ATI Maternal Newborn Flashcards


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1

Diaphragm

Spermicide must be applied with each act of sexual intercourse and should remain in place 6 hrs after. Empty bladder prior to coitus

2

Transdermal contraceptive patch

Patch applied to dry skin overlying subQ tissue, excluding breast

3

Depo-Provera

IM injection given every 11-13 weeks (start should be during first 5 days of clients menstrual cycle)

4

Essure

Insertion of agent resulting in development of scar tissue in Fallopian tubes. Not reversible

5

Female sterilization

Burning or blocking the Fallopian tubes. Not reversible

6

Vasectomy

Ligation and severance of vas deferens. Need alternate form of birth control for 20 ejaculations

7

RhoGAM

Administered at 28 weeks gestation to a mother who is Rh-negative and gives birth to an Rh-positive infant. Recommended following an amniocentesis

8

Oxytocin (Pitocin)

Monitor for water intoxication (lightheaded, n/v, headache, malaise) which can lead to cerebral edema, seizures, coma, and death. Contraindicated based on late decelerations

9

3 hour glucose tolerance test

Screens for gestational diabetes and is done at 28 weeks of gestation

10

Rubella titer

Obtained at initial prenatal visit (about 6 weeks gestation)

11

Betamethasone (Celestone)

Glucocorticoid administered IM in 2 injections 24 hr apart, given to stimulate fetal lung maturity if early delivery is anticipated and to prevent respiratory distress. Can cause pulmonary edema (crackles, chest pain, SOB)

12

Leopold Maneuver

Abdominal palpation of fetus, lie, attitude, helps nurse assess the position of the fetus to determine the optimal placement of the fetal monitoring transducer. Empty bladder beforehand, supine positioning

13

Steps of Leopold Maneuver

Palpate client's fundus, determine location of fetal back, palpate fetal part presenting at the inlet, and palpate the cephalic prominence to identify the attitude of the head

14

Ferning test

If positive, indicates rupture of membranes

15

Expected newborn temp

36.5-37.2

16

Expected newborn HR

120-160

17

Expected newborn RR

30-60

18

Expected newborn BP

60-80 S, 40-50 D

19

Expected newborn length

45-55 cm

20

Expected newborn weight

2,500-4,000 g

21

What is effleurage?

Client strokes abdomen using circular motion during contractions

22

Maternal Serum Alpha-Fetoprotein

Screening tool for neural tube defects that is effective between 15 and 22 weeks. levels above indicate the need for an ultrasound

23

Position for transvaginal ultrasound

Lithotomy position

24

Biophysical profile assesses?

Fetal HR, breathing, body movements, fetal tone, and qualitative amniotic fluid volume

25

What does biophysical profile indicate?

The risk of asphyxia

26

Nonstress test

Client presses a button whenever they feel fetal movement which allows nurse to assess FHR in relationship to the fetal movement

27

Reactive stress test

FHR has moderate variability, accelerated to 15 beats/min for at least 15 seconds and occurs two or more times during a 20 minute period

28

Nonreactive stress test

FHR does not accelerate adequately with fetal movement. Does not meet criteria after 40 minutes. Contraction stress test or biophysical profile is indicated

29

Contraction stress test

FHR in response to contractions which decreases placental blood flow

30

Amniocentesis

Performed after 14 weeks gestation, empty bladder beforehand, client in supine position

31

High levels of AFP

Alpha-Fetoprotein is measured between 16 and 18 weeks and is used to detect neural tube defects (anencephaly), spina bifida, and omphalocele

32

Low levels AFP

Chromosomal disorders (Down syndrome)

33

Fetal lung tests

Lecithin/sphingomyelin ratio- 2:1 indicating lung maturity or 3:1 for diabetes mellitus

34

Percutaneous blood sampling

Obtains fetal blood from umbilical cord which evaluates isoimmune fetal hemolytic anemia and assesses need for fetal blood transfusion

35

Chorionic Villus sampling

Alternative to amniocentesis (10-12 weeks gestation)

36

Quad marker screening

Blood test that ascertains info about likelihood of fetal birth defects. Includes AFP, hCG, Estriol, Inhibin-A

37

Placenta previa

Placenta abnormally implants in the lower segment of the uterus near or over the cervix. Results in abnormal bleeding during the 3rd trimester as cervix begins to dilate

