Exam 1 - NUR 102

  1. Affordable Care Act (ACA)
  2. assent
  3. certified nurse midwife (CNM)
  4. child abuse and neglect
  5. childhood mortality rate
  6. cultural competence
  7. discipline
  8. dissent
  9. do not attempt resuscitate (DNAR) orders
  10. doula
  11. emancipated minor
  12. enculturation
  13. ethnocentrism
  14. family structure
  15. fetal mortality rate
  16. foster care
  17. infant mortality rate
  18. maternal–fetal conflict
  19. maternal mortality ratio
  20. mature minor
  21. morbidity
  22. neonatal mortality rate
  23. punishment
  24. resilience
  25. stem cells
  26. breasts
  27. cervix
  28. endometrium
  29. estrogen
    • Promotes enlargement of the genitals, uterus, and breasts, and increases vascularity, causing vasodilatation
    • Relaxation of pelvic ligaments and joints
    • Associated with hyperpigmentation, vascular changes in the skin, increased activity of the salivary glands, and hyperemia of the gums and nasal mucous membranes
    • Aids in developing the ductal system of the breasts in preparation for lactation
  30. fallopian tubes
  31. follicle-stimulating hormone (FSH)
  32. luteinizing hormone (LH)
  33. menarche
  34. menstruation
  35. ovaries
  36. ovulation
  37. penis
  38. progesterone
    • Often called the “hormone of pregnancy” because of the critical role it plays in supporting the endometrium of the uterus
    • Supports the endometrium to provide an environment conducive to fetal survival
    • Produced by the corpus luteum during the first few weeks of pregnancy and then by the placenta until term
    • Initially, causes thickening of the uterine lining in anticipation of implantation of the fertilized ovum. From then on, it maintains the endometrium, inhibits uterine contractility, and assists in the development of the breasts for lactation
  39. testes
  40. uterus
  41. vagina
  42. vulva
  43. bolus feeding
  44. enteral nutrition
  45. gastric residual
  46. gastrostomy
  47. gavage feedings
  48. infiltration
  49. parenteral nutrition
  50. pharmacodynamics
  51. pharmacokinetics
  52. total parenteral nutrition
  53. acquaintance rape
  54. battered women syndrome
  55. cycle of violence
  56. date rape
  57. female genital cutting (FGC)
  58. human trafficking
  59. incest
  60. intimate partner violence (IPV)
  61. posttraumatic stress disorder (PTSD)
  62. rape
  63. sexual abuse
  64. statutory rape
  65. ballottement
    the examiner pushes against the woman’s cervix during a pelvic examination and feels a rebound from the floating fetus
  66. Braxton Hicks contractions
    Spontaneous, irregular, and painless contractions that begin during the first trimester.
  67. Chadwick’s sign
    • a bluish-purple coloration of the vaginal mucosa and cervix
    • Probable S&S of Pregnancy
  68. dietary reference intakes (DRIs)
    For most pregnant women, supplements of 27 mg of ferrous iron and 400 to 800 mcg of folic acid per day are recommended by the dietary reference intakes (DRIs)
  69. sources of folic acid
    • dark green vegetables such as broccoli, romaine lettuce, and spinach
    • baked beans
    • black-eyed peas
    • citrus fruits
    • peanuts
    • liver
  70. sources of calcium for lactose intolerance
    • peanuts, almonds, sunflower seeds, broccoli, salmon, kale, and molasses
    • also encourage lactose-free dairy products or calcium-enriched orange juice or soy milk
  71. vegetarian diets
    • For protein: substitute soy foods, beans, lentils, nuts, grains, and seeds.
    • For iron: eat a variety of meat alternatives, along with vitamin C–rich foods.
    • For calcium: substitute soy, calcium-fortified orange juice, and tofu.
    • For vitamin B12: eat fortified soy foods and a B12 supplement.
  72. Goodell’s sign
    • softening of the cervix
    • Probable S&S of Pregnancy
  73. Hegar’s sign
    • softening of the lower uterine segment or isthmus
    • Probable S&S of Pregnancy
  74. linea nigra
    The skin in the middle of the abdomen may develop a pigmented line called linea nigra, which extends from the umbilicus to the pubic area.
  75. Melasma
    • "Mask of Pregnancy"
    • The increased pigmentation that occurs on the breasts and genitalia also develops on the face to form the “mask of pregnancy,” which is also called facial melasma.
  76. physiologic anemia of pregnancy
    The number of red blood cells also increases throughout pregnancy to a level 25% to 33% higher than nonpregnant values, depending on the amount of iron available. This increase is necessary to transport the additional oxygen required during pregnancy. Although there is an increase in red blood cells, there is a greater increase in the plasma volume as a result of hormonal factors and sodium and water retention. Because the plasma increase exceeds the increase of red blood cell production, normal hemoglobin and hematocrit values decrease. This state of hemodilution is referred to as physiologic anemia of pregnancy. Changes in red blood cell volume are due to increased circulating erythropoietin and accelerated red blood cell production. The rise in erythropoietin in the last two trimesters is stimulated by progesterone, prolactin, and human placental lactogen.
  77. pica
    the intense craving for and eating of non-food items
  78. quickening
    fetal movements
  79. trimester
  80. Subjective (Presumptive) Signs of Pregnancy
    • signs that the mother can perceive
    • most common is absence of menstruation
    • usually accompanied by consistent nausea, fatigue, breast tenderness, and urinary frequency
  81. Probable S&S of Pregnancy
    • Positive preg test
    • Hegar's sign (softening of the lower uterine segment or isthmus)
    • Chadwick's sign (a bluish-purple coloration of the vaginal mucosa and cervix)
    • Goodell's sign (softening of the cervix)
    • Ballottement (the examiner pushes against the woman’s cervix during a pelvic examination and feels a rebound from the floating fetus)
  82. Positive S&S of Pregnancy
    • U/S verification of embryo or fetus
    • Fetal movement felt by experienced clinician
    • Auscultation of fetal heart tones
  83. ptyalism
    Some women complain about excessive salivation, termed ptyalism, which may be caused by the decrease in unconscious swallowing by the woman when nauseated. Ptyalism typically resolves spontaneously, although in some women it endures throughout the pregnancy.
  84. Maternal Emotional Responses
    ambivalence, introversion, acceptance, mood swings, and changes in body image
  85. Becoming a Mother - Rubin
    • 1 - Ensuring safe passage throughout pregnancy and birth:
    • Primary focus of the woman’s attention
    • First trimester - woman focuses on herself, not on the fetus
    • Second trimester - woman develops attachment of great value to her fetus
    • Third trimester - woman has concern for herself and her fetus as a unit
    • Participation in positive self-care activities related to diet, exercise, and overall well-being
    • 2 - Seeking acceptance of infant by others:
    • First trimester - acceptance of pregnancy by herself and others
    • Second trimester - family needs to relate to the fetus as member
    • Third trimester - unconditional acceptance without rejection
    • 3 - Seeking acceptance of self in maternal role to infant (“binding in”)
    • First trimester - mother accepts idea of pregnancy, but not of infant
    • Second trimester - with sensation of fetal movement (quickening), mother acknowledges fetus as a separate entity within her.
    • Third trimester - mother longs to hold infant and becomes tired of being pregnant.
    • 4 - Learning to give of oneself
    • First trimester - identifies what must be given up to assume new role
    • Second trimester - identifies with infant, learns how to delay own desires
    • Third trimester - questions her ability to become a good mother to infant
  86. alpha-fetoprotein
    • a glycoprotein produced initially by the yolk sac and fetal gut, and later predominantly by the fetal liver. In a fetus, the serum AFP level increases until approximately 14 to 15 weeks, and then falls progressively.
    • elevated levels of maternal serum AFP (MSAFP) or amniotic fluid AFP are linked to the occurrence of fetal neural tube defects
    • If a developmental defect is present, such as failure of the neural tube to close, more AFP escapes into amniotic fluid from the fetus. AFP then enters the maternal circulation by crossing the placenta, and the level in maternal serum can be measured. The optimal time for AFP screening is 16 to 18 weeks of gestation.
    • A variety of situations can lead to elevation of MSAFP, including open neural tube defect, underestimation of gestational age, the presence of multiple fetuses, gastrointestinal defects, low birth weight, oligohydramnios, maternal age, diabetes, and decreased maternal weight.
    • Lower-than-expected MSAFP levels are seen when fetal gestational age is overestimated or in cases of fetal death, hydatidiform mole, increased maternal weight, maternal type 1 diabetes, and fetal trisomy 21 (Down syndrome) or trisomy 18 (Edwards syndrome)
  87. amniocentesis
    involves a transabdominal puncture of the amniotic sac to obtain a sample of amniotic fluid for analysis. The fluid contains fetal cells that are examined to detect chromosomal abnormalities and several hereditary metabolic defects in the fetus before birth. In addition, amniocentesis is used to confirm a fetal abnormality when other screening tests detect a possible problem.
