Term
| __________ is the # of live births per 1000 people |
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Definition
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Term
| _________ ___________ is the # of deaths of infants under 1 year of age per 1000 live births in a given population. |
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Definition
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Term
| ___________ ___________ is the # of deaths of infants less than 28 days of age per 1000 live births. |
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Definition
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Term
| _________ ____________ number of deaths during the pregnancy cycle (including the 42 day postpartal period) per *100,000* live births. |
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Definition
| maternal mortality. This is higher in african americans |
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Term
| What are some risk factors to pregnancy? |
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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. |
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Term
| The HC does want to know the mom's MOTIVATION FOR PREGNANCY. Why do people have babies?? |
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Definition
| * self-concept... self-esteem, *masculinity.... femininity *generativity... creating the next generation |
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Term
| We do view pregnancy as a CRISIS situation. The body is under going stress. why? |
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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.) |
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Term
| women who are older (above 35) having their first babies are esp at risk. they're called _________. |
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Definition
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Term
| how is SES a risk factor for pregnancy? |
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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. |
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Term
| What obstetric events are a risk factor? |
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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. |
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Term
| How can a nurse help with the 'crisis resolution' of a pregnancy. what does she want to know? |
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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. |
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Term
| What interventions help with crisis resolution of pregnancy?? |
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Definition
| support them through EDUCATION. Teaching, teaching… esp in pregnancy we’re very focused on “anticipatory” guidelines. |
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Term
| What are the 2 primary tasks of pregnancy? |
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Definition
• Acceptance (throughout the pregnancy) and
• Safe Passage |
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Term
| What is a very common 'feeling' during the first trimester of a pregnancy? |
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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?” |
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Term
| Where is the concern at for the first trimester? |
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Definition
| Self-concern happens b/c baby is “non-event” at this point. |
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Term
| What teaching is appropriate from nursing during the first trimester of pregnancy? |
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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! ☺ ) |
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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. |
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Definition
| Acceptance… mom is not feeling as tired in the 2nd trimester |
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Term
| _______________ is the first perceived fetal movement. |
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Definition
| Quickening - baby becomes real with “quickening.” |
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Term
| During the second trimester, the date when the mom feels quickening is important. why? |
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Definition
| quickening date helps give data for due date estimation. |
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Term
| During the 2nd trimester and once the fetus is moving, the pregnancy is established, mom is okay & feeling better… the concern is more .... |
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Definition
| focus is on the baby now in the 2nd trimester. The mom will seek information about the baby & fantasize about it.. |
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Term
| What happens during the 3rd trimester? What is the mom feeling? |
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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." |
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Term
| What is the mom preparing for in the 3rd trimester? |
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Definition
| emotional separation from baby. Some women feel a loss in a way. |
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Term
| What behavior by the mom (if shown during pregnancy) shows potential risk? |
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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 |
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Term
| What is the duration of gestation? "9 months is not completely correct" A full-term is ___ weeks. Or ___ lunar months. |
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Definition
| 40 weeks. 10 lunar months. |
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Term
| The definition of pre-mature is __ weeks or less. |
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Definition
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Term
| How many weeks are in the 3 trimesters then? |
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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) |
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Term
| What are some physiologic changes of pregnancy? |
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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. |
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Term
| The uterus grows to _____ - ______ times its capacity due to hypertrophy of the _______________ cells. the growth is related to what hormone? |
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Definition
| 500 - 1000 times. myometrial cells. hormone = estrogen. |
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Term
| What other changes occur due to growing fetus? |
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Definition
| Distention by growing fetus, Fibrous tissue increases … adds to strength & elasticity, Walls thicken… thinning with distention, Circulatory requirements increase |
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Term
| Do contractions occur before birth? |
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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 |
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Term
| Why can a woman who has had babies (multigravida) feel the contractions more than a 1st time pregnancy mom? |
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Definition
| Because she has felt them before. Also, the uterus loses tone & so it's likely working harder. |
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Term
| what happens to the ovaries during pregnancy? |
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Definition
| Cease ovum production. Once pregnant, can’t get pregnant for awhile. |
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Term
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Definition
| endocrine structure that secretes progesterone until it can be produced by the placenta. Does this until 10th-12th week. |
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Term
| What does progesterone do? |
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Definition
| Progesterone maintains the pregnancy. Low progesterone levels = higher loss of pregnancy. Multiple miscarriages? Going to assess progesterone levels early into pregnancy. |
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Term
| The cervix has mucosal changes during pregnancy. what happens? |
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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. |
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Term
| The cervix also has an "Increase in vascularization & congestion of tissues" (there is a different consistency!) What is Goodell's sign? |
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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 |
