Womans health exam 3 study guide

• Normal newborn thermoregulation

  • Conduction
  • Radiation
  • Convection
  • Evaporation
• High Risk Infants


  • IDM
  • LGA
  • SGA/IUGR
  • Drug-exposed
  • Jaundice
  • Pre/Post Term
• LGA


  • Greater than 4050 (greater than 9 lb), 90th percentile
  • Newborns of mothers with diabetes
  • Genetic predisposition
  • Multiparity
  • Erthroblastosis fetalis (Rh negative mom carries Rh positive baby)
  • Beck-weidman syndrome
  • Maternal diabetes that is poorly controlled during pregnancy
  • macrosomia
• Symptoms of LGA


  • Hypoglycemia
  • Polycythemia
  • Hyperviscosity
  • Birth trauma cephalopelvic disproportion
• Care for LGA baby

  1. Monitor vitals

  2. Screen for hypoglycemia

  3. Screen for polycythemia

  4. Observe for signs and symptoms related to head trauma

  5. Facilitate attatchement behaviors
• IUGR/SGA


  • Fetus with limited growth potential during pregnancy due to a variety of factors
  • Caused by environmental factors
  • Caused by placental factors
  • Caused by fetal factors
• Causes of IUGR/SGA


  • TORCH (toxoplasmosis, other, rubella, cytomegalovirus, herpes)
  • Congenital malformations
  • Metabolic issues (galactosemia, phenylketonuria)
  • Chromosomal issues (trisomy 21)
• Types of IUGR/SGA


  • Symmetric
  • Asymmetric
• Symptoms of IUGR/SGA


  • Hypoglycemia
  • Hypoxia
  • Hypothermia
  • Polycythemia
  • Congenital malformations
  • Intrauterine infections
  • Cognitive difficulties
  • Cracked skin peeling skin
• Interventions for IUGR/SGA


  1. Provide neutral thermal environment

  2. Monitor temp

  3. Warm with radiant warmer

  4. Minimize heat loss and prevent cold stress

  5. Monitor blood glucose

  6. Initiate feedings

  7. Support family
• IDM


  • Infants of diabetic mothers
• Symptoms/causes of IDM


  • Hypoglycemia
  • Hypocalcemia
  • Hyperbilirubinemia
  • Birth trauma
  • Polycythemia
  • Respiratory distress syndrome
  • Congential birth defects
  • Ruddy in color
  • Excessive adipose tissue
  • Macrosomic
  • Thick umbilical cord, large placenta
  • Not edematous
  • Cardiomegaly
  • Increased body fat
• Interventions for IDM


  1. Blood glucose via cord blood or heel stick

  2. Feedings for below 40 mg

  3. IV infusion of glucose if glucose not contained via oral feedings
• Preterm


  • Less than 36 weeks
  • Morbidity rate is high
• Symptoms/risks of Preterm


  • Respiratory distress syndrome
  • SGA
  • Apnea
  • PDA
  • RDS
  • Rink or ruddy, acrocyanotic
  • Reddened and translucent
  • Lanugo present
  • Head size large for body
  • Minimal cartilage in ears, folded over
  • Posture: froglike
  • Weak cry
  • Poor reflexes: poor suck, swallow or gag
  • Jerky, generalized movements, decreased tone
  • Retinopathy of prematurity (caused by ongoing oxygen treatement)
• Interventions for Preterm


  1. Maintain airway/positioning

  2. Monitor heart and respiratory rates

  3. Maintain neutral thermal environment

  4. Maintain fluid and electrolyte imbalance

  5. Ensure adequate feedings/nutrition

  6. Prevent infections
• Postterm


  • Beyond 42 weeks
• Risks/complications of Postterm


  • Placenta deterioration
  • Poor blood flow, decreased nutrients and decreased oxygen to baby
  • Baby may not toleralte labor well
  • SGA/LGA
  • CPD
  • Shoulder dystocia
• Findings in Postterm


  • Dry, cracked, peeling skin
  • Long fingernails/hair
  • No vernix
  • No lanugo
  • Body long, thin, wasting,
  • Head circumference and length typically WNL
• Symptoms of Postterm