  88. biophysical profile (BPP)
    • uses a real-time ultrasound and NST to allow assessment of various parameters of fetal well-being. A BPP includes ultrasound monitoring of fetal movements, fetal tone, and fetal breathing and ultrasound assessment of amniotic fluid volume with or without assessment of the fetal heart rate. A BPP is performed in an effort to identify infants who may be at risk of poor pregnancy outcome, so that additional assessments of well-being may be performed, or labor may be induced or a caesarean section performed to expedite birth. The primary objectives of the BPP are to reduce stillbirth and to detect hypoxia early enough to allow delivery in time to avoid permanent fetal damage resulting from fetal asphyxia.
    • Scored by five components (2 pts each):
    • Body movements: three or more discrete limb or trunk movements
    • Fetal tone: one or more instances of full extension and flexion of a limb or trunk
    • Fetal breathing: one or more fetal breathing movements of more than 30 seconds
    • Amniotic fluid volume: one or more pockets of fluid measuring 2 cm
    • NST: normal NST = 2 points; abnormal NST = 0 points
  89. chorionic villus sampling (CVS)
    • nvolving an 18-gauge needle stick through the abdomen or passage of a suction catheter through the cervix under ultrasound guidance. This test is used to obtain a sample of the chorionic villi from the placenta for prenatal evaluation of chromosomal disorders such as Down syndrome or cystic fibrosis, enzyme deficiencies, and fetal gender determination and to identify sex-linked disorders such as hemophilia, sickle cell anemia, and Tay–Sachs disease.
    • Does not detect neural tube defects.
  90. high-risk pregnancy
    include those that are complicated by maternal or fetal conditions (coincidental with or unique to pregnancy) that jeopardize the health status of the mother and put the fetus at risk for uteroplacental insufficiency, hypoxia, and death
  91. natural childbirth
    a birth without pain-relieving medications
  92. perinatal education
    includes childbirth education, birthing options, health care provider options, preparation for breast-feeding or bottle-feeding, and final preparation for labor and birth
  93. preconception care
    • the promotion of the health and well-being of a woman and her partner before pregnancy
    • The goal of preconception care is to identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management interventions, these include:
    • Immunization status of the woman
    • Underlying medical conditions, such as cardiovascular and respiratory problems or genetic disorders
    • Reproductive health data, such as pelvic examinations, use of contraceptives, and sexually transmitted infections (STIs)
    • Sexuality and sexual practices, such as safer-sex practices and body image issues
    • Nutrition history and present status
    • Lifestyle practices, including occupation and recreational activities
    • Psychosocial issues such as levels of stress and exposure to abuse and violence
    • Medication and drug use, including use of tobacco, alcohol, over-the-counter and prescription medications, and illicit drugs
    • Support system, including family, friends, and community
  94. Isotretinoins
    • Risk Factor for adverse pregnancy outcomes
    • Use of isotretinoins (e.g., Accutane®) in pregnancy to treat acne can result in high risk of congenital malformations which may include craniofacial, cardiac, and central nervous systems injuries. It is contraindicated in pregnancy
  95. Alcohol misuse
    • Risk Factor for adverse pregnancy outcomes
    • No time during pregnancy is safe to drink alcohol, and harm can occur early, before a woman has realized that she is or might be pregnant. Fetal alcohol syndrome and other alcohol-related birth defects can be prevented if women cease intake of alcohol before conception.
  96. Antiepileptic drugs
    • Risk Factor for adverse pregnancy outcomes
    • Certain antiepileptic drugs are known teratogens (e.g., valproic acid). Recommendations suggest that before conception, women who are on a regimen of these drugs and who are contemplating pregnancy should be prescribed a lower dosage of these drugs.
  97. Diabetes (preconception)
    • Risk Factor for adverse pregnancy outcomes
    • The threefold increase in the prevalence of birth defects among infants of women with type 1 and type 2 diabetes is substantially reduced through proper management of diabetes.
  98. Folic acid deficiency
    • Risk Factor for adverse pregnancy outcomes
    • Daily use of vitamin supplements containing folic acid (400 mcg) has been demonstrated to reduce the occurrence of neural tube defects by two thirds.
  99. Hepatitis B
    • Risk Factor for adverse pregnancy outcomes
    • Vaccination is recommended for men and women who are at risk for acquiring hepatitis B virus (HBV) infection. Preventing HBV infection in women of childbearing age prevents transmission of infection to infants and eliminates risk to the woman of HBV infection and sequelae, including hepatic failure, liver carcinoma, cirrhosis, and death.
  100. HIV/AIDS
    • Risk Factor for adverse pregnancy outcomes
    • If HIV infection is identified before conception, timely antiretroviral treatment can be administered, and women (or couples) can be given additional information that can help prevent mother-to-child transmission.
  101. Rubella seronegativity
    • Risk Factor for adverse pregnancy outcomes
    • Rubella vaccination provides protective seropositivity and prevents congenital rubella syndrome.
  102. Obesity
    • Risk Factor for adverse pregnancy outcomes
    • Adverse perinatal outcomes associated with maternal obesity include neural tube defects, preterm delivery, diabetes, cesarean section, and hypertensive and thromboembolic disease. Appropriate weight loss and nutritional intake before pregnancy reduce these risks.
  103. STIs
    • Risk Factor for adverse pregnancy outcomes
    • Chlamydia trachomatis and Neisseria gonorrhoeae have been strongly associated with ectopic pregnancy, infertility, and chronic pelvic pain. STIs during pregnancy might result in fetal death or substantial physical and developmental disabilities, including intellectual disability and blindness. Early screening and treatment prevents these adverse outcomes.
  104. Smoking
    • Risk Factor for adverse pregnancy outcomes
    • Preterm birth, low birth weight, and other adverse perinatal outcomes associated with maternal smoking in pregnancy can be prevented if women stop smoking before or during early pregnancy. Because only 20% of women successfully control tobacco dependency during pregnancy, cessation of smoking is recommended before pregnancy.
  105. Thresholds for diagnosis of overt diabetes during pregnancy
    • Fasting plasma glucose: 126 mg/dL
    • Hemoglobin A1c level: at least 6.5%
    • Random plasma glucose: 200 mg/dL
  106. Nagele Rule
    • To determine estimated date of delivery (EDD)
    • subtract 3 months from the month of her LMP and then add 7 days to the first day of the LMP
    • For instance, if a woman reports that her LMP was October 14, 2015, you would subtract 3 months (July) and add 7 days (21), then add 1 year (2016). The woman’s EDD is July 21, 2016.
    • Margin of error of +/- 2 weeks.
  107. GTPAL notation
    • G = gravida, T = term births, P = preterm births, A = abortions, L = living children
    • G—the current pregnancy to be included in count
    • T—the number of term gestations delivering between 38 and 42 weeks
    • P—the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks
    • A—the number of pregnancies ending before 20 weeks or viability
    • L—the number of children currently living
  108. Gravid
    The state of being pregnant
  109. Gravida/Gravidity
    The total number of times a woman has been pregnant, regardless of whether the pregnancy resulted in a termination or if multiple infants were born from a pregnancy.
  110. Nulligravida
    A woman who has never experienced pregnancy
  111. Primigravida
    A woman pregnant for the first time
  112. Secundigravida
    A woman pregnant for the second time
  113. Multigravida
    A woman pregnant for at least the third time
  114. Para
    The number of times a woman has given birth to a fetus of at least 20 gestational weeks (viable or not), counting multiple births as one birth event.
  115. Parity
    Refers to the number of pregnancies, not the number of fetuses, carried to the point of viability, regardless of the outcome
  116. Nullipara (para 0)
    A woman who has not produced a viable offspring.
  117. Primipara
    A woman who has given birth once after a pregnancy of at least 20 weeks, commonly referred to as a ‘“primip” in clinical practice.
  118. Multipara
    A woman who has had two or more pregnancies of at least 20 weeks’ gestation resulting in viable offspring. Commonly referred to as a “multip.”
  119. McDonald method
    • Fundal height measurement
    • Fundal height is the distance (in centimeters) measured with a tape measure from the top of the pubic bone to the top of the uterus (fundus) with the client lying on her back with her knees slightly flexed.
  120. Danger signs of pregnancy during the first trimester
    • spotting or bleeding (miscarriage),
    • painful urination (infection),
    • severe persistent vomiting (hyperemesis gravidarum),
    • fever >100°F (37.7°C; infection), and
    • lower abdominal pain with dizziness and accompanied by shoulder pain (ruptured ectopic pregnancy)
  121. Danger signs of pregnancy during the second trimester
    • regular uterine contractions (preterm labor);
    • pain in calf, often increased with foot flexion (blood clot in deep vein);
    • sudden gush or leakage of fluid from vagina (premature rupture of membranes);
    • and absence of fetal movement for more than 12 hours (possible fetal distress or demise)
  122. Danger signs of pregnancy during the third trimester
    • sudden weight gain;
    • periorbital or facial edema, severe upper abdominal pain, or headache with visual changes (gestational hypertension and/or preeclampsia); and
    • a decrease in fetal daily movement for more than 24 hours (possible demise).
    • Any of the previous warning signs and symptoms can also be present in this last trimester.
