439 Final

characteristics of a preterm infant (before 37 weeks)

fewer alveoli, less surfactant, less fat, weak gag reflex, fewer antibody production

characteristics of a late preterm infant (34-36 weeks)

immature liver, hyperbili

characteristics of a postterm infant (over 42 weeks)

meconium aspiration syndrome, PPHN

respiratory distress syndrome (sx and cause)

caused by lack of surfactant

sx: crackles, retractions, apnea

treatment for respiratory distress syndrome

o2 therapy, positive pressure ventilation, artificial surfactant

what do large birth weight infants need for nutrition

fortification added to human milk

retinopathy of prematurity

abnormal growth of blood vessels in retina, high po2 lvls,

make sure to monitor o2 levels

bronchopulmonary dysplasia

caused by prolonged exposure to o2

tachypnea, retractions, inc wob

use of o2 after 28 days

patent ductus arteriosus

connection between pulmonary artery and aorta doesn’t close

murmur, bounding pulses, tachycardia, hypotension, crackles

intraventricular hemorrhage cause

common in premature babies, fluctuations in o2 and bp cause this

intraventricular hemorrhage SYMPTOMS

anemia, full fontanel, dc tone, respiratory depression,

how to manage intraventricular hemorrhage

slow infusions, cluster care, bp monitor, steroids

necrotizing enterocolitis

inflammation of bowel mucosa leading to necrosis and perforation

abd distention, vomiting, bloody stools, resp distress

what is a risk for necrotizing enterocolitis

enteral feed

pain in infant sign

eye squeeze, brow bulge, inc hr, inc bp, rapid shallow breathing

what pain med is used for infants

morphine

perinatal asphyxia

caused by lack of o2 during delivery

dc tone, dc hr, cyanosis, muconium stained fluid, weak breathing

meconium aspiration sx

retractions, labored breathing, grunting, cyanosis, meconium staining

discharge teaching for late preterm infants

jaundice, feeding problems, hypoglycemia, respiratory distress, thermal instability

common problems with SGA

IGR, asphyxia, hypoglycemia, polycythemia, thermoregulation

common problems with LGA

macrosomia, hypoglycemia, hypoxia, birth trauma, cardiomyopathy, hyperbili, polycythemia

primary ways to prevent sti

abstience, condoms, mutual monogamy, vaccination, prep, aware of partner status

secondary ways to prevent sti

sti testing between every new partner, timely sti treatment, expidited partner therapy, pep

tertiary sti prevention

sx manage, HIV ART

when do you test for chlamydia after infection

4 weeks after treatment and 3 months later

when do you retest for gonorrhea if positive

3 months

when do you test for STI

all pregnant women under 25, or pregnant who are high risk retest during 3rd trimester

what are risk factors for syphillis

no prenatal care, late prenatal care, infection with hiv

when do you retest for syphilis when negative

28 weeks, test at delivery if high risk

what are symptoms of syphilis

hepatosplenomegaly, pneumonia, edema, rash, anemia, thrombocytopenia

what can syphilis cause with pregnant women

IUGR, preterm birth, still birth, congenital infection

HIV and pregnancy maintence

continue to take meds and give newborn antiviral medication for 4-6 weeks after delivery

what can HSV cause

IUGR, microcephaly, hydranencephaly, fetal death

how is HSV spread

viral shedding at birth

after 32 weeks, highest rate of infection

HSV and pregnancy

will deliver c-section if any tingling or lesions

GBS treatment

penicilin

PID sx

lower abd tender, cervical motion tender, fever, cervical discharge, elevated CRP

treated with antibiotics

TORCH

toxoplasmosis, other, rubella, cytomegalovirus, herpes

how to prevent TORCH

don’t handle cat litter

what can untreated chlamydia and ghonnorhea can lead to

PID

risk factors for gestational diabetes

over 25, previous pregnancy, family hx, obesity

GDM puts baby at risk for…

iufd, birth injuries, congenital malformations, CNS defects, hypoglycemia

how to manage GDM antepartum

fetal movement count begin at 28 w, nst, cst, bpp at 34 w, monitor bs, diet and exercise

