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CVS sampling done between 10-12 weeks of gestation .

. it is a GENETIC testing Absent- 0 Minimal - < 5 Moderate FHR variability 5-25 Maximal variability= greater than 25 Normal Fetal Heart Rate during the MIDDLE of pregnancy= 160-180 Normal Fetal Heart Rate during the END of pregnancy = 120-160 Fetal lung maturation ratio: 2:1 Umbilical cord: 2A(deox) and 1Vein (oxygenated) 1) Bacteria cannot pass through the placenta but drugs, alcohol, nutrients, antibodies can. 2) Passive Immunity (third trimester) passed down from the mother lasts till few months after birth. 3) Amniotic Fluid is 800-1200 mL at the end of pregnancy Diet changes during pregnancy: 1) increase calories by 300 2) increase protein 3) increase calcium and phosphorous together 4) increase iodine 5) increase iron Std and its affects:

Infertility Options: - In Vitro Fertilization (famous) - Surrogate mothers - Embryo Hosts - Adoption Nigels rule= first day of last menstruation , add seven days and 9 months Gravida- number of pregnancies Parita- number of births Fundal Height in CMs= Gestational Age Week 16- Fundal height halfway between pubic area and umbilicus Week 22- Fundal Height at the umbilicus spot Week 36- Xyphoid Process Vital signs changes: BP decreases during 2nd semester while HR increase by 10-15. 3 types of Pregnancy Signs

1- Presumptive- early symptoms of pregnancy - Missing period - Breasts enlargement - N/V - Quickening (fetal movement felt by mother. Usually at 16 weeks of gestation-20th week) 2- Probable - Positive pregnancy test - Uterine enlargement - Chadwicks sign= purple discoloration of vagina around (week 4) - Goodells Sign- softening of cervix (week 5) - Hegar sign- softening of lower uterine segment (week 6) - Braxton Hicks contractions - Ballotment rebounding of fetus upon examiners touch on the abdomen 3- Positive (most definite)- diagnostic - Fetal Heart Rate detected by Dropplers Tranducer at weeks 10-12 - Fetal palpation felt week 20 - Ultra-sound

Adolescent Pregnancy interventions 1) provide extra perinatal care due to lack nutrition, lack of knowledge , lack of development 2) refer adolescent to support groups that can counter the negative socioeconomic environment Folic acid to prevent neural tube defects such as Left Cleft Lip, Myelengoccal Alcohol can lead to fetal alcohol syndrome Usual Antepartum schedule is Weeks 28-32- ONCE Weeks 32-36- every two weeks Weeks 36-40- once every week 1) Sexually transmitted disease Trichomoniasis- Causes pre-mature rupture of membranes
2) If pregnant mother is Rh Negative, must get repeated screenings and receive RHOgam at 28 weeks of gestation. 3) Rubella vaccine should not be administered at the same time that RHOgam is administered because the vaccine wont be as effective Disorders of Labor and Delivery 1) Supine Hypotension- If happens, position mother on her side to get the uterus weight off of the vena cava 2) Premature rupture of membranes- Be aware of infection! Also do plenty of vital signs/ assessment The symptoms of premature labor are: 1) Back pain that wouldnt go away 2) Contractions/cramps that are not alleviated by water and laying down 3) watery discharge during lying down. 3) Variable Decelerations- PROLAPSED CORD- when mother can feel the chord coming out. In that case, position mother on Trendelenberg (or Sims lateral or knee chest) position, then SOHIB. Stop Pitocin, Oxygen, Assess for Hypoxia, IV fluids, Immediate Birth 4) Early Decelerations- HEAD compression it is okay if Heart beat variability is within normal range doesnt need interventions