38

Placenta previa- marginal or low lying

Placenta is attached to lower uterine segment but does not reach cervix

39

Signs of placenta previa

Painless vaginal bleeding

40

Abruptio placenta

Premature separation of placenta from uterus. Can occur after 20 weeks gestation

41

Signs of abruptio placenta

Sudden onset of dark red vaginal bleeding, sharp abdominal pain, and tender rigid uterus (board like)

42

Spontaneous abortion

Pregnancy is terminated before 20 weeks or fetal weight is less than 500 g. Vaginal bleeding, uterine cramping, and partial or complete expulsion of products of conception

43

Ectopic pregnancy

Abnormal implantation of a fertilized ovum outside the uterine cavity usually in fallopian tubes. Abrupt unilateral lower-quadrant abdominal pain with or without vaginal bleeding, scant dark red vaginal spotting occurring 6-8 weeks after last normal menses

44

Gestational trophoblastic disease

Swollen, fluid-filled grape like clusters in the placenta. Associated with choriocarcinoma which is a rapidly metastasizing malignancy

45

Signs of gestational trophoblastic diease

Uterine size increasing abnormally fast, abnormally high levels of hCG, nausea and increased emesis, no fetus present on ultrasound, and scant or profuse dark brown or red vaginal bleeding

46

HIV/AIDs

Avoid amniocentesis and episiotomy because of the risk of blood exposure

47

Retrovir

Antiviral given at 14 weeks gestation throughout pregnancy for HIV/AIDs. Given to infant for 6 weeks following birth

48

TORCH

Toxoplasmosis, Rubella, Cytomegalovirus, and Herpes Simplex Virus

49

Toxoplasmosis

Consumption of raw or undercooked meat or handling cat feces, fever and tender lymph nodes

50

Rubella

Contracted through children who have rashes or neonates who are born to mothers who had rubella during pregnancy, rash, mild lymphedema, fever, and fetal consequences

51

Cytomegalovirus

Member of the herpes family, transmitted by droplet infection, found in semen, cervical or vaginal secretions, breast milk, placental tissue, urine, feces, or blood

52

Herpes Simplex Virus

Oral or genital lesions, transmission to the fetus is greatest during vaginal birth if the woman has active lesions. Fetal consequences include miscarriage, preterm labor, and intrauterine growth restriction

53

Group B Streptococcus B-hemolytic

Positive GBS may have effects including premature rupture of membranes, preterm labor, chorioamnionitis, infections of urinary tract, and maternal sepsis. Vaginal and rectal cultures are performed at 36-37 weeks of gestation

54

Medications for GBS

Penicillin G or Ampicillin (Principen)

55

Chlamydia

Vaginal spotting, vulvar intching, postcoital bleeding and dysuria, white watery discharge

56

Chlamydia medications

Azithromycin (Zithromax), amoxicillin (Amoxil), erythromycin (Ery-Tab)

57

Gonorrhea

Painful urination, frequency, lower abdominal pain (female), dysmenorrhea, yellow-green vaginal discharge, reddened vulva and vaginal walls, if left untreated it can cause PID, heart disease and arthritis

58

Gonorrhea medications

Ceftriaxone (Rocephin)

59

Candida Albicans

Thick, creamy, white vaginal discharge, vulvar redness, white patches on vaginal walls, grey-white patches on tongue and gums (neonate)

60

Candida Albicans medications

Fluconazole (Diflucan) and clotrimazole (Monistat)

61

Recurrent premature dilation of the cervix (Incompetent cervix)

Expulsion of the products of conception occurs

62

Treatment for recurrent premature dilation of the cervix

Prophylactic cervical cerclage is the surgical reinforcement of the cervix with a heavy ligature that is placed submucosally around the cervix to strengthen it and prevent premature cervix dilation (best done 23-24 weeks of gestation)

63

Dehydration

Stimulates uterine contractions

64

Hyperemesis Gravidarum

Excessive n/v possibly related to elevated hCG levels prolonged past 12 weeks of gestation

65

hCG elevation in hyperemesis gravidarum

Elevated because inability to retain fluid results in hemoconcentration

66

Anemia

Iron-deficiency occurs during pregnancy due to inadequacy in maternal iron stores and consuming insufficient amounts of dietary iron

67

Lab tests for Anemia

Hgb less than 11 in 1st and 3rd trimester and 10.5 in 2nd trimester, and Hct less than 33%

68

Medication for Anemia

Ferrous sulfate, take on empty stomach, encourage diet rich in vitamin C to increase absorption. Iron dextran when oral supplements cannot be tolerated

