One of the most common trauma in macrosomic neonates is fractured clavicle. What are the manifestation of a fractured clavicle?
1. crepitus as bone ends rub together
2. edema over the area
3. limited arm movement
4. asymmetrical arm movement
5. asymmetrical moro reflex
How would a nurse first assess jaundice in a neonate?
Blanching the skin with pressure in the forehead, nose to note a yellow tint
What is one distinction of nevous flammeous (stork bite) that sets it aside from portwine stains, strawberry hemangiomas and Mongolian spots?
Those other skin spots do not blanch when pressed
What is one common MAS (Meconium aspiration syndrome - complication of post-term) complication?
PPHTN (persistent pulmonary hypertension)
Newborn fails to enter newborn circulation & maintain fetal circulation (pulmonary vascular resistance is high)
Preterm infants' motor development permits less flexion than full term infants. What is a position you can put the baby in to encourage flexion?
Prone position
T or F.
Swaddle the preterm infant that weights 1000g to prevent hypothermia
FALSE. Preterm infant has less flexion. Give them boundaries to lie in. Don't swaddle until 1250 g or more.
What does L/S test measure.
If the result is within normal limit, how does it look like?
When can you dectect lecithin? When would this amount increase? What is it?
1. L/S tests the amniotic fluid to assess for fetal lung immaturity.
2. When L/S reaches 2:1, infant's lungs are mature, usually at 35 weeks. If less than 1.5 = high risk of infant respiratory distress syndrome.
3. Lecithin is detectable after 21 wks. Amt increases after wk 24. Lecithin is surfactant.
On auscultatioin of a C/S neonate, you heard a wet sound, suspicions of fluid in the lungs & upper respiratory tract. Why is thatt?
What kind of complications would you see in this type of baby?
1. C/S neonate does not benefit from thoracic squeeze process that vaginally neonate gets.
2. They may run into respiratory issues, have troubles when you try to feed them (tend to vomit), or they don't suck or swallow very well.
Why doesn't newborn shiver when they're cold?
Non-shivering is accomplished by brown fat burning. When the temperature drops, newborn will have hypoglycemia
List risk factors that could potentially predispose babies to hypoglycemia
EARLY FEED THESE BABIES WHEN THEIR BG DROPS TO 50 OR 60
1. SGA
2. IDM
3. perinatal stress
4. potential for sepsis
What are some nursing interventions for hypoglycemic babies?
1. Early feeding
2. Keep infant warm
3. Glucose by nipple, gavage, or IV
4. Recheck BG 30 min after feeding
Pseudomenses (slight bloody spotting), small amounts of blood tinged mucous or frank blood passing vaginally within the first 2 weeks of life. Is this normal?
Yes. This is due to withdrawal from high hormone levels (estrogen) that infant was exposed to in utero
1. Well fed hydrated newborn should have how many wet diapers a day?
2. If not, what should you encourage the mother to do?
3. Should the m mother give supplemental feedings to breastfed baby?
1. 6-10 wet diapers/day
2. Drink more fluids to produce more milk.
3. NO. this will cause nipple confusion
What is the drug of choice for chronic hypertension?
What is the drugs of choice for chronic hypertensive breastfeeding mother?
1. methyldopa (Aldomet)
2. methyldopa, hydralazine
What should we assess for in PP for a mom w/ chronic htn?
Pulmonary edema
renal failure
heart failure
encephalopathy
What's considered proteinuria in preeclampsia?
How is the urine collected?
>/ 30 mg/dl or 1+ on urine dipstick
2 random urine samples collected at least 6 hours apart
What are some risk factors for developing preeclampsia
1. primi gravida
2. change in partners in multiparous woman.
3. < 20 y.o or > 40 y.o
4. Multiple gestations
5. Hydatiform moles: molar preg (HCG level @ 14 wk when only @ 6th). Abnormal cells.
6. H/O infertility rx. Family H/O
7. Rh Incompatibility
8. Obesity
9. African American
10. Insulin resistance
11. Limited sperm exposure with same partner (theory: allergic rxn)
12. PreE in previous pregnancy.
13. Pregnancy after donor insemination, oocyte donation, embryo donation
14. Maternal infxn
Patient comes in @ 33th week with severe preeclampsia HELLP syndrome sx: epigastric pain, elevated AST/ALT, platelet counts of 92,000. Other sx: projectile vomitting, blurred vision, headache, proteinuria. You know we need to deliver this baby immediately!!
What are some nursing interventions?
Labor induction. Vaginal if possible
Give corticosteroids because fetal lungs are not mature at this point.
Control BP with antihypertensive meds.
Magnesium Sulfate
When given Labetalol IV push, what should we need to have also?
Cardiac monitoring
What is therapeutic range for magnesium?
4-7
What are some sx of eclampsia?
headache, severe epiggastric pain, hyperreflexia
convulsions
increased htn, tonic clonic contraction --> tonic-clonic convulsions followed by hypotension and coma
What is the immediate goal of care for an eclampsic patient?