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Term
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Definition
| Discoloration - cervix gets a bit darker. This is Chadwick’s sign. |
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Term
| The Vagina's Epithelium undergoes hypertrophy & hyperplasia. This is due to ___________ being induced. |
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Definition
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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??? |
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Definition
| whitish discharge called "LEUKORRHEA." It’s normal. The secretions are thick, white & acidic (pH 3.5-6.0). |
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Term
| What is the point of leukorrhea/white discharge? |
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Definition
| it's a protective against invasive pathogens |
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Term
| Unfortunately, leukorrhea favors the growth of: |
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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. |
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Term
| Are more lumps felt in the breasts normal? |
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Definition
| it’s a normal change in breasts, there is an increase in nodularity… glandular hypertrophy & hyperplasia. That is influenced by estrogen & progesterone |
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Term
| What else becomes more prominent in breasts normally during pregnancy? What are Montgomery Follicles? |
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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) |
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Term
| What happens to the mom's heart during pregnancy? |
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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. |
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Term
| the increase in BLOOD VOLUME is a major change in pregnancy! How much does it increase? When does it peak? |
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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) |
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Term
| With the increase in blood volume, comes an increase in _________ ____________. |
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Definition
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Term
| So the blood volume increases. and the cardiac output increases. How is it possible that Blood Pressure remains unaltered? |
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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. |
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Term
| The total red blood cells increase significantly. This is because of the increased ____________ needs. |
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Definition
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Term
| The hemodilution that occurs during pregnancy is referring to a decrease in ____________. |
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Definition
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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. |
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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!) |
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Term
| When is a pregnant mom most hemodiluted? (low on the Hgb & Hct and really need the iron?) |
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Definition
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Term
| What happens to clotting factors during pregnancy? |
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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. |
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Term
| THe downside of have the INCREASE in CLOTTING FACTORS is the pregnant mom is at an increased risk for: |
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Definition
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Term
| What happens to the peripheral circulation during pregnancy? |
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Definition
| There is DECREASED VENOUS RETURN. |
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Term
| What kind of things happen to the pregnant woman b/c of the 'decreased venous return'? |
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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. |
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Term
| What is Vena Caval Syndrome? |
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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. |
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Term
| The respiratory system change when a person is pregnant. There is a small degree of _____________________. |
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Definition
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Term
| What happens to the respiratory rate and tidal volume (lung volume & amt of air inhaled & exhaled)? |
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Definition
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Term
| What happens to women who have asthma when they get pregnant? |
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Definition
| They may show improvement b/c of the DECREASE IN AIRWAY RESISTANCE B/C OF "SMOOTH MUSCLE RELAXATION." |
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Term
| Oxygen consumption __________ in a pregnant woman about 14%. |
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Definition
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Term
| The diaphragm becomes elevated and causes an __________ in the substernal angle. |
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Definition
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Term
| The rib cage flares when pregnant. What happens to the length of the rib cage (vertical diameter) and the diameter around? |
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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. |
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Term
| What happens to the nasal area during pregnancy? |
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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. |
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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. |
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Definition
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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? |
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Definition
| there is no significant loss in intrathoracic volume |
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Term
| Do pregnant women breathe with abd or thoracic as the pregnancy progresses? |
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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. |
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Term
| How can superior vena caval syndrome be corrected? |
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Definition
| have the woman lay on her left side or place a pillow or wedge under her right hip. |
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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... |
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Definition
| the physiologic anemia of pregnancy. |
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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. |
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Definition
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Term
|
Definition
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Term
| What happens to leukocytes in a pregnant woman? |
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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. |
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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.... |
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Definition
| venous thrombosis (blood clots) |
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Term
| nausea and vomiting are common during the first trimester because of elevated __________ ______________ ______________ levels and changed carbohydrate metabolism. |
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Definition
| human chorionic gonadotropin (HCG) levels |
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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. |
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Definition
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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. |
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Definition
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Term
| ___________ frequently develop in late pregnancy from constipation (DECREASE IN INTESTINAL MOTILITY) and from pressure on vessels below the level of the uterus. |
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Definition
