Newborn Care after Delivery
When performing the 1 minute and 5 minute APGAR score and it is 5 each time what are we going to do?
we need to repeat the APGAR Q5 mins until 2 APGARs are over 7
When is a glucose challenge test done and what is the procedure?
Administered between 24 and 28 weeks
Women ingest 50g of oral glucose and 1 hour later a blood sample is taken. If > or equal to 140 then a 3-hour OGTT is recommended
3-hour OGTT
Fasting glucose is drawn
The women should ingest 100g of oral glucose
Blood glucose levels are drawn at 1,2, and 3 hours
If there are 2 or more abnormalities the mom will be diagnosed with gestational diabetes
A woman with type one diabetes will likely have a small baby which is the opposite for type 2
What are methods of heat loss?
Evaporation- wet skin (during birth or bathing)
Conduction- a cold weight scale, cold hands
Convection - air flow (fans turned off)
Radiation- laying next to a cold wall (skin to skin with mom warms baby)
**Drying stimulates the baby to breathe and gets the wet liquid off which promotes warming. When a baby’s temperature drops the blood glucose can drop or the baby can have a seizure.**
If we see early deceleration's in a FHR strip what are we going to prepare for?
Delivery!
What is the difference between threatened and inevitable abortions?
Threatened- Spotting or light bleeding
Inevitable- Membranes rupture and cervix dilates
Circumcision care
Ointment on gauze first 12-24 hours
Ointment for a week can be put on the diaper
Be concerned if it is more than a few drops of blood
Monitor for signs of infection
What to teach parent who is doing photo-therapy with infant due to jaundice
Make sure infant is wearing eye protection, as much skin exposure as possible, take temp frequently, rotate baby, frequent feedings- every 2-3 hours to increase BM to expel the meconium
Signs and Symptoms of Placenta Previa- A placenta previa is when the placental completely covers the cervical OS
Painless bright red vaginal bleeding these pts are at high risk for early labor and hemorrhage
EMERGENT C-SECTION
What are Late deceleration's and what are some interventions we should do as nurses when we see them?
Late Deceleration:
If deceleration happens after contraction and does not recover to baseline until after the contraction
30 seconds or more from the onset of the nadir
Interventions- reposition mom, give oxygen, stop oxytocin if it is running, give fluid
What is the major nursing education point for a Molar Pregnancy?
Wait a year before trying to have a baby (TAKE BCP)!!
Cord Care
Keep open to air
Can be submerged in water if given a bath. Keep clean with warm water and mild soap
Redness around the base of the cord is a concern for infection
Don't clean with alcohol wipes
The cord should fall off within 10-14 days
Do not give a bath until the newborn's temperature is stable for more than 2 hours, a sponge bath is not recommended as it can promote low temp
Why do we do an External version and what are Nursing Considerations?
This is done with the hopes to try and rotate the baby so that the mom can have a vaginal birth (from breech to cephalic)
Nursing Considerations:
1 NST (Consent signed)
2. Infant 37 wks gestation
3. Pain medication is given prior
4. Make sure mom is RH negative if not she will need Rhogam
What 3 clinical features are seen with Fetal Alcohol Syndrome
Prenatal and Postnatal growth restriction
CNS impairment
Recognizable combination of facial features
What defines variable deceleration's
Abrupt decrease in FHR
15 BPM or more below baseline
Lasting 15 seconds to 2 minutes
**Strip looks like a "V"**
What are signs of a Molar Pregnancy?
Grape like clusters,
1st prenatal visit at 16 weeks- we might see increased fundal height,
High HCG levels
Excessive N/V
Early HTN before (20 weeks)
Risk for cancer
Nursing education for SIDS
Supine to sleep
Avoid overheating
Pacifier use in infants OVER 1 month of age
Not to sleep in a bed or couch with adults
Contraindications for an external version
-Previous C-section
-Fetal size greater than 4000g
-Placenta Previa
-Multifetal Gestation
What is an Ectopic Pregnancy? What are some risk factors?
Implementation of the fertilized ovum in an area outside of the uterine cavity. Symptoms include missed period and severe pelvic and abdominal pain, usually on one side.
Risk factors:
History of STD
History of previous ectopic
Use of IUD’s
Multiple induced abortions
Anatomic or functional defects in Fallopian tubes
What is the number one nursing intervention when we see variable deceleration's?
Number one nursing intervention is change moms position even if you need to try 3-4 different ones and then advise provider of possible IUPC
What is HELLP syndrome and how does it present?
RUQ pain
Risk factor from pre-eclampsia and looking for RUQ pain for liver involvement check liver enzymes which are elevated and low platelets
Physiological: Occurs AFTER the first 24 hours of life as a result of hemolysis of RBC (fewer erythrocytes are needed than during fetal life) and immaturity of the liver
Pathological: Occurs in the FIRST 24 hours and may require treatment with photo therapy- ABO incompatibilities, infection, and metabolic disorders. (ABO compatibility problem)
When should RhoGam be given?
Rhogam is given prophylactically at 28 weeks if concern for mixing of blood and given if mom is negative and baby is positive. Another dose is given within 72 hours after delivery. Given if there is any trauma where blood could be mixed such as MVC or external version.
Factors that increase the risk of Jaundice
The Baby’s liver is immature
Preterm more prone
ABO Incompatibility (PATHOLOGIC)
Delayed feedings
Trauma
Cold Stress
If we are seeing prolonged deceleration's what does this usually mean?
Typically means there is a cord prolapse!
What is chorioamnionitis?
Infection of amniotic fluid. Can result from prolonged rupture of membranes, can lead to sepsis for the baby.