mL's. Burp after every 1/2 oz (15 mL).
Term
When are bowel sounds present in a newborn?
Definition
bowel sounds are present within the first 30-60 minutes of birth and the newborn can successfully feed at this time.
Term
What happens b/c the cardiac sphincter is immature? What will help?
Definition
Regurgitation. Avoid overfeeding.
Term
How many calories per kg does the newborn require to gain weight?
Definition
120 cal/kg/day is required to gain weight
Term
A full-term newborn will usually pass their first meconium within ___ - ___ hours.
Definition
8-24 (this is important, if a baby does not pass their first stool w/in 24 hrs - call the physician)
Term
Where is the first meconium from? what's it look like (tell parents not to be alarmed)
Definition
the meconium is formed in utero from the amniotic fluid and its constituents, intestinal secretions, and shed mucosal cells. It is recognized by its thick, tarry black or dark green appearance. <-- normal stool
Term
The term newborn's kidneys have full complement of functioning nephrons by ___ to ___ weeks gestation.
Definition
34-36 (just before GI system that is 36-38 weeks)
Term
What is the GFR rate of a newborn compared to an adult?
Definition
newborn's GFR is lower than an adults. Because of this, the newborn cannot eliminate water rapidly when it is necessary.
Term
Full term newborns cannot concentrate urine because...
Definition
their tubules are short and narrow.
Term
Also, urine is not well concentrated in newborns because..
Definition
there is limited tubular reabsorption of water and limited excretion of solutes (principally sodium, potassium, chloride, bicarbonate, urea and phosphate) in the growing newborn.
Term
In the first few days after birth (postnatally) the newborn voids how much?
Definition
2-6 times a day with a urine output of 15 mL/day.
Term
How much does the newborn subsequently void?
Definition
5 to 25 times every 24 hours, with a volume of 25 mL/kg per day.
Term
The newborns immune system is not fully activated until some time after birth. There are limitations in the newborn's ________________ response & this results in failure to recognize, localize & destroy invasive bacteria.
Definition
inflammatory
Term
The newborn has a poor hypothalamic response (what controls body temperature) and so TEMPERATURE is NOT A RELIABLE INDICATOR OF INFECTION. In the neonatal period (first 28 days of life) _____________ is a more reliable sign of infection.
Definition
Hypothermia
Term
The newborn who breast feeds has increased IgA immunoglobulin which helps with imunity. This does not prevent everything though. What should be taught to new parents to avoid infection?
Definition
Avoid crowds in flu season or letting people hold the baby that are obviously sick.
Term
The period of immunity in a newborn varies. About how long do they have immunity to common viral infections such as measles? What about to bacteria?
Definition
immunity to common viral infections like measles may last = 4-8 months. Immunity to certain bacteria may disappear within 4-8 weeks.
Term
Can a normal newborn produce antibodies in response to an antigen? When do immunizations (to develop active acquired immunity) start?
Definition
The normal newborn can produce antibodies in response to an antigen but not as effectively as an older child does. Immunizations start at 2 months of age (they can then develop active acquired immunity).
Term
Because IgM does not normally cross the placenta, elevated levels at birth may indicate placental leaks or that newborn was exposed to _________.
Definition
TORCH (Toxoplasmosis, Other=beta strep, hep B, Rubella, Cytomegalovirus, Herpes Simplex Virus)
Term
The newborn lacks the maternal IgM and makes them more susceptible to...
Definition
gram negative organisms (like E. Coli)
Term
IgG is obtained when?
Definition
IgG is Passive Acquired Immunity. It is passed in utero primarily during the 3rd trimester (pre-term infants are more at risk for infection w/o this)
Term
With "passive acquired immunity" - does the fetus produce antibodies itself?
Definition
No, the fetus is not producing its own antibodies, rather antibodies from the mom are being passed in utero.
Term
What happens during a newborns initial period of reactivity? how long does it last?
Definition
The first period of reactivity lasts about 30 minutes after birth, the new baby is awake and active, they have a strong sucking reflex right away and this is a natural oportunity to initiate breast feeding.
Term
After the initial period of reactivity is a sleep phase...
Definition
the newborns activity gradually diminishes. The sleep phase may last 30 mins to 120 mins. During this period the newborn is hard to wake up & shows no interest in sucking. The heart rate & respirations decrease. Bowel sounds become audible. Cardiac & respiratory rates return to baseline values.
Term
During the second period of reactivity:
Definition
the newborn is awake & alert again. This period lasts 2 to 8 hours. The physiological responses at this time are variable. The heart & respiratory rates increase. The newborn's production of respiratory & gastric mucus increases, and newborn responds by gagging, choking, and regurgitating. The GI tract becomes more active & the first meconium stool is usually passed and initial voiding may occur.
Term
The production of __________ is crucial to keeping the lungs expanded during expiration by reducing alveolar surface tension.
Definition
surfactant
Term
Why is Vit. K given in the newborn?
Definition
Prophylactic injection of vit K to prevent hemorrhagic disease of the newborn. It is given within an hour of birth. Phytonadione dose: 0.5 to 1 mg within 1 hour of birth. This activates coagulation factors, babies have no gut bacterial flora. Given: VASTUS LATERALIS
Term
Why is ophthalmic erythromycin (0.5%) ointment used?
