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Questions and Answers

A postpartum patient is prescribed Methergine. Which pre-existing condition would contraindicate the administration of this medication?

  • Asthma
  • Preeclampsia (correct)
  • Deep Vein Thrombosis (DVT)
  • Hypotension

A newborn is placed under a radiant warmer for an extended procedure. Which principle of heat loss is most relevant in this scenario?

  • Conduction, due to direct contact with the warmer's surface.
  • Evaporation, due to moisture on the newborn's skin.
  • Convection, due to the movement of air across the newborn's skin.
  • Radiation, due to the emission of heat waves from the warmer. (correct)

A postpartum patient presents with unilateral leg swelling, tenderness, redness, and warmth. Which condition is most likely indicated by these symptoms?

  • Mastitis
  • Deep Vein Thrombosis (DVT) (correct)
  • Metritis
  • Postpartum Blues

A nurse is caring for a newborn in the first few hours of life. Which of the following activity patterns is expected during the period from 30 minutes to 2 hours after birth?

<p>The newborn is alert, moving, and may appear hungry. (C)</p> Signup and view all the answers

A postpartum patient is diagnosed with metritis. What is the primary treatment approach for this condition?

<p>Intravenous antibiotics (B)</p> Signup and view all the answers

A breastfeeding mother exhibits localized redness, pain, swelling, and warmth in one breast. Which intervention is most appropriate for managing this condition?

<p>Antibiotics and continued emptying of the breast (A)</p> Signup and view all the answers

Parents are struggling to console their crying infant. Which combination of the '5 S's' is most appropriate to initially soothe the baby?

<p>Swaddling, side-lying, shushing, swinging, and sucking. (B)</p> Signup and view all the answers

Which assessment finding would be cause for concern when preparing a 24-hour-old male infant for circumcision?

<p>The infant has not voided since birth. (D)</p> Signup and view all the answers

When assessing a postpartum patient's perineal area, the nurse uses the acronym REEDA. What does 'E' stand for in this acronym?

<p>Edema (A)</p> Signup and view all the answers

Following a circumcision, what should parents be instructed to report to the health care provider?

<p>Foul-smelling drainage from the circumcision site. (B)</p> Signup and view all the answers

A postpartum patient reports experiencing emotional lability, irritability, and insomnia, starting on postpartum day 3. By which postpartum day should these symptoms typically resolve if they are related to baby blues?

<p>Postpartum day 10 (A)</p> Signup and view all the answers

A patient is diagnosed with postpartum depression. According to the information provided, which of the following Edinburgh scores would support this diagnosis?

<p>Greater than 12 (C)</p> Signup and view all the answers

A postpartum patient presents with sleep disturbances, fatigue, depression, and disorganized behavior within two weeks after delivery. Which condition is most concerning given these symptoms?

<p>Postpartum psychosis (D)</p> Signup and view all the answers

A newborn is suspected to be small for gestational age (SGA). Which assessment finding would be LEAST likely to support this suspicion?

<p>Abundant lanugo covering the body. (B)</p> Signup and view all the answers

A nurse is caring for a large for gestational age (LGA) newborn. Which intervention is MOST critical during the first few hours after birth?

<p>Encouraging early and frequent feedings. (B)</p> Signup and view all the answers

A postterm newborn is at higher risk for certain complications. Which assessment finding is MOST indicative of a postterm newborn?

<p>Dry, cracked skin. (C)</p> Signup and view all the answers

A preterm newborn is admitted to the NICU. Which intervention is MOST important to address a common physiological challenge faced by preterm infants?

<p>Maintaining a neutral thermal environment. (B)</p> Signup and view all the answers

A nurse suspects a postpartum patient is experiencing hypomania. Which behavior would MOST likely lead to this suspicion?

<p>Exhibiting rapid speech and inflated self-esteem. (D)</p> Signup and view all the answers

A postpartum patient with a history of bipolar disorder begins exhibiting signs of psychosis. What is the PRIORITY nursing intervention?

