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SAC Exam #2
Modules 3, 4, 5
| Question | Answer |
|---|---|
| Wht about newborn's body surface area? | larger in relation to mass and dec. SQ tissue |
| newborn's skin? | thin w/ blood vessels close to surface, 2x wrap for warmth |
| Newborn's arms and legs to reduce heat loss | will flex |
| What part of newborn's body loses heat fastest? What to do? | Head, put a cap |
| APGAR | 10 pts possible at 1min/5min; 10min for bad baby; for APPEARANCE, PULSE, GRIMMACE, ACTIVITY, RESPIRATION |
| Methods of Heat loss | Convection, Radiation, Evaporation, Conduction |
| What is convection? | Drafts over skin |
| What's evaporation? | Water on/from skin/body |
| What is conduction? | Something cold touching baby's skin |
| What is Radiation? | Something cold close to baby (no draft) |
| Non-shivering thermogenesis? | Brown Fat Metabolism; fat from back of neck metabolizes, which creates heat for baby, but metabolism causes increase O2 need |
| Risk of non-shivering thermogenesis? | metabolism of brown fat causes dec. in glucose --> hypoglycemia |
| Signs of cold baby? | mottled skin, tachypneic |
| Effects of cold stress/overheating on baby? | increased metabolic rate, inc. O2 need, inc. glucose consumption |
| What does glucose metabolism in presence of insufficient O2 leads to what? | production of acid --> metabolic acidosis |
| What do blood vessels do to preserve heat? Which ones? | Vasoconstrict; Peripheral and Pulmonary blood vessels |
| What is the weight of term baby? | 5lbs 8oz |
| How much will a baby weigh to be considered LGA? | Greater than 4000g |
| Norms for respiration and SpO2? | 30-60rr/min; 96-1000% |
| What are the shunts that most fetal blood bypasses through lungs and liver? | Ductus arteriosus, Foramen ovale, Ductus venosus |
| Acrocyanosis | Bluish discoloration of hands/feet d/t reduced peripheral circulation; accentuated if cold |
| What happens at birth with the fetal shunts and pulmonary vessels? why? | Shunts close, Pulmonary vessels dilate because of changes in blood O2 levels and pressure shifts in heart, pulmonary, and systemic circulations |
| Where is placement to check HR? | At 3rd/4th intercostal space, left of midclavicular line |
| Where do most newborn heart murmurs come from? What is ordered? | PDA= patent ductus arteriosis; Echocardiogram ordered |
| Signs of respiratory distress in newborn? | Retractions, Nasal flaring, Grunting, Tachypnea, Apnea, Cyanosis |
| Why is neonate less effective in fighting off infections? | Immature hypothalamus and immature inflammatory response |
| When do full term newborns receive antibodies? | Last trimester |
| What kind of immunity is provided when mom breastfeeds? | Passive immunity |
| What is 1st stool from newborn? When? What if they don't? | Meconium, w/in first 24hrs of life; if none, may have obstruction |
| Urobilinogen? | Conjugated bilirubin excreted in stools |
| When is newborn's first void? What if not? | usually w/in 24 hours; inadequate fluid intake --> dehydration --> metabolic acidosis |
| How much fluids does baby need to maintain fluid balance? | 65mL/kg (30mL/lbs) during first 2 days, then 100-150mL/kg (45-68mL/lbs)/day |
| Who is at risk for hypoglycemia? | SGA, LGA, Preterm, Postterm, GDM - because of inadequate stores or excessive consuption of glycogen/fat for metabolism |
| Sings of hypoglycemia? | Jitterness, Poor muscle tone, Diaphresis, Poor sucking, Tachypnea, Dyspnea, Cyanosis, Apnea, Low temp, High pitched cry, Irritable, Lethargy, Sz, Coma |
| At what level is hypoglycemic? What to do? | Less than 40mg/mL; feed and reassess in 30-45min |
| When will cord stump detach? | 10-14days |
| How much birth weight is lost? Why? | 5-10%; d/t normal loss of extrcellular H2O + less calorie consumption |
| How much calories needed to meet energy needs for growth & development? | 110-120 cal/kg (50-55cal/lbs)/day |
| how often should baby feed; by breast & bottle? | Breast- q 1.5-3hrs; Bottle- q 3-4hrs |
| Nutrients in breast milk | Amino acids, Protein, Carbs, Fat |
| Signs of INFANT problems w/ breastfeeding | falls asleep w/in 5min, refusing to feed, tongue thrust, smacking sounds, cheek dimpling, failure to open wide, turned in lower lip, choppy jaw motions, no audible swallowing, formula use, less than 3 stools by 3rd day |
| Signs of MATERNAL breastfeeding problems | Hard,tender breasts, painful nipples, flat/inverted nipples, edema/pain in breast, fever, aches, malaise |
| Chronic HTN | elevated BP prior to 20 wks gestation |
