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124 Cards in this Set
- Front
- Back
antepartal period
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prior to delivery
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signs and symptoms of pregnancy:
presumtive |
presumtive- not diagnostic. Amenorrhea, nausea and vomiting, breast tenderness, increased urination, fatigue, abdominal enlargement, quickening
discoloration during first 12 weeks) |
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s/s of pregnancy:
probable |
probable- Goodell's sign (softening cervix)Hegar's sign (uterine isthmus softening)
Chadwick's sign- (vagina, cervix and vulva with purplish discoloration during first 12 weeks), uterine enlargement, palpable fundus, braxton hicks, increased pigmentation(nipples, linea nigra, chloasma, striae gravidarum), pregnancy tests |
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s/s of pregnancy:
positive |
conclusively prove pregnancy. Fetal heartbeat, abdominal ultrasound, fetal movement felt by the examiner
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Physiological changes of pregnancy:
reproductive system changes |
uterine growth, anemorrhea, suppression of FSH, cervical and vaginal changes, changes in breast size, color and production of colostrum
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Physiological changes of pregnancy:
integumentary changes |
striae gravidarum or stretch marks, separation of rectus muscles, melasma or chloasma
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Physiological changes of pregnancy:
respiratory changes |
SOB in late pregnancy
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Physiological changes of pregnancy:
temperature changes |
increased blood volume 30%, increased cardiac output 25-50%, increased HR by 10
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Physiological changes of pregnancy:
gastrointestinal changes |
nausea, vomiting, heartburn, and increased saliva
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Physiological changes of pregnancy:
urinary changes |
fluid retention and change in renal, ureter, and bladder function
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Physiological changes of pregnancy:
hormonal changes |
increased estrogen and progesterone cause thickening of uterine walls, cervix cells proliferates and secrete a thick, tenacious mucus. The corpus luteum secretes progesterone to maintain the endometrium until the placenta produces enough progesterone to maintain the pregnancy
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Physiological changes of pregnancy:
couvade syndrome |
the expectant father develops physical symptoms of pregnancy: fatigue, depression, headache, backache, and nausea
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Calculating due date:
nagele's rule |
first day of last menses, subtract 3 mons. and add 7 days
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Calculating due date:
gestation calculator |
chart or wheel
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amniocentesis
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14-16 week withdrawl of amniotic fluid through the abdominal wall, carries only a 0.5 % risk of abortion
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Calculating due date:
chorionic villi sampling |
8-10 week retrieval and analysis of chorionic villi for chromosome analysis. 2-4 % risk of excessive bleeding leading to loss of pregnancy
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stress test
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oxytocin challenge test evaluates placental function and fetal health. Contractions are induced and monitored by external fetal monitor
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nonstress test
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does not induce contractions, assesses fetal heart rate related to fetal movement
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Rubella
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has a teratogenic effect on the fetus. Immunizations can not take place during pregnancy. Pregnancy should not occur in less than 3 mon after immunization
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nutrition
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a pregnant woman needs an additional 300 calories a day (2 milk and 1 protein)Lactating women need 500 cal increase/day
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childbirth education
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prepares mother and support person for childbirth experience, increases knowledge of obstetric care, helps clients reduce/mangae pain, improves overall enjoyment and satisfaction of child birth. Childbirth exercises may be taught-perineal and abdominal exercises, tailor sitting, squatting, Kegel, abdominal muscle contractions and pelvic rocking
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Childbirth pain management methods:
bradley |
husband coached- abdominal breathing, ambulation and use of a focal point to disassociate the pain of labor and birth
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Childbirth pain management methods:
psychosexual method |