69

Gestational Diabetes Mellitus

Can result in spontaneous abortion, infections (r/t increased glucose in urine), hydraminos, ketoacidosis, hypoglycemia, and hyperglycemia

70

Hypoglycemia

Jittery, nervousness, weak shrill cry, hypothermia, flaccid muscle tone, headache, weakness, irritability, hunger, blurred vision, tingling of mouth and extremities

71

Hyperglycemia

Thirst, nausea, abdominal pain, frequent urination, flushed dry skin, and fruity breath

72

Lab test for Gestational Diabetes Mellitus

24-28 weeks gestation, a glucola screening test/1-hr glucose tolerance test (50 g oral glucose load followed by plasma glucose analysis 1 hr later, fasting not necessary (positive reading is 130-140 mg/dL or above

73

OGTT

Overnight fasting, avoid caffeine, no smoking for 12 hours prior to test, fasting glucose is obtained, 100 g glucose load is given, and serum glucose levels are determined at 1, 2, and 3 hours following ingestion

74

Gestational Hypertension

Begins after 20th week of pregnancy, elevated BP of 140/90 or greater recorded at least twice, 4-6 hours apart, within 1 week period. NO proteinuria

75

Mild Preeclampsia

Gestational hypertension along with proteinuria of greater than 1+

76

Severe preeclampsia

BP 160/100 or greater, proteinuria greater than 3+, oliguria, elevated serum creatinine- 1.2+, cerebral or visual disturbances (headache or blurred vision), hyperreflexia with ankle clonus, peripheral edema, hepatic dysfunction, RUQ pain, and thrombocytopenia

77

Eclampsia

Severe preeclampsia symptoms along with seizure activity or coma. Preceded by headache, severe epigastric pain, hyperreflexia, and hemoconcentrations

78

HELLP syndrome

Hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction

79

H

Hemolysis resulting in anemia and jaundice

80

EL

Elevated liver enzymes (ALT and ASP), epigastric pain, and n/v

81

LP

Low platelets (less than 100,000) resulting in thrombocytopenia, abnormal bleeding and clotting, bleeding gums, petechiae, and possible DIC

82

Gestational hypertension medications

Methyldopa, Nifedepine, Hydralazine, Labetalol hydrochloride, avoid ACE inhibitors and angiotensin 2 receptor blockers

83

Magnesium Sulfate

Anticonvulsant, monitor BP, pulse, RR, deep tendon reflexes, LOC, urinary output, presence of headache, visual disturbances, epigastric pain, uterine contractions, and FHR, maintain fluid restriction of 100-150 mL/hr

84

Magnesium Sulfate toxicity

Absence of patellar deep tendon reflexes, urine output less than 30 mL/hr, respirations less than 12/min, decreased LOC, and cardiac dysthythmias

85

If magnesium sulfate toxicity is expected

Discontinue, administer calcium fluconate, prepare for actions to prevent respiratory and cardiac arrest

86

Preterm labor

Uterine contractions and cervical changes occurring between 20 and 37 weeks gestation, persistent low back ache

87

Diagnostic for preterm labor

Vaginal swab for fetal fibronectin which appears between 24-34 weeks. Found when fetal membrane integrity is lost

88

Medications for preterm labor

Nifedipine (inhibits calcium which suppresses contractions) and Magnesium sulfate

89

Premature rupture of membranes

Spontaneous rupture of amniotic membranes 2 hour or more prior to the onset of true labor

90

Preterm premature rupture of membranes

After 20 weeks of gestation and prior to 37 weeks

91

Nitrazine paper test or ferning test

Positive test (blue, pH 6.5-7.5) verifies rupture of membranes

92

5 P's that define the labor process

Passenger, passageway, powers, position, and psychological response

93

Passenger

Fetus and palcenta, presentation, lie, attitude, and fetopelvic or fetal position

94

Passageway

The size and shape of the bony pelvis must be adequate to allow fetus to pass through

95

Powers

Uterine contractions cause effacement and dilation of the cervix

96

Position

Of the woman who is in labor, should engage in frequent position changes during labor to increase comfort, relieve fatigue, and promote circulation

97

Psychological response

Maternal stress, tension, and anxiety

98

Prolonged or too frequent contraction

Greater than 90 seconds or more than five in a 10-min period

99

True labor contractions

Stronger, last longer, more frequent, felt in lower back radiating to abdomen,doesn't decrease with comfort measures, walking can increase intensity, cervix shows progressive change

