KnowTHIS OB EXAM 4 PDF

NUR 335 E4 SG 62 MC 3 Hot Spot 6 SATA 2 FITB 2 MedMath ** Know this shit ** (SATA) Everyth...

NUR 335 E4 SG 62 MC 3 Hot Spot 6 SATA 2 FITB 2 MedMath ** Know this shit ** (SATA) Everything but 150pbm, failing hearing test (SATA) Everything but anemia Newborn Care (Module 7) and High Risk Newborn Care (Module 8) Preterm Newborn (3qs) - The nurse assesses a neonate at 30 mins of age. The infant is lying in a frog-like position; has red, translucent skin, adamant lanugo; has 20 second periods of apnea with apical pulse decreasing to 80 bpm and a soft murmur; both his cry and suck are weak. His testicles are undescended and his scrotum is small. He has only one anterior plantar crease and movements of his extremities are jerky. Which interventions should the nurse implement first? - Complete the New Ballard Tool for a specific gestational age assessment - The nurse admits a 29-week gestation infant to the NICU. Which intervention should be an initial part of the plan to prevent skin breakdown? - Place the premature on a gel mattress inside a double walled incubator.. (pg.588) - Premature infant - Don’t use alcohol and limit tape use with frequent position changed - Respiratory distress/surfactant Respiratory Distress (4qs)  - The newborn displays a respiratory rate of 70 breaths/min, circumoral cyanosis, flaring of the nostrils, intercostal retractions, sputum in mouth, and grunting. Pulse of 160 bpm; temp 36.5C (97.7F). Which action should the nurse take next? - Suction the airway with bulb syringe - Respiratory distress - PaCO2: nasal flaring, expiratory grunting, tachypnea, retractions - Complications of RDS - PDA, pneumothorax, BPD, pulmonary edema, hypotension, anemia, oliguria, hypoglycemia and altered calcium and sodium levels, ROP, seizures, and IVH Patent Ductus Arteriosus (2qs) - A nurse is assessing a newborn for manifestations of patent ductus arteriosus. Which of the following findings should the nurse expect? - Heart murmur - Closure of the ductus venosus shunt - Increase in SVR (systemic vascular resistance) & LA (left atrium) pressure - Reversal of blood flow → ductus arteriosus - Closure of ductus arteriosus and FA (foramen ovale) - Presence of surfactant in alveoli established functional residual capacity (keeps alveoli open) - Low surfactant levels and severe hypoxemia and acidosis → increase in pulmonary vascular resistance and failure to dilate - 10% require respiratory aid at birth - Ductus venosus → connects umbilical cord to inferior vena cava closed within 2 weeks; becomes ligament - Foramen ovale → opening between right atrium and left atrium; closes when it pressure exceeds right as PVR declines and SVR in increases; functionally closes in 1-2 hours/permanently at 30 minutes - Ductus arteriosus → connects pulmonary artery with aorta; closes in 15 hours (term)...96 hours (all neonates) Persistent Pulmonary Hypertension of the Newborn (1q) Persistent pulmonary hypertension (PPHN) results when the normal vasodilation and relaxation of the pulmonary vascular bed does not occur. This leads to elevated pulmonary vascular resistance, high pulmonary artery pressure, right ventricular hypertension, and right-to-left shunting of blood through the foramen ovale and ductus arteriosus. (pg. 563) - The result is hypoxemia, reduced cardiac output, ­systemic hypotension, impaired tissue oxygenation, and metabolic acidosis, which contributes to a cycle of worsening pulmonary vasoconstriction and clinical deterioration. PPHN is predominantly a problem among term or near-term neonates who experience hypoxia or asphyxia, RDS, meconium aspiration, sepsis, or congenital lung anomalies such as diaphragmatic hernia. Main goal is to correct hypoxia and acidosis. - Preductal and postductal blood gases and continuous pulse oximetry: - Right-to-left shunting is suspected when there is a difference of 15 mm Hg or more between the preductal and postductal PaO2, with preductal higher - Pulse oximetry will reveal a difference of 5% or greater between pre- and postductal oxygen saturation - Medications - Vasopressors such as dopamine decrease right-to-left shunting by maintaining systemic vascular pressure above pulmonary vascular pressure - Vasodilators such as sildenafil and prostaglandins are used to promote pulmonary artery dilation. - Paralyzing agents for neonates who resist ventilation have become controversial and may increase pulmonary vascular resistance - Sedatives and analgesics are used such as midazolam (Versed) and morphine - Antibiotic therapy is used to decrease the risk of or treat infection. Necrotizing Enterocolitis (1q)  - The nurse assesses a 3-day-old neonate born at 34 weeks’s gestation that has abdominal distention and vomiting. The nurse concludes these assessment findings are most likely related to: - Necrotizing enterocolitis (NEC) (pg. 560) Intraventricular Hemorrhage (1q) - The nurse evaluates a 28-week gestation premature infant who has been treated with artificial ventilation for respiratory distress syndrome (RDS). Which assessment finding indicated possible intraventricular hemorrhage? - The anterior fontanel is full and tense (pg. 559) Hyperbilirubinemia (4qs) - The nurse assesses a 39-week gestation neonate at 12 hrs of age for evidence of jaundice. Which finding places the infant at an increased risk for pathological jaundice? - Mother’s blood type O-, newborn A+ - The nurse is caring for a newborn receiving phototherapy. Which statement by the nurse requires the charge nurse to immediately intervene? - “You must stop breastfeeding and substitute formula since your baby is jaundice and is not getting enough nutrition from your breastmilk.” - SGA/LGA (2qs) - SGA – Term used for neonates whose weight is below the 10th percentile for gestational age - Dry immediately after birth - Skin to skin - Warm room (not below 74) - Infant hat - Warm hands and equipment  - LGA – Term used for neonates whose weight is above the 90th percentile for gestational age - Blood sugars need to be done due to SGA and LGA being risks for hypoglycemia Neonatal Infection/GBS (2qs) - The nurse performs a routine newborn assessment on an infant born at 40 weeks gestation at one hour of age. Which assessment finding increases this neonate’s risk for infection? - A small laceration on the scalp is noted from the use of an internal scalp electrode during labor - The nurse cares for a 36 week gestation neonate born to a mother who had no group B streptococcal culture collected prenatally. The mother did not receive antibiotic treatment during labor. Which action is the priority for the nurse? - Assess the newborn for signs of infection (pg. 575) Neonatal abstinence (2qs) - The nurse admits a newborn to the nursery whose mother has screened positive for alcohol, marijuana, and cocaine on admission in labor. Which nursing action should be performed to identify complications of neonatal abstinence syndrome? - Assess the newborn using a neonatal abstinence scoring tool and report increasing scores. - The nurse is caring for a 1 day old neonate who is suspected of suffering from drug withdrawal. Which sign indicates neonatal abstinence syndrome? - High-pitched cry (pg. 579) Discharge planning for the high risk newborn (1q) Transition to Extrauterine Life (APGARS) (3qs)  - Appearance (color), pulse (HR), grimace (reflex activity), activity (muscle tone), and respiration (respiratory effort) - A standard measurement system that looks for a variety of indications of good health in newborns. Obtained at 1 min and 5 mins after birth. If 5 min score is