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EXAM #3 - FAMILY
Maternal & Neonatal Postpartum
| Question | Answer |
|---|---|
| Thermoregulation | The process of maintaining the balance between heat loss and heat production in order to maintain the body's core internal temperature. It is a critical physiologic function that is closely related to the transition and survival of the newborn. |
| An infant with cold stress presents with a | weak cry |
| Conduction | Involves the transfer of heat from one object to another when the two objects are in direct contact with each other. Refers to heat fluctuation between the newborn's body surface when in contact with other solid surfaces such as a cold mattress, scale, or circumcision restraining board |
| Convection | Involves the flow of heat from the body surface to cooler surrounding air or to air circulating over a body surface. Examples include a cool breeze that flows over the newborn, a cool room, cool corridors, or outside air currents. |
| Evaporation | Involves the loss of heat when a liquid is converted to vapor. May be insensible (such as from skin and respiration). Or sensible (such as from sweating) |
| Radiation | Involves the loss of body heat to cooler, solid surfaces that are in proximity but not in direct contact with the newborn. Example is when the newborn is placed in a single-wall isolate next to a cold window |
| Mongolian Spots | benign blue or purple splotches that appear solitary on the lower back and buttocks of newborns |
| Harlequin Sign | dilation of blood vessels on only one side of the body, giving the newborn the appearance of wearing a clown suit |
| Vernix Caseosa | a thick white substance that protects the skin of the fetus |
| Stork Bites | superficial vascular areas found on the nape, on the eyelids, and between the eyes and upper lip |
| Nevus Vasculosous | strawberry mark or strawberry hemangioma, is a benign capillary hemangioma in the dermal and subdermal layers |
| Milia | multiple pearly-white or pale yellow unopened sebaceous glands frequently found on a newborn’s nose |
| Erythema Taxcium | benign, idiopathic, generalized, transient rash that occurs in up to 70% of all newborns during the first week of life |
| Nevus Flammeus | port-wine stain, commonly appears on the newborn’s face or other body areas |
| Microcephaly | a head circumference more than two standard deviations below average or less than 10% of normal. Caused by failure of brain development. A reduced production of neurons leading to a reduction of brain volume and as a consequence of that a reduced skull size. It can be genetically derived or may be associated with infections (cytomegalovirus, rubella, toxoplasmosis), Zika virus exposure, syndromes such as trisomy 13, 18, or 21 and in utero exposure to alcohol or certain other drugs |
| Macrocephaly | Usually a benign condition that does not require intervention. It is a head with a circumference more than 90% of normal, typically related to hydrocephalus. It is often familial (with autosomal dominant inheritance) and can be either an isolated anomaly or a manifestation of other anomalies, including hydrocephalus and skeletal disorders (achondroplasia). |
| Large Fontanels | more than 6 cm in the anterior diameter bone to bone or more than a 1-cm diameter in the posterior fontanel; possibly associated with malnutrition, hydrocephaly, congenital hypothyroidism, trisomies 13, 18, and 21, and various bone disorders such as osteogenesis imperfecta |
| Small or Closed Fontanels | smaller-than-normal anterior and posterior diameters or fontanels that are closed at birth. Craniosynostosis and abnormal brain development refer to the premature fusion of cranial sutures, with inhibition of perpendicular cranial bone growth and are associated with a small fontanel or early fontanel closure associated with microcephaly. Management strategies for syndromic craniosynostosis infants require multidisciplinary subspecialty teams to provide optimal care for complex reconstructive approaches |
| Palmar Reflex | When you place a finger or stroke the inside of the patient's hand, and they close their hand around it. Disappears around 4-6 months. |
| Plantar Reflex | When you place a finger under the infant's toes, and the toes curl around it. Disappears around 9 months to a year |
| Moro Reflex | When the infant hears a sudden loud noise or experiences an unexpected movement. The infant extends their arms with their palms up. They may bring their arms back to the body, or sometimes cry. Also called the startle reflex. Disappears around 6 months of age |
| Rooting Reflex | When you brush or stroke the cheek or side of the infant's mouth, and they turn towards it. The infant will open their mouth in an attempt to suck. Disappears around 6 months of age |
| Sucking Reflex | When something touches the top of the infant's mouth, the infant will begin to suck. Disappears around 4 months of age. |
| Babinski Reflex | When you stroke the bottom of the foot from the heel, upward along the outward part of the foot. The big toe will dorsiflex (bend back) and the other toes will fan/spread out. Disappears around 1 year of age |