100

False labor contractions

Decrease in frequency, duration, and intensity, painless, irregular frequency, felt in lower back or abdomen above umbilicus, often stop with sleep or comfort measures, no change with dilation

101

Latent phase

Cervix 0-3 cm (non pharmacological pain management)

102

Active phase

Cervix 3-7 cm (opioids and epidural)

103

Transition phase

Cervix 8-10 cm

104

Second stage

Full dilation and ends with birth (intense contractions every 1-2 minutes) (spinal block, pudendal, and local infiltration)

105

Third stage

Delivery of neonate and ends with delivery of placenta

106

Fourth stage

Delivery of placenta and ends with maternal stabilization of vital signs

107

Braxton Hicks contractions

Decrease with hydration and walking

108

Effleurage

Light, gentle, circular stroking of client's abdomen

109

Sacral counterpressure

Consistent pressure against sacral area to counteract pain of lower back

110

-barbitals

Can be used during early or latent phase of labor to relieve anxiety and induce sleep

111

Opioids

Meperidine, fentanyl, butorphanol, and nalbuphine (have nalozone ready as the antidote)

112

Antiemetics

Ondansetron and metoclopramide

113

Epidural

Bupivacaine, along with morphine or fentanyl (given when client is dilated at least 4 cm). Administer bolus of fluids to offset hypotension, place client in side-lying, sitting, or modified Sims' position

114

Pudenal block

Local anesthetic such as lidocaine or bupivacaine administered transvaginally

115

Normal baseline FHR

110-160

116

Absent variability

Flat line

117

Minimal variability

<5/min

118

Moderate variability

6-25/min

119

Marked variability

Greater than 25/min

120

Category 1

Baseline 110-160, variability is moderate, accelerates present or absent, early decelerations present or absent, and variable or late decelerations absent

121

Category 2

Could be tachycardic or bradycardic

122

Category 3

Sinusoidal pattern, absent baseline fetal HR variability, nervous system of neonate not intact

123

Fetal bradycardia

Discontinue pitocin, assist client to side-lying position, administer 02, insert IV, administer tocolytic, notify provider

124

Fetal tachycardia

Administer antipyretic if maternal fever is present, administer 02, administer IV bolus

125

Variable deceleration of FHR

Reposition client from side to side or into knee-chest

126

Late deceleration of FHR

Place client in side-lying position, insert IV catheter and increase fluids, discontinue pitocin, administer 02

127

Decrease or loss of FHR variability

Stimulate fetal scalp, assist provider with application of scalp electrode, and place client in left lateral position

128

Average uterine pressure

50-85 mm Hg

129

1st degree laceration

Extends through skin of perineum

130

2nd degree laceration

Extends through skin and muscle

131

3rd degree laceration

Extends through skin, muscle, perineum, and anal sphincter muscle

132

4th degree laceration

Extends through skin, muscle, anal sphincter, and anterior rectal wall

133

Bishop score

Determines maternal readiness for labor by evaluating whether the cervix is favorable by rating cervical dilation, effacement, consistency, position, and station

134

Cervical ripening

Misoprostol and dinoprostone are agents to ripen servix

135

Amniotomy

Artificial rupture of amniotic membranes

136

Amnioinfusion

0.9% sodium chloride or lactated ringer's solution is instilled into amniotic cavity to supplement the amount of amniotic fluid. Reduces severity of variable decelerations caused by cord compression

137

Fetal distress

HR below 110 or above 160, shows decreased or no variability, and is hyperactive or no activity

138

Nursing care for fetal distress

Position client in left side lying reclining position with legs elevated, 8-10 liters of 02

139

Dystocia

Abnormal labor related to the 5 P's. Hypotonic or hypertonic contractions, with failure to efface and dilate the cervix

140

What to do with hypertonic contractions?