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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. |
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Definition
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Term
| Urinary frequency on the bladder is common during pregnancy due to pressure on the bladder. What trimesters will urinary frequency be the worst? |
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Definition
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Term
| The ureters dilate during pregnancy. There is an increased potential for ______________ infections. |
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Definition
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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. |
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Definition
| Glycosuria. - it may be normal or it may indicate gestational diabetes, so it always warrants further testing. |
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Term
| During pregnancy, many hormone levels are changes and there are changes in their skin. What areas become hyperpigmented? |
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Definition
| primarily pigmentation increases in areas that are already hyperpigmented: the areola, the nipples, the vulva, and the perianal area. |
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Term
| The skin in the abdomen may develop a pigmented line, the ______ ________, which usually extends from the umbulicus or above to the pubic area. |
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Definition
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Term
| Chloasma is also known as the "________ of _________." due to darkening where? |
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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. |
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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. |
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Definition
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Term
| What happens to the sweat and sebaceous glands during pregnancy? |
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Definition
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Term
| Striae may develop during pregnancy. what is this? |
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Definition
| stretch marks. they're normal and will decrease after awhile. |
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Term
| Talk about the physiological leukocytosis that occurs w/ pregnancy. Is the immune system intact for pregnancy & birth? |
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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! |
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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". |
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Definition
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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: |
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Definition
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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. |
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Definition
| lubosacral or lumbodorsal spine curves |
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Term
| Why might a pregnant woman experience facial nerve paralysis or an exacerbation in her carpal tunnel syndrome? |
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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. |
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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? |
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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. |
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Term
| The basal metabolic rate increases by 25%. (why pregnant women are warm). This provides for the increased needs of... |
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Definition
| the fetus and maternal tissue growth |
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Term
| What happens with the thyroid in a pregnant woman? |
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Definition
| The thyroid function increases and often the thyroid gland enlarges slightly. |
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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. |
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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) |
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Term
| What is the recommended weight gain during pregnancy for a normal weight woman? |
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Definition
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Term
| We know the weight should be put on gradually. about how much should be gained in the 1st, 2nd and 3rd trimesters? |
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Definition
| 1st: 4 lbs. 2nd: 11 lbs. 3rd: 11 lbs. |
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Term
| A sudden excessive weight gain during pregnancy (more than 2 lbs. a week) is a symptom of: |
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Definition
| pregnancy induced hypertension |
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Term
| Is wt gain the same for all pregnancies? |
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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. |
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Term
| What is the recommended increase in calories for a pregnant woman? |
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Definition
| increase of 300 kcal's over RDA. |
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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? |
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Definition
| moms tissue demands: highest in 1st & 2nd trimesters. Fetal demands: highest in 3rd trimester |
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Term
| There is increase need for calcium & iron. The mom's will be receiving oral supplements, but what foods need to be recommended? |
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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. |
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Term
| What are the 3 main dangers in food that pregnant women need to avoid? |
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Definition
| Listeria (bacteria even in refrigerator), Mercury (harmful metal found in some fish) and Toxoplasma (parasite i undercooked meat and unwashed fruits & vegetables) |
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Term
| A new mom can NOT eat raw or undercooked meat, poultry, fish or shellfish. So NO |
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Definition
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Term
| What fish is not allowed for pg mom? |
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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. |
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Term
| what meats are not recommeneded? |
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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) |
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Term
| What cheeses must be avoided when pregnant? |
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Definition
| Soft cheeses & unpasteurized. (ok if label says they are pasteurized or made from pasteurized milk) |
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Term
| What does a pregnant woman need to do to her fruits & veggies? |
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Definition
| Wash them! Or she is at risk for toxoplasma |
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Term
| Increased water retention is a basic chemical alteration of pregnancy. This is due to the increased levels of ____________ sex hormones. |
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Definition
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Term
| We do have water retention in pregnancy & we want it! why? |
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Definition
| The increased fluid demands are necessary for: blood volume, amniotic fluid, fetus and placenta. |
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Term
| A pregnant woman needs adequate fluid intake. how much? Do we ever restrict water intake in pg moms? |
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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... |
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Term
| What are the 4 hormones of pregnancy? |
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Definition
| estrogen, progesterone, hCG (human chorionic gonadotropin) and relaxin |
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Term
| Which hormone maintains the pregnancy? |
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Definition
|
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Term
| which hormone is the basis of the pregnancy test? |