<p>Ensure the infant is NEVER left alone with the mother. (D)</p> Signup and view all the answers

Which of the following assessment findings in a newborn would be MOST concerning and require immediate intervention?

<p>Glucose level of 35 mg/dL. (A)</p> Signup and view all the answers

During a home visit, a nurse assesses a late preterm infant. Which parental statement indicates a NEED for further teaching?

<p>&quot;We let the baby sleep in our bed so we can monitor him closely.&quot; (A)</p> Signup and view all the answers

A postpartum mother experiences a rapid shift in her center of gravity. Which of the following is the most significant risk associated with this physiological change?

<p>Increased risk of falls (A)</p> Signup and view all the answers

Which postpartum patient would Rhogam be administered to?

<p>Rh-negative mother, regardless of the baby's Rh status. (C)</p> Signup and view all the answers

A woman who chooses not to breastfeed can expect menstruation to return within approximately what timeframe?

<p>7 to 9 weeks postpartum (D)</p> Signup and view all the answers

During an amnioinfusion, what potential complication should the nurse monitor for most closely?

<p>Increased uterine resting tone and possible rupture (D)</p> Signup and view all the answers

A newborn weighs 3.5 kg. Approximately how many calories per day does this newborn require during the first three months of life?

<p>385-420 calories (C)</p> Signup and view all the answers

What anatomical structure is affected in a fourth-degree perineal laceration during childbirth?

<p>Anterior rectal wall (B)</p> Signup and view all the answers

A postpartum patient begins to experience a seizure. After calling for assistance, what is the next immediate nursing action?

<p>Protecting the airway (B)</p> Signup and view all the answers

The return of menstruation in a lactating woman depends on which factors?

<p>Frequency and duration of breastfeeding (C)</p> Signup and view all the answers

A newborn presents with jaundice and a serum bilirubin level of 7 mg/dL on the first day of life. Which condition is MOST likely to cause this presentation?

<p>Pathologic jaundice potentially due to Rh isoimmunization. (B)</p> Signup and view all the answers

Which intervention is MOST critical in managing hyperbilirubinemia in a newborn, especially in resource-limited settings?

<p>Ensuring early and frequent feeding to promote bilirubin excretion. (C)</p> Signup and view all the answers

A neonate displays a temperature of 96.5°F along with lethargy and poor feeding. Which condition should be HIGHLY suspected, warranting immediate investigation?

<p>Early onset sepsis needing antibiotic treatment. (D)</p> Signup and view all the answers

A newborn is diagnosed with early-onset sepsis. What is the MOST likely source of this infection?

<p>Acquisition of infection during the perinatal period, often through GBS. (A)</p> Signup and view all the answers

What is the PRIMARY mechanism by which surfactant prevents alveolar collapse in newborns?

<p>Reducing surface tension within the alveoli. (A)</p> Signup and view all the answers

Which of the following signs and symptoms is LEAST likely to be associated with Fetal Alcohol Syndrome?

<p>High nasal bridge and prominent philtrum. (D)</p> Signup and view all the answers

An infant undergoing weaning from narcotics scores above 8 twice on the Finnegan Assessment Tool. What is the MOST appropriate next step in management?

<p>Introduce supplementary narcotics to facilitate a safer weaning process. (A)</p> Signup and view all the answers

Which immunoglobulin class provides the MOST significant passive immunity to the newborn and how does it cross to the baby?

<p>IgG, via the placenta. (A)</p> Signup and view all the answers

A new mother is concerned about the yellow exudate forming around her newborn son's penis after a circumcision. What is the most appropriate instruction to give the mother?

<p>Leave the yellow exudate alone as it is a normal part of the healing process. (B)</p> Signup and view all the answers

When educating new parents about umbilical cord care, which instruction should be included to prevent infection and promote proper drying?

<p>Fold the diaper down and away from the cord to allow for air drying. (D)</p> Signup and view all the answers

A postpartum woman is 3 days after childbirth and is experiencing pinkish-brown vaginal discharge. Which type of lochia is the woman most likely experiencing?

<p>Lochia serosa (B)</p> Signup and view all the answers

What is the primary purpose of encouraging postpartum women to urinate every 2 to 3 hours?