  123. triple marker screen
    AFP, hCG, and unconjugated estriol
  124. quad screen
    • AFP, hCG, and unconjugated estriol and:
    • inhibin A (glycoprotein secreted by the placenta).
    • The quad screen is used to enhance the accuracy of screening for Down syndrome in women younger than 35 years of age.
    • Low inhibin A levels indicate the possibility of Down syndrome.
  125. Possibility of Down Syndrome
    low MSAFP, unconjugated estriol levels, and a high hCG level.
  126. Elevated MSAFP
    • (Maternal serum Alpha-fetoprotein)
    • associated with open neural tube defects, ventral wall defects, some renal abnormalities, multiple gestation, certain skin disorders, fetal demise, and placental abnormality
  127. NST
    • Nonstress test
    • the most common method of prenatal testing used in practice today. The NST provides an indirect measurement of uteroplacental function. Unlike the fetal movement counting done by the mother alone, this procedure requires specialized equipment and trained personnel. The basis for the NST is that the normal fetus produces characteristic fetal heart rate patterns in response to fetal movements. In the healthy fetus there is an acceleration of the fetal heart rate with fetal movement.
    • An NST is recommended twice weekly (after 28 weeks of gestation) for clients with diabetes and other high-risk conditions, such as IUGR, preeclampsia, postterm pregnancy, renal disease, and multifetal pregnancies.
  128. Sexual activity during pregnancy is permissible unless there is a history of:
    • Vaginal bleeding
    • Placenta previa
    • Risk of preterm labor
    • Cervical insufficiency
    • Premature rupture of membranes
    • Presence of infection
  129. Vaccines that should be considered in pregnancy
    • Hepatitis B
    • Influenza (inactivated) injection
    • Tetanus/diphtheria (Tdap)
    • Meningococcal
    • Rabies
  130. Vaccines contraindicated during pregnancy
    • Influenza (live, attenuated vaccine) nasal spray
    • Measles
    • Mumps
    • Rubella
    • Varicella
    • BCG (tuberculosis)
    • Meningococcal
    • Typhoid
  131. Frequency of prenatal visits
    The recommended schedule is every 4 weeks up to 28 weeks (7 months); every 2 weeks from 29 to 36 weeks; and every week from 37 weeks to birth.
  132. attachment
    • Several factors take place during the early postpartum period that can have a large influence on the attachment/bonding that occurs during this time. Oxytocin plays an essential role in the chemistry aspect of bonding, and its effects can be enhanced by skin-to-skin contact, breast-feeding, eye contact, social vocalizations, maternal and milk odors, which are soothing for the newborn, and newborn message during the first postpartum hour.
    • The process of attachment is complex and is influenced by many factors including environmental circumstances, the newborn’s health status, and the quality of nursing care.
  133. engorgement
    occurs 48 to 72 hours after giving birth due to increase in blood and lymph supply to the breasts
  134. engrossment
    • The father’s or significant other’s developing bond with the newborn—a time of intense absorption, preoccupation, and interest.
    • Characterized by 7 behaviors:
    • 1-Visual awareness of the newborn—the partner perceives the newborn as attractive, pretty, or beautiful.
    • 2-Tactile awareness of the newborn—the partner has a desire to touch or hold the newborn and considers this activity to be pleasurable.
    • 3-Perception of the newborn as perfect—the partner does not “see” any imperfections.
    • 4-Strong attraction to the newborn—the partner focuses all attention on the newborn when they are in the room.
    • 5-Awareness of distinct features of the newborn—the partner can distinguish his/her newborn from others in the nursery.
    • 6-Extreme elation—the partner feels a “high” after the birth of his/her child.
    • 7-Increased sense of self-esteem—the partner feels proud, “bigger,” more mature, and older after the birth of his/her child
  135. involution
    • The uterus returns to its normal size through a gradual process of involution, which involves retrogressive changes that return it to its nonpregnant size and condition. Involution involves three retrogressive processes:
    • -Contraction of muscle fibers to reduce those previously stretched during pregnancy
    • -Catabolism, which shrinks enlarged, individual myometrial cells
    • -Regeneration of uterine epithelium from the lower layer of the decidua after the upper layers have been sloughed off and shed during lochial discharge
  136. subinvolution
    • delayed or absent involution
    • occurs as a result of retained placental fragments or infection
  137. lactation
  138. letting-go phase
    In the letting-go phase, the third phase of maternal adaptation, the woman reestablishes relationships with other people. She adapts to parenthood through her new role as a mother. She assumes the responsibility and care of the newborn with a bit more confidence now. The focus of this phase is to move forward by assuming the parental role and to separate herself from the symbiotic relationship that she and her newborn had during pregnancy. She establishes a lifestyle that includes the infant. The mother relinquishes the fantasy infant and accepts the real one.
  139. lochia
    • the vaginal discharge that occurs after birth and continues for approximately four to eight weeks
    • Lochia passes through 3 stages:
    • -Lochia rubra is a deep-red mixture of mucus, tissue debris, and blood that occurs for the first 3 to 4 days after birth. As uterine bleeding subsides, it becomes paler and more serous.
    • -Lochia serosa is the second stage. It is pinkish brown and is expelled 3 to 10 days postpartum. Lochia serosa primarily contains leukocytes, decidual tissue, red blood cells, and serous fluid.
    • -Lochia alba is the final stage. The discharge is creamy white or light brown and consists of leukocytes, decidual tissue, and reduced fluid content. It occurs from days 10 to 14 but can last 3 to 6 weeks postpartum in some women and still be considered normal.
  140. Descriptions of amount of lochia passed
    • Scant: a 1- to 2-in lochia stain on the perineal pad or approximately a 10-mL loss
    • Light or small: an approximately 4-in stain or a 10- to 25-mL loss
    • Moderate: a 4- to 6-in stain with an estimated loss of 25 to 50 mL
    • Large or heavy: a pad is saturated within 1 hour after changing it
  141. puerperium
    The puerperium period begins after the delivery of the placenta and lasts approximately 6 weeks.
  142. taking-hold phase
    • The taking-hold phase, the second phase of maternal adaptation, is characterized by dependent and independent maternal behavior. This phase typically starts on the second to third day postpartum and may last several weeks.
    • As the client regains control over her bodily functions during the next few days, she will be taking hold and becoming preoccupied with the present. She will be particularly concerned about her health, the infant’s condition, and her ability to care for her or him. She demonstrates increased autonomy and mastery of her own body’s functioning, and a desire to take charge with support and help from others. She will show independence by caring for herself and learning to care for her newborn, but she still requires assurance that she is doing well as a mother. She expresses a strong interest in caring for the infant by herself.
  143. taking-in phase
    The taking-in phase is the time immediately after birth when the client needs sleep, depends on others to meet her needs, and relives the events surrounding the birth process. This phase is characterized by dependent behavior. During the first 24 to 48 hours after giving birth, mothers often assume a very passive role in meeting their own basic needs for food, fluids, and rest, allowing the nurse to make decisions for them concerning activities and care. They spend time recounting their labor experience to anyone who will listen. Such actions help the mother integrate the birth experience into reality—that is, the pregnancy is over and the newborn is now a unique individual, separate from herself.
  144. uterine atony
    A boggy or relaxed uterus is a sign of uterine atony (loss of muscle tone in the uterus). This can be the result of bladder distention, which displaces the uterus upward and to the right, or retained placental fragments. Either situation predisposes the woman to hemorrhage.
  145. Postpartum vital signs
    It is not uncommon for women to have a temperature elevation up to 100.4°F in the first 24 hours postpartum. There may also be a slight decrease in blood pressure. The nurse should be most concerned about a blood pressure elevation because preeclampsia may occur during the early postpartum period.
  146. Four Stages a Woman Progresses Through in Establishing a Maternal Identity in Becoming a Mother
    • 1. Commitment, attachment to the unborn baby, and preparation for delivery and motherhood during pregnancy
    • 2 .Acquaintance/attachment to the infant, learning to care for the infant, and physical restoration during the first 2 to 6 weeks following birth
    • 3. Moving toward a new normal routine in the first 4 months after birth
    • 4. Achievement of a maternal identity through redefining self to incorporate motherhood (around 4 months). The mother feels self-confident and competent in her mothering and expresses love for and pleasure interacting with her infant
  147. attachment
    the development of strong affection between an infant and a significant other (mother, father, sibling, and caretaker). This attachment is reciprocal; both the significant other and the newborn exhibit attachment behaviors. The attachment relationship formed between the infant and primary caregiver influences the child’s view of the world and future relationships
  148. bonding
    the close emotional attraction to a newborn by the parents that develops during the first 30 to 60 minutes after birth. It is unidirectional, from parent to infant. It is thought that optimal bonding of the parents to a newborn requires a period of close contact within the first few minutes to a few hours after birth. Bonding is really a continuation of the relationship that began during pregnancy.
  149. en face position
    • (face-to-face)
    • A method of attachment
  150. pelvic floor exercises
  151. peribottle
    for rinsing the perineal area
  152. postpartum blues
    • The postpartum woman may report feelings of emotional lability, such as crying 1 minute and laughing the next.