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Definition
| hCG. This is the first hormone that will secrete estrogen & progesterone to maintain the pregnancy. |
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Term
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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 |
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Term
| The mom has ______________ demands for insulin during pregnancy. |
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Definition
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Term
| What is hPL? What does it have to do with insulin? |
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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. |
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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? |
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Definition
| amenorrhea, nausea and vomiting, urinary frequency, breast tenderness, quickening. |
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|
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!) |
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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. |
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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. |
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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. |
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Term
| What trimesters is fatigue highest? what's recommended? |
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Definition
| 1st & 3rd trimesters. promote adequate periods every day. |
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|
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. |
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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. |
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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. |
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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). |
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Term
| When are hemorrhoids most common? |
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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. |
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Term
| When do variscosities appear? why? what can help? |
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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). |
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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. |
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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. |
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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) |
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|
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. |
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|
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. |
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|
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. |
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|
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. |
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|
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. |
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|
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 |
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|
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. |
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|
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
|
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. |
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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. |
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|
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) |
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|
Term
| Toxoplasmosis is a _____________ infection. |
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Definition
|
|
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. |
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|
Term
| Is there a test for toxoplasmosis? |
|
Definition
| Yes, serologic testing of antibody, specifically IgG and IgM fluorescent antibody tests. |
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|
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. |
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|
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. |
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|
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. |
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|
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. |
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|
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 |
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|
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. |
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|
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. |
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|
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 __________. |
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Definition
|
|
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? |
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Definition
|
|
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 |
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|
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) |
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Term
| Primary infection has been associated with: |
|
Definition
| spontaneous abortion, low birth weight, and preterm birth. |
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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 |
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Definition
|
|
Term
| If the children do survive, 50% will have high risk of: |
|
Definition
| microcephaly, mental retardation, seizures, retinal dysplasia |
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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. |
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|
Term
| An infection that puts a risk on pregnancy is a Urinary Tract Infection. When should Cystitis (lower UTI) be treated? |
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Definition
|
|
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. |
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|
Term
| Bacterial Vaginosis may be a cause of ____-_______ labor. |
|
Definition
|
|
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. |
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|
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
|
|
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
|
|
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. |
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Definition
|
|
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. |
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|
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. |
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|
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. |
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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. |
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|
Term
| _____________ is a major risk factor for adolescent pregnancy. (what SES?) What is their educational level? |
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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. |
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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. |
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|
Term
| When do teens begin prenatal care? |
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Definition
| Teens tend to begin prenatal care later in pregnancy |
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|
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) |
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|
Term
| There are higher incidences of sexually transmitted infections in adolescence & this presents an increased risk for the _________. |
|
Definition
|
|
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
|
|
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. |
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|
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. |
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|
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. |
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|
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 |
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|
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 |
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|
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. |
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|