Maintain hydration, promote rest and relaxation, and place client in lateral position and provide 02 by mask

141

Precipitous labor

Labor that lasts 3 hours or less from onset of contractions to time of delivery

142

Anaphylactoid Syndrome

Amniotic fluid embolism. Rupture of amniotic sac causing infiltration of amniotic fluid into the maternal circulation. Amniotic fluid travels to and obstructs pulmonary vessels

143

Sign of anaphylactoid syndrome

Sudden chest pain, cyanosis, dyspnea, pulmonary edema, respiratory arrest

144

Care for anaphylactoid syndrome

Administer 02, intubate, cardiopulmonary resuscitation as necessary, administer fluids, position client on side with pelvis tilted 30 degrees to displace uterus, administer blood products

145

Greatest risks during postpartum period

Hemorrhage, shock, and infection

146

Decreased estrogen

Breast engorgement, diaphoresis, diuresis, diminished vaginal lubrication

147

Decreased progesterone

Increase in muscle tone

148

Decreased placental enzyme insulinase

Blood sugar lowers immediately after birth

149

Kleihauer-Betke test

Determined amount of fetal blood in maternal circulation if large fetomaternal transfusion is suspected

150

When is Rho-GAM administered

Within 72 hrs to women who are Rh-negative and gave birth to an infant who is Rh-positive

151

Postpartum focused exam- BUBBLE

Breasts, uterus, bowel, bladder, lochia, episiotomy

152

Postpartum fundus

Decreased in size from 1,000 g to 60 g in two weeks

153

Fundus location postpartum

1 cm above umbilicus 12 hours postpartum

154

Oxytocics

Oxytocin, methylergonovine maleate, and carboprost

155

Methylergonovine (Methergine)

140/90 and above BP- don't give. Also assess for n/v and headache

156

Lochia rubra

Bright red, clots, 1-3 days after delivery

157

Lochia serosa

Pinkish/brown, serosanguineous. Lasts day 4-10 postpartum

158

Lochia alba

Yellowish, white cream color. Lasts approx 11 days-6 weeks postpartum

159

Scant

Less than 2.5 cm

160

Light

Less than 10 cm

161

Moderate

More than 10 cm

162

Heavy

One pad saturated within 2 hr

163

Excessive blood loss

One pad saturated in 15 min or less or pooling of blood under buttocks

164

Continued flow of lochia serosa or alba indicative of

Endometritis

165

Perineum comfort care

Apply ice packs for first 24-48 hours, encourage sitz baths at temp of 38-40 degrees Celsius, administer analgesia

166

Breast milk

Milk is produced 2-3 days after delivery of newborn

167

Hct, Hgb, and leukocyte changes postpartum

Increased Hct and Hgb (up to 72 hr) leukocytosis of up to 20,000-25,000 (10-14 days)

168

Vital sign changes postpartum

Elevated pulse, temp (100 degrees F), cardiac output, orthostatic hypotension

169

GI changes postpartum

Constipation, hemorrhoids

170

Urinary and bladder changes postpartum

Urinary retention (resulting in distended bladder) assess client's ability to void every 2-3 hours. Excessive diuresis (1500-3000 mL/day) is normal within the first 2-3 days

171

Rubella vaccine

Client should not get pregnant for 1 month following the immunization

172

Hepatitis vaccine

Newborns born to infected mothers should receive the hep B vaccine and hep B immune globulin within 12 hours of birth

173

Rubella vaccine and RhoGAM

Assess after 3 months to determine whether immunity to rubella has been developed

174

Varicella vaccine

Client should not get pregnant for 1 month following immunization. A second dose is given at 4-8 weeks

175

Tetanus-diphtheria-acellular pertussis vaccine

Administered prior to discharge

176

Dependent: taking in phase

First 24-48 hours, meeting personal needs, needs others for assistance, excited, talkative, need to review birth experience with others

177

Dependent-independent: taking hold phase

Begins on day 2 or 3, up to 10 days to several weeks. Focus on baby care, wanting to take charge but needs acceptance from others, wants to learn and practice

178

Interdependent: letting go phase

Focuses on family as a unit, resumption of role (partner, family member)

179

Return of menses for nonlactating clients

4-10 weeks

180

Return of menses for lactating clients

3 months or until cessation of breast feeding

181

Heparin monitoring

Monitor aPTT (should be 1.5-2 times 30-40 seconds), have protamine sulfate ready

182

Warfarin monitoring

Monitor PT (should be 1.5-2.5 times 11-12.5 seconds) and INR of 2 or 3

183

Pulmonary embolism interventions

Semi-fowler's position, administer 02, administer alteplase or streptokinase

184

Interventions for DIC

Administer fluid volume replacement (blood products), administer antibiotics, vasoactive drugs, and uterotonics, administer 02, and provide protection from injury

185

Postpartum hemorrhage medications

Oxytocin, methylergonovine (Methergine), misoprostol (Cytotec), and Carboprost tromethamine (Hemabate)