<p>To prevent uterine displacement. (C)</p> Signup and view all the answers

A breastfeeding mother is experiencing engorgement on day 4 postpartum. While waiting for her milk to come in, what strategies will help relieve discomfort while she waits for her milk to come in?

<p>Wearing a tight-fitting bra and avoiding nipple stimulation. (A)</p> Signup and view all the answers

A postpartum patient has a perineal laceration that involves the muscle but not the anal sphincter. How would this laceration be classified?

<p>Second-degree laceration (D)</p> Signup and view all the answers

A bottle-feeding mother wants to decrease milk production. What non-pharmacological measure can be implemented?

<p>Applying ice packs and cabbage leaves to the breasts. (C)</p> Signup and view all the answers

Using the BUBBLEEE acronym, what does the second 'B' represent in postpartum assessment?

<p>Bowels (C)</p> Signup and view all the answers

Flashcards

Methergine contraindications

Patients with asthma, hypertension, or preeclampsia.

DVT treatment

NSAIDs, tedhose, anticoagulant therapy (heparin), emergency measures for pulmonary embolism if needed, and plenty of fluids.

DVT signs and symptoms

Unilateral swelling of extremity, tenderness, redness, and warmth.

Metritis

Infection of the endometrium, decidua, and adjacent myometrium after delivery. Treat with IV antibiotics.

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Mastitis

Infection of the breast, often due to poor latch or nipple damage. S&S: red, painful, swollen, warm breast. Treat with antibiotics and emptying the breast.

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REEDA

Redness, Ecchymosis, Edema, Drainage, Approximation. Used to assess wound healing.

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Baby Blues

Normal emotional lability, irritability, and insomnia that typically resolves within 2 weeks postpartum.

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Postpartum Depression

Major depressive episode associated with childbirth, lasting beyond 2-6 weeks. S&S: hopelessness, worthlessness, guilt, anhedonia. Treat with SSRIs.

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Convection

Heat loss through air currents.

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Radiation

Heat loss from a warm object to a cooler surface not in direct contact.

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Newborn's first 8 hours

Alertness, sleep/decreased activity, awakens and shows interest in stimuli.

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The 5 S's for consoling a baby

Swaddling, side lying, shushing, swinging, sucking (feeding).

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Post-circumcision care

Assess bleeding, document first void, monitor for bleeding every 30 minutes for 2 hours.

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Postpartum Psychosis

A state characterized by hypomania, hallucinations, and delusions. Never leave the infant alone with the mother if this is suspected.

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Small for Gestational Age (SGA) Newborns

Newborns weighing less than 2500g at term or below the 10th percentile for their gestational age.

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Common Problems of SGA Newborns

Perinatal asphyxia, difficulty thermoregulating, hypoglycemia, hyperbilirubinemia, birth trauma; monitor for polycythemia

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Treatment for SGA Newborns

Frequent and early feeding, temperature monitoring, and monitoring for polycythemia.

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Large for Gestational Age (LGA) Newborns

Newborns with weight greater than the 90th percentile or >4000g at term; maternal diabetes is a risk factor.

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Characteristics of LGA Newborns

Poor motor skills, difficulty regulating behavioral states, proportional increase in body size, large, plump full faced

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Common Problems in LGA Babies

Birth trauma, shoulder dystocia, hypoglycemia, hyperbilirubinemia, asphyxia, jaundice.

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Postterm Baby

Born after 42 weeks of gestation.

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Pathologic Jaundice

Serum bilirubin > 5 mg/dL, appearing within 24 hours, often due to Rh/ABO incompatibility. Requires intervention.

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Physiologic Jaundice

"Normal" jaundice appearing after 24 hours, peaking at day 2-3. It is due to immature liver function.

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Hyperbilirubinemia Management

Phototherapy, early feeding, increased elimination. Exchange transfusions in severe cases.

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Early Onset Sepsis

Infection within 24-48 hours after birth, often from GBS. Requires antibiotics (ABX).