conscientious relaxation, progressive breathing, flow with contractions rather than struggle
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Childbirth pain management methods:
dick read method |
fear leads to tension leads to pain. Use of abdominal breathing with contractions
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Childbirth pain management methods:
lamaze |
psychoprophylactic- stimulus response conditioning. Controlled breathing is used to reduce pain sensation during labor
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Medications of pregnancy:
prenatal vitamins |
folic acid prevents neural tube defects
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Medications of pregnancy:
magnesium sulfate |
CNS depressant halts premature labor
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Medications of pregnancy:
ritodrine (Yutopar)tocolytic |
relaxes uterine muscle through beta-2 receptor sites. Infusion for 12-24 hours after uterine contractions stop before oral administration
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Medications of pregnancy:
Terbutaline sulfate tocolytic |
oral dose in quite large to maintain uterine inactivity
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Medications of pregnancy:
iron prepartation |
60mg recommended. Best absorbed when taken with orange juice
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Medications of pregnancy:
docusate sodium (colace) |
stool softener that lowers the surface tension of feces. Should be swallowed with a full glass of water
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Medications of pregnancy:
Betamethasone sodium phosphate (celestone) |
corticosteroid administered to accelerate lung surfactant formation in the fetus. Takes 24 hours to be effective
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true labor
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contraction intervals are regular and gradually shortened. Intensity and duration increases, may become stronger with ambulation. The cervix softens , effaces and dilates
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false labor
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contractions are irregular,interval stays the same, no change in intensity or duration and may stop with ambulation. The cervix only softens
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Stages and phases of labor:
First stage |
begins with contractions and ends with fully dilated cervix.
Latent phase: (preparatory)- onset to rapid cervical dilation Active phase: cervical dilation 4 centimeters to 7. Stronger contractions lasting 40-60 seconds and occuring 3-5 minutes Transitional phase: maximum dilation of 8-10 centimeters. Contractions reach their intensity peak, full dilation, complete cervical effacement. Phase ends with an irreversible urge to push. |
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Stages and phases of labor:
second stage |
full dilation to birth of infant. Crowning to pushing the fetus out of the birth canal.
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Stages and phases of labor:
third stage |
placental stage
placental separation- approx. 5 minutes after birth of the infant placental expulsion- placenta delivered by bearing down or gentle exterior pressure |
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fetal presentation-
1.most common position 2. second monst common position |
1.is LOA (Left,occipital-anterior)
2.ROA The first letter indicates Left or right of the mother. The middle letter is for presenting part/fetal landmark: O for occiput, M for mentum, Sa for sacrum and A for acromion process. The last letter defines where the landmark points: A-anterior, P-posterior and T-transverse |
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Labor complications:
PROM |
increased risk of infection, dangerous to both mother and infant. Must avoid tub bathing, coitus, and douching. Report fever > 100.4, uterine tenderness, or odorous vaginal discharge.
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Labor complications:
deceleration-early |
viewed ad normal,normally occurs late in labor when the head is fairly low represent pressure on the fetal head during contractions
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Labor complications:
deceleration- late |
delayed 30-40 seconds after contraction onset and continue after the contraction. Suggests uteroplacental insufficiency or decreased blood flow. Maternal position should be changed to lateral, oxytocin should be stopped or slowed, O2 and fluid admin should be considered. Prompt delivery should be prepared for
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Labor complications:
deceleration-variable |
unpredictable, indicates compression of the cord. Position should be changed to lateral or trendelenburg, O2, fluids and possible anmioinfusion with NS or lactated ringer's
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Labor complications:
prolapes |
can occur with PROM, placenta previa, small fetus, hydramnios, cephalopelvic disproportion and multiple gestation. Compression and resulting anoxia must be relieved
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Labor complications:
inertia |
sluggish contractions, dysfunctional labor.
