exam 3 last exam! :) Flashcards
(138 cards)
1
Q
assess uterus (fundus) for what 3 things
A
firm or boggy (if its squishy its filling with blood) ,
middle or off to the side (if its off to the side then the bladder may be full),
if its higher than belly button
2
Q
what to do if uterus off to the side
A
have them void
3
Q
what is role of ptosin after labor
A
decrease bleeding
4
Q
if everything is normal on assessment and VS are normal then what is priority????
A
mom and baby bonding
5
Q
what is episiotomy
A
any laceration to get baby out
6
Q
what is episiostomy
A
laceration
7
Q
what is homans sign
A
dorsoflexing foot and seeing if there is pain in calf - pain can indiciate DVT THINK hypercoaguable bc theyre more hypercoacuable after labor
8
Q
avg blood loss for vag delivery
A
300 mL
9
Q
what is a hemorrage for vag delivery
A
500mL
10
Q
if pt who has Hg 9 (anemia) , are they more at risk for hemorrage or less
A
more so watch for hemorrage s/s
11
Q
What are expected physiological changes in the PP period? 6
A
Increase in CO, increase in clotting factors and risk for hypercoagulation, increased urinary output, increased hunger, elevated WBC, after pains with uterine involution
12
Q
what is uterine involution
A
Process by which the uterus returns to pre-pregnant size, shape, and location; and placental site heals.
Occurs through uterine contractions (release of oxytocin) to decrease the risk of PP hemorrhage.
13
Q
what is uterine involution
A
Process by which the uterus returns to pre-pregnant size, shape, and location; and placental site heals.
Occurs through uterine contractions (release of oxytocin) to decrease the risk of PP hemorrhage.
14
Q
G1P1 vs G1P5 who will have more painful contractions
A
5 - bc more pregnancies and more breastfeeding means more painful contractions bc of the inc oxytocin
15
Q
who has the most afterpains
A
more pregnancies and more breastfeedings
16
Q
what to do if boggy uterus
A
massage!
17
Q
position for fundal assessment
A
flat HOB
18
Q
6 facotrs that dont facilitate uterine involution
A
complications
retained product
no breastfeeding bc no ptsoin
not giving ptosin
no ambulation
full bladder
19
Q
what is lochia
A
Bloody discharge from uterus that contains necrotic tissue
20
Q
2 abnormal findings for lochia
A
Saturating a full-size pad in less than an hour or passing large clots.
Foul odor may indicate infection
21
Q
why is not all pp bleeding lochia
A
lacerations(tear)
22
Q
what is normal bleeding finding postpartum in weeks
A
4-8 weeks
23
Q
Assessment acronym for the perineum
A
Redness
Edema
Ecchymosis
Discharge
Approximation
24
Q
what are expected peritoneal findings 4
A
Mild edema, minor ecchymosis (bruising), approximation (edges together)of any laceration or incision, mild-mod pain
25
what are 4 abnormal findings for peritoneal and what to do
Moderate-severe pain, excessive edema, excessive ecchymosis, and purulent drainage - contact HCP
26
5 risk factors for perineal lacerations
Fetal macrosomia, operative vaginal birth, precipitous birth, episiotomy, primip
27
priority intervention for perineal laceration
look at skin integrity bc could be source of infection
28
6 interventions for perineal laceration/hematoma
Ice packs
Spray bottle
Witch hazel pads
Anesthetic sprays
Sitz baths
Oral pain medication prn
NO HEAT
29
can people who have a c section lactate
yes - it doesnt delay it
30
when to breastfeed when starting out
on DEMAND
31
education if someone is not breastfeeding 3
dont ever ever release - no stimulation, cool showers, supportive bra 24/7
32
9 education for lactating pt
Supportive bra
Warm showers
Correct position
Correct latch-on technique
Nipple inspection: skin integrity
Exposure to air
Frequent nursing, on demand (assess readiness and feeding)
Increase fluid intake
Hydrate!
33
what hormones dec after birth
Estrogen and progesterone
34
if someone is not lactating , prolactin drops and what can happen
ovulation 2 weeks postpartum meaning someone can get pregnant before they would even have a period
35
education after postpartum regarding sex
not for 6 weeks because of the ability to ovulate 2 weeks postpartum
36
what is a priority education regarding sex post partum
contraception counseling
37
diastasis recti
Separation of rectus muscle
38
what is GI change after labor 5
increase in hunger
Decreased GI motility
Dehydration
Perineal pain
CONSTIPATION
39
how many calories when someone is lactating
500
40
3 bladder problems after labor
urinary distention, incomplete emptying, retention with overflow
41
interventions for bladder care ppost partum 3
early ambulation, remove catheter as soon as possible, void within 12 (6-8 is best) hours after birth
42
6 ADL education post partum
No driving for 2 weeks.
