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Perinatal Nursing

Perinatal Nursing



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Published by Marcus, RN
useful handout on perinatal nursing
useful handout on perinatal nursing

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Published by: Marcus, RN on Sep 21, 2008
Copyright:Attribution Non-commercial


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(Taken from Google Document)
- A blue or purple mottled discoloration of the extremities, esp. the fingers, toes and/or nose. This physical finding is associated with many diseases and conditions, such as anorexia nervosa, autoimmune diseases,cold agglutinins, or Raynaud’s disease or phenomenon. Cyanosis of the extremities may be commonly observed innewborns and in others after exposure to cold temperatures, and in those patients with reduced cardiac output. In patients with suspected hypoxemia, it is an unreliable sign of diminished oxygenation.
- or startle reflex- a reflex seen in infants in response to stimuli, such as that produced by suddenly strikingthe surface on which the infant rests. The infant responds by rapid abduction and extension of the arms followed by an embracing motion of the arms.
- a mass composed of clotted blood, located between the periosteum and the skull of a newborn.It is confined between suture lines and usually is unilateral. The cause is rupture of periosteal bridging veins due to pressure and friction during labor and delivery. The blood reabsorbs gradually within a few weeks of birth.
caput succedaneum
- diffuse edema of the fetal scalp that crosses the suture lines. Head compression against thecervix impedes venous return, forcing serum into the interstitial tissues. The swelling reabsorbs within 1 to 3 days.
ductus arteriosis
- a channel of communication between the main pulmonary artery and the aorta of the fetus.
ductus venosus
- the smaller, shorter, and posterior of two branches into which the umbilical vein divides after entering the abdomen of the fetus. It empties into the inferior vena cava.
-anterior and posterior-where located?-why?-shape?- an unossified membrane or soft spot lying betweenthe cranial bones of the skull of a fetus or infant.Anterior- the diamond-shaped junction of the coronal, frontal, and sagittal sutures; it becomes ossified within 18 to24 months.Posterior- the triangular fontanel at the junction of the sagittal and lambdoid sutures; ossified by the end of the firstyear.
foramen ovale
- The opening between the two atria of the fetal heart. It usually closes shortly after birth as a resultof hemodynamic changes related to respiration.
shaping of the fetal head to adapt itself to the dimensions of the birth canal during its descent throughthe pelvis.
erythema toxicum-
(papules, 24-28 hr.-newborn rash) a benign, self-limited rash marked by firm, yellow-white papules or pustules from 1 to 2 mm in size present in about 50% of full-term infants. The cause is unknown, andthe lesions disappear without need for treatment.
chemical conjunctivitis-
most common eye infection- of the conjunctiva usually caused by chemical burns.
vernix caseosa
- a protective sebaceous deposit covering the fetus during intrauterine life, consisting of exfoliations of the outer skin layer, lanugo, and secretions of the sebaceous glands. It is most abundant in thecreases and flexor surfaces. It is not necessary to remove this after the fetus is delivered.
- fine downy hairs that cover the body of the fetus, esp. when premature. The presence and amount of lanugo aids in estimating the gestational age of preterm infants. The fetus first exhibits lanugo between weeks 13and 16. By gestational week 20, it covers the face and body. The amount of lanugo is greatest between weeks 28and 30. As the third trimester progresses, lanugo disappears from the face, trunk, and extremities.
- white pinhead-size, keratin-filled cyst. In the newborn, milia occur on the face and, less frequently, on thetrunk, and usually disappear without treatment within several weeks.
telangiectatic nevi or hemangioma
- (stork bite) a benign tumor of dilated blood vessels.
Mongolian spots
- bluish-black areas of pigmentation may appear over any part of the exterior surface of the body.Commonly noted whose ethnic origins are in the Mediterranean area, Latin America, Asia, or Africa
Apgar (know scoring)
- a system for evaluating an infant’s physical condition at birth. The infant’s heart rate,respiration, muscle tone, response to stimuli, and color are rated at 1 min, and again at 5 min after birth. Eachfactor is scored 0,1, or 2; the maximum total score is 10. Interpretation of scores: 7 to 10, good to excellent; 4-6,fair; less than 4, poor condition. A low score at 1 min is a sign of perinatal asphyxia and the need for immediateassisted ventilation. Infants with scores below 7 at 5 min should be assessed again in 5 more min; scores less than6 at any time may indicate need for resuscitation. In depressed infants, a more accurate determination of the degreeof fetal hypoxia may be obtained by direct measures of umbilical cord oxygen, carbon dioxide partial pressure, and pH.
Silverman (respiratory function test)
- 5 evaluations – what are they? – (handout)1. Upper chest. 2. Lower chest. 3. Xiphoid retractions. 4. Nares dilation.5. Expiratory grunt. Graded 0, 1, 2
- withdrawal bleeding after birth, a scant vaginal discharge that reflects the physiologicalresponse of some female infants to an exposure to high levels of maternal hormones in utero.