    • Although postpartum blues is usually benign and self-limited, these mood changes can be frightening to the woman. It is prudent to ask two questions—about having pleasure and interest in things, or feeling predominately down, depressed, or hopeless. Once postpartum blues are determined to be the likely cause of her mood symptoms, the nurse can offer anticipatory guidance that these mood swings are commonly experienced and usually resolve spontaneously within a week and offer reassurance. Women should also be counseled to seek further evaluation if these moods do not resolve within 2 weeks, as postpartum depression may be developing.
  153. sitz bath
  154. Postpartum assessment intervals
    • During the first hour: every 15 minutes
    • During the second hour: every 30 minutes
    • During the first 24 hours: every 4 hours
    • After 24 hours: every 8 hours
    • Postpartum assessment of the mother typically includes vital signs, pain level, epidural site inspection for infection, and a systematic head-to-toe review of body systems. The acronym BUBBLE-EE – breasts, uterus, bladder, bowels, lochia, episiotomy/perineum/epidural site, extremities, and emotional status – can be used as a guide for this head-to-toe review
  155. Postpartum diuresis
    • Begins within 12 hours after childbirth
    • Can be as much as 3000 mL/day, a single void may be 500 mL or more.
    • Urinary retention can displace the uterus upward and to the side (usually right), which prevents the uterine muscles from contracting properly and can lead to excessive bleeding.
  156. Lacerations that occur during delivery
    • First-degree laceration: involves only skin and superficial structures above muscle
    • Second-degree laceration: extends through perineal muscles
    • Third-degree laceration: extends through the anal sphincter muscle
    • Fourth-degree laceration: continues through anterior rectal wall
  157. Nutrition for the Breast-Feeding Mother
    • Calories: + 500 cal/day for the first and second 6 months of lactation
    • Protein: + 20 g/day, adding an extra 2 cups of skim milk
    • Calcium: + 400 mg daily—consumption of four or more servings of milk
    • Iodine: 290 mcg daily—dairy products, seafood, and iodized salt
    • Fluid: + 2 to 3 quarts of fluids daily (milk, juice, or water); no sodas
    • Fruits: 4 servings
    • Vegetables: 4 servings
    • Milk: 4 to 5 servings
    • Bread, cereal, pasta: 12 or more servings
    • Meat, poultry, fish, eggs: 7 servings
    • Fats, oils, and sweets: 5 servings
  158. General Dietary Guidelines for Americans from the Food Guide on MyPlate (for the Nonlactating Woman)
    • Fruits: Make half of your plate fruits and vegetables.
    • Vegetables: Eat red, orange, and dark-green vegetables.
    • Milk: Switch to skim milk or 1%.
    • Breads, grains, and cereals should be whole grains.
    • Meat, poultry, fish, eggs: Eat seafood twice a week and beans, which are high in fiber.
    • Eat the right amount of calories for you; enjoy your food, but eat less.
    • Be physically active your way in activities that you enjoy.
    • Fats, oils, and sweets: Cut back on these.
    • Use food labels to help you make better choices (U. S. Department of Agriculture [USDA] & USDHHS, 2014).
  159. Women who should not breast-feed
    Drugs such as antithyroid drugs, antineoplastic drugs, alcohol, herpes infection on the breasts, or street drugs (methamphetamines, cocaine, PCP, marijuana) enter the breast milk and would harm the infant, so women taking these substances should not breast-feed. To prevent HIV transmission to the newborn, women who are HIV positive should not breast-feed. Other contraindications to breast-feeding include a newborn with an inborn error of metabolism such as galactosemia or phenylketonuria (PKU), active tuberculosis, or a mother with a serious mental health disorder that would prevent her from remembering to feed the infant consistently
  160. Immunizations for the mother prior to discharge
    • Rubella
    • Tdap
  161. cold stress
    excessive heat loss that requires a newborn to use compensatory mechanisms (such as nonshivering thermogenesis and tachypnea) to maintain core body temperature. The consequences of cold stress can be quite severe. As the body temperature decreases, the newborn becomes less active, lethargic, hypotonic, and weaker.
  162. jaundice
    • When unconjugated bilirubin pigment is deposited in the skin and mucous membranes as a result of increased bilirubin levels, jaundice, also known as icterus, develops, with a yellowing of the skin, sclera, and mucous membranes. Visible jaundice as a result of increased blood bilirubin levels occurs in more than half of all healthy newborns. Even in healthy term newborns, extremely elevated blood levels of bilirubin during the first week of life can cause bilirubin encephalopathy, a permanent and devastating form of brain damage.
    • Newborns that are fed early pass stools sooner, which helps to reduce bilirubin buildup
    • Physiologic jaundice typically starts after 72 hours of breast-feeding. There is an enzyme in breast milk that inhibits the breakdown of bilirubin, and it is reflected on the newborn skin as jaundice.
  163. meconium
    Meconium is composed of amniotic fluid, shed mucosal cells, intestinal secretions, and blood. It is greenish black, has a tarry consistency, and is usually passed within 12 to 24 hours of birth. The first meconium stool passed is semisterile, but this changes rapidly with ingestion of bacteria through feedings.
  164. neonatal period
    the first 28 days of life
  165. neurobehavioral response
    Newborns demonstrate several predictable responses when interacting with their environment. How they react to the world around them is termed as neurobehavioral response. It comprises predictable periods that are probably triggered by external stimuli. Expected newborn behaviors include orientation, habituation, motor maturity, self-quieting ability, and social behaviors. Any deviation in behavioral responses requires further assessment, because it may indicate a complex neurobehavioral problem.
  166. neutral thermal environment
    • An environment in which body temperature is maintained without an increase in metabolic rate or oxygen use.
    • Within a neutral thermal environment, the rates of oxygen consumption and metabolism are minimal, and internal body temperature is maintained because of thermal balance. A neutral thermal environment promotes growth and stability, conserves energy for basic bodily functions, and minimizes heat (energy) and water loss.
  167. periodic breathing
    the cessation of breathing that lasts 5 to 10 seconds without changes in color or heart rate
  168. reflex
    an involuntary muscular response to a sensory stimulus. It is built into the nervous system and does not need the intervention of conscious thought to take effect. The physical assessment of the neurologic system of the newborn includes evaluating the major reflexes (gag, Babinski, Moro, and Galant) and minor ones (finger grasp, toe grasp, rooting, sucking, head righting, stepping, and tonic neck).
  169. Moro reflex
    also called the embrace reflex, occurs when the neonate is startled. To elicit this reflex, place the newborn on his or her back. Support the upper body weight of the supine newborn by the arms, using a lifting motion, without lifting the newborn off the surface. Then release the arms suddenly. The newborn will throw the arms outward and flex the knees; the arms then return to the chest. The fingers also spread to form a C. The newborn initially appears startled and then relaxes to a normal resting position.
  170. Galant reflex
    truncal incurvation reflex (Galant reflex) is present at birth and disappears in a few days to 4 weeks. With the newborn in a prone position or held in ventral suspension, apply firm pressure and run a finger down either side of the spine. This stroking will cause the pelvis to flex toward the stimulated side. This indicates T2–S1 innervation. Lack of response indicates a neurologic or spinal cord problem.
  171. surfactant
    • a surface tension–reducing lipoprotein found in the newborn’s lungs that prevents alveolar collapse at the end of expiration and loss of lung volume.
    • Prevents atelectasis
  172. thermoregulation
    • the process of maintaining the balance between heat loss and heat production in order to maintain its core internal temperature. It is a critical physiologic function that is closely related to the transition and survival of the newborn. An appropriate thermal environment is essential for maintaining a normal body temperature.
    • Thermoregulation, the balance between heat loss and heat production, is related to the newborn’s rate of metabolism and oxygen consumption. The newborn attempts to conserve heat and increase heat production by increasing the metabolic rate, increasing muscular activity through movement, increasing peripheral vasoconstriction, and assuming a fetal position to hold in heat and minimize exposed body surface area.
  173. Normal Newborn Blood Value of Hemoglobin
    16-18 g/dL
  174. Normal Newborn Blood Value of Hematocrit
  175. Normal Newborn Blood Value of Platelets
  176. Normal Newborn Blood Value of RBCs
  177. Normal Newborn Blood Value of WBCs
  178. Newborn respiratory rate
    • 30-60 breaths per minute
    • can have short periods of apnea (less than 15 seconds)
    • increases with crying
  179. Newborn heart rate
    • up to 180 during crying
    • 110-160 bpm
  180. Newborn blood pressure
    50-75 mmHg systolic, 30-45 mmHg diastolic
  181. Newborn temperature
    Axillary - 97.7°-99.5°F (36.5°-37.5°C)
  182. Newborns are predisposed to heat loss due to:
    • Thin skin with blood vessels close to the surface
    • Lack of shivering ability to produce heat until 3 months old
    • Limited stores of metabolic substrates (glucose, glycogen, fat)
    • Limited use of voluntary muscle activity or movement to produce heat
    • Large body surface area relative to body weight
    • Lack of subcutaneous fat, which provides insulation
    • Little ability to conserve heat by changing posture (fetal position)
    • No ability to adjust their own clothing or blankets to achieve warmth
    • Inability to communicate that they are too cold or too warm
  183. Conduction
    Conduction involves the transfer of heat from one object to another when the two objects are in direct contact with each other. Conduction 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.