Definition
Prophylactic eye treatment for Neisseria gonorrhoeae, Chlamydia. Babies become infected during the birth process. It is instilled 1 hour after birth. Wash hands. put on gloves, clean infants eye and remove drainage. retract lower eyelid with finger. instill 1/4 inch strand along lower conjunctival sac, start at inner canthus. Wipe excess ointment away after 1 minute. This allows eye contact during the parent-newborn bonding.
Term
What is a DIRECT Coomb's test?
Definition
measuring the BABIES blood for Rh antibodies. (Think 'direct' is going right to the point & testing the baby)
Term
What are the first signs & symptoms of neonatal hypoglycemia? what will you do about it?
Definition
jitteriness, lethargy, feeding problems, temperature instability. Institute the hospital's protocol. Should be steady by 4 hrs.
Term
What is the nursing goal during a neonate's transition to extrauterine life?
Definition
to identify actual or potential problems that may require immediate or emergency attention.
Term
How does a baby lose body heat through CONDUCTION?
Definition
baby is on a cold scale = loss of heat to cooler surface by direct contact.
Term
What might thick meconium in the amniotic fluid indicate?
Definition
fetal hypoxia
Term
Why are babies born by cesarean at higher risk for respiratory distress than babies born via vaginal birth?
Definition
Because their lungs were not compressed while exiting the birth canal and fluid was not pushed out.
Term
Explain PHYSIOLOGIC JAUNDICE
Definition
caused by: accelerated destruction of fetal RBC's, impaired conugation of bilirubin (conversion of yellow lipid-soluble pigment into water-soluble pigment), and increased bilirubin reabsorption from the intestinal tract. Signs appear after the first 24 ours. (the time frame differentiates physiologic from pathologic jaundice)
Term
Explain PATHOLOGIC JAUNDICE
Definition
shows up in the first 24 hours & shows on legs, abdomen
Term
What newborn care decreases probability of high bilirubin levels?
Definition
1) Maintain the newborn's skin temp at 36.5 (97.8) 2) monitor stool for amount and characteristics (inadequate stooling may result in reabsorption & recycling of bilirubin... early breastfeeding should be encouraged) 3) encourage feedings to promot intestinal elimination
Term
What is Kernicterus?
Definition
an encephalopathy caused by unconjugated bilirubin in brain cells, may result in impaired brain function or death. Happens when bilirubin levels are 20+.
Term
What are babies with a cephalhematoma at risk for?
Definition
this is a collection of blood from ruptured vessels at the cranial bone. Their scalps feel loose & have edema. These can be unilateral or bilateral, but it does not cross the suture lines. These babies are at risk for JAUNDICE b/c extra RBC's are being destroyed.
Term
What is DIRECT CONJUGATION OF BILIRUBIN?
Definition
conversion of yellow lipid soluble pigment into water soluble. (This is on the test!)
Term
What is indirect bilirubin?
Definition
It is the breakdown product of hemoglobin (destroyed RBC's). unconjugated in utero crosses the placenta and the maternal liver breaks down.
Term
What is cold stress in a newborn?
Definition
excessive heat loss resulting in the use of compensatory mechanisms (such as increased respirations & nonshivering thermogenesis) to maintain core body temperature.
Term
what negative outcomes develop from a newborn being cold stressed?
Definition
Respiratory distress syndrome & the ultimate outcome of the infant. Both preterm & small for gestational age newborns are at risk for cold stress b/c they have decreased adipose tissue, brown fat stores, and glycogen available for metabolism.
Term
What nursing interventions minimize the risk of cold stress?
Definition
turn off the fan, dry the baby asap, if low birth weight baby: polyethylene wrap right after birth. nurse should monitor all signs of cold stress: including increased movement & respirations, decreased skin temp & peripheral perfusion, and development of hypoglycemia.
Term
What are some priority goals and diagnoses in the newborn period?
Definition
Priority goal is to identify actual or potential problems that may require immediate or emergency attention (the nurse needs to be knowledgeable about a newborn's normal physiologic and behavioral adaptations and to be able to recognize alterations from normal).
Term
What are some diagnoses in the newborn period?
Definition
maintenance of clear airway & VS, maintenance of a neutral thermal environment, prevention of complications of heorrhagic disease of newborn, risk for ineffective breathing pattern r/t periodic breathing, altered nutrition: less than body requirements r/t to limited nutritional & fluid intake and increased caloric expenditure, altered urinary elimination r/t meatal edema secondary to circumcision, risk for infection r/t to umbilical cord healing, circumcision site, immature immune system, or potential birth trauma, health-seeking behaviors r/t lack of information, altered family processes r/t integration of newborn into family or demands of newborn care & feeding.
Term
What is the difference between caput & cephalohematoma?
Definition
caput: is localized edema due to increased pressure, it crosses the suture line & is present at birth. Caput is a localized, soft area of the scalp, from long difficult labor. cephalohematoma: is a collection of blood that DOES NOT CROSS THE SUTURE LINE. It is not generally present at birth.
Term
What are the pale pink or red spots frequently fond on a babies eyelids, nose, lower occipital bone and nape of the neck? These lesions are common in newborns of light complexions & are more noticeable when they cry. They have no clinical significance and usually fade by the 2nd b-day.
Definition
Telangiectatic Nevi (T. Nevi) - aka "stork bites"
Term
What are the white or pale yellow papule with red base. often called a "newborn rash"... ?
Definition
Erythema Toxicum
Term
How many arteries/veins are in the umbilical cord?
Definition
2 arteries & one vein (2 A & 1 V)
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