| PIH | Developing HTN after 20wks gestation; sustained 140/90 or +15 systolic and/or +20 diastolic |
| Types of Pregnancy Induced Hypertension | Pre-eclampsia, Eclampsia, HELLP syndrome |
| Pre-eclampsia | Renal involvement that leads to proteinuria |
| Eclampsia | CNS involvement leading to seizures |
| HELLP syndrome | Hemolysis, Elevated Liver enzymes, Low Platelets |
| Generalized edema | fluid retention especially in hands/feet |
| Proteinuria | >300mg/dL protein/24hr OR 100mg/dL in 2 random 6hr samples; develops after edema and inc. BP |
| Risk factors of PIH | first pregnancy, -16y.o. or +35y.o., family hx, obesity, CRD, DM, mult. gestation, chronic HTN, pre-existing vascular disease, Angiotensin gene T235 |
| Bio Changes of PIH | Dec. brain perfusion, Dec. liver perfusion, Dec. renal perfusion, Dec. Uterine/Placental perfusion |
| what does Dec. brain perfusion in PIH lead to? | cerebral edema and small cerebral hemorrhage; hyper-reflexia, scotomas (floating things in vision), visual changes, sz |
| What does dec. liver perfusion in PIH lead to? | impaired liver function, hepatic edema, sub-capsular hemorrhage, elev liver enzymes, epigastric pain |
| What does dec. renal perfusion in PIH lead to? | Edema (dec GFR--> protein leaks across glomerular membrane reducing colloid osmotic pressure, fluid shifts to interstitial space) = hypovolemia |
| How does body respond to hypovolemia? | Inc. Angiotensin II and aldosterone retaining both water and salt |
| S/S of dec renal perfusion in PIH? | Inc. BUN/Cr, inc. uric acid, edema, Inc. hematocrit, dec. urine output, excess wt gain (>2 lbs/wk) |
| What does dec. Uterine/placental perfusion in PIH lead to? | IUGR, Placenta Abruption, inc. risk of fetal death |
| Anti-hypertensive for PIH? | Apresoline/Hydralazine |
| Nursing actions for PIH? | Tocolytics and/or antihypertensives, fetal monitoring, bedrest (left lateral), calm environment, sz precautions, v/s/I&O/DTR q hr, daily wt, Mg level q 6hrs |
| signs of altered tissue perfusion in PIH? | Urine output <500mL/day, 3+ pitting edema, edema of hands/face |
| monitor interventions for PIH | monitor for edema q 4hrs, monitor for proteinuria, monitor BP q hr, monitor urine output q hr, monitor lung sounds q 2hrs, monitor for dyspnea, monitor fluids q hr |
| manage interventions for PIH | admin MgSO4 2g/hr IV, place foley to measure UO, admin fluid restriction 100mL/hr |
| What does MgSO4 do? | magnesium sulfate used to control sz; relaxes smooth muscle and reduces vasoconstriction |
| What is #1 complaint for pre-eclampsia? | Headache not relieved by reg. strength Tylenol --> disorientation |
| What is diabetes? | a deficit in carb metabolism whereby glucose can't enter cell and body cells become energy depleted and results in fats/proteins being broken down for energy. |
| When do they screen for GDM? | at 24-28wks using 1hr 50g oral GTT. |
| what happens if GTT = >135mg/dL? | 3hr 100g GTT given |
| What are the criteria for diagnosing GDM? | Fasting 95mg/dL OR 1hr= 180mg/dL OR 2hr= 155mg/dL OR 3hr= 140mg/dL; need 2 of these values |
| Risk factors for Maternal GDM? | Hydramnios, Pre-eclampsia/Eclampsia, Hyperglycemia leading to ketoacidosis, Dystocia, Monilal vaginitis, c/s birth |
| Fetal GDM risk factors? | Congenital anomalies, Macrosomia, IURG, RDS, Hypoglycemia |
| White's classification of Diabetes in Pregnancy? | Class A1 --> Class A2--> Class B--> Class C--> Class D--> Class F--> Class H--> Class R |
| Breakdown of how diet for GDM should be? | 40-50% calories from Carbs; 15-20% from protein; 20-30% from fats |
| How many meals a day for GDM? | 3 meals and 3 snacks |
| What is okay glucose level when fasting? After meal? | 70-100mg/dL; 2hrs after meal= <120mg/dL |
| How do they assess for lung maturity? | Amniocentesis |
| Types of placenta previa? | Marginal, Partial, Total |
| S/S of CONCEALED Placenta Abruption? | INC. fundal height, Hard,boardlike abd, High uterine baseline tone, PERSISTENT abd pain, early hemorrhage, PERSISTENT late decels, Decreasing baseline variability, slight/absent vag bleed |
| S/S hypovolemic shock? | Inc. pulse, dec. blood pressure, weak/diminished/thready pulse, cool,moist skin, dec. Urine output, dec H&H, ALOC |
| GDM risk factors? | Obesity, >25y.o, previous preg w/ GDM, hx abnormal GTT, family hx of DM, high risk ethnic group |
| MgSO4 action? | Ca antagonist which inhibits UCs by interrupting flow of extracellular Ca into smooth muscle |
| dose for MgSO4? | 4-6g loading dose over 30min, then maintenance dose 2-3g/hr IV |
| S/E of MgSO4? | flushing, thirst, lethargy, N/V, SOB, pulmonary edema, visual changes |