What are some nursing interventions to take?
1. Ensuring patent airway
2. Turn woman onto side to prevent aspiration of vomitus & supine hypotension syndrome.
Suction food/fluid from glottis past convulsion
Provide 10 L of oxygen via facemask
Note time & duration of convulsion.
After ensuring patent airway of an eclampsic pt., what should you do next?
1. Mg bolus up to 6 g
2. Valium or ativan may be administered if mag limit reached
3. Chest X-Ray & possibly ABG to r/o aspiration
4. Assess fetus, uterine activity, & cervical status tocheck for imminent delivery
Always ____ first when administering IV Valium
Besides MgS, what other meds are used to stop a seizure?
1. flush
2. Valium & Ativan
What are some conditions that lead to the secondary diagnosis of DIC in pregnant woman ? (6)
1. Severe preeclampsia
2. HELLP syndrome
3. Abruptio placentae
4. Retained dead fetus
5. Amniotic fluid embolus
6. Gram-negative sepsis
What are some physical exam findings of DIC patient
-Spontaneous bleeding from gums, nose
-Oozing, excessive bleeding from venipuncture site, IV access site, or insertion site of urinary catheter
-Petechiae
-Other signs of bruising
-Hematuria
-GI bleeding
-diaphoresis
Symptoms of PreE & Eclampsia usually resolve within ______ hours.
Resolution usually manifested with diuresis, usually within ____ hours
HELLP syndrome usually resolves within _____ hours
1. 48 hours.
2. 24 hours
3. 72-96 hours
If mom goes into shock d/t trauma, what's the prognosis of the fetus gonna look like?
8 out of 10 result in fetal death
80%
What's the most common cause of fetal death with maternal survival?
Placental abruption
When doing a physical assessment on a trauma pregnant patient, you notice vaginal lacerations & bone fragments in the vagina. What do these indicate?
Pelvic fracture
At your facility, you notice that the OB doctor is not doing a bimanual exam for a trauma pregant patient. Why is that?
Your setting might not have the option of emergency C-section available
A pregnant patient came in from MVA. On assessment, you found that the airbag didn't go off and it was a minor abdominal trauma. HOw many hours should you do cardiotographic monitoring (fetal monitoring)?
4 hours.
In major trauma, then the suggestion is 24 hours
What is the most reliable indicator of active or impending placenta abruption?
i.e: NOT ULTRASOUND. very insensitive.
Fetal distress
What are the symtpoms of endometritis (or chorioamnitis)?
1. General discomfort, uneasiness, or feeling malaise
2. Anorexia, uterine tenderness
3. Tachycardia, subinvolution (uterus does not return to normal size)
4. Chills, low grade fever usually after 24 hours after delivery
5. Lower abdominal or pelvic pain (uterine pain), and could have infection internally
6. Abnormal vaginal bleeding (normal pattern of lochia is ruba --> seroso --> alba. It should never go backwards. If discharge is gone & then reoccurs then they need to call provider.
After delivery, patient was in L&D for monitoring before sending to PP. Temp is at 104, tachycardic, and is experiencing lower abdominal pain. She looks sick, & her uterine is tender and is NOT 2cm below umbilicus like it's supposed to be.
At first, her lochia was red, then the amt decreased. The amount suddenly increased and turned rubra again when you went back to assess her. Her discharge is purulent and has a foul smell.
Her history states positive group B strep test at 35 weeks, and abx was administered during delivery. She spiked a fever in L&D, but it was not a cause for alarm. After delivery, her abx was disconnected.
Based on the assessments, what kind of medical condition do you think she has?
Endometritis
You're working in the PP unit.
Your patient is having a temp of 102.2, and is experiencing flu-like sx, aching muscles, headache, pain on the L breast -- redness, heat & inflammation at the site, & enlarged lymphnode.
What do you suspect she has? What's the expected treatment? What interventions should you encourage the mother to take?
1. Mastitis.
2. Abx (early on & mastitis resolves in 24-48 hr), but continue taking meds for 10-14 days. If developed abscess, surgical drainage & abx
3. Emptying of breast (feed or pump). Continue to breastfeed from both breasts. Massage over affected area before/during feeding promotes milk emptying. Increase fluid intake.
Supportive measures: moist heat to increase circulation, ice packs, breast support, bed rest, analgesics.
What are some interventions to take to prevent mastitis?
1. position infant correctly
2. avoid nipple trauma/ milk stasis (completely empty the breast)
3. breastfeed q 2-3hr, avoid formula supplements
4. avoid cont pressure on breast from tight bras or carrying infant.
What usually are the causes of subinvolution in late PP hemorrhage?
Infxn, retained placenta
What are the 2 important characteristics of chorioamniotitis?
What is the common cause of chorioamniotitis?
1. maternal fever & uterine tenderness
2. premature rupture of membrane
What are the interventions to take if a PP woman has a uterine inversion?
1. Administer tocolytic agents (Terbutaline or MgS)