186

Carboprost Tromethamine (Hemabate)

Monitor for adverse effects such as fever, chills, diarrhea, headache, and n/v

187

Uterine atony

Boggy uterus, tachycardia, hypotension, skin is pale, cool, clammy, loss of turgor, may result in hysterectomy

188

Care for uterine atony

Ensure bladder is empty, assess uterus, monitor vitals, IV fluids, 02 2-3 liters via NC, medications for postpartum hemorrhage

189

Subinvolution of uterus

Uterus remains enlarged with continued lochial discharge which may result in postpartum hemorrhage

190

Inversion of uterus

Turning inside out of the uterus (emergency situation)

191

Signs of inversion of the uterus

Pain in the lower abdomen, large, red mass protruding 20-30 cm outside the vaginal opening , dizziness, hypotension, pallor

192

Medication for inversion of the uterus

Terbutaline (Brethine) which relaxes the uterus in order to place it back into the uterine cavity

193

Signs of retained placenta

Uterine atony, subinvolution, inverstion, clots larger than a quarter, the return of lochia rubra, malodorous discharge, elevated temp

194

Treatment of retained placenta

Oxytocin. If it doesn't work then move to Terbutaline (Brethine)

195

Medication for endometritis

Clindamycin (Cleocin)

196

Postpartum blues

Tearfulness, insomnia, lack of appetite, sleep pattern disturbances, crying, and feeling letdown. Typically resolve in 10 days without intervention

197

Postpartum depression

Occurs within 6 months of delivery and is characterized by persistent feeling of sadness, guilt, weight loss, flat affect, rejection of infant, anxiety, irritability, intense mood swings

198

Postpartum psychosis

Develops within the first 2-3 weeks. Confusion, disorientation, paranoia, pronounced sadness, and obsessive behaviors

199

APGAR Heart Rate

0- absent, 1- less than 100, 2- greater than 100

200

APGAR Respiratory Rate

0- absent, 1- slow, weak cry, 2- good cry

201

APGAR Muscle Tone

0- flaccid, 1- some flexion, 2- well flexed

202

APGAR Reflex Irritability

0- none, 1- grimace, 2- cry

203

APGAR Color

0- blue, pale, 1- pink body, cyanotic hands and feet (acrocyanosis, 2- completely pink

204

Appropriate for gestational age

Weight is between 10th and 90th percentile

205

Small for gestational age

Weight is below 10th percentile

206

Large for gestational age

Weight is above 90th percentile

207

Low birth weight

Weight is of 2,500 grams or less at birth

208

Intrauterine growth restriction

Growth rate does not meet expected norms

209

Term

Birth between week 38 and 42

210

Preterm or premature

Born prior to completion of 37 weeks

211

Postterm

Born after completion of 42 weeks gestation

212

Telangiectatic nevi

Flat, pink or red marks that easily blanch and are found on the back of the neck, nose, upper eyelids, and middle of forehead

213

Nevus flammeus

Capillary angioma below the surface of the skin that is purple or red, caries in size and shape, is commonly seen on the face, and does not blanch or disappear

214

Caput succedaneum

Localized swelling of the soft tissue of the scalp caused by pressure in the bead during labor. Resolved in 3-4 days

215

Cephalohematoma

Collection of blood between the periosteum and skull bone

216

Epstein Pearls

Small white cysts found on the gums and at the junction of the soft and hard palates

217

Signs of Downs Syndrome

Low set ears, protruding tongue, absence of head control

218

Plantar grasp

Touch sole of foot, toes curl downwards

219

Moro reflex

Startle

220

Normal bilirubin values

0-6 day 1, 8 or less day 2, and 12 or less day 3

221

First period of reactivity

15-30 min after birth, HR may be 160-180

222

Period of relative inactivity

30 min- 2 hr after birth, newborn is quiet, HR and RR will decrease

223

Second period of reactivity

2-8 hours after birth. Often gags or chokes on mucus that has accumulated in his mouth

224

Phenylketonuria

PKU is a defect in protein metabolism which can result in mental retardation

225

Newborn bradycardia

Less than 25

226

Newborn tachycardia

More than 60

227

Conduction heat loss

Contact with cooler surface

228

Convection heat loss

Flow of heat from body to cooler air

229

Evaporation heat loss

Loss of heat as surface liquid is converted to vapor

230

Radiation heat loss

Loss of heat from body to cooler surface that is close to but not in direct contact