5) Late Decelerations- Placental Insufficiency- Reposition the mother (LEFT SIDE), then S.O.I= Stop Pitocin, Give Oxygen and IV fluids 6) Hypotension during anesthesia epidural- STOP= Stop Pitocin, Turn Patient to the LEFT, Give Oxygen and Push IV fluids 7) Placenta previa- is when the placenta detaches itself from the wall of the uterus and drops to the cervix before term. It is classified as either Partial or Total. SYMPTOMS: Painless Red discharge , SOFT uterus, HIGHER fundal height than expected. 1) Side lying position 2) monitor for bleeding due to continuous bleeding 3) if bleeding too much = C section 8) Abruptio Placenta is when the fetus abruptly detaches from the uterine wall and travels somewhere th else around 20 week of gestation. This is PAINFUL, uterus is RIGID, with DARK RED Discharge = symptoms involve pain Right away, 1) Trendelenberg or lateral position 2) Assess for pain, and hemorrhage 3) Oxygen and IV fluids 4) prepare for Delivery ! P.P.H.O.I.D 9) risk factors for preterm= multifetus preg, pregnancy younger than 18 and over 40. Preterm is characterized with changing of colors/consistency of usual discharge, contractions, low back pain and rupture membranes. 1) stop delivery 2) assess mother and child 3) fluids and medications (tocolytics) 10)percipituous labor= labor that lasts for 3 hours. Have delivery tray available 11)Dystocia- difficult and painful labor . causes: large fetus . Amniotomy and Pitocin are treatments. A lot of uterine, abdominal pain and lack of progression in labor. Shoulder dystocia of the infant requires an emergency response by using Mc Roberts maneuver by flexing thighs of the mother to the abdomen to change the angle of the pelvis. 12) amniotic embolism- amniotic fluid goes into pulmonary circulation= could be fatal . 1) Oxygen 2)turn patient to the left 3) IV fluids 4) delivery when stable 13) fetal distress (<120 or >160 bpm)= Prepare for C section . 1. Turn patient to the left 2) Oxygen 3) Stop Oxytocin 4) monitor 5) C section 14) Intrauterine Fetal Demise- absent heart tones, fetal movements= interventions= allow family to express their feelings . low DIC, low HGB, low platelets, low hct 15) Rupture of the uterus= the fetus had rupture through the uterus. Fetus is palpated outside of uterus 16) Inversion of uterus= monitor for shock, hemorrhage, pain, fix inversion if not surgery 17) fetal bradycardia/tachycardia= Change mothers position, stop Pitocin, give oxygen and notify physician is a must 18) decreased variability can indicate hypoxemia and acidosis . Temporary decreased variability means fetal1 sleep state 19) accelerated FHR is a good thing and usually occurs during fetal movements/uterine contractions. When the accelerations lasts 15 secs with 15 more heart beats. Means that baby is non-acidodic 20) Meconium amniotic fluid= fetal distress 21) Pitocin is discontinued if frequency contraction is less than every 2 minutes and they last longer than 90 seconds. Not prescribed to HYPERtonic uterus. Only hypotonic. 22) Painful red blood discharge with rigid uterus: Abruptio Placenta 23) Painless red blood discharge with soft uterus: Placenta Previa 24) Amniotomy: artificial rupture of membranes 25) Unpleasant odor; infection in amniotic fluid th 26) RHOgam is given at 28 week of gestation. Kleihauer Betke test is to determine if more RHOgam is needed. st 27) Epiostomy patients: ice packs for the 1 24 hours, sitz bath, pain reliever, wipe front to back and hold the blot area, shower rather than bath , perineal pad and report signs of bleeding 28) Forceps Delivery: using a double crossed spoon like articulated blades to assist in delivery 29) Vaccum extraction: cup suctioning to get fetal head out. Should not be kept in place for more than 25 minutes. Assess every 5 minutes Caput succedaneum is normal and resolves in 24 hours 30) C section 1- informed consent, 2.explanation of procedure, 3. Rh factor testing,4. foley catheter, 5. prepare abdomen . post op- v/s, pain relieving, coughing/deep breathing, ambulation, signs of infection. Watch out for INFECTION such as foul smelling lochia which means endometritis . Productive cough pneumonia. Red redness and edema- thrombophlebitis 31) If during delivery the mother feels that something is coming through the vagina= prolapsed umbilical cord. Long with slow irregular fetal heart rate= variable fetal heart rate decels and hypoxic . 1) change position, Oxygen, push IV fluids

32) Bethmethasone is administered to fasten fetal lung maturity 33) If the clients labor progression hasnt changed in 2 hours, call the doctor 34) Shoulder dystocia of the infant requires an emergency response by using Mc Roberts maneuver by flexing thighs of the mother to the abdomen to change the angle of the pelvis.