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 |
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|
Term
| ___________ is the number of pregnancies regardless of outcome. (ALWAYS COUNT THE CURRENT PREGNANCY AS ONE, students ALWAYS FORGET THIS!) |
|
Definition
|
|
Term
| ________ is the number of births AFTER 20 WEEKS of gestation. (This includes stillbirths and live births.) |
|
Definition
|
|
Term
| _____________ are any birth BEFORE 20 WEEKS of gestation. |
|
Definition
|
|
Term
| LIVING CHILDREN (LC) may also be included in some assessments. true or false/ |
|
Definition
|
|
Term
|
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. |
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|
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. |
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|
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 |
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|
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) |
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|
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 |
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|
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
|
|
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
|
|
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) |
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|
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
|
|
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. |
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|
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) |
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|
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) |
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Term
| If the fundal height is greater than expected... what are 3 possibilities? |
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Definition
| multiple pregnancy, hydraminos (increased amniotic fluid), molar pregnancy (an overgrowth of tissue that results in uterus being larger than expected) |
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Term
| At 16 weeks, where should the fundal height be? this is a landmark... |
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Definition
| expect 1/2 way between symphis pubis and umbilicus. that's a landmark - after that we can start measuring. |
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Term
| What labs are evaluated later? |
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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. |
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Term
| Teach about the common discomforts of pregnancy in the 2nd & 3rd trimester & what to do... pg. 233 |
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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) |
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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. |
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Definition
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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. |
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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). |
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Term
| What is done if an Rh - woman (father is Rh+ or unknown) and she has an abortion... ? |
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Definition
| She needs to be treated with Rhogam |
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Term
| The Rh- mom gives birth to an Rh+ fetus... what should be done |
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Definition
| Rhogam IM within 72 hours of birth (so she doesn't have time to produce antibodies to the fetal cells) |
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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? |
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Definition
| the mom is given Rh immune globulin within 72 hours of birth |
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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? |
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Definition
| Rh immune globulin is NOT given, in this case, the infant is carefully monitored for hemolytic disease. |
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Term
| When should Rh immune globulin be given prenatally? |
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Definition
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Term
| How do we prevent Rh sensitiation? |
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Definition
| administer Rhogam (Rh immune globulin) |
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Term
| Is Rh immune globulin administered after an abortion? |
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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) |
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Term
| Tests are done to provide information about... |
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Definition
| growth of the fetus... this relates to gestational age, presence of congenital abnormalities, location of the placenta, and fetal lung maturity |
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Term
| What does vigorous activity and marked decrease in activity of the fetus indicate? |
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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. |
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Term
| one method to tracking fetal activity is the "Cardiff count-to-ten method." how would you teach a woman to do this? |
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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) |
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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? |
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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. |
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Term
| Is an ultrasound "routine?" |
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Definition
| NO, an ultrasound is NOT a routine test |
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Term
| Is an ultrasound medically indicated to determine gender? |
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Definition
| NO, an ultrasound is NOT medically indicated for gender determination. |
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Term
| The Nonstress Test (NST) is used alone or as part of the biophysical profile. What is the test based on? |
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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 |
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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. |
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Definition
| reactive (this is good-you want this) |
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Term
| A __________ test: does not meet the reactive criteria. The accelerations are not present indicating the fetus is at risk or asleep. |
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Definition
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Term
| If a nonreactive test happens, what is done to stimulate the fetus? |
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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. |
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Term
| A biophysical profile (BPP) is an NST plus... |
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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 |
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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? |
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Definition
| Each of the 5 measures has a maximum score of two. A score of 8 to 10 indicates a healthy fetus. |
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Term
| The contraction stress test (CST) is a means of evaluating... |
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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. |
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Term
| What is an amniocentesis? |
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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. |
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Term
| What does the amniocentesis provide info about? |
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Definition
| genetic disorders, fetal health, fetal lung maturity (LS ratio and PG level). |
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Term
| What is the LS ratio and PG level? |
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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.) |
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Term
| A Contraction Stress Test demonstrates reaction of FHR to stress of uterine contractions. Results are either: |
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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) |
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Term
