Nursing Care: Cesarean Birth, High-Risk Newborns, and Acute Conditions of Neonates

Flashcards based on lecture notes on Cesarean Birth, High-Risk Newborns, and Acute Conditions of Neonates.

What is a cesarean birth?

Birth accomplished through an abdominal incision into the uterus.

From what Latin word is 'cesarean' derived?

Cae-dore, meaning 'to cut.'

Why is term 'cesarean birth' preferred over 'cesarean delivery'?

To accentuate that this is a birth more than a surgical procedure.

What is a common use for cesarean birth?

As a prophylactic measure to alleviate problems of birth such as cephalopelvic disproportion or failure to progress in labor.

Name two types of cesarean birth.

Elective CS and Emergent CS.

What characterizes a Scheduled CS (Elective CS)?

Planned with thorough preparation throughout the antepartal period, often done at 39 weeks.

What characterizes an Emergent CS?

Done for reasons that arise suddenly in labor, such as newly discovered placenta previa, abruptio placenta, fetal distress or failure to progress.

How can poor nutritional status affect a pregnant patient undergoing CS?

May result in a prolonged healing period that increases the risk for infection and rupture of the incision (dehiscence).

How does age affect surgical risk in CS?

It can cause both decreased circulatory and renal function; > 40 years old falls into category of slightly higher risk due to GDM, HPN or nonreassuring fetal heart tracings.

How does CS birth affect the newborn's respiratory system?

Newborns are at greater risk than with vaginal birth because the pressure on the chest during vaginal birth helps to rid the newborn’s lungs of fluid.

What is the significance of vaginal flora exposure for newborns?

NSVD allows newborns gut be populated with vaginal flora

What preoperative teaching is important for CS birth?

Surgical skin preparation, eating nothing before time of surgery, premedication, methods of transport to surgery, need for indwelling bladder catheter, IV fluid administration, epidural catheter, and activities to maintain respiratory and skeletal-muscle function (early ambulation).

Name two types of Cesarean Incisions.

Classic Cesarean Incision and Low Segment Incision

What are the three questions in NEONATAL RAPID ASSESSMENT?

Term gestation? Good tone? Breathing or crying?

What are the four actions in sequence for neonatal resuscitation?

Initial steps in stabilization, Ventilate and oxygenate, Initiate chest compressions, Administer epinephrine and/or volume

What is a preterm infant?

A live-born neonate born before the end of week 37 of gestation.

What are the classifications of preterm birth?

Early Preterm (24-34 weeks) and Late Preterm (34-37 weeks)

Name three specific problems of prematurity.

Respiratory distress syndrome, hypoglycemia, and intracranial hemorrhage.

How is the maturity of a newborn determined?

Physical findings (sole creases, skull firmness, ear cartilage), neurologic findings, mother’s report of LMP, and sonographic estimations of gestational age.

List five common factors associated with preterm birth.

Low socioeconomic level, poor nutritional status, lack of prenatal care, multiple pregnancy, previous early birth.

List five common factors associated with preterm birth.

Order of birth, Closely spaced pregnancies, abnormalities of the mother’s reproductive system, Infections, Obstetric complications

What advice to give a mother who asks what caused the preterm birth?

“No one really knows what causes prematurity.”

What are the visible characteristics of a preterm infant?

Small and underdeveloped, disproportionately large head, ruddy skin, noticeable veins, high degree of acrocyanosis, and covered with vernix caseosa.

What are the characteristics of very preterm newborns?

Vernix is absent, lanugo is extensive, anterior and posterior fontanelles are small, and there are few or no creases on the soles of the feet.

How does neurologic function manifest in preterm infants?

Sucking and swallowing reflexes will be absent if age is below 33 weeks, deep tendon reflexes are diminished, less active, and cry is weak and high-pitched.

List five potential complications of prematurity.

Anemia of Prematurity, Kernicterus, Persistent Patent Ductus Arteriosus, Periventricular/Intraventricular Hemorrhage, Respiratory distress syndrome

What is a post-term infant?

An infant born after the 42nd week of a pregnancy.

Why is a post-term baby at risk?

A placenta appears to function effectively for only 40 weeks.

What is observed during the assessment of the post-term infant?

They may be lightweight, the amount of amniotic fluid may be less, Fingernails will have grown well beyond the end of the fingertips, may demonstrate an alertness much more like a 2- week-old baby than a newborn.

What diagnostic tests are done for post-term infants?

Sonogram, nonstress test, complete biophysical profile

What are the likely characteristics of the post-term baby observed at birth?

difficulty establishing respirations, Hypoglycemia, Subcutaneous fat levels may also be low, Polycythemia

What is SGA?

SMALL for GESTATIONAL AGE; An infant is SGA if the birth weight is below the 10th percentile on an intrauterine growth curve for that age.

What is IUGR?

Intrauterine growth restriction; Failed to grow at the expected rate in utero

What is the appearance of SGA?

Small liver, poor skin turgor, large head ,Skull sutures may be widely separated from lack of normal bone growth, dull Hair ,Sunken abdomen, Cord stained yellow

What is LGA?

LARGE for GESTATIONAL AGE; An infant is LGA (also termed macrosomia) if the birth weight is above the 90th percentile on an intrauterine growth chart for that gestational age.

What are characteristics assessed LARGE for GESTATIONAL AGE?

Unusually large- rapid growth,May show immature reflexes and low scores on gestational age examinations in relation to their size, bruising or a birth injury such as a broken clavicle or Erb-Duchenne paralysis

What are Cardiovascular Dysfunction observed in LGA newborns?

hyperbilirubinemia ,polycythemia/ cyanosis (transposition of the great vessels

Why is hypoglycemia often present in LGA newborns?

If the mother had diabetes that was poorly controlled, the infant will have had an increased blood glucose level in utero causing the infant to produce elevated levels of insulin.

What are the three main causes of RDS in neonates?

Prematurity, Infants of diabetic mothers, Infants born by cesarean birth

What are the main causes of RDS?

A lack of lung surfactant, genetic problems with lung development.

What are the symptoms of MAS?

Bluish skin color (cyanosis) in the infant Breathing problems, e.g. Difficulty breathing, No breathing, Rapid breathing.Limpness in infant at birth

How can surfactant can be administered therapeutically

Increase lung compliance

What is HDN?

Hemolytic disease of the newborn is a blood disorder in a fetus or newborn infant

How is HDN tested for?

Complete blood count and immature red blood cell (reticulocyte) count Bilirubin level and Blood typing

What is SIDS?

Also prone to SIDS are infants with

What is Transient Tachypnea of the Newborn?

Is a parenchymal lung disorder characterized by pulmonary edema resulting from delayed reabsorption and clearance of fetal alveolar fluid

How is Transient Tachypnea diagnosed?

The mother’s pregnancy and labor history are important to make the diagnosis and Tests performed on the baby may include Chest x-ray, Blood count and blood culture. Continuous monitoring

What is Periventricular Leukomalacia?

PVL is a type of brain injury that affects infants.

What is Hemorrhagic Disease of the Newborn

A lack of vitamin K causes hemorrhagic disease of the newborn.

What is Necrotizing Enterocolitis

Necrotizing enterocolitis is the death of intestinal tissue. It most often affects premature or sick babies.