Know the different positions of fetal position. Lightning- the dropping of fetus 2 weeks before delivery. Signs= Braxton hicks increase, blood tinged discharge, sudden energy of nesting 24 hours before. Also known as dropping and engagement Internal rotation of fetus- when fetus turns from transverse line to occipital position Crowning- the head appears first Extension- the rest of the head descends after crowning

True labor- increasing painful contractions like menstrual cramps False labor- no increase in intensity. More annoying than painful 4 stages of Labor st 1 stage- Early phase, active phase, latent phase Early phase- 1-3 cms dilated. Contractions every 15- 30 mins for about 30 -45 seconds Active Phase- 4-7 cms dilated. Contractions every 3-5 minutes for about 40 seconds Latent Phase- 8-10 dilated. Contractions every 2-3 minutes for about 60-90 seconds Interventions- monitor fetal and maternal heart rate. Teach mom breathing exercises. Offer fluids/ice chips for dehydration. Use droppler transducer 2 stage- Expulsion of the fetus contractions every 2-3 minutes= more bloody show. The head of the fetus shows. Assess the mother/fetal every 5 minutes 3 stage- expulsion of Placenta after this event, fundus is 2-3 finger breaths below the umbilicus th 4 stage- 1-4 hours after delivery BP returns to prelabor measurement, pulse is slightly lower than during labor. Bright red lochia. First hour- assessment every 15 minutes nd 2 hour- assessment every half an hour rd th 3 and 4 hour- once every hour Put ice packs on perineum Give blankets ANESTHESIA is given right before the delivery (for episiotomy) of the fetus to reduce comfort. Pudendal block- give through vagina that lasts for 30 minutes Lumbar Epidural block- Given at L3-L4 and usually is before C section or establishment of delivery . Risk of HYPOTENSION. Inthratecal Opiod- Given at Subarachnoid area Spinal block- given at the spine area is given before birth. L3 and L5. Must lay down supine 8-12 hours after the injection General Anesthesia- S/E: respiratory depression Bishops score: readiness to give birth. 6 is ready. Station of presenting part -3= 0 cms dilated -2= 1-2 cm dilated -1= 3-4 cms dilated +1, +2= more than 5 cms dilated Postpartum
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Recovery 1) weight of uterus goes from 2 lbs to 2 ounces in six weeks 2)fundus decreases by 1 finger breath per day (1 cm) . by 10 days, uterus cannot be palpated 3) flaccid fundus= nurse should massage. Rigid fundus= nurse should know its an infection 4) Rubera color of discharge 1-3 days after delivery Serosa (brown) discharge 4-10 days after delivery White clear discharge- 11 days on Nurse can determine lochia flow by weighing perineal pads before and after use 5) vagina muscle tone is never restored completely 6) Menstruation comes back 1-2 months in non breast feed, and 3-6 months in breast feeding mothers 7) 48-72 hours after delivery- columstrum is secreted , increased prolactin promotes breast milk. By third day, the breasts are distended with milk. 8) urination should occur within 12 hours after delivery 9) hunger and hemmorhoids commonly occur after delivery 10) after delivery: ASSESS for v/s, PAIN, FUNDUS (must void), Thrombophletits, hemorrhage, administer Rhogam, assess bonding with new born and provide support. Common problems after delivery: Uterus pain (afterpain), Perineal Pain, Breast pain, Constipation and depression 11) no heavy lifting for at least 3 weeks 12) Pitocin side effects post-partum- afterbirth pains also in clients who are multifarous 13)perineal pain -pain reliever for after delivery: ice packs and sitz bath! Ice pack on boobs and perineum -Analgesic spray for perineal care after episiotomy 15) breast pain carewear sports bra even when sleeping , ice packs on boobs , warm soaks/shower before breast feeding. Breasts must be washed once daily for breast-feeding mothers since infants will be exposed to themreduce risk of infection 16) constipation Drink at least 2000 mLs of water daily , fiber, laxative 17) depression must assess before and after delivery 18) breast feeding women must increase caloric intake Breast feeding for mothers procedures 1) put the infant on babys breast as soon as both are stable 2) assess LATCH L- LATCH from the infant a- audible swallowing of the infant t- type of nipple c- comfort of mother h- help given to mother by nurse 3) give ice packs between breast feedings on breasts and warm pack before feeding for blood flow. st 4) Contraceptives should not be used within 1 6 weeks, but if used afterwards should be PROGESTIN contraceptives, nOT estrogen based 5) calorie intake must increase 6) cracked nipples should be exposed to air for 10-20 minutes 7) do not use soap to wash breasts because they would remove natural oil and increase crackedness 8) infants stool should be yellow 9) bra should fit well 10) gas producing food should be avoided PROCEDURES of breast feeding: Wash hands first