Primary- occurs at the onset of labor Secondary- occurs late in labor |
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Interventions during labor:
anmiotomy |
artificial rupturing of membranes with womanin dorsal recumbent position
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Interventions during labor:
episiotomy |
surgical incision of perineum (taint)done to allow fetal head to pass, preventing a tear to the perineum. Shortens the last portion of 2nd stage of labor
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Interventions during labor:
induction |
artificially starting labor at term. Hygroscopic suppositories of seaweed and prostaglandin get can be used to ripen cervix. Oxytocin induces contractions
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Interventions during labor:
forceps |
steel instrument used to assist delivery
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Interventions during labor:
vacuum |
disk-shaped cup pressed against the fetal scalp to help pull the fetus out. Procedure usually caused marked caput. Contraindicated in preterm infant births
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Interventions during labor:
cesarean |
birth through a surgical abdominal incisioninto the uterus. Indications include cephalopelvic disproportion, active genital herpes or papilloma, previous c-section, PIH, heart disease, placenta previa, premature separtation of the placenta, transverse fetal lie, low birth weight, fetal distress
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Medications for labor:
prostaglandins |
cervical softening to prepare for labor induction
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Interventions during labor:
oxytocin |
synthetic form of posterior pituitary hormone used ot initiate uterine contractions
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Interventions during labor:
epidural anesthesia |
narcotic injected into the epidural space
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Interventions during labor:
narcotic analgesics |
analgesic effect by may cause fetal CNS depression. Demerol, morphine, nubain, Fentanyl, and Stadol
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postpartal period
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after birth
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involution
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return of reproductive organs to prepregnancy size and condition.
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fundal descent
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descends @ 1cm/day for 10 days after birth. Breastfeeding and an empty bladder facilitate fundal descent and involution
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cervix
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regainsits shape by 18 hrs after birth
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lochia
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uterine/vaginal discharge after birth
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lochia rubra
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1st three days,mostly blood with pieces of decidua and mucus
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locia serosa
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fourth day amount decreases and color changes to pink/pinkish
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locia alba
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after 10th day discharge becomes yellowish white. May last for 6 weeks or more
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breasts
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milk production is sustained wiht frequent breastfeeding sessions. Lactation will cease within a week if breastfeeding never begun
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Body system changes:
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bladder/ureters return to prepregnant size. Urine increases to diureses excess fluid from pregnancy
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phychosocial adaptation:
taking in phase |
mother's need for food, fluid and sleep. Phase of nurturing and protective care. Integraiton of labor/birth experience
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phychosocial adaptation:
taking hold phase |
becomes more independent and takes responsibility for her care and shifts focus to the care of the infant. Lasts @ 10 days
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phychosocial adaptation:
letting-go phase |
role change from carefree lifestyle of being only a couple. The parents move forward as a unit with a new member
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postpartum blues
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mild, transient condition. Lasts about 2 weeks with crying for no apparent reason, fatigue, anxiety, restlessness, letdown feeling, headache and sadness
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postpartum depression
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(PPD) serious, intense, persistent. Characterized by inability to feel love, irritability, guilt, shame, unworthiness,loss of self, spontaneous crying, insomnia/hypersomnia, fatigue, decreased concentration. Negative feelings may be directed to the infant like disinterest, annoyance with care demands and thoughts of harm to the infant
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Postpartum complications:
hemorrhage |
x
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Postpartum complications:
puerperal infection |
infection between birth and 6 weeks postpartum with a temp of 100.4 or more on 2 consecutive days during the first 10 after birth.