  184. Convection
    Convection involves the flow of heat from the body surface to cooler surrounding air or to air circulating over a body surface. An example of convection-related heat loss would be a cool breeze that flows over the newborn.
  185. Evaporation
    Evaporation involves the loss of heat when a liquid is converted to a vapor. Evaporative loss may be insensible (such as from skin and respiration) or sensible (such as from sweating). Insensible loss occurs, but the individual is not aware of it. Sensible loss is objective and can be noticed. It depends on air speed and the absolute humidity of the air. For example, when the baby is born, the body is covered with amniotic fluid. The fluid evaporates into the air, leading to heat loss.
  186. Radiation
    Radiation involves the loss of body heat to cooler, solid surfaces that are in proximity but not in direct contact with the newborn. The amount of heat loss depends on the size of the cold surface area, the surface temperature of the newborn’s body, and the temperature of the receiving surface area. For example, when a newborn is placed in a single-wall isolette next to a cold window, heat loss from radiation occurs.
  187. Brown Fat
    • The newborn’s primary method of heat production is through nonshivering thermogenesis. This is a process in which brown fat (adipose tissue) is oxidized in response to cold exposure. Brown fat is a special kind of highly vascular fat found only in newborns. Brown adipose tissue is a unique tissue that is able to convert chemical energy directly into heat when activated by the sympathetic nervous system.
    • These fat deposits, which are capable of intense metabolic activity – and thus can generate a great deal of heat – are found between the scapulae, axillae, at the nape of the neck, in the mediastinum, and in areas surrounding the kidneys and adrenal glands. Brown fat makes up about 6% of term body weight in the full-term newborn
  188. Newborn pattern of behaviors
    • First Period of Reactivity:
    • begins at birth and may last from 30 minutes up to 2 hours. The newborn is alert and moving and may appear hungry. This period is characterized by myoclonic movements of the eyes, spontaneous Moro reflexes, sucking motions, chewing, rooting, and fine tremors of the extremities. Muscle tone and motor activity are increased. Respiration and heart rate are elevated but gradually begin to slow as the next period begins.
    • Period of Decreased Responsiveness:
    • At 30 to 120 minutes of age, the newborn enters the second stage of transition—that of the sleep period or a decrease in activity. This phase is referred to as a period of decreased responsiveness. Movements are less jerky and less frequent. Heart and respiratory rates decline as the newborn enters the sleep phase. The muscles become relaxed, and responsiveness to outside stimuli diminishes.
    • Second Period of Reactivity:
    • The second period of reactivity begins as the newborn awakens and shows an interest in environmental stimuli. This period lasts 2 to 8 hours in the normal newborn (Davidson, 2014). Heart and respiratory rates increase. Peristalsis also increases. Thus, it is not uncommon for the newborn to pass meconium or void during this period. In addition, motor activity and muscle tone increase in conjunction with an increase in muscular coordination.
  189. Orientation
    The response of newborns to stimuli is called orientation. They become more alert when they sense a new stimulus in their environment. Orientation reflects newborns’ response to auditory and visual stimuli, demonstrated by their movement of head and eyes to focus on that stimulus. Newborns prefer the human face and bright shiny objects. As the face or object comes into their line of vision, newborns respond by staring at the object intently. Newborns use this sensory capacity to become familiar with people and objects in their surroundings.
  190. Habituation
    Habituation is the newborn’s ability to process and respond to visual and auditory stimuli. It is a measure of how well and appropriately an infant responds to the environment. Habituation is the ability to block out external stimuli after the newborn has become accustomed to the activity. During the first 24 hours after birth, newborns should increase their ability to habituate to environmental stimuli and sleep. Habituation provides a useful indicator of their neurobehavioral intactness.
  191. Motor Maturity
    Motor maturity depends on gestational age and involves evaluation of posture, tone, coordination, and movements. These activities enable newborns to control and coordinate movement. When stimulated, newborns with good motor organization demonstrate movements that are rhythmic and spontaneous. Bringing the hand up to the mouth is an example of good motor organization. As newborns adapt to their new environment, smoother movements should be observed. Such motor behavior is a good indicator of the newborn’s ability to respond and adapt accordingly; it indicates that the central nervous system is processing stimuli appropriately.
  192. Self-Quieting Ability
    • Self-quieting ability (also called self-soothing) refers to newborns’ ability to quiet and comfort themselves. Newborns vary in their ability to console themselves or to be consoled. “Consolability” is how newborns are able to change from the crying state to an active alert, quiet alert, drowsy, or sleep state. They console themselves by hand-to-mouth movements and sucking, alerting to external stimuli and motor activity (Karp, 2014). Recent research outlines five things (the five “S’s”) that parents can do to calm a fussy infant:
    • Swaddling tightly;
    • Side/stomach position on the lap of the caretaker;
    • Shushing loudly or continuous white noise;
    • Swinging using any rhythmic movement; and
    • Sucking.
    • Assisting parents to identify consoling behaviors to quiet their newborn if the newborn is not able to self-quiet is important.
  193. Social Behaviors
    Newborns begin extrauterine life able to engage in it with their sensory capabilities and communicate with their environment through a complex repertoire of behaviors.Social behaviors include cuddling and snuggling into the arms of the parent when the newborn is held. Usually newborns are very sensitive to being touched, cuddled, and held. Cuddliness is very important to parents, because they frequently gauge their ability to care for their newborn by the newborn’s acceptance or positive response to their actions. This can be assessed by the degree to which the newborn nestles into the contours of the holder’s arms. Most newborns cuddle, but some will resist. Assisting parents to assume comforting behaviors (e.g., by cooing while holding their newborn) and praising them for their efforts can help foster cuddling behaviors.
  194. acrocyanosis
    • Appropriate body color; blue extremities 
    • Gets 1 point for the appearance (color) score portion of APGAR
  195. caput succedaneum
    describes localized edema on the scalp that occurs from the pressure of the birth process. It is commonly observed after prolonged labor. Clinically, it appears as a poorly demarcated soft tissue swelling that crosses suture lines. Pitting edema and overlying petechiae and ecchymosis are noted. The swelling will gradually dissipate in about 3 days without any treatment. Newborns who were delivered via vacuum extraction usually have a caput in the area where the cup was used.
  196. cephalhematoma
    a localized subperiosteal collection of blood of the skull which is always confined by one cranial bone. This condition is due to pressure on the head and disruption of the vessels during birth. It occurs after prolonged labor and use of obstetric interventions such as low forceps or vacuum extraction. The clinical features include a well-demarcated, often fluctuant swelling with no overlying skin discoloration. The swelling does not cross suture lines and is firmer to the touch than an edematous area. Aspiration is not required for resolution and is likely to increase the risk of infection. Hyperbilirubinemia occurs following the breakdown of the RBCs within the hematoma. This type of hyperbilirubinemia occurs later than classic physiologic hyperbilirubinemia. Cephalhematoma usually appears on the second or third day after birth and disappears within weeks or months. Large cephalhematomas can lead to increased bilirubin levels and subsequent jaundice.
  197. circumcision
  198. Epstein pearls
    multiple pearly-white or pale yellow unopened sebaceous glands (milia) that are found in a newborn's mouth and gums
  199. erythema toxicum
    (newborn rash) is a benign, idiopathic, generalized, transient rash that occurs in up to 70% of all newborns during the first week of life. It consists of small papules or pustules on the skin resembling flea bites. It is often mistaken for staphylococcal pustules. The rash is common on the face, chest, and back. One of the chief characteristics of this rash is its lack of pattern. It is caused by the newborn’s eosinophils reacting to the environment as the immune system matures. Histologically, erythema toxicum shows an abundance of eosinophils. Although it has been recognized and described for centuries, its etiology and pathogenesis remain unclear. It does not require any treatment and disappears in a few days.
  200. gestational age
  201. harlequin sign
    refers to the dilation of blood vessels on only one side of the body, giving the newborn the appearance of wearing a clown suit. It gives a distinct midline demarcation, which is described as pale on the nondependent side and red on the opposite, dependent side. It results from immature autoregulation of blood flow and is commonly seen in low-birth-weight newborns when there is a positional change. It is transient, lasting as long as 20 minutes, and no intervention is needed.
  202. immunizations
  203. infant abduction
  204. milia
    multiple pearly-white or pale yellow unopened sebaceous glands frequently found on a newborn’s nose. They may also appear on the chin and forehead (Fig. 18.12B). They form from oil glands and disappear on their own within 2 to 4 weeks.
  205. molding
    the elongated shaping of the fetal head to accommodate passage through the birth canal. It occurs with a vaginal birth from a vertex position in which elongation of the fetal head occurs with prominence of the occiput and overriding sagittal suture line. It typically resolves within a week after birth without intervention.