how to manage GDM intrapartum

monitor for dehydration, check sugar hourly, continuous EFM, IVF regular insulin

GDM postpartum management

risk for hemorrhage, 1st 24 hrs insulin requirement drop

fasting glucose normal lvl

95

normal glucose after 1 hr food

less than 140

normal glucose after 2 hrs meal

less than 120

hyperemesis sx

excessive prolonged vomiting, 3x day, weight loss, ketouria

hyperthyroidism (graves disease) sx

heat intolerance, diaphoresis, fatigue, goiter, tachy

hypothyroidism sx

weight gain, lethargy, cold intolerance, activity intolerance

hypothyroidism inc babies risk for what

miscarriage

1st line therapy for hypothyroidism

levothyroxine

CPR pregnancy

uterine displacement, push belly to left

place paddles one rib space higher, under left breast

what to consider after 4-5 min of no ROSC

perimortem cesarian birth

complciations of cpr on pregnant pt

lacerate liver/spleen, fracture sternum

chronic hypertension

before 20 w pregnant

gestational htn

over 140/90

preeclampsia without severe features

over 140/90, 1+ proteinuria, u/o=intake

preeclampsia with severe features

bp over 160/110, 3+ proteinuria with dipstick, output 400-500 24 hr, rib pain

what can preeclampsia lead to

HELLP syndrome

HELLP syndrome

hemolysis, elevated liver enzymes (ast/alt), low plt

what are HELLP pts at risk for

DIC

normal mg levels

1.7-2.3

eclampsia

preeclampsia with seizures and coma

management of htn

low dose asprin, hydralazine iv, nifedipine po, labetalol iv

mg sulfate

signs of mg toxicity

no deep tendon reflexes, dc rr, shallow resp, hb, chest pain, pulmonary edema

what treats mg toxicity

ca glluconate/chloride

nursing care for preeclampsia pt

take bp every 20 min, assess reflexes and edema

nursing care for severe preeclampsia pt

quiet, dark room, seizure precautions, o2, suction, emergency meds at bedside

NO MORE THAN 125 ml/hr (po and iv)

what does cytotec do

soften and dilate cervix

what does membrane stripping do

loosen amniotic sac from cervix

amniotomy

break water artificially

what does oxytocin do

stimulate uterine contractions, aids milk let down

pitocin

synthetic oxytocin

who is responsible for titration of pitocin

nurses

how to administer pitocin

piggyback onto main iv fluids

tachysystole

more than 5 contractions within 10 mins, contractions lasting longer than 2 min

when to stop pitcoin

tachysystole, 3 late decels

cervical insufficiency

dilation of cervix in 2nd trimester

risk factors for cervical insufficiency

previous d&c, trauma, 2nd tri miscarriage, marfan syndrome, instrument assisted birth, DES (synthetic estrogen)

how to manage cervical insufficiency

cereclage, remove after 36 weeks

how to fix ectopic pregnancy

methoxtrate, mifepistrone

what are ectopic pregnancy pts high risk for

hemorrhage

sx of ectopic pregnancy

unilateral, stabbing pain

placenta previa

uterus implanted in lower uterine segment near cervical os

how to diagnose placenta previa

ultrasound

placenta previa sx

painless, vaginal bleeding after 20 weeks

management of placenta previa

NO VAGINAL CHECKS, deliver c section

placenta accrete

palcenta grows into uterine wall

placenta increta

placenta grows into uterine muscles

placenta percreta

placenta grows through uterine wall

placenta abruptio

detachment of all or part of placenta after 20 weeks

what is a risk factor for placenta abruptio

maternal htn, cocaine, trauma

sx of placenta abruptio

painful, sustained contractions, late decels, tachysystole, bradycardia, rigid uterus, low h&h

how to manage placenta abruptio

emergent c-section, watch for shock, monitor 4 hrs, NST

kleihauer betke test

measures amt of fetal hg in moms blood, determines how much rhogam needed

what is consdiered hemorrhage

more than 500 ml vaginal, 1000ml csection

large blood clot, saturating pad in 15 mins

risk factors for hemorrhage

lacteration, hematoma, macrosomia, multiparity

interventions for hemorrhage

fundal massage, empty bladder, 2nd iv

pitocin