High Risk Newborn
A baby is born at 1250 grams. How would you classify them according to weight?
a. LBW
b. VLBW
c. ELBW
d. Preterm
b. VLBW (very low birth weight)
Review:
LBW is < 2500 g
VLBW is < 1500 g
ELBW is < 1000 g
Preterm is classified based on weeks gestation, not weight
What are the 5 stages of the grief cycle?
AND
Do all these stages have to go in order?
Denial, anger, bargaining, depression, acceptance
NO! Each individual will have a different experience with grief and may go back and forth among these stages
In regards to maternal substance abuse, what is the period of time that poses the greatest risk for drug relapse?
The postpartum period
This is likely because they no longer have to worry about causing harm to the baby
Fill in the blanks of this sentence:
Gestational Hypertension is characterized by a BP greater than ______ without proteinuria or other signs of preeclampsia, occurring for the first time (before or after?) 20 weeks gestation and disappearing by _____ weeks postpartum
Gestational Hypertension is characterized by a BP greater than 140/90 without proteinuria or other signs of preeclampsia, occurring for the first time after 20 weeks gestation and disappearing by 12 weeks postpartum
T or F: Women with COVID-19 who have just given birth are not allowed to breastfeed.
FALSE
There is not current evidence to suggest that COVID-19 can be passed through breast milk. At this point, HCPs still think it is good to breastfeed to provide newborn with maternal antibodies. However, women are advised to wear a mask during breastfeeding and use proper hand hygiene.
Which cluster of symptoms would most alert you to inadequate thermoregulation in a preterm infant?
a. Flexed tone, lusty cry, pink skin
b. Feeding intolerance, lethargic, poor muscle tone
c. Weight loss, dry skin and mucous membranes
b. Feeding intolerance, lethargic, poor muscle tone
Other signs of inadequate thermoregulation include: irritability, cool or mottled skin
Which of the following statements is not true in regards to perinatal loss?
a. Parents likely want to know that their child's birth and death had meaning
b. Nurses should provide the same physical care to the baby as is he or she were still alive at the parent's discretion
c. Fathers need less support than mothers with this type of loss
d. Each family is unique, and the nurse should respect their wishes in regards to their baby
c. Fathers need less support than mothers with this type of loss
This is NOT true, but a common misconception. As nurses, we must also assess the father's needs
T or F: It is essential that a pregnant woman immediately stops taking opioids when she discovers she is pregnant.
FALSE
Sudden cessation of opioids can cause death to the mom and baby!
Which of the following interventions is not appropriate in the case of abruptio placenta?
a. Monitor and stabilize mom's cardiovascular system (BP, pulse, etc.)
b. Perform sterile vaginal exam to assess where bleeding is coming from
c. Anticipate a C/S
d. Administer RhoGam if mom is Rh negative
b. Perform sterile vaginal exam to assess where bleeding is coming from
This intervention is NOT appropriate- Nurses should NOT perform vaginal exam if bleeding is present → may cause additional placental separation or tear of placenta itself, causing severe hemorrhage and extreme risk to fetus. This rule applies to other conditions such as placenta previa where vaginal bleeding is a common symptom.
T or F: Pregnant women with COVID-19 will likely have more severe symptoms than nonpregnant women.
FALSE
Although there is little evidence, currently it is believed that pregnant women will have mild symptoms to COVID-19, and there is no reason to believe that they would need extra antenatal surveillance.
a. LGA baby
b. Postmaturity syndrome
c. Cold stress
d. SGA baby
b. Postmaturity syndrome
Review: postmaturity syndrome "refers to a fetus whose weight gain in the uterus after the due date has stopped, usually due to a problem with delivery of blood to the fetus through the placenta, leading to malnourishment. After birth, these infants have a distinctive appearance "
Which of the following is appropriate to say to a mother who recently gave birth to a stillborn child.
a. "At least your child is no longer suffering"
b. "You shouldn't have any problems with your next pregnancy"
c. "What can I do for you today that would be most helpful?"
d. "I understand how hard this is for you, but I know that in time you will feel better."
c. "What can I do for you today that would be most helpful?"