| Crawling Reflex | When you place the infant on the stomach and apply pressure on the sole of the foot. The infant will attempt to push against the hand and move the arms and legs in a crawling motion. Also called the Bauer Crawling Reflex. Disappears a few weeks to months after birth |
| Step Reflex | When you hold the infant upright with the legs and feet touching a surface, the infant will move the legs like they are taking steps. Disappears around 3-4 months |
| Tonic Neck Relfex | When the infant's head is turned to one side, the leg and arm on that side will extend, while the other arm and leg on the opposite side will flex. Also called the fencing reflex. Disappears around 4 months |
| Appropriate Preterm Stimulation | Sensorimotor Interventions such as rocking, sucking on a pacifier, skin-to-skin contact with parents, and containment (swaddling). Soft singing or music, cuddling, gentle stroking of the infant’s skin, colorful mobiles, gentle massage. Providing sucrose (if tolerated) and waterbed mattress (in a specialized setting) |
| Common Newborn Pain Behaviors | Sudden High-Pitched Cry. Facial Grimace (Furrowing Brow, Quivering Chin). Increased Muscle Tone. Increased HR, BP, Pulse, Respirations. Oxygen Desaturation. Body Posturing, Squirming, Kicking, Arching. Limb Withdrawal, Thrashing Movements. Fussiness & Irritability |
| Premature Infant Pain Profile (PIPP) | Asseses HR and Oxygen Saturation |
| Cries Pain Tool | Cry requires oxygen, increased vital signs, expression, and sleeplessness |
| Neonatal Infant Pain Scale (NIPS) | Evaluates respiratory patterns |
| Techniques to decrease Pain in the Preterm Infant | Gentle Handling, Rocking, Cuddling, Massaging, Kangaroo care (skin-to-skin contact), Facilitated Tuck (holding arms and legs in a flexed position), Swaddling and positioning Nonnutritive sucking (pacifier dipped in sucrose), Minimal use of tape, with gentle removal to avoid skin tears. Warm blankets for wrapping, to facilitate relaxation. Reduction of environmental stimuli. Distraction such as with colored objects, or mobiles Narcotics (limited), Acetaminophen or NSAIDs. Benzodiazepines. |
| INTRAUTERINE FETAL DEMISE | The nurse should encourage discussion of the loss and allow the couple to vent their feelings of grief and guilt. Allow the parents to spend unlimited time with their stillborn infant so that they can validate the death. Providing the parents and family with mementos of the infant helps validate the reality of the death. Assisting with arrangements is helpful to reduce the stress of coping INCREASED RISK IN PROLONGED PREGNANCY |
| Monitoring for complications | During the first hour every 15 minutes, the next 2 hours should be every 30 minutes. The following 2-6 hours should be every hour. The next 24 hours should be every 4 hours, and the remaining should be every 8 to 12 hours. |
| Danger Signs of the Maternal Postpartum Assessment | Fever OVER 100.4. Foul smelling lochia or an unexpected color/amount. Large blood clots or bleeding that saturates pad in an hour. Severe headaches or blurry/spotty vision. Calf pain with dorsiflexion of the foot. Swelling, redness, or discharge at the episiotomy, epidural, or abdominal sites. Dysuria, burning, or incomplete bladder emptying. SOB, or difficulty breathing without exertion. Depression or extreme mood swings |
| Postpartum Hemorrhage | Defined as a cumulative blood loss greater than 1,000 mL. With signs and symptoms of hypovolemia within 24 hours of the birth process, regardless of the route of delivery. Can occur at any time between the separation of the placenta and its expulsion or removal. Most common cause is uterine atony, failure of the uterus to contract and retract after birth. |
| Postpartum Hemorrhage Symptoms | Tachycardia, Decreased LOC, Lochia much greater in amount than usual, Urinary output diminished with signs of acute renal failure, Uterus may also be soft and boggy instead of firm |
| Postpartum Hemorrhage Interventions | MASSAGE, URINATE, MEDICATE. MEDICATIONS include misoprostol (Cytotec), oxytocin (Pitocin), methergine, hemabate |
| The four Ts of Postpartum Hemorrhage | Tone, which includes uterine atony, distended bladder. Tissue which includes retained placenta and clots, uterine subinvolution. Trauma which includes lacerations, hematomas, inversion, rupture. Thrombin which include coagulopathy either preexisting or acquired. and Traction which is too much pulling on the umbilical cord |
| Medications for Postpartum hemorrhaging | Oxytocin (Pitocin) , Misoprostol (Cytotec), Dinoprostone (Prostin E2) |
| Oxytocin (Pitocin) for Postpartum hemorrhaging | First line therapy for post partum hemorrhage. Assess the fundus, vital signs, uterine tone, every 15 minutes. Monitor for hyperstimulation. NEVER GIVE UNDILUTED AS A BOLUS INJECTION IV |
| Misoprostol (Cytotec) for Postpartum hemorrhaging | Not FDA approved for this indication. other contraindications include active cardiovascular disease, pulmonary/hepatic disease |
| Dinoprostone (Prostin E2) for Postpartum hemorrhaging | Monitor BP frequently as hypotension is a side effect. Monitor fo vomiting, diarrhea, nausea, temperature elevation. DO NOT GIVE TO THOSE IN CARDIAC, PULMONARY, RENAL, OR HEPATIC DISEASE |
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