- Wear seat belt and use infant car seat.
No strenuous exercise or heavy lifting until after 6 week exam.
Rest when the baby sleeps.
No sexual intercourse until 6 week check-up.
Can conceive prior to resumption of menses and during breastfeeding.
Mood swings are common.
43
6 times (emotionaly) when you need to go to ER or contact HCP after discharge
Doesn’t want to be with the baby
Inability to cope with baby’s demands
No interest in eating
Inability to sleep,
Becoming more upset, unable to emotionally regulate
Feeling that patient may harm self or baby
44
5 times to call hcp or go to the ER to educate after discharge
saturating pad every hour or more
foul odor
hot raised pain leg or uterus or vagina
100 deg temo
abdominal pain
hemorrage, infection, emotions, hypercoag
45
major complication of PPH
shock related to hypovolemia
46
main cause of PPH
atony or uterine inertia (uterus not contracting or involuting)
47
blood loss greater than what is PPH
500 for vaginal and 1000 for csection
48
assessments for uterine atony 4
Boggy fundus, saturation of peripad w/in 15 minutes, blood clots, s/sx shock
49
intervention for uterine atony 5
fundal massage
assess bladder
give ptosin and methergine, cytotec
h and h
contact HCP
50
IMPORTANT priority for methergine
TAKE BP - dont give if someone has HTN
51
what person shouldnt get methergine
HTN hx
52
what pt shouldnt get hemabate
asthmatics hx
53
8 risk factors for uterine atony
Macrosomia
Birth weight >4000 grams (8.5 lbs)
Overdistended uterus
Polyhydramnios
Operative vaginal delivery
Prolonged first or second stage of labor
Precipitous labor and/or delivery
General anesthesia
Postpartum administration of Magnesium Sulfate
54
what is endometritis
infection of uterine lining
55
who is most at risk for endometritis 2
ROM for >24 hours / internal monitoring
56
7 ss of infection
Elevated Temp (>101),
tachycardia,
redness,
tenderness,
discharge at site of infection,
malaise,
abnormal labs
57
3 risk factors for hypercoag/thrombosis
stasis like in a csection, obesity, pariety
58
4 assesments of thrombosis
Redness,
tenderness,
and/or swelling in affected leg
+ Homan’s Sign
59
what is diff between PP blues and depression
Characterized by emotional lability, irritability and insomnia that typically resolves within 2 weeks. Woman remains able to care for herself and infant.
vs
A major depressive episode which occurs within 6 – 12 months following childbirth
60
7 risk factors for PP depression
History of depression before or during pregnancy
Poor quality relationship with partner
Inadequate social support
Poor coping skills
Low self-esteem
Numerous life stressors
Substance abuse
61
mercer theory
commitment, attachment, and prep during pregnancy
62
rubin theory intervention
sharing birth story
63
bonding v attachment
attachment is bidirectional
64
6 risk factors of delayed bonding and attachment
Maternal illness or postpartum complications
Neonatal illness or complication
Fatigue for mother and partner
Physical discomfort post-birth
Maternal age or developmental delay
Outside stressors, psychosocial issues, depression
65
Complex emotional responses experienced after the death of a child
perinatal bereavement
66
#1 priority of nursing care in neonate
resp function
67
5 focus of nursing care in the nenonate period
Maintaining respiratory function (#1 priority)***
Maintaining body heat
Decreasing risk of infection
Assisting parents in providing appropriate nutrition
Assisting parents in learning to care for their newborn
68
normal temp, HR, resp and BP of newborn
Temperature
97.8–99.5 degrees F Axillary
Rectal temp only once to determine patency
Heart rate
100–160 bpm; regular rhythm
FULL minute
Respirations
30-60
Respirations irregular, shallow, unlabored
Symmetrical chest movements
Blood Pressure
Taken once for “normal” newborn
69
if baby VS and everything is normal what is priority
baby to mom
70
2 factors that can impede resp transition
Decreased surfactant levels (<36wks) (helps w/ oxygen exchange in lungs)
Persistent hypoxemia and acidosis - leads to constriction of the pulmonary arteries.