The others statements discount the parent's feelings.
All of the following statements regarding Cocaine use during pregnancy are true EXCEPT:
a. Cocaine causes vasoconstriction which decreases blood flow to placenta and fetus
b. Cocaine causes maternal effects such as bradycardia, drowsiness, and decreased muscle tone
c. Cocaine use increases the risk for placental abruption, SAB, premature ROM, and/or preterm labor
d. Maternal cocaine use can lead to IUGR and low birth weight of the fetus
b. Cocaine causes maternal effects such as bradycardia, drowsiness, and decreased muscle tone
This statement is FALSE. Maternal effects of cocaine use include: HTN, tachycardia, arrhythmia, tremors, anemia. Cocaine is a CNS STIMULANT.
What does the acronym HELLP stand for in HELLP Syndrome and what is the treatment for this syndrome?
It stands for: Hemolysis, Elevated Liver Enzymes, Low Platelets.
The treatment is to deliver the baby no matter what the gestational age or mother will die!
Review: HELLP syndrome is a complication associated with severe preeclampsia. It consists of:
- Decreased Hgb and PLT (<100,000)
- Increased bilirubin, LDH, AST, and Alanine Aminotransferase
- Subjective symptoms of RUQ or epigastric pain, N/V, and malaise
Which of the following are objectives of mechanical ventilation?
a. Improve pulmonary gas exchange
b. Relieve respiratory distress
c. Alter pressure-volume relations (ex: prevent and reverse atelectasis)
d. Permit lung and airway healing
e. All of the above
e. All of the above
Which of the following is not an intervention to maintain skin integrity in the neonate?
a. Avoid using tape on skin
b. Avoid cleaning with chemicals such as alcohol
c. Bathe baby daily
d. Humidify the incubators
c. Bathe baby daily
This is not an intervention to maintain skin integrity as bathing is not always necessary- too much bathing can even dry out the newborn's fragile skin
Which of the following is an appropriate therapeutic communication tool by the nurse?
a. Answering the patient when asked "Why did this happen to me?"
b. Telling the patient that you "understand" her loss
c. Avoiding silence so the parents will not feel awkward in the room
d. Using open-ended questions to encourage the parents' communication
d. Using open-ended questions to encourage the parents' communication
Open-ended questions are good. The other options are not appropriate. Silence can also be a good therapeutic tool that allows the parents to think through their feelings.
a. Intake during the second trimester has the largest negative impact on cell growth and division
b. Alcohol use during pregnancy leads to increased risk for miscarriage, preterm labor, and/or placental abruption
c. There is no safe amount of alcohol to drink during pregnancy
d. Fetal Alcohol Spectrum Disorder describes a range of effects due to fetal alcohol exposure such as physical, behavioral, and/or learning disabilities
a. Intake during the second trimester has the largest negative impact on cell growth and division
This is FALSE. The correct statement would be: "Intake during the first trimester has the largest negative impact on cell growth and division"
The patient you are caring for is a G3P2 patient with severe preeclampsia. She is currently on continuous monitoring and bedrest in the hospital. She is being administered Magnesium Sulfate. On your most recent assessment, you note that she has a respiratory rate of 11, absent patellar reflex, and reports that she has not gone to the bathroom in the past 12 hours. What is the most appropriate action?
a. Administer only half of her next dose of Magnesium Sulfate
b. Encourage her to drink water to relieve her dehydration and enable her to void
c. Administer Calcium Gluconate
d. Administer Diazepam to prevent a seizure
c. Administer Calcium Gluconate
Calcium Gluconate is the ANTIDOTE for magnesium toxicity.
Signs of magnesium toxicity include: depressed/absent reflexes, depressed respirations (<12), SOB, cardiac dysrhythmias, oliguria, hypocalcemia, and Serum Mg > 10 mEq/L
Which of the following statements is not true regarding physiological changes that occur during pregnancy?
a. Oxygen consumption is decreased
b. Tidal volume is increased
c. Functional residual capacity is decreased
d. Hyperventilation may likely occur
a. Oxygen consumption is decreased
This is NOT true. Oxygen consumption is increased in pregnancy.