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Postpartum complications:
Common postpartum infxns: |
wound, metritis (inflammation of the uterus), mastitis (tender, hot, swollen wedge shaped area of the breast), and UTI
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Postpartum complications:
Laceration/tears |
of the birth canal, cervix, vagina or perineum. Perineal are classified from the fourth degree dependant on depth and extent of tissue involvement
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Postpartum complications:
cardiac decompensation |
postpartal PIH. Easier to tx with antihypertensive therapy because fetal risk is no longer present(pregnancy induced hypertension)
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Postpartum complications:
Mastitis |
can be caused by staphylococcus aureus or candida albicans. A crack or fissure in the nipple of the portal of entry
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Medications after birth:
rhogam |
is given within 72hrs of birth to prevent semsitization of Rh negative moms who have given birth to Rh positive infants
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Oxytocin
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is used to contract the uterus if extensive bleeding is evident due to uterine atony, retained placental fragments, or laceration of the birth canal
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Postpartum complications:
Mastitis |
can be caused by staphylococcus aureus or candida albicans. A crack or fissure in the nipple of the portal of entry
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NAACOG
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(Nurses Assoc of the American College of Ob/Gyn) formed in 1969 to improve women and newborn health. Name change in 1993 AWHONN (Association of Women's Health, Obstetric and Neonatal Nurses)
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Venal Caval syndrome
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uterus compresses the aorta and vena cava when mother is supine decreasing fetoplacental blood flow. Tx is changing position of mother, elevating one hip in a side-lying position, providing oxygen and IV fluids
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Care of the Fetus and neonate:
"A love story" |
sperm and ovum unite to form a zygote in the distal thrid of the fallopian tube. After 5 days of impact they become a trophoblast and implant in their first apartment, the endometrium
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3 stages of fetal development
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1 preembryonic/germinal; first 14 days
2. embryonic: day fifteen through week 8 3. fetal: week nine to full term (38-40 weeks) 1st trimester: 0-12 weeks 2nd trimester: 13-27 weeks 3rd trimester: 28-40 weeks |
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describe the umbilical cord
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@ 21 inches long. Contains 2 umbilical arteries that carry unoxygenated blood from the fetus to the mother and 1 vein carrying oxygenated blood. All vessels are surrounded and protected by Wharton's jelly. The umbilical cord functions to eliminate waste and carbon dioxide from the infant and deliver nutrients, hormones, antibodies etc to the fetus
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Placenta
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develops in response to progesterone secreted by the corpus luteum. It has three major functions: transport, endocrine, and metabolic. The placenta secretes five hormones that are essential to pregnancy
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HCG
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human chorionic gonadotropin: responsible for positive pregnancy tests
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HPL
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human placental lactogen
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estrogen
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X
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progesterone
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X
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relaxin
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X
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**note**
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The placenta also produces fatty acids, glycogen, and cholesterol for fetal use and hormone production
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Transition to extrauterine life:
respiratory |
during birth the fetal chest is compressed and fluid is squeezed from the lungs and intrathoracic pressure increases. Chest recoil at birth creates negative intrathoracic pressure which stimulates air movement into the lungs and fluid movement into the interstitial tissue. Change in temperature from intrauterine to extrauterine stimulates breathing too
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Transition to extrauterine life:
Circulatory |
lower pulmonary resistance aids blood flow to the lungs to be oxygenated. Ductus arteriosus has a reversal of blood flow because of increased aortic pressure and increased O2 in the blood. Pressure in the R artium decreases and the L atrium increase. Blood flow to the liver begins and filtration of the blood begins
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Transition of extrauterine life:
Thermoregulation |
heat is generated through metabolism, muscular activity and nonshivering thermogenesis (metabolism of brown fat). Heat is lost through four mechanisms.