71
7 signs of resp distress
Cyanosis (Central - mouth, lips)
Apnea, tachypnea (>60)
Retractions
Grunting
Flaring of nostrils
Hypotonia
Rate <30 or >60
72
when to give meds to baby
apgar <7
73
if baby has metabolic acidosis then give
sodium bicarb
74
APGAR scoring
Heart rate
No pulse = 0
Less than 100 = 1
Over 100 = 2
Respiratory effort
No respirations = 0
Slow, irregular = 1
Respiratory normal (good cry) = 2
Muscle tone
Limp = 0
Moving = 2
Reflex irritability
No crying = 0
Grimace = 1
Screaming and crying =2
Color
Pale = 0
Body pink, extremities blue = 1
Pink = 2
75
why is erythromycin ointment given
to prevent gonorrhea blindness
76
why is vitamin K given
Clotting factors (don’t produce it themselves for about 1 week)
77
what is cold stress
excessive heat loss that leads to hypothermia and results in compensatory mechanisms to maintain body temp
78
5 assessment findings for cold stress
Axillary temp less than 98
Increased RR and HR
Decreased O2 saturation
Hypoglycemia
Respiratory Distress
79
what happens when baby takes first breath
decrease pulmonary resistance → increase pulmonary blood flow → 3 fetal shunts close
Shunts need to close
80
what is brown fat
highly dense and vascular adipose tissue that is unique to neonates which produces heat
81
goal of thermmoreg
A Neutral Thermal Environment (NTE) is an environment which maintains body temp with minimal metabolic changes and/or O2 consumption
82
what is convection
flow of heat from body surface to cooler surrounding air
83
what is evaporation
loss of heat when a liquid is converted to a vapor
84
what is conduction
transfer of heat from object to object when the two objects are in direct contact
85
what is radiation
loss of body heat to cooler, solid surfaces in close proximity, but not in direct contact
86
how to prevent heat loss from convection
turn off fans
87
how to prevent heat loss from evaporation
dry off baby
88
how to prevent losing heat to conduction
skin to skin
89
what to do if baby hypoglycemic and what bg value
<40 - cold stress happening so need to rewarm to put naked under radiant warmer
90
4 ways to prevent cold stress
Dry neonate, remove wet linen, put on hat
Skin-to-skin or radiant warmer
Swaddle
Maintain NTE
91
4 causes of jaundice
immature liver
High RBC (more things to “break down”)
Increased break down
Not peeing or pooping (decreased elimination)
92
physilogical jaundice
60% of newborns
Appears after 24 hrs****
Resolves within a week
Breastfed babies = more likely to have jaundice**
93
pathological jaundice
Appears in the first 24 hrs***
Leads to neurotoxicity
Serum bilirubin = greater than 15mg/dl in preterm****
94
4 signs of hypoglycemia
jitteriness (jittery judah), hypotonia, hypothermia, apnea
95
how to prevent hypoglycemia
Place infant at breast w/in 1st hour after birth.
early feeding
96
baby weight normal
no more than 10% loss
97
when should cord fall
7-14 days
98
when should newborn eat normal
after 1st 24 hours
99
what is normal elimination pattern 3
void and stool in 1st 24 hours
6-8 diapers a day
several stools
100
what is cheesy white coating on skin
vernix caseosa
101
what is stork bite
nevus simplex
102
what is tiny white bumps
milia
103
what is macular blue grey pigmentation on butt
dermal melanocytosis
104
what is erythmetaous macules/papules
erthma toxicum
105
what is port wine stain
nevus flammeus
106
3 normal skin variationa
Nevus simplex (“stork bite”)
Milia
Dermal Melanocytosis - almost appears like a bruise - common in certain skin tones - previously called “Mongolian Spot”
107
Caput succedaneum vs cephalohematoma
Caput Succedaneum: crosses suture lines, above periosteum (more symmetric) - fits like a “cap” (ie: over sutures)
Cephalohematoma: Under periosteum, does NOT cross suture lines (more asymmetric) collection of blood from trauma ** at greater risk for jaundice **
108
when do newborn relfexs dissapear normally
6 months
109
if mom is GBS pos. what to do
baby can get sick but mom isnt so give mom abx during labor - CAN STILL HAVE VAGINAL
110
2 categories of gestational aging
NM
physical maturity
111
5 risk factors for LGA
Maternal diabetes mellitus or glucose intolerance
Prior history of a macrosomic infant
Postdates gestation
Maternal obesity
Genetics
112
risk factors for SGA 5
Pre-eclampsia
Smoking
Drug Use
Decreased Maternal Nutrition
Multiple Gestation Prior
113
what constitutes AGA
80% of newborns
114
what qualifies sga
Birth weight is below the 10th percentile