  206. Mongolian spots
    benign blue or purple splotches that appear solitary on the lower back and buttocks of newborns, but may occur as multiple over the legs and shoulders. They tend to occur in African American, Asian, Hispanic, and Indian newborns but can occur in dark-skinned newborns of all races. The spots are caused by a concentration of pigmented cells and usually disappear spontaneously within the first 4 years of life. They should not be confused with bruises caused by trauma.
  207. nevus flammeus
    also called a port-wine stain, commonly appears on the newborn’s face or other body areas (Fig. 18.12E). It is a capillary angioma located directly below the dermis. It is flat with sharp demarcations and is purple-red. This skin lesion is made up of mature capillaries that are congested and dilated. It ranges in size from a few millimeters to large, occasionally involving as much as half the body surface. Although it does not grow in area or size, it is permanent and will not fade. Although they may occur anywhere on the body, the majority are located in the head and neck areas. Port-wine stains may be associated with structural malformations, bony or muscular overgrowth, and certain cancers. Recent studies have noted an association between port-wine birthmarks and childhood cancer, so newborns with these lesions should be monitored with periodic eye examinations, neurologic imaging, and extremity measurements. Lasers and intense pulsed light have been used to remove larger lesions with some success. The optimal timing of treatment is before 1 year of age.
  208. nevus vasculosus
    also called a strawberry mark or strawberry hemangioma, is a benign capillary hemangioma in the dermal and subdermal layers. It is raised, rough, dark red, and sharply demarcated. It is commonly found in the head region within a few weeks after birth and can increase in size or number. They are commonly found in about 10% of children. This type of hemangioma may be very subtle or even absent in the first few weeks of life, but they proliferate in the first few months of life. Commonly seen in premature infants weighing less than 1,500 g, these hemangiomas tend to resolve by age 3 without any treatment.
  209. ophthalmia neonatorum
    a hyperacute purulent conjunctivitis occurring during the first 10 days of life. It is usually contracted during birth when the baby comes in contact with vaginal discharge of the mother infected with gonorrhea and chlamydia. Most often both eyelids become swollen and red with purulent discharge.
  210. phototherapy
    • involves exposing the newborn to ultraviolet light, which converts unconjugated bilirubin into products that can be excreted through feces and urine. Phototherapy is the most common treatment for hyperbilirubinemia and has virtually eliminated the need for exchange transfusions in newborns now.
    • Phototherapy reduces bilirubin levels in the blood by breaking down unconjugated bilirubin into colorless compounds. These compounds can then be excreted in the bile. Phototherapy aims to curtail the increase in bilirubin blood levels; thereby preventing kernicterus, a condition in which unconjugated bilirubin enters the brain. If not treated, kernicterus can lead to brain damage and death.
  211. pseudomenstruation
    A vaginal discharge composed of mucus mixed with blood may also be present during the first few weeks of life. This discharge requires no treatment.
  212. stork bites
    Stork bites or salmon patches are superficial vascular areas found on the nape of the neck, on the eyelids, and between the eyes and upper lip (Fig. 18.12A). The name comes from the marks on the back of the neck where, as myth goes, a stork may have picked up the baby. They are caused by a concentration of immature blood vessels and are most visible when the newborn is crying. They are considered a normal variant, and most fade and disappear completely within the first year.
  213. vernix caseosa
    a thick white substance that protects the skin of the fetus. It is formed by secretions from the fetus’s oil glands and is found during the first 2 or 3 days after birth in body creases and the hair. It does not need to be removed because it will be absorbed into the skin.
  214. RAPP Assessment
    • an easy, rapid newborn assessment tool developed to enhance the nurse’s ability to quickly and accurately assess the newborn’s physiologic condition.
    • The RAPP assessment (respiratory activity, perfusion, and position) provides a method to swiftly evaluate the newborn’s condition so that decisions can be made regarding newborn stability.
  215. APGAR
    • A = appearance (color)
    • P = pulse (heart rate)
    • G = grimace (reflex irritability)
    • A = activity (muscle tone)
    • R = respiratory (respiratory effort)
    • Performed at 1 minute and 5 minutes after birth
    • Additional scoring performed at 10 minutes if 5 minute score is less than 7.
    • Each is worth 2 points, 10 is best score. 8-10 requires no interventions.
  216. APGAR score is influenced by:
    the presence of infection, newborn maturity, mother’s age, congenital anomalies, physiologic immaturity, maternal sedation via medications, labor management, and neuromuscular disorders
  217. Newborn birth weights
    • Low birth weight: >2,500 g (>5.5 lb)
    • Very low birth weight: >1,500 g (>3.5 lb)
    • Extremely low birth weight: >1,000 g (>2.5 lb)
  218. Newborn Skin texture
    typically ranges from sticky and transparent to smooth, with varying degrees of peeling and cracking, to parchment-like or leathery with significant cracking and wrinkling
  219. Lanugo
    soft downy hair on the newborn’s body, which is absent in preterm newborns, appears with maturity, and then disappears again with postmaturity
  220. Plantar creases
    creases on the soles of the feet, which range from absent to covering the entire foot, depending on maturity (the greater the number of creases, the greater the newborn’s maturity)
  221. Newborn Breast tissue
    the thickness and size of breast tissue and areola (the darkened ring around each nipple), which range from being imperceptible to full and budding
  222. Newborn Eyes and ears
    eyelids can be fused or open and ear cartilage and stiffness determine the degree of maturity (the greater the amount of ear cartilage with stiffness, the greater the newborn’s maturity)
  223. Newborn Genitals
    in males, evidence of testicular descent and appearance of scrotum (which can range from smooth to covered with rugae) determine maturity; in females, appearance and size of clitoris and labia determine maturity (a prominent clitoris with flat labia suggests prematurity, whereas a clitoris covered by labia suggests greater maturity)
  224. Preterm or premature
    born prior to 37 completed weeks’ gestation, regardless of birth weight
  225. Term
    born between 38 and 42 weeks gestation
  226. Postterm or postdates
    born after completion of week 42 of gestation
  227. Postmature
    born after 42 weeks and demonstrating signs of placental aging
  228. Small for gestational age
    (SGA)—weight less than the 10th percentile on standard growth charts (usually >5.5 lb)
  229. Appropriate for gestational age
    (AGA)—weight between 10th and 90th percentiles
  230. Large for gestational age
    (LGA)—weight more than the 90th percentile on standard growth charts (usually >9 lb)
  231. Phytonadione (vitamin K [Aqua-MEPHYTON, Konakion, Mephyton])
    • Provides the newborn with vitamin K (necessary for production of adequate clotting factors II, VII, IX, and X by the liver) during the first week of birth until newborn can manufacture it
    • Prevents vitamin K deficiency bleeding (VKDB) of the newborn
    • Administer within 1–2 hr after birth.
    • Give as an IM injection at a 90-degree angle into the outer middle third of the vastus lateralis muscle.
    • Use a 25-gauge, 5/8-in needle for injection.
    • Hold the leg firmly and inject medication slowly.
    • Adhere to standard precautions.
    • Assess for bleeding at injection site after administration.
  232. Erythromycin ophthalmic ointment 0.5% or tetracycline ophthalmic ointment 1%
    • Provides bactericidal and bacteriostatic actions to prevent Neisseria gonorrhea and Chlamydia trachomatis conjunctivitis
    • Prevents ophthalmia neonatorum
    • Be alert for chemical conjunctivitis for 1–2 days.
    • Wear gloves, and open eyes by placing thumb and finger above and below the eye.
    • Gently squeeze the tube or ampoule to apply medication into the conjunctival sac from the inner canthus to the outer canthus of each eye.
    • Do not touch the tip to the eye.
    • Close the eye to make sure the medication permeates.
    • Wipe off excess ointment after 1 min.
  233. Length of newborn
    • average length is 50 cm (20 in)
    • can range from 44-55 cm (17-22 in)
  234. Weight of newborn
    • average weight is 3400 g (7.5 lb)
    • can range from 2500-4000 g (5 lb, 8 oz to 8 lb, 13 oz)
  235. Head circumference of newborn
    • average is 32-38 cm (13-15 in)
    • should be approx 1/4 of the newborn's length or about half the infant's body length +10 cm
    • A small head might indicate microcephaly caused by rubella, toxoplasmosis, or SGA status;
    • An enlarged head might indicate hydrocephalus or increased intracranial pressure.
    • Both need to be documented and reported for further investigation.