| Terbutaline action? | Beta-mimetic drug that stimulates beta-adregnergic receptors on smooth muscles that interferes w/ muscle contraction |
| Dose for Terb? | 0.25mg SQ; then 2.5-5.0mg PO q 2-4hrs |
| S/E of Terb? | inc. pulse, inc. glucose, dec. K, palpitations |
| Nursing implications for MgSO4? | continuous fetal monitoring, monitor v/s (*rr*) q hr, monitor UO q hr, fluid restrict to 100mL/hr, Mg level q 4-6hrs, CALCIUM GLUCONATE on hand |
| Nursing implication for Terb? | hold if pulse >110-120bpm, contraindicated for DM |
| Nifedipine (Procardia) action? | Ca antagonist; blocks Ca in Ca channels of myometrial cells |
| Procardia dose? | initial dose 30mg PO, followed by 10-20mg q 4-6 |
| S/E Procardia? | facial flushing, HA, dec. BP, Inc. liver enzymes, MONITOR BP |
| Indomethacin (Indocin) action? | Prostaglandin, synthetase inhibitor; stops enzymes that make prostaglandins that start labor |
| Indocin dose? | 100mg rectal, followed by 25-50mg q 4-6hrs PO |
| Indocin S/E | HA, GI upset, HYPOtension, oligohydramnios, premature closure of DA (?), dec. UO, hyperbilirubinemia; MONITOR AMNIOTIC FLUID VOLUME |
| Management for MgSO4 for Preterm labor? | Loading dose 4-6g over 30min, [v/s (especially rr), DTR, UO q hr], Mg level q 6hrs, fluid intake q hr (100cc/hr fluid restriction), monitor for s/e (flushing, sweating, n/v, CNS/resp depression), CALCIUM GLUCONATE @ bedside, pt on bedrest |
| What is Celestone (betamethasone)? | Non-tocolytic agent used in preterm labor pts who are high risk for delivery to help w/ fetal maturity |
| What is the best measurement of pain? | Pt's subjective description |
| what does it mean if pt's description starts to worsen? | inc. intensity of uterine contraction |
| In pre-eclampsia, what causes reduced blood flow to the kidneys? | Inc. peripheral resistance |
| In pre-eclampsia, what happens when protein leaks acorss glomerular membrane? | protein loss reduces colloid pressure, then allows for fluid to shift to interstitial space = edema |
| What does reduced blood flow to kidneys affect? | GFR --> dec. UO |
| How often do you assess lung sounds w/ preeclampsi? | q 2hrs |
| what does dec. colloid oncotic pressure in preeclampsia lead to? Where? | Edema in hands, feet, and lungs |
| With MgSO4, when is pt on 100cc/hr fluid restriction, preterm labor or preeclampsia? | Both |
| What is the spontaneous/elective termination of a pregnancy before 20 weeks gestation? | abortion |
| what is another name for spontaneous abortion? | Miscarriage |
| what are complications from abortion? | bladder injury, bowel injury, inc. risk of breast CA, affect on future preg, lac of cervix |
| Reasons people give to abort? | Fetal anomalies, maternal conditions (pre-eclampsia, diabetes, cardiac conditions), victims of rape/incest |
| Where is immunoglobulin IgA? | Breastmilk, provides infection protection |
| Where is immunoglobulin IgG? | crosses placenta, w/ Rh inompatibility |
| Suction D&C? | terminates pregnancies from 3-12wks (1st trimester) |
| Treatment for Syphilis? | Penicilin |
| How is HPV diagnosed? | Genital warts and abnormal pap |
| Why should one NOT receive hormonal contraceptives? | Clotting issues, CA hx, smoking |
| Methods of permanent sterilization? | Vasectomy, Tubal ligation, Essure |
| When mom has Positive Indirect Coombs, do we give Rhogam? | No, she is already sensitized; won't do any good |
| Presumptive signs of pregnancy? | Amenorrhea, nausea, fatigue, frequency, breast sensitivity, quickening |
| Probable signs of pregnancy? | Abd enlargement, Positive preg test, Chadwicks sign, Goodell's sign, Hegar's sign, Braxton Hicks contractions |
| Chadwick's sign? | discoloration of cervix, vagina, labia because of inc. estrogen |
| Goodell's sign | softening of cervix |
| Hegar's sign? | softening of the uterus, between cervix and fundus |
| What is quickening? | Feeling the fetus move in the uterus |
| Positive signs of pregnancy? | FHTs, seeing fetus in US, palpation of fetus |
| Nagele's Rule? | 3mos from LMP + 7days = EDC |
| When is AFP done? High? Low? | 15-18wks; high= neural tube defect; low = Down's syndrome |
| How do they assess fetal lung maturity? | Amniocentesis; L/S ratio and progesterone level |
| Components of Biophysical Profile? | Fetal breathing, body movement, tone, Amniotic fluid index (AFI)- to r/o oligo/polyhydramnios, NST for fetal heart reactivity, |
| On who and why do Contraction Stress Test? | On PIH moms because uterus tends to wear out |
Created by:
cobedad
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