231

Temp when bathing can be initiated

97.7 or 36.5

232

Application of Erythromycin

To prevent ophthalmia neonatorum. Lower conjunctival sac of each eye starting from inner canthus and moving outwards

233

Vitamin K

To prevent hemorrhagic disorders because this vitamin is not produced in the GI tract until day 8 (once breast milk is introduced into gut)

234

Hep B dosage schedule

Birth, 1 month, and 6 months

235

Hypoglycemia: monitor for

Blood glucose less than 40, jitteriness, twitching, weak high pitched cry, irregular respiratory effort, cyanosis, seizures, eye rolling, give formula immediately

236

Healthy newborn fluid intake

100-140 mL/kg/24 hr

237

Healthy newborn caloric intake

110 kcal/kg/day then 3-6 months it's 100 kcal/kg/day

238

Breast milk and formula caloric amount

20 kcal/oz

239

How often should newborns breastfeed?

Every 3 hours during day, every 4 hours during night (8-12 times within a 24 hr day)

240

Meds that increase breast milk production

Fenugreek and metoclopramide (Reglan)

241

Breast milk storage

Room temp 8 hr, refrigerated 8 days, freezer 6 months, and deep freezer 12 months

242

Adequately fed newborn signs

Bowel movements are yellow, soft, and formed, stool after every feeding, after couple of weeks movements will decrease to 1-2 times a day, void 6-8 times per day

243

Circumcision care

Do not wash off the yellowish mucus that forms over the glans, avoid wrapping in tight gauze, check for bleeding every 15 min after procedure for the first hour, monitor for the first void

244

Car seat safety

Use rear-facing car seat in back seat, preferably the middle until age 2 or until the child reaches max height and weight

245

Neonatal withdrawal

High pitched shrill cry, tremors, increased Moro reflex, increased deep tendon reflexes, increased muscle tone, tachypnea, sweating, temp greater than 99 degrees

246

Opiate withdrawal

Rapid mood changes, hypersensitivity to noise, dehydration, and poor weight gain

247

Heroin withdrawal

Low birth weight, SGA, decreased Moro reflex, hypo or hyperthermia

248

Methadone withdrawal

Increased incidence of seizures, higher birth weight, higher risk of SIDs

249

Marijuana withdrawal

Preterm birth and meconium staining

250

Amphetamine withdrawal

Preterm or SGA, drowsy, jittery, respiratory distress, frequent infections, poor weight gain, emotional disturbances

251

Fetal Alcohol syndrome withdrawal

Facial anomalies, stabismus, ptosis, cleft lip or palate, deafness, abnormal palmar creases, irregular hair, developmental delays, prenatal and postnatal growth retardation

252

Cocaine addiction

Avoid eye contact, and use vertical rocking and a pacifier

253

Neonatal Hypoglycemia

Blood glucose of 40 or less or in a preterm newborn 25 or less

254

Respiratory distress syndrome, asphyxia, meconium staining

Tachypnea, nasal flaring, expiratory grunting, retractions, fine crackles, cyanosis

255

Medication for respiratory distress syndrome

Beractant (Survanta)

256

Findings for SGA

Below 10th percentile, hair is sparse, dry, loose skin, decreased fat, dry yellow umbilical cord, acrocyanosis, wide-eyed and alert

257

Findings for LGA

90th percentile or more than 8 lbs, 12 oz, findings of increased ICP (dilated pupils, vomiting, bulging fontanels), plump face, tachypnea, retractions, cyanosis, hypotonic muscles

258

Physiologic jaundice

Normal newborn physiology, no other manifestations, appears after 24 hours

259

Pathologic jaundice

Result of an underlying disease appearing before 24 hours (or persistent after day 7)

260

Kernicterus

Results from untreated hyperbilirubinemia with levels t or higher than 25 mg/dL

261

Phototherapy

Primary treatment for hyperbilirubinemia, prescribed if the level is greater than 15 mg/dL prior to 48 hr of age, greater than 18 mg/dL prior to 72 hr of age, and greater than 20 mg/dL at any time

262

Phototherapy indications

Maintain eye mask over neonate's eyes, keep female undressed, avoid lotions or ointments, remove from phototherapy every 4 hours, reposition every 2 hours

263

Tracheoesophageal atresia

Failure of the esophagus to connect to the stomach

264

Galactosemia

Inability to metabolize galactose into glucose, give newborn soy-based formula because galactose is present in milk, breastfeeding is contraindicated