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Late Onset Sepsis

Sepsis occurring 7-30 days after birth, acquired inside or outside the hospital. Requires ABX

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Hypothermia (in Neonates)

Temperature less than 97°F (36.1°C).

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Surfactant Function

Surfactant reduces surface tension in the alveoli preventing complete collapse.

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IgG

Only immunoglobulin to cross the placenta, providing passive immunity to the fetus.

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Umbilical cord stump care

Keep clean and dry. Fold diaper back to allow air to dry.

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Lochia rubra

Bright red lochia.

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Lochia serosa

Pinkish-brown lochia.

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Lochia alba

Whitish-yellow lochia.

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BUBBLEEE

Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy/Perineum, Extremities, Emotional Status.

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When does mature milk come in?

4-5 days after childbirth.

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Decrease lactation (bottle feeding)

Wear a tight bra, use cabbage leaves/ice packs, avoid warm water on breasts.

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Postpartum urination frequency

Every 2-3 hours.

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Third-degree perineal laceration

Tear extends through the external anal sphincter.

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Fourth-degree perineal laceration

Tear extends through the anterior rectal wall.

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Postpartum fall risk

Increased risk due to rapid changes in center of gravity.

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Menstruation return (non-lactating)

Typically resumes 7-9 weeks postpartum.

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Menstruation return (lactating)

Can range from 2-18 months, depends on frequency/duration.

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Newborn caloric needs (first 3 months)

110-120 calories per kg of body weight.

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Amnioinfusion

Instillation of isotonic fluids into the uterus via IUPC to dilute meconium or relieve cord compression.

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Seizure treatment steps

Protect airway, provide oxygen if needed, and ensure safety with padded side rails.