Note: Functional residual capacity (volume of air present in the lungs at the end of passive expiration) is decreased during pregnancy due to compression of diaphragm by the uterus. This causes respiratory failure to occur faster in pregnant women rather than nonpregnant women.
List 3 risk factors for an SGA baby and 3 risk factors for an LGA baby
SGA baby risk factors include: poor placental function, maternal illness (PIH, severe DM), smoking/drugs/alcohol abuse, malnutrition, congenital abnormalities, chromosomal abnormalities, fetal infections (Rubella, Cytomegalovirus)
LGA baby risk factors include: diabetes, multiparity, hereditary (large parents), overnutrition
All of the following are appropriate nursing actions in regards to perinatal EXCEPT:
a. Provide the family with a memory box filled with ID bracelet, footprint certificate, and blood pressure cuff
b. Ensure that the patient schedules a 6-week follow-up with OB
c. Assess for signs of depression such as poor hygiene, excessive sleeping, and apathy
d. Make sure that the parents name their child because it is required for the birth certificate
d. Make sure that the parents name their child because it is required for the birth certificate
This is NOT true. You can allow them to name their child, but should not pressure them to do so
Which of the following is not an appropriate nursing intervention when taking care of a newborn with NAS?
a. Assess for symptoms of withdrawal such as irritability, increased muscle tone, high-pitched cry, fever, diaphoresis, and/or tremors
b. Score the neonate every 2-4 hours using the Finnegan Scoring System
c. Place the infant with colorful, musical toys to promote Sensorimotor development
d. Administer Methadone when Finnegan Score is 8 or higher for 3 consecutive scores
e. Encourage mother to hold baby when baby is awake
c. Place the infant with colorful, musical toys to promote Sensorimotor development
This is FALSE. The newborn with NAS should be placed in a quiet, dark environment and avoid overstimulation
Identify the true statement:
(once you have the answer, can you correct the other statements?)
a. In iron-deficiency anemia, the patient should take their iron with milk to increase absorption
b. A pregnant women with type 1 diabetes will likely need less insulin during the first trimester
c. Epidurals are contraindicated in pregnant women with cardiac disease
d. Maternal cystitis during pregnancy typically leads to conjunctivitis in the fetus
e. Chorioamnionitis can be both a cause and result of precipitous labor
b. A pregnant women with type 1 diabetes will likely need less insulin during the first trimester
This statement is TRUE- during 1st trimester, they are prone to hypoglycemia (less secretion of placental hormones that are antagonistic to insulin and N/V results in decreased food intake) so an insulin-dependent person may need LESS insulin
Correction of other statements:
- In iron-deficiency anemia, the patient should take their iron with citrus juice to increase absorption
- Pregnant women with cardiac disease will likely get an epidural as it decreases stress (we want to decrease stress on the heart as much as possible)
- Chlamydia during pregnancy can potentially lead to conjunctivitis in the fetus (as well as pneumonia)
- Chorioamnionitis can be both a cause and result of prolonged rupture of membranes
A G1P0 woman at 24 weeks gestation came into the hospital with symptoms of headache, fever, cough, and SOB. Her labs just came back + for COVID-19. Last night, her vitals were T 101.4, RR 30, P 115, and O2 sat 98%. You administered oxygen and tylenol. This morning, she states she does not feel well despite the tylenol and feels short of breath. Her vitals are now T 102, RR 38, P 131, and O2 sat 88%. What intervention do you anticipate?
a. Administration of IV antibiotics
b. Emergency C-section of fetus
c. Sedation and intubation
d. Administration of Chloroquine
c. Sedation and intubation
This would be the answer as her symptoms suggest ARDs (acute respiratory distress syndrome) which is "a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs" and typically requires support of a ventilator.
(This question was based off of case study from podcast)