  236. Chest circumference
    2 cm less than head circumference
  237. PKU
    • Autosomal recessive inherited deficiency in one of the enzymes necessary for the metabolism of phenylalanine to tyrosine—essential amino acids found in most foods
    • Irritability, vomiting of protein feedings, and a musty odor to the skin or body secretions of the newborn; if not treated, mental and motor retardation, seizures, microcephaly, and poor growth and development
    • Tx - Lifetime diet of foods low in phenylalanine (low protein) and monitoring of blood levels; special newborn formulas available (Phenex and Lofenalac)
    • Universally screened for in the United States; testing is done 24–48 hrs after protein feeding (PKU)
  238. Hypoglycemia in newborns
    • less than 30 mg/dL
    • certain newborns are at greater risk for hypoglycemia
    • infants of mothers who have diabetes, preterm newborns, and newborns with intrauterine growth restriction (IUGR), inadequate caloric intake, sepsis, asphyxia, hypothermia, polycythemia, glycogen storage disorders, and endocrine deficiencies
  239. Reasons for parents of a newborn to call their pediatrician
    • Warning signs of illness:
    • Temperature of 101°F (38.3°C) or higher
    • Forceful, persistent vomiting, not just spitting up
    • Refusal to take feedings
    • Two or more green, watery diarrheal stools
    • Infrequent wet diapers and change in bowel movements from normal pattern
    • Lethargy or excessive sleepiness
    • Inconsolable crying and extreme fussiness
    • Abdominal distention
    • Difficult or labored breathing
  240. abortion
    spontaneous or elective/therapeutic
  241. Inevitable abortion
    An inevitable abortion is characterized by vaginal bleeding that is greater than slight, rupture of membranes, cervical dilation, strong abdominal cramping, and possible passage of products of conception.
  242. Threatened abortion
    The threatened abortion involves slight vaginal bleeding, no cervical dilation and no change in cervical consistency, mild abdominal cramping, a closed cervical os, and no passage of fetal tissue.
  243. Incomplete abortion
    An incomplete abortion involves intense abdominal cramping, heavy vaginal bleeding, and cervical dilation.
  244. Missed abortion
    A missed abortion involves the absence of contractions and irregular spotting with possible progression to inevitable abortion.
  245. abruptio placentae
    Abruptio placentae is the premature separation of a normally implanted placenta after the 20th week of gestation prior to birth, which leads to hemorrhage. It is a significant cause of third-trimester bleeding, with a high mortality rate. It occurs in about 1% of all pregnancies throughout the world, or approximately 1 in 100 pregnancies. There is a 10 to 20 times greater risk of reoccurrence in a subsequent pregnancy. It typically peaks between 24 and 26 weeks’ gestation.
  246. eclampsia
    Onset of seizure activity in a woman with preeclampsia.
  247. ectopic pregnancy
    any pregnancy in which the fertilized ovum implants outside the uterine cavity.
  248. gestational hypertension
    blood pressure elevation (140/90 mm Hg) identified after 20 weeks’ gestation without proteinuria. Blood pressure returns to normal by 12 weeks’ postpartum.
  249. gestational trophoblastic disease (GTD)
    GTD comprises a spectrum of neoplastic disorders that originate in the placenta. There is abnormal hyperproliferation of trophoblastic cells that normally would develop into the placenta during pregnancy. GTDs encompass hydatidiform mole (complete and partial), invasive mole, gestational choriocarcinoma, placental-site trophoblastic tumor, and epithelioid trophoblastic tumor.
  250. high-risk pregnancy
    one in which a condition exists that jeopardizes the health of the mother, her fetus, or both. The condition may result from the pregnancy, or it may be a condition that was present before the woman became pregnant.
  251. polyhydramnios
    a condition in which there is too much amniotic fluid (more than 2,000 mL) surrounding the fetus between 32 and 36 weeks. It occurs in approximately 2% of all pregnancies and is associated with fetal anomalies of development such as upper gastrointestinal obstruction or atresias, neural tube defects, and anterior abdominal wall defects, together with impaired swallowing in fetuses with chromosomal anomalies, such as trisomy 13 and 18.
  252. hyperemesis gravidarum
    • a severe form of nausea and vomiting of pregnancy associated with significant costs and psychosocial impacts.
    • Risk factors for hyperemesis include previous pregnancy complicated by hyperemesis, molar pregnancies, history of helicobacter pylori infection, multiple gestation, prepregnancy history of genitourinary disorders, clinical hyperthyroid disorders, and prepregnancy psychiatric diagnosis
  253. multiple gestation
    a pregnancy with two or more fetuses
  254. oligohydramnios
    a decreased amount of amniotic fluid (less than 500 mL) between 32 and 36 weeks’ gestation. It occurs in approximately 4% of all pregnancies. Oligohydramnios may result from any condition that prevents the fetus from making urine or blocks it from going into the amniotic sac.
  255. placenta accreta
    Placenta accreta is a potentially life-threatening obstetrical hemorrhagic condition that requires a multidisciplinary approach to management. The incidence of placenta accreta has increased and seems to parallel the increasing cesarean birth rate or intrauterine procedures. Placenta accreta is a condition in which the placenta attaches itself too deeply into the wall of the uterus but does not penetrate the uterine muscle. It is further subcategorized as placenta increta, when the placenta invades the myometrium, and placenta percreta, when it has extended through the myometrium and uterine serosa and adjacent tissue. A common risk of placenta accreta during the birthing process is the possibility of hemorrhaging during manual attempts to detach the placenta.
  256. placenta previa
    Placenta previa is a bleeding condition that occurs during the last two trimesters of pregnancy. In placenta previa (literally, “afterbirth first”), the placenta implants over the cervical os. It may cause serious morbidity and mortality to the fetus and mother.
  257. preeclampsia
    most common hypertensive disorder of pregnancy, which develops with proteinuria after 20 weeks’ gestation. It is a multisystem disease process, which is classified as mild or severe, depending on the severity of the organ dysfunction.
  258. premature rupture of membranes (PROM)
    the rupture of the bag of waters before the onset of true labor. There are a number of associated conditions and complications, such as infection, prolapsed cord, abruptio placentae, and preterm labor. High-risk factors associated with preterm PROM include low socioeconomic status, multiple gestation, low BMI, tobacco use, history of preterm labor, placenta previa, abruptio placentae, urinary tract infection, vaginal bleeding at any time in pregnancy, cerclage, and amniocentesis
  259. preterm premature rupture of membranes (PPROM)
    rupture of membranes prior to the onset of labor in a woman who is less than 37 weeks’ gestation. Perinatal risks associated with PPROM may stem from immaturity, including respiratory distress syndrome, intraventricular hemorrhage, patent ductus arteriosus, and necrotizing enterocolitis.
  260. Dissemintated Intravascular Coagulation
    DIC is a bleeding disorder characterized by an abnormal reduction in the elements involved in blood clotting resulting from their widespread intravascular clotting. This disorder can occur secondary to abruptio placentae, amniotic fluid embolism, endotoxin sepsis, retained dead fetus, posthemorrhagic shock, hydatidiform mole, and gynecologic malignancies.
  261. Medications for treatment of preeclampsia and eclampsia
    • Magnesium sulfate:
    • Blockage of neuromuscular transmission, vasodilation
    • Prevention and treatment of eclamptic seizures
    • Hydralazine hydrochloride (Apresoline):
    • Vascular smooth muscle relaxant, thus improving perfusion to renal, uterine, and cerebral areas
    • Reduction in blood pressure
    • Labetalol hydrochloride (Normodyne):
    • Alpha-1 and beta blocker
    • Reduction in blood pressure
    • Nifedipine (Procardia):
    • Calcium channel blocker/dilation of coronary arteries, arterioles, and peripheral arterioles
    • Reduction in blood pressure, stoppage of preterm labor
    • Sodium nitroprusside:
    • Rapid vasodilation (arterial and venous)
    • Severe hypertension requiring rapid reduction in blood pressure
    • Furosemide (Lasix): Diuretic action, inhibiting the reabsorption of sodium and chloride from the ascending loop of Henle
    • Pulmonary edema (used only if condition is present)
  262. HELLP syndrome
    • HELLP syndrome is an acronym for hemolysis, elevated liver enzymes, and low platelet count. It is a variant of the preeclampsia/eclampsia syndrome that occurs in 10% to 20% of clients whose conditions are labeled as severe. Women with HELLP syndrome are at increased risk for complications such as cerebral hemorrhage, retinal detachment, hematoma/liver rupture, acute renal failure, disseminated intravascular coagulation (DIC), placental abruption and maternal death. It is a life-threatening obstetric complication considered by many to be a severe form of preeclampsia involving hemolysis, thrombocytopenia, and liver dysfunction.
    • Dx by:
    • Low hematocrit that is not explained by any blood loss
    • Elevated LDH (liver impairment)
    • Elevated AST (liver impairment)
    • Elevated ALT (liver impairment)
    • Elevated BUN
    • Elevated bilirubin level
    • Elevated uric acid and creatinine levels (renal involvement)
    • Low platelet count (less than 100,000 cells/mm3)
  263. amnioinfusion
    a technique in which a volume of warmed, sterile, normal saline or Ringer lactate solution is introduced into the uterus transcervically through an intrauterine pressure catheter to increase the volume of fluid when oligohydramnios is present. It is a procedure used during labor. It is used to change the relationship of the uterus, placenta, cord, and fetus to improve placental and fetal oxygenation. Instilling an isotonic glucose-free solution into the uterus helps to cushion the umbilical cord to prevent compression or dilute thick meconium.