| The triple test marker is a triple marker. It is commonly used by taking .... |
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Definition
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Term
| What does the triple test marker test for? |
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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) |
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Term
| The first few hours of life when the newborn stabilizes respiratory and circulatory functions is called the _______________ transition. |
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Definition
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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? |
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Definition
| true - identify any resuscitative measures asap |
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Term
| The initiation of respiration in the newborn requires 2 radical changes for the lungs to function: |
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Definition
| 1) pulmonary ventilation must be established through lung expansion following birth 2) a marked increase in the pulmonary circulation must occur |
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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... |
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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. |
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Term
| WHat are the 3 factors opposing the babies first breath? |
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Definition
| 1) alveolar surface tension 2) viscosity of lung fluid within the respiratory tract, and 3) degree of lung compliance. |
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Term
| The alveolar surface tension would cause the alveoli to collapse between each inspiration were it not for the presence of ________________. |
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Definition
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Term
| Lecithin/Sphingomyelin (L/S Ratio must be __:__ to support breathing and oppose the alveolar surface tension. |
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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. |
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Term
| The greater _________ volume contributes to the conversion of fetal circulation to newborn circulation... a successful transition to extrauterine life. |
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Definition
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Term
| Is shunting of blood common in a newborn? (bidirectional blood flow, or right-to-left shunting?) |
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Definition
| Yes, this is common in the newborn period |
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Term
| The cardiovascular system adapts in a newborn. The onset of ________________ triggers increases blood flow to the lungs after birth. |
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Definition
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Term
| Where are the major areas of change in the cardiopulmonary adaptation? |
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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! |
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Term
| Who has greater oxygen saturation, a newborn or an adult? |
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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) |
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Term
| The oxygen saturation is better in a newborn's blood, but what is the catch with newborns? |
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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!) |
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Term
| What is the average newborn resting heart rate (when they are in a quiet & alert state)? |
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Definition
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Term
| What is the average BP for a full-term, resting newborn that is over 3 kg during the first 12 hours of life? |
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Definition
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Term
| __% of murmurs in newborns are transient and not associated w/ anomalies. |
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Definition
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Term
| What is the normal newborn RR? |
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Definition
| 30 to 60 breaths per minute |
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Term
| The baby is displaying a breathing pattern that has pauses lasting 5-15 seconds. What is this? Is the baby okay? |
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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) |
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Term
| Is some cyanosis or acrocyanosis normal at birth? |
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Definition
| Yes, it's normal for several hours, thereafter the infants color improves steadily. |
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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? |
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Definition
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Term
| What happens to a newborns hematocrit? why? |
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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. |
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Term
| What happens to a newborns hemoglobin? |
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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) |
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Term
| Why is a leukocytosis a normal finding in a newborn if they are not sick? |
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Definition
| The increase in WBC is normal b/c the STRESS OF BIRTH stimulates production of neutrophils in the babies first few days. |
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Term
| How much blood volume is in a term infant? |
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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.) |
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Term
| Answer: What is the blood volume of an 8 lb. (3.6 kg) newborn? |
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Definition
| 80 mL : 1 kg = X mL : 3.63 kg x=290.4 290 mL blood volume in the infant |
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Term
| Blood volume varies for the newborn depending on: (pg. 570) |
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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) |
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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). |
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Definition
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Term
| The newborn's impaired thermoregulation is closely related to .. |
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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) |
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Term
| How else does a baby thermoregulate? |
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Definition
| increases metabolic demands and/or increased oxygen demands can quickly deplete glycogen stores leading to hypoglycemia. |
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Term
| So, is it important to keep babies in a normal temperature range? |
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Definition
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Term
| A newborns blood sugar should be maintained about ___ mg/dl. |
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Definition
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Term
| Neonatal hypoglycemia is defined as a blood sugar below __ mg/dl. |
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Definition
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Term
| What are the 1st s/s of neonatal hypoglycemia? |
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Definition
| jitteriness, lethargy (baby won't wake to eat), feeding problems, temperature instability |
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Term
| what should you do if a newborn is hypoglycemic? |
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Definition
| institute the hospital's protocol.. usually it is formula feed, there is no time to breastfeed |
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Term
| Heat is lost from the body in 4 ways: Convection, Radiation, Evaporation & Conduction. Explain CONVECTION... |
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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 |
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Term
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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. |
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Term