1. convection 2. conduction 3. radiation 4. evaportation |
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1. convection
2. conduction 3. radiation 4. evaportation |
1. heat flows fromt the body surface to cooler surrounding air
2. heat transfers to a cooler solid object in direct contact 3. body heat transfer to a cooler solid object not in contact 4. evaportation heat loss through conversion of a liquid to vapor |
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Transition of extrauterine life:
gastrointestinal system |
sterile at birt, does not provide necessary bacteria to synthesize vitamin K. Limited ability to digest fat and starch. Immature cardiac sphincter allow for easy regurgitation. First stool is meconium, thich, sticky, and tar-like
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Newborn reflexes:
rooting |
infant turns head to side when corner of mouth is stroked
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Newborn reflexes:
sucking |
elicited by touching the newborn's lips
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Newborn reflexes:
extrusion |
infant forces the tongue outward when the tip is depressed or touched. Disappears at 4 months allowing for easier feeding
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Newborn reflexes:
palmar grasp |
fingers flex and grasp a finger placed across their palm
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Newborn reflexes:
tonic neck |
fencing reflex. Flexing and extension of limbs of turning of the head
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Newborn reflexes:
moro reflex |
startle reflex. Response may be asymmetrical due to injury of the clavicla, humerus, or brachial plexus
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Newborn reflexes:
gallant reflex |
an infant lying prone will trun shoulder and pelvis to the stimulated side when skin near the spine is stroked
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stepping reflex
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X
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Newborn reflexes:
babinski's reflex |
stroking to plantar surface of an infant's foot upward causes great toe dorsiflexion and fanning out of the other toes
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Newborn reflexes:
crossed extension reflex |
stimulation the foot of the held down leg will elicit flex, adduct and extension of the other foot
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Newborn reflexes:
placing reflex |
backward step onto a firm surface when one foot is already resting there
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Complications of the neonate:
hyperbilirubinemia |
excessive bilirubin in the blood. Can cause yellow staining in the brain (kernicterus)at levels of 20mg/dl. Commone cause of Rh incompatibility. Phototherapy and fluid intake are used to treat jaundice
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Complications of the neonate:
respiratory distress |
transient tachypnea that is the result of the newborn's failure to clear the airway of fluid and mucus or aspiration of amniotic fluid. Tx is supportive and may include humidified O2, CPAP, or mechanical ventilation
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small for gestational age
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X
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large for genstational age
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X
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preterm infant
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higher risk for respiratory distress syndrome, hypoglycemia, and intracranial hemorrhage
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Complications of the neonate:
post-term infants |
beyond 42 weeks the placenta loses its ability to effectively cary nurtients to the fetus
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Complications of the neonate:
infection |
(GBS) group B streptococcal organism. Symptomatic infants (lethargy, fever, loss of appetite increased ICP) receive antibiotics (ampicillin, gentamicin or penicillin)
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hypoglycemia
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serum glucose less than 40 mg/dl. Infants at risk include born to diabetic mothers, large for gestational age infants. Tx feed early with formula or admin IV glucose, bolus not recommended
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Complications of the neonate:
cold stress |
keep in warm environment to prevent increased O2 needs due to increased metabolism to stay warm
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Complications of the neonate:
FAS |
growth restriction, CNS depression, cognitive impairment etc. demonstrated with tremors, fidgetiness, irritabilty. Weak sucking reflex and sleep disturbances
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Neonate's immunizations and meds at birth:
vitamin K |
intestine is sterile and can not synthesize initially after birth. Needed for clotting process. Most newborns produce enough by day 8. Given within first hour of birth to prevent hemorrhagic disorders
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Neonate's immunizations and meds at birth:
Hep B |
vaccine should be given within 12 hours of birth
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Neonate's immunizations and meds at birth:
erythromycin et al |
is administered as a prophylactic opthalmic ointment. It is mandatory in the US. May be delayed to promote bonding and attached
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neonate
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birth through the first 28 days of life
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Brazelton Neonate Behavior
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behavioral capacity and ability to respond to set stimuli
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Caphalhematoma
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blood between the periosteum of the skull bone and bone itself due to rupture capillaries at birth. May take weeks to absorb
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Caput succedaneum
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edema of scalp at the presenting part of the babies head. Edema crosses the suture lines and usually disappears in the third day of life
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APGAR
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assessment of wellness of newborn at 1 minute and repeated at 5 minutes
HEART RATE -0-absent, 1-slow(<100), 2 >100 RESPIRATORY EFFORT- 0-absent,1-slow, irregular, weak cry, 2- good, srong cry MUSCLE TONE- 0-flaccid, 1- some extremity flexion, 2- well flexed REFLEX IRRITABILITY-sx nostrils with catheter, or slap soles of feet- 0-no response, 1-grimacing, 2-infant coughs, sneezes or cries and withdraws feet COLOR-0- blue or pale, 1 body pink, extremities are blue, 2-completely pink |