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Study Notes

  • A caput is an edematous area of the scalp commonly found on the occiput. It crosses suture lines and results from birth trauma.
  • A cephalohematoma is a collection of blood between the skull bone and the periosteum, typically from birth trauma, and does not cross the cranial suture lines.
  • Vitamin K is given to the baby to prevent hemorrhagic disease of the newborn.
  • Transient tachypnea of the newborn appears soon after birth when fetal lung fluid is removed slowly or incompletely. It is common in C-section babies and resolves over 24-72 hours. It is not true respiratory distress.
  • Normal voiding for a newborn is 6-8 times per day.
  • Normal estimated blood loss is less than 500mL for vaginal birth and less than 1000mL for C-section.
  • The 5 Ts of postpartum hemorrhage are tone (uterine atony), tissue (retained placenta & clots), trauma (vaginal, cervical or uterine injury), thrombin (lack of coagulopathy), and traction (uterine inversion).
  • The most common cause of postpartum hemorrhage is uterine atony.
  • Risk factors for postpartum hemorrhage include multiparity, multiple gestation (twins), polyhydramnios, macrosomia, chronic coagulation disorders, prolonged labor, induction of labor, and general anesthesia.
  • Uterotonics to stop postpartum hemorrhage include oxytocin, misoprostol (Cytotec) per rectum, carboprost, methergine, and tranexamic acid (Lysteda).
  • Patients with asthma cannot receive carboprost.
  • Patients with hypertension or preeclampsia can't receive methergine (methylergonovine).
  • Treatment for a DVT involves NSAIDs, tedhose, anticoagulant therapy (heparin), emergency measures for pulmonary embolism, and plenty of fluids.
  • Signs and symptoms of DVT include unilateral extremity swelling, tenderness, redness, and heat.
  • Metritis is an infection of the endometrium, decidua, and adjacent myometrium. It is also known as a uterus infection after delivery. Signs/symptoms include tender abdomen and treatment is IV antibiotics.
  • Mastitis is a breast infection characterized by redness, pain, swelling, and warmth in one breast. Treat with antibiotics and breast emptying. It is usually caused by poor latch or breakdown of nipple tissue that becomes infected.
  • REEDA stands for redness, ecchymosis, edema, drainage, and approximation.
  • Baby blues are considered normal, with symptoms of emotional lability, irritability, and insomnia. They typically resolve within 2 weeks by postpartum day 10 and are usually self-limiting.
  • Postpartum depression is not normal and is a major depressive episode associated with childbirth. Symptoms last beyond 2-6 weeks and worsen, including hopelessness, worthlessness, guilt, anhedonia, loss of Libido, and feeling sad, greater than 12 on the Edinburgh scale. It is treated with SSRIs as gold standard.
  • Postpartum psychosis is severe and surfaces within 3 weeks of giving birth, with an increased risk for those with a history of mental illness. Symptoms include sleep disturbances, fatigue, depression, hypomania, hallucinations, and delusions. Never leave infant alone with mother if this is suspected.
  • Small for gestational age (SGA) newborns weigh less than 2500g at term or are below the 10th percentile. Their head is disproportionately bigger than their body and they have a wasted appearance of extremities and loose, dry skin. They also have reduced subcutaneous fat stores, wide skull sutures, and a thin umbilical cord, making them prone to hypothermia. Common problems include perinatal asphyxia, difficulty thermoregulating, hypoglycemia, and hyperbilirubinemia.
  • Large for gestational age (LGA) newborns weigh greater than 90th percentile or >4000g at term. They have poor motor skills, difficulty regulating behavioral states, proportional increase in body size, and large, plump, full faces. Maternal diabetes is the number one risk factor.
  • Common problems seen in LGA babies include birth trauma, shoulder dystocia, hypoglycemia, hyperbilirubinemia, asphyxia, and jaundice.
  • Management of LGA Includes monitoring vitals and blood glucose, hydrate, and phototherapy for increased bilirubin levels.
  • A postterm baby is born after 42 weeks.
  • A preterm baby is born before 37 weeks.
  • A late preterm baby is born between 34 +0 and 36+6 weeks.
  • A postterm baby has dry, cracked, wrinkled skin, may be meconium stained, has long thin extremities, long nails, wide eyed alert expression*, abundant hair on scalp, thin umbilical cord, limited vernix and lanugo. Common problems include perinatal asphyxia, hypoglycemia, hypothermia, polycythemia, and meconium aspiration.
  • The most common problem seen in postterm newborns is meconium aspiration.
  • The 2nd leading causes of infant death in the US is prematurity and low birth weight.
  • A preterm newborn has: weight < 5.5lbs, scrawny, poor muscle tone, minimal subq fat, undescended testes, lots of lanugo, poorly formed ear pinna, soft spongy skull bones, matted scalp hair, absent to few creases in soles and palms, minimal scrotal rugae, prominent labia and clitoris, thin transparent skin, abundant vernix*, and fused eyelids.