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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. |
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Term
| The newborn has several mechanisms to produce heat (thermogenesis). what are they? |
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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. |
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Term
| What characteristics predispose newborns to heat loss: |
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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. |
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Term
| how can we prevent hypothermia in newborns? |
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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 |
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Term
| When is physiologic jaundice normal in a newborn? |
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Definition
| It is normal AFTER THE FIRST 24 HOURS of LIFE. (it's never normal in the 1st 24 hrs) |
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Term
| why does natural physiologic jaundice occur? |
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Definition
| accelerated destruction of fetal RBC's, impaired conjugation of bilirubin, increased bilirubin reabsorption from intestinal tract. |
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Term
| What is the definition of the conjugation of bilirubin? |
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Definition
| it's the conversion of yellow lipid soluble pigment into water-soluble pigment (conjugated form-Direct billi) |
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Term
| Unconjugated (indirect) bilirubin is breakdown product that is: |
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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 |
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Term
| Conjugated (direct) + Unconjugated (indirect) bilirubin = Total serum bilirubin. What are the levels shortly after birth? Levels should not be greater than... |
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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. |
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Term
| What is conjugated (direct) bilirubin again? |
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Definition
| conversion of yellow lipid soluble pigment into water-soluble pigment |
|
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Term
| what is unconjugated (indirect) bilirubin? |
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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.) |
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Term
| What newborn care is necessary to decrease the probability of high bilirubin levels? |
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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. |
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Term
| What is breastfeeding jaundice? |
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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 |
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Term
| How do we prevent breastfeeding jaundice? |
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Definition
| encourage frequent breast feeding, avoid supplementation if you can, access maternal lactation counseling |
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Term
| Know normal bilirubin. What is it? |
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Definition
| Anything 12+ is NOT normal. |
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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 _______________. |
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Definition
| Vitamin K (the blood coagulation factors 2, 7, 9, & 10 are considered dependent on vitamin K to develop) |
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Term
| Why is Vitamin K levels naturally low at birth? |
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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. |
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Term
| When is Vit K given to the newborn & why? |
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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. |
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Term
| By __ to __ weeks gestation, the gastrointestinal system is adequately mature, with enzymatic activity and the ability to transport nutrients. |
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Definition
| 36-38 weeks gestation (So, the full-term newborn has sufficient intestinal and pancreatic enzymes to digest most simple carbohydrates, proteins & fats) |
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Term
| The only enzyme lacking is pancreatic _____________ in the newborn. |
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Definition
| amylase (it will remain deficient during the first few months of life) |
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Term
| B/c of the lacking enzyme (pancreatic amylase), Newborns have trouble digesting __________________. |
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Definition
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Term
| Newborns also digest & absorb _______ less efficiently. |
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Definition
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Term
| However, ___________ are well digested and absorbed by the newborn intestine. |
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Definition
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Term
| _______ enters the stomach immediately after birth. |
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Definition
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Term
| How big is the newborn's stomach capacity? not very big... |
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Definition
| 50-60 mL (IMPORTANT to know that, it's not very large. |
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Term
| Considering the size of a babies stomach, how much should be fed & how often burped? |
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Definition
| Feed 30-50 mL's. Burp after every 1/2 oz (15 mL). |
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Term
| When are bowel sounds present in a newborn? |
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Definition
| bowel sounds are present within the first 30-60 minutes of birth and the newborn can successfully feed at this time. |
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Term
| What happens b/c the cardiac sphincter is immature? What will help? |
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Definition
| Regurgitation. Avoid overfeeding. |
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Term
| How many calories per kg does the newborn require to gain weight? |
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Definition
| 120 cal/kg/day is required to gain weight |
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Term
| A full-term newborn will usually pass their first meconium within ___ - ___ hours. |
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Definition
| 8-24 (this is important, if a baby does not pass their first stool w/in 24 hrs - call the physician) |
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Term
| Where is the first meconium from? what's it look like (tell parents not to be alarmed) |
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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 |
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Term
| The term newborn's kidneys have full complement of functioning nephrons by ___ to ___ weeks gestation. |
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Definition
| 34-36 (just before GI system that is 36-38 weeks) |
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Term
| What is the GFR rate of a newborn compared to an adult? |
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Definition
| newborn's GFR is lower than an adults. Because of this, the newborn cannot eliminate water rapidly when it is necessary. |
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Term
| Full term newborns cannot concentrate urine because... |
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Definition
| their tubules are short and narrow. |
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Term
| Also, urine is not well concentrated in newborns because.. |
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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. |
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Term
| In the first few days after birth (postnatally) the newborn voids how much? |
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Definition
| 2-6 times a day with a urine output of 15 mL/day. |
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Term
| How much does the newborn subsequently void? |
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Definition
| 5 to 25 times every 24 hours, with a volume of 25 mL/kg per day. |