Brush nipple on the lower lip of infant, and guide the nipple in Make sure the aerola is also in the infants mouth Nurse for 15-20 minutes Stop the sucking by putting a clean finger in Burp the infant (must)

100 . 4 F the first 24 hours after postpartum is NORMAL. Its not normal after 24 hours. Tret of Fallot- VHOP RIGHT TO LEFT SHUNT = DEFICIENT OXYGEN= ACIDOSIS Ventricular septal defect (LEFT TO RIGHT SHUNT) Hypertrophy on the right DUE TO LEFT TO RIGHT SHUNT Overriding Aorta Pulmonary Stenosis Interventions: knee chest position, morphine/propanolol and oxygen Postpartum conditions 1) forceps cause HEMATOMAS due to damage to the blood vessels . vulvar is the most common one . life threatening . signs of shock= decreased bp, decreased rr, increased HR, pallor + BROWN SENSITIVE mass protruding of vagina. Immediately put ice there and pain relieve. Monitor I/O for hemorrhage. Prepare for immediate evacuation of the hematoma! P.P= pain relief then prepare for evacuation. Monitor for infection . 2) cystitis can be caused from delivery. Must get urine specimen before getting started on antibiotics. Burning pain / costalvertebrae angle tenderness are signs 3) any bleeding of more than 500 mL is considered hemorrhage. Massage, assess frequently (5-15 minutes) notify physician, note blood loss by pad count, Pitocin, assess for infection. Prepare for blood transfusion . risk factors include: multiparity. Causes include: uterine atony, hematoma and lacerations in the vagina 4) infection- noted by malodurous discharge (smelly) and elevated WBC and elevated temperature . high calorie, high protein diet, LOTS of fluids, (3k) =I/O, obtain cultures, and administer antibiotics 5) mastitis 6) pulmonary embolism tachycardia, lung crackles, hemoptysis, impending doom. Interventions: oxygen, elevate head of bed, assess respiratory, give fluids, give anticoagulants 7) subinvolution uterus: larger than usual uterus, a uterus that doesnt go back in size, give Methergine (to increase contraction) 8) thrombophlebitis a clot in the blood vessel that caused an infection. Usually pelvic thrombophlebitis after delivery. Pulmonary embolism is the first sign, with chills. Assess for Edema in the legs (first thing)part of Circulation of ABCs. Then elevate affected leg, and use a bed cradle to keep the leg off of bedclothes. Assess for signs of pulmonary embolism. Provide pain relief by putting heat on the affected leg and elastic stockings. To combat the infection, use antibiotics. -Use heparin to prevent future clots. 9) perinatal loss- stillbirth etc. consider religious cultures and beliefs. give mother a box with infants memories.

Care of the newborn!


1) assist with the start of RESPIRATIONS - look at the cry, if there is seesaw breathing, cyanosis -look for any gross anomalies APGAR score immediately after birth- 1 minute and 5 minutes after birth. Scores between 8-10 is okay/no interventions needed. Scores 4-7= interventions by stimulating infant. Lower than 4= infant resuscitation Respiratory: vigorous cry or not?