  • Common problems seen in a preterm newborn include hypothermia, hypoglycemia, hyperbilirubinemia, and problems related to immaturity of the systems, especially breathing and eating since lungs and neurological systems are last to mature
  • Nursing management of the preterm newborn includes oxygenation, thermal regulation, nutrition and fluid balance, infection prevention, stimulation, pain management, and parental support.
  • Problems late preterm babies typically experience include respiratory distress, hypoglycemia, temperature instability, poor feeding, jaundice, and discharge delays.
  • Neonatal asphyxia is the failure to establish adequate, sustained respirations after birth. Signs and symptoms include grunting, nasal flaring, low O2, retractions. Treat with immediate resuscitation, blood glucose levels, and support.
  • Transient tachypnea of the newborn typically resolves within 72 hours, neonatal asphyxia does not.
  • Respiratory distress syndrome (RDS) is due to lung immaturity and lack of alveolar surfactant. A ground glass appearance may be seen on X-ray, which means atelectasis. It's often seen in premature infants, those with perinatal asphyxia or cold stress, or maternal diabetes. Signs and symptoms include grunting, nasal flaring, chest wall retractions, tachypnea, generalized cyanosis, heart rate greater than 150, and fine crackles.
  • Management of respiratory distress syndrome (RDS) includes supportive care (endogenous surfactant through an ET tube), close monitoring, antibiotics for positive cultures, correcting metabolic acidosis, cluster care, prone or side-lying position, and fluids and vasopressors, gavage or IV feedings.
  • Meconium aspiration syndrome is the inhalation of particulate meconium with amniotic fluid into the lungs, secondary to hypoxic stress. It is seen most often in postterm infants. Risk factors include placental insufficiency, cord compression, maternal HTN, oligohydraminos, or maternal drug abuse. Signs and symptoms include tachypnea, barrel chest, retractions, cyanosis, atelectasis, and end-expiratory grunting.
  • Treat meconium aspiration syndrome by suction at birth, cluster care, and ensuring a neutral thermal environment.
  • The biggest issue with meconium aspiration syndrome is hypoxic ischemic encephalopathy, deadly and need cooling protocol to preserve brain function
  • The underlying problem associated with meconium aspiration syndrome in utero involves hypoxic stress
  • Hypoglycemia is the number one symptom seen in infants from diabetic mothers.
  • Signs and symptoms seen in infants from diabetic mothers include: full rosy cheeks, ruddy skin, short neck, buffalo hump, massive shoulders, distended upper abdomen, excessive subq fat, hypoglycemia, hypocalcemia, hypomagnesemia, polycythemia, and hyperbilirubinemia.
  • The most important management of infants from diabetic mothers is careful monitoring of serum glucose levels.
  • Jitteriness (shivering) is the number one sign of low blood glucose in newborn babies. Remember babies don't shiver to regulate temp.
  • The best way to manage infant hypoglycemia is PO breastfeeding or formula.
  • Hypoglycemia in the newborn is level of less than 40 mg/dL.
  • The chief complication from any birth trauma that caused bruising is hyperbilirubinemia/jaundice.
  • Hyperbilirubinemia is an imbalance in rate of bilirubin production and elimination with a total serum bilirubin level > 5 mg/dL.
  • Pathologic jaundice is more severe, occurs within 24 hours of life, is often caused by Rh isoimmunization or ABO incompatibility, and requires phototherapy or exchange transfusion.
  • Physiologic jaundice, known as "normal newborn jaundice," occurs after 24 hours of life, usually at day 2-3. It is usually the result of the immature liver's inability to process excess old red blood cells and often resolves on its own.
  • Management of hyperbilirubinemia often involves phototherapy, early feeding, and elimination. Exchange transfusions rarely happen in worst case
  • Early onset or congenital sepsis usually manifests within 24-48 hours after birth, acquired in perinatal period. GBS is the most common causative agent, treat with ABX.
  • Late onset sepsis occurs 7-30 days of age and is considered to be an infection acquired in the hospital or community. Treat with ABX.
  • Neonatal sepsis is one of the most common causes of neonatal death
  • Hypothermia (temperature less than 97°F) is the number one sign of neonatal sepsis.
  • Signs and symptoms of fetal alcohol syndrome include low nasal bridge, epicanthal folds, minor ear abnormalities, indistinct philtrum, thin upper lip, flat midface and short nose, cognitive and behavior changes and problems throughout life.
  • A score greater than 8 twice on the Finnegan Assessment Tool means the infant needs supplementary narcotics to wean them off safely.
  • Surfactant prevents alveolar collapse by reducing surface tension.
  • IgG is the only immunoglobulin to cross the placenta and is also the most abundant
  • Human breastmilk is a major source of IgA.
  • IgA is an immunoglobulin that does not cross the placenta and protects mucous membranes from viruses and bacteria in gut and respiratory tracts. It is the second most abundant.