tonic neck reflex
- (“fencing”) –with infant facing left side, arm and leg on that side extend; opposite arm and legflex (turn head to right, and extremities assume opposite postures).
- high in?-breast fluid that may be secreted from the second trimester of pregnancy onward but that ismost evident in the first 2 to 3 days after birth and before the onset of true lactation. This thin yellowish fluidcontains a great number of proteins and calories in addition to immune globulins.
- from birth through 28h day of life.
 – normal? Why higher in neonate?- normal <5 mg.dl. (usually drop to 1 mg/dl). Neonatal jaundiceoccurs because the newborn has a higher rate of bilirubin production and the reabsorption of bilirubin from theneonatal small intestine is considerable.
physiologic jaundice
 – when?- 50-80% of all full-term newborns are visibly jaundiced during the first 3 days of life.Term: appears after 24 hours and disappears by the end of the 7
day.Preterm: evident after 48 hours and disappears by the 9
or 10
- a congenital, autosomal recessive disease marked by failure to metabolize the amino acid phenylalanine to tyrosine. It results in severe neurological deficits in infancy if it is unrecognized or left untreated.PKU is present in about 1 in 12,000 newborns in the US. In this disease, phenylalanine and its byproductsaccumulate in the body, esp. in the nervous system, where they cause severe mental retardation, seizure disorders,tremors, gait disturbances, coordination deficits, and psychotic or autistic behaviors. Eczema and an abnormal skinodor also are characteristic. The consequences of PKU can e prevented if it is recognized in the first weeks of lifeand a phenylalanine restricted (very low protein) diet is maintained throughout infancy, childhood, and youngadulthood.
- (pinpoint rash) small, purplish, hemorrhagic spots on the skin that appear in patients with plateletdeficiencies (thrombocytopenias) and in many febrile illnesses.
- a form of jaundice occurring in newborns during the second to eighth day after birth. The basalganglia and other areas of the brain and spinal cord are infiltrated with bilirubin, a yellow substance produced bythe breakdown of hemoglobin. The disorder is treated aggressively by phototherapy and exchange transfusion tolimit neurological damage. The prognosis is quite poor if the condition is left untreated.
nevus flammeus
- (port-wine stain) – a large reddish-purple discoloration of the face or neck, usually not elevatedabove the skin. It is considered a serious deformity due to its large size and color. In children, these have beentreated with the flashlamp-pulsed tunable dye laser.
Epstein’s pearls
 – in infants, benign retention cysts resembling small pearls, which are sometimes present in the palate. They disappear in 1 to 2 months.
umbilical arteries
- (2) carry blood from the fetus to the placenta, where nutrients are obtained and carbon dioxideand oxygen are exchanged.
umbilical vein
- (1) oxygenated blood returns to the fetus through the umbilical vein.ALTERNATE VOCAB LIST
 NEWBORN VOCABULARY LISTAbdominal Circumference: measured by placing the tape around the newborn’s abdomen at the levelof the umbilicus with the bottom edge of the tape measure at the top edge of the umbilicus.Acrocyanosis: Cyanosis of the extremities. May be present in the first 2 to 6 hours after birth.Condition is due to poor peripheral circulation which results in vasomotor instability and capillarystasis, especially when the baby is exposed to cold. If the central circulation is adequate, the bloodsupply should quickly return to the extremity after the skin is blanched with a finger. If hands and nailsare blue, face and mucous membranes should be assessed for pinkness indicating adequateoxygenation.Apgar Score: A scoring system used to evaluate infants at 1 minute and 5 minutes after birth. The totalscore is achieved by assessing five signs: heart rate, respiratory effort, muscle tone, reflex irritability,and color. Each of the signs is assigned a score of 0, 1 or 2. The highest possible score is 10. See page670 for further detail.Behavioral States: States in the infant sleep/awake cycle. See below for specific states. Page 1115 has agreat chart on behavioral states.Sleep State: consists of deep or quiet sleep and light or active rapid eye movement sleep. In deep or quiet sleep the baby has closed eyes with no eye movement, regular even breathing and jerky motionor startles at regular intervals. Behavioral responses to external stimuli are likely to be delayed. Startlesare rapidly suppressed and changes in state are not likely to occur. Heart rate may range from 100 to120 bpm. In active rapid eye movement (REM) sleep, the baby has irregular respirations, eyes closedwith REM, irregular sucking motions, minimal activity, and irregular but smooth movement of theextremities. Environmental and internal stimuli initiate a startle reaction and a change of state.Active Sleep State: Same as light or active eye movement sleepDrowsy State: Infant may return to sleep or awaken further. Has smooth movements with variableactivity level. Eyes may open and close. Eyes may appear heavy lidded or may appear like slits. Mayhave no facial movement and appear still or may have some facial movements. Breathing is irregular.Infant will usually react to stimuli but may be slowed. May change to other states such as quiet alert,active alert or crying If infant left alone, may return to a sleep state.

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