Heart Rate: more than 100/minute? Muscle Tone- active motion or no? Reflex Irritability- responding with a cry or no? Skin Color- cyanosis or no/ 2) Vital Signs and see if babys is hypothermia or hyperthermia (96-99 with axillary temperature) Normal vital signs for newborn BP-73/55 HR- 110-170 RR- 30-50/minute 3) interventions for new born: airway focus first. Use a bulb syringe and suction out secretions in the nd mouth. Then breathing is the 2 focus= crying. Stimulate crying by rubbing the infant. Circulation= make sure that the babys temperature is stable and keep the baby warm with BLANKETS - immediately place infant on mother after birth before putting it in the warmer. - put the baby in the warmer right after to keep the temperature stable Get footprints and finger prints Give mother and child same ID bands 4) VITAL SIGNS th a) Auscultate at 4 intercoastal space and listen to heart sounds for 1 full minute. Normal Is more than 110 beats per minute b) keep baby warm throughout the whole examination c) axillary temperature (96.6-99) d) respirations : 30-60 per minute 5) body measurement normal: 18-22 inches in length 5-9 lbs in weight 13-14 inches in head circumference 6) fontanels: Anterior fontanel: diamond shape= closes at 12 months Posterior: triangular shape = at 2-3 years old Asymmetry of molding initially due to birth , and disappears in 72 hours Caput succedaneum is normal. It is a soft mass on the head and subsides within a few days Cephalhematoma- hematoma in the head. Subsides/absorbed within 6 weeks of birth 7) head lag 8) eyes- presence of red reflex and edematous 9) low set ears= downsyndrome 10)nose should not be flared up 11)tongue: Epstein pearls may be present they are small white cysts in the mouth/tongue . they are normal 12) when assessing an infants tongue, look for signs of candida- white thrush- which cannot be removed by wash cloth and can be painful and bleed happens 1-2 days after birth 13) neck inclined to the side. torticollis 14) chest should be circular appearance= anteroposterior = lateral diameter. Should rise and fall in synchrony. Bronchial sounds heard on auscultation. Milky secretion is common. 15) skin should be pink-red/pink-yellow, cheesy white substance can be found on entire body but more prominent between folds, milia (small white sebaceous glands) may appear on forehead/nose/chin, dry peeling skin 16) Kopliks spots- white patchy spots that happen 2 days before measles rash. Cyanosis- hypothermia, infection, hypoglycemia, cardiac respiratory, neurological abnormalities

Acrocyanosis (normal) peripheral cyanosis is normal in the first few hours and may be notd for the next 7-10 day Assess hydration status of the infant by checking skin turgor over the abdomen Assess for Harlequin Sign (one side being pink/red and other side being pale) abnormalmeans that there is problem with blood shunt cardiac problem Birth marks: 1) Telangiectatic Nevi (Stork bites) normal, will disappear by age 2- red, flat dilated capillaries on nape of neck, nose, eyelids 2) Nevus Flammeus- require surgery- no fading- red to purple dense areas of capillaries /capillary angioma directly below epidermis usually on face 3) Nevus Vasculosus- (strawberry mark)- normal- disappears by age 7-9- raised, dark red rough surface hemangioma. Usually on head. 4) Mongolian spots- disappears by years 1-2 usually on lumbar dorsal area/buttocks common in Asians 16) anus- ensure that opening is patent and first stool meconium should pass within 1 24 hours 17) Genitals: Female: -Smegma (thick white discharge) near clitoris normal - Pseudonmenstruation- blood tinged mucus - first voiding within 24 hours Male: -prepuce covers glans penis -verify meatus -testes can retract with cold - hernia -voiding should occur 24 hours 18) Spine: Assess spine, arms, legs, well-coordinated, sporadic movements assess for hypertonicity/hypotonicity and indentation CNS damage 19) Extremities: common ones, legs should have a distinct space, creases on soles of feet, assessment for fractures (especially clavicle) - assess for Ortolanis sign and Barlows sign= two assessment tools for developmenta l dysplasia of the hip . No clicks should be heard . positive ortolani maneuver= dysplasia of hips - pulses are palpated Tremors: may indicate hypoglycemia Full body Care on newborns: 1) Cardiovascular System Keep the infant warm, apical heart rate for 1 minute, listen for murmurs, assess oxygen saturation, palpate pulses, blanch the skin on the trunk and extremities, observe for cardiac distress 2) Respiratory System-Suction the airway as necessary: use a bulb syringe/French catheter for deeper suctioning - respiratory distress and hypoxemia - nasal flaring, severe retractions, grunting, cyanosis, bradycardia of apnea lasting longer than 15 seconds -administer oxygen is a priority th 3) Hepatic System: - Jaundice is normal after 24 hours of birth and up to 5 day of birth bilirubin also increases- 6-7 mg/dL - feed early to keep the bilirubin low - Liver stores iron from the mother for 5-6 months - glycogen storage occurs in the liver
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- infant is at risk for hemorrhagic disorders because of the lack of Vitamin K. Therefore handle newborn carefully. Must administer vitamin K in lateral aspect of the middle third of the castus lateralis muscle -liver stores iron for 5-6 months - assess for hemoglobin and blood glucose levels 4) Renal System -weight loss of 5-15% is normal during the first week of life from voiding/limited intake. Birth weight should be regained 10-14 days after -weigh the newborn daily -weigh diapers daily (for input and output) -measure specific gravity of urine -assess for dehydration dry mucus membrane, poor skin turgor, sunken fontanels) Sunken fontanels: is a sign of DEHYDRATION 5) Immune System - newborn receives passive immunity from immunoglobin G (from PLACENTA) and immunglobin A (colostrum) -immunoglobin M= infection in utero - aseptic technique/standard precautions when handling the newborn- use gloves/wash hands -must administer eye medication within 1 hour to prevent ophthalmia neonatorum (usually erythromycin, tetracycline) * Silver nitrate may be prescribed but is use is minimal because it doesnt protect against chlamydial infection/cause chemical conjunctivitis 6) Chord Care: Umbilical clamp can be removed after24 hours if not bleeding keep cord keep and dry. Diaper must be below the cord and not touch it -assess cord for swelling/discharge -cord falls off within 2 weeks 7) Circumcision Care: - apply petroleum jelly gauze to the penis except when a plastibell is used. After first void, remove it- then observe for infection teach how to care for circumcision by squeezing warm water over the penis after each void. Milky covering the glans penis is normal and should not be disrupted 8) Newborns are able to digest carbs, proteins PARTIALLY and NOT fats. -sterile water/d5W may be given to bottle fed babies before bottle feeding them Schedule for milk feeding: breast feeding: every 2-3 hours. Bottle-fed: every 3-4 hours. Always burp the infant every time after feeding . position baby on right side after feeding However side lying/prone lying is not recommended= leads to death easily 9) normal stool passing a) first stool is passed within 24 hours- meconium- greenish black/thick/sticky/tar like consistency b) transitional stool- greenish brown and looser consistency - seedy yellow stool- more common in breast fed infants - looser yellow to light brown stools- formula fed newborns 10) must perform phenylketonuria test- tests for neurological deficits 11) head -size is usually bigger. -open fontanels to allow for brain growth -assess for sunken fontanels - test newborns reflexes 12) prevent cold stress. Keep infant warm and wrapped in blanket.