  • Hypoglycemia
  • Meconium aspiration
  • Polycythemia
  • Congenital anomalies
  • Seizures
  • Cold stress (hypothermia)
• Treatment/nursing care for Postterm

  Monitor for s/sx of hypoglycemia, polycythemia, RDS, hypothermia, meconium asipiration
• Symptoms of Drug Exposed Infant

  • Constant motion
  • High pitch cry
  • Hyperirritability
  • Increased muscle tone
  • Tremors
  • Seizures
  • Excessive yawning
  • Short, unquiet, sleeo
  • Face scratching
  • Vomiting
  • Excessive sucking
  • Sensitive gag reflex
  • Diarrhea
  • Poor feeding (less than 15 mL on first day of life, takes longer than 30 min to feed)
  • Tachypnea
  • Sweating
  • Hyperthermia
• Interventions for Drug Exposed Infant

  1. Quiet, dimly lit area

  2. Small, frequent feedings

  3. Meds

  4. Gentle rocking if infant crying

  5. Protect hands with mittens

  6. Apply protective barrier to groin area
• Common complications of at risk newborns

  • Cold stress
  • Hypoglycemia
  • Jaundice
  • Respiratory distress syndrome
  • Meconium aspiration syndrome
  • Sepsis
• Cold stress


  • Newborn loses more heat than body can produce
  • At risk newborns often have smaller brown fat stores, have difficulty maintain core temp
  • Can lead to hypoxemia, metabolic acidosis, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, neonatal asphyxia
• Signs/symptoms of cold stress

  • Increased movements
  • Increased respirations
  • Decreased skin temp
  • Hypogylcemia
  • Metabolic acidosis
• Interventions for cold stress

  1. Prevention

  2. Warm baby slowly, or radiant warmer

  3. Warm IV fluids before use

  4. Warm oxygen sources
• Hypoglycemia


  • Risks: newborns of diabetic mothers, IUGR, SGA and LGA
  • Can lead to intellectual problems
• Interventions for hypoglycemia


  1. Prevention is best interetion, promote early/regular feedings

  2. Required if drops less than 45-47

  3. Blood glucose check outside of heels

  4. IV dextrose may be necessary
• Symptoms of hypoglycemia


  • Lethargic
  • Poor feeding/vomiting
  • Temp instability
  • Apnea/dyspnea/cyanosis
  • Limpness
  • Tremors/jitteriness
  • High pitch cry
  • Exaggerated moro reflex
  • Blood glucose <40-45 mg/dL
• Jaundice


  Elevated bilirubin levels
• Types of jaundice


  • Physiologic jaundice
  • Breastfeeding jaundice
  • Hyperbilirubinemia
• Causes of jaundice


  • Respiratory distress
  • High bilirubin levels
• Symptoms of jaundice


  • Bilirubin level > 4-6 mg/dL
  • Yellow tint to skin
• Interventions for jaundice


  1. Prevention is best, frequent feeds to help eliminate bilirubin via urine and stool

  2. Phototherapy

  3. Exchange transfusion

  4. Bilirubin lights interventions
• Bilirubin lights interventions


  • Cover newborn eyes with patches
  • Remove all clothing other than diaper
  • Monitor vitals every 4 hours
  • Encourage frequent feedings
  • Keep track of I&O's
• Respiratory distress syndrome


  • Causes: Preterm, IDM
  • Symptoms: Prematurity, Increasing cyanosis, Tachypnea/apneaa, Jaundice, Edema, Labored respirations, Retractions, Nasal flaring, Grunting, Murmurs, hypothermia
• Interventions for respiratory distress syndrome

  1. Prevent premature delivery

  2. If premature is suspected, administer steroids (betamethasone) to enhance fetal lung development

  3. Monitor for signs and symptoms

  4. CPAP
• Meconium aspiration syndrome


  Meconium inhaled into babys lungs
• Symptoms of meconium aspiration syndrome


  • Meconium stained amniotic fluid
  • Fetal hypoxia in utero
  • Signs of resp distress