  • IgM is an immunoglobulin that is the main source of protection from blood borne infections. It does not cross the placenta, so levels are low at birth.
  • Heat production in the newborn occurs via the metabolism of brown fat (not through shivering).
  • Conduction in the newborn is the transfer of heat when objects are in direct contact with each other, e.g., baby on a cold scale.
  • Convection in the newborn is the flow of heat from body surface to cooler surrounding air, e.g., baby under a draft.
  • Evaporation in the newborn is the loss of heat when a liquid is converted to a vapor, e.g., baby after a bath.
  • Radiation in the newborn is the loss of body heat to cooler solid surfaces in close proximity but not in direct contact, e.g., baby next to a cold window.
  • To prevent heat loss:
    • Conduction - place infant skin to skin, warm objects like scales or stethoscopes on scales before putting infant on them
    • Convection - use blankets and clothing to insulate infant - swaddling
    • Evaporation - dry newborn immediately after birth and baths
    • Radiation - use radiant warmer for long procedures or baths
  • The newborn goes through different phases in the first 8 hours of life:
    • birth to 30 minutes to 2 hours after birth - newborn is alert, moving, may appear hungry
    • 30 to 120 minutes old - period of sleep or decreased activity
    • 2 to 8 hours old, newborn awakens and shows interest in stimuli
  • The 5 S's of consoling a baby are swaddling, side lying, shushing, swinging, and sucking (aka feeding)
  • Preop circumcision prep includes confirming that the infant is at least 12 hours old, has received Vitamin K, has voided normally at least once since birth, has not eaten for at least 1 hour prior to procedure, and consent is documented on chart
  • Post circumcision care includes:
    • document 1st void to evaluate for obstruction or edema
    • assess bleeding every 30 minutes for at least 2 hours - a small streak of blood on diaper is normal but active bleeding is not
    • instruct parents to report foul smelling drainage and apply petroleum impregnated gauze for at least 24 hours daily
    • clean with warm water and mild soap
    • delay submersion baths until after cord falls off bc penis should be healed by this time
    • instruct parents not to remove yellow exudate that forms around head of penis to maintain moisture
  • To care for an umbilical cord stump:
    • wait to submerge in baths until cord falls off
    • dry cord completely after each bath and fold back diaper to allow to air dry
    • observe for redness, drainage, or foul odor, never pull on cord or attempt to loosen it
    • typically dries and falls off within 7-10 days of life
  • The different types of lochia are:
    • rubra (bright red)
    • serosa (pinkish brown)
    • alba (whitish-yellow)
  • BUBBLEEE stands for: Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy and perineum, Extremities, Emotional Status
  • Volume milk comes in 4-5 days after childbirth.
  • A bottle feeding woman should wear a tight sports bra, use cabbage leaves and ice packs, and face away from warm water in shower to decrease lactation
  • Postpartum women should be encouraged to urinate every 2 to 3 hours to prevent uterine displacement
  • The different degrees of perineal lacerations are:
    • first degree - skin only, no muscle
    • second egree - muscle, no anal sphincter
    • third degree - external anal sphincter torn
    • fourth degree - anterior rectal wall torn
  • The rapid change in center of gravity in the postpartum mother leads to a risk for falls.
  • Menstruation will return in nonlactating women 7 to 9 weeks after delivery and lactating women 2 to 18 months, depending on breast feeding frequency and duration.
  • Newborns need 110-120 calories/kg of body weight per day during the first 3 months of life.
  • Amnioinfusion is the instillation of isotonic fluids into the uterine cavity through an intrauterine pressure catheter to essentially wash out a uterus filled with meconium stained fluid. Blockage of the outflow could lead to increased resting tone of uterus and uterine rupture. Can be used to replace lost fluid in oligohydraminos and cord compression may be noted by variable decels.
  • The steps to treat a seizure are:
    • protect the airway - open/suction if necessary
    • provide supplemental oxygen if desaturation occurs
    • maintain safety (side rails up)
  • Rhogam is given to moms that are Rh negative regardless of if their baby is negative or positive, at 28 weeks and in the postpartum period.
  • Rhogam is given IV or IM.
  • Ideal candidates for VBAC are those with a low transverse incision and had a previous c-section for a breech baby
  • Contraindications to a VBAC include previous classical incision, myomectomy, cephalopelvic disproportion, and previous c section due to failure to progress
  • A primary risk involved with VBAC's is a uterine rupture
  • Signs of magnesium toxicity include decreased blood pressure, decreased urine output, decreased respirations less than 12, and absent or decreased DTRs.
  • Newborns should be fed every 2-3 hours if breastfed and every 3-4 hours if bottlefeeding.

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