Cold stress can lead to acidosis Cold stress-> pulmonary constriction and peripheral constriction-> reduced uptake of oxygen consumption-> anaerobic glycolysis-> lowered pH and lowered O2-> metabolic acidosis st Take temperature of a newborn every hour for the 1 four hours , and every 4 hours for the remainder of the first 24 hours and then ever shift 13) Reflexes: -Rooting reflex diminishes by 3-4 months. -Swallowing happens after sucking -Tonic Neck/Flexing: disappear within 3-4 months -when face is faced to left side, left leg and arm are extended while right arm and leg flex 14) Palmar-plantar graspWhen you place a finger on the infants palm/feet and infant curls the fingers, and newborns toes curl downwards Plantar response diminishes within 8 months Palmar response diminishes within 3-4 months 15) Moro-reflex When you make the infant fall backwards to at least a 30 degree angle, the infants arms and legs flex and assume a C position. (or a body jerk) Should diminish by 6 months of age. But if not, neurological delay 16) Startle Elicit- best after 24 hours of birth - arms adduct while elbows flex -hands are clenched -should disappear within 4 months 17) pull to sit response Head lags as pulling infant up from a supine position- then the head is level with the chest/shoulders momentarily before falling forward. Head lifts for a few minutes . 18) Plantar reflex: disappears after 1 year old -stroke the heel of the foot and the toes will hyperextend while the big . 19) walking reflex: disappears for 3-4 months Holding baby up and baby starts walking while being held up. 20) crawling reflex: disappears after 6 week - place the newborn on the abdomen and he/she starts crawling. 21) Formula Feeding: - do not heat the bottle of formula in a microwave oven - inform that the formula is a sufficient diet for the first 4-6 months - assess the clients ability to burp the newborn Breast feeding -assess the newborns ability to suck Sufficient diet for 4-6 months ___________________________________-PRETERM NEWBORN- infant born before 37 weeks of gestation Symptoms: IMMATURITY of ALL body systems! Plus lanugo on the skin Interventions: maintain A, B, C Reposition baby every 1-2 hours

Vital signs frequently (every 2-4 hours) Humidification POST-TERM newborns and Larger gestational newborns 1) assess for HYPOGLYCEMIA