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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. |
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Definition
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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. |
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Definition
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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? |
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Definition
| Avoid crowds in flu season or letting people hold the baby that are obviously sick. |
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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? |
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Definition
| immunity to common viral infections like measles may last = 4-8 months. Immunity to certain bacteria may disappear within 4-8 weeks. |
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Term
| Can a normal newborn produce antibodies in response to an antigen? When do immunizations (to develop active acquired immunity) start? |
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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). |
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Term
| Because IgM does not normally cross the placenta, elevated levels at birth may indicate placental leaks or that newborn was exposed to _________. |
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Definition
| TORCH (Toxoplasmosis, Other=beta strep, hep B, Rubella, Cytomegalovirus, Herpes Simplex Virus) |
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Term
| The newborn lacks the maternal IgM and makes them more susceptible to... |
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Definition
| gram negative organisms (like E. Coli) |
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Term
|
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) |
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Term
| With "passive acquired immunity" - does the fetus produce antibodies itself? |
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Definition
| No, the fetus is not producing its own antibodies, rather antibodies from the mom are being passed in utero. |
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Term
| What happens during a newborns initial period of reactivity? how long does it last? |
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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. |
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Term
| After the initial period of reactivity is a sleep phase... |
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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. |
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Term
| During the second period of reactivity: |
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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. |
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Term
| The production of __________ is crucial to keeping the lungs expanded during expiration by reducing alveolar surface tension. |
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Definition
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Term
| Why is Vit. K given in the newborn? |
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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 |
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Term
| Why is ophthalmic erythromycin (0.5%) ointment used? |
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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. |
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Term
| What is a DIRECT Coomb's test? |
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Definition
| measuring the BABIES blood for Rh antibodies. (Think 'direct' is going right to the point & testing the baby) |
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Term
| What are the first signs & symptoms of neonatal hypoglycemia? what will you do about it? |
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Definition
| jitteriness, lethargy, feeding problems, temperature instability. Institute the hospital's protocol. Should be steady by 4 hrs. |
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Term
| What is the nursing goal during a neonate's transition to extrauterine life? |
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Definition
| to identify actual or potential problems that may require immediate or emergency attention. |
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Term
| How does a baby lose body heat through CONDUCTION? |
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Definition
| baby is on a cold scale = loss of heat to cooler surface by direct contact. |
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Term
| What might thick meconium in the amniotic fluid indicate? |
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Definition
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Term
| Why are babies born by cesarean at higher risk for respiratory distress than babies born via vaginal birth? |
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Definition
| Because their lungs were not compressed while exiting the birth canal and fluid was not pushed out. |
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Term
| Explain PHYSIOLOGIC JAUNDICE |
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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) |
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Term
| Explain PATHOLOGIC JAUNDICE |
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Definition
| shows up in the first 24 hours & shows on legs, abdomen |
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Term
| What newborn care decreases probability of high bilirubin levels? |
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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 |
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Term
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Definition
| an encephalopathy caused by unconjugated bilirubin in brain cells, may result in impaired brain function or death. Happens when bilirubin levels are 20+. |
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Term
| What are babies with a cephalhematoma at risk for? |
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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. |
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Term
| What is DIRECT CONJUGATION OF BILIRUBIN? |
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Definition
| conversion of yellow lipid soluble pigment into water soluble. (This is on the test!) |
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Term
| What is indirect bilirubin? |
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Definition
| It is the breakdown product of hemoglobin (destroyed RBC's). unconjugated in utero crosses the placenta and the maternal liver breaks down. |
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Term
| What is cold stress in a newborn? |
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Definition
| excessive heat loss resulting in the use of compensatory mechanisms (such as increased respirations & nonshivering thermogenesis) to maintain core body temperature. |
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Term
| what negative outcomes develop from a newborn being cold stressed? |
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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. |
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Term
| What nursing interventions minimize the risk of cold stress? |
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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. |
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Term
| What are some priority goals and diagnoses in the newborn period? |
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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). |
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Term
| What are some diagnoses in the newborn period? |
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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. |
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Term
| What is the difference between caput & cephalohematoma? |
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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. |
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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. |
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Definition
| Telangiectatic Nevi (T. Nevi) - aka "stork bites" |
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Term
| What are the white or pale yellow papule with red base. often called a "newborn rash"... ? |
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Definition
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Term
| How many arteries/veins are in the umbilical cord? |
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Definition
| 2 arteries & one vein (2 A & 1 V) |
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