  264. arrest disorders
    complete cessation of progress
  265. cesarean birth
    the surgical birth of the fetus through an incision in the abdomen and uterine wall and is the most commonly performed surgery in the United States
  266. dystocia
    abnormal or difficult labor, can be influenced by a vast number of maternal and fetal factors. Dystocia is said to exist when the progress of labor deviates from normal; it is characterized by a slow and abnormal progression of labor. It occurs in approximately 8% to 11% of all labors and is the leading indicator for primary cesarean birth in the United States. It is of concern because of its fatiguing factor for both mother and fetus and frequently requires medical or surgical interventions, which increases risk.
  267. forceps
  268. hypertonic uterine dysfunction
    Hypertonic uterine dysfunction occurs when the uterus never fully relaxes between contractions. Subsequently, contractions are ineffectual, erratic, and poorly coordinated because they involve only a portion of the uterus and because more than one uterine pacemaker is sending signals for contraction. Women in this situation experience a prolonged latent phase, stay at 2 to 3 cm, and do not dilate as they should. Placental perfusion becomes compromised, thereby reducing oxygen to the fetus. These hypertonic contractions exhaust the mother, who is experiencing frequent, intense, and painful contractions with little progression. This dysfunctional pattern occurs in early labor and affects nulliparous women more than multiparous women.
  269. hypotonic uterine dysfunction
    Hypotonic uterine dysfunction occurs during active labor (dilation more than 5 to 6 cm) when contractions become poor in quality and lack sufficient intensity to dilate and efface the cervix. Factors associated with this abnormal labor pattern include overstretching of the uterus, a large fetus, multiple fetuses, hydramnios, multiple parity, bowel or bladder distention preventing descent, and excessive use of analgesia. Clinical manifestations of hypotonic uterine dysfunction include weak contractions that become milder, a uterine fundus that can be easily indented with fingertip pressure at the peak of each contraction, and contractions that become more infrequent and briefer. The major risk with this complication is hemorrhage after giving birth because the uterus cannot contract effectively to compress blood vessels.
  270. labor induction
    the stimulation of uterine contractions by medical or surgical means before the onset of spontaneous labor.
  271. Medications used to induce labor
    • Dinoprostone (Cervidil insert; Prepidil gel) - Directly softens and dilates the cervix/to ripen cervix and induce labor
    • Misoprostol (Cytotec) - Ripens cervix/to induce labor
    • Oxytocin (Pitocin) - Acts on uterine myofibrils to contract/to initiate or reinforce labor
    • FDA approved for cervical ripening
  272. macrosomia
  273. precipitate labor
    labor that is completed in less than 3 hours from the start of contractions to birth. Not only can labor be too slow, but it can be abnormally rapid. The prevailing opinion has been that too rapid a labor can result in maternal injury and place the fetus at risk for traumatic or asphyxia insults. Women experiencing precipitate labor typically have soft perineal tissues that stretch readily, permitting the fetus to pass through the pelvis quickly, or abnormally strong uterine contractions. Maternal complications are rare if the maternal pelvis is adequate and the soft tissues yield to a fast fetal descent. However, if the fetus delivers too fast, it does not allow the cervix to dilate and efface, which leads to cervical lacerations and the potential for uterine rupture. Potential fetal complications may include head trauma, such as intracranial hemorrhage or nerve damage, and hypoxia due to the rapid progression of labor.
  274. preterm labor
    the occurrence of regular uterine contractions accompanied by cervical effacement and dilation before the end of the 37th week of gestation. If not halted, it leads to preterm birth. Preterm births remain one of the biggest contributors to perinatal morbidity and mortality in the world. According to the March of Dimes (2015b), about 12% of births (one in eight infants) in the United States are premature.
  275. postterm pregnancy
    • > 42 weeks gestation
    • fetal risks include:
    • macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scores, postmaturity syndrome (loss of subcutaneous fat and muscle and meconium staining), and cephalopelvic disproportion. All of these conditions predispose this fetus to birth trauma or a surgical birth. The perinatal mortality rate at more than 42 weeks of gestation is twice that at term and increases sixfold and higher at 43 weeks of gestation and beyond.
  276. protracted disorders
    a series of events including protracted active phase dilation (slower than normal rate of cervical dilation) and protracted descent (delayed descent of the fetal head in the active phase). A laboring woman with a slower than normal rate of cervical dilation is said to have a protraction labor pattern disorder. A slow progress may be the result of cephalopelvic disproportion. Most women, however, benefit greatly from adequate hydration and some nutrition, emotional reassurance, and position changes—these women may go on and give birth vaginally.
  277. shoulder dystocia
    • Delivery of fetal head with neck not appearing; retraction of chin against the perineum; shoulders remaining wedged behind the mother’s pubic bone, causing a difficult birth with potential for injury to both mother and baby.
    • If shoulders still above the brim at this stage, no advancement. Newborn’s chest trapped within the vaginal vault; chest unable to expand with respiration (although nose and mouth are outside).
    • Risk of umbilical cord compression between the fetal body and the maternal pelvis.
  278. tocolytic
    • drugs that promote uterine relaxation by interfering with uterine contractions
    • Magnesium sulfate:
    • Relaxes uterine muscles to stop irritability and contractions, to arrest uterine contractions for preterm labor (off-label use).
    • Has been used in seizure prophylaxis and treatment of seizures in preeclamptic and eclamptic clients for almost 100 yrs
    • Indomethacin (Indocin):
    • Inhibits prostaglandins, which stimulate contractions; inhibits uterine activity to arrest preterm labor
    • Nifedipine (Procardia):
    • Blocks calcium movement into muscle cells, inhibits uterine activity to arrest preterm labor
    • Betamethasone (Celestone):
    • Promotes fetal lung maturity by stimulating surfactant production; prevents or reduces risk of respiratory distress syndrome and intraventricular hemorrhage in the preterm neonate less than 34 wks’ gestation
  279. umbilical cord prolapse
    a rare obstetrical emergency that occurs when the cord precedes the fetus out. An umbilical cord prolapse is the protrusion of the umbilical cord alongside (occult) or ahead of the presenting part of the fetus. This condition occurs in 1 out of every 300 births and requires prompt recognition and intervention for a positive outcome.
  280. vacuum extractor
  281. vaginal birth after cesarean (VBAC)
    a woman who gives birth vaginally after having at least one previous cesarean birth. Despite evidence that some women who have had a cesarean birth are candidates for vaginal birth, most women who have had a cesarean birth once undergo another for subsequent pregnancies.
  282. mastitis
    inflammation of the breast
  283. metritis
    an infectious condition that involves the endometrium, decidua, and adjacent myometrium of the uterus. Extension of metritis can result in parametritis, which involves the broad ligament and possibly the ovaries and fallopian tubes, or septic pelvic thrombophlebitis, which results when the infection spreads along venous routes into the pelvis. It occurs within the first two days postpartum or as late as two to six weeks postpartum
  284. postpartum depression (PPD)
    a form of clinical depression that can affect women, and less frequently men, after childbirth. It affects as many as 20% of all mothers in the United States, and as many as 60% of adolescent mothers. Unlike the postpartum blues, women with postpartum depression feel worse over time, and changes in mood and behavior do not go away on their own. Postpartum depression may persist for a minimum of six months if untreated. Different from the baby blues, the symptoms of PPD last longer, are more severe, and require treatment.
  285. postpartum hemorrhage
    • (PPH)
    • PPH is defined as a blood loss greater than 500 mL after vaginal birth or more than 1,000 mL after a cesarean birth.
  286. subinvolution
    refers to incomplete involution of the uterus or failure to return to its normal size and condition after birth. Typically, subinvolution occurs when the myometrial fibers of the uterus do not contract effectively and causes relaxation. Complications of subinvolution include hemorrhage, pelvic peritonitis, salpingitis, and abscess formation. Causes of subinvolution include retained placental fragments, distended bladder, excessive maternal activity prohibiting proper recovery, uterine myoma, and infection. All of these conditions contribute to delayed postpartum bleeding.
  287. uterine atony
    • Loss of muscle tone in the uterus
    • A boggy or relaxed uterus is a sign of uterine atony
  288. uterine inversion
    Uterine inversion happens when the top of the uterus collapses into the inner cavity due to excessive fundal pressure or pulling on the umbilical cord when the placenta is still firmly attached to the fundus after the infant has been born. Treatment for uterine inversion includes giving uterine relaxants and immediate manual replacement by the health care provider.
  289. venous thromboembolism
    PE or DVT
  290. First stage of labor
    • 3 phases:
    • latent - effacement of cervix, little fetal descent - longest phase
    • active - dilation and fetal descent - anxious/increased discomfort
    • transition - rapid dilation, fetal descent
  291. Second stage of labor
  292. Third stage of labor
    placenta is delivered
  293. Fourth stage of labor
    recovery stage
  294. Homan's Sign
    extend leg, force dorsiflexion of foot, if pain in calf, may indicate lower extremity thrombophlebitis
  295. Coombs' test
    • should be negative
    • determines if infant's erythrocytes have been exposed to incompatible blood and are coated with antibodies
Card Set
Exam 1 - NUR 102
Exam 1: Ricci Ch 1, 3, 35, 9, 11, 12, 19, 21, 22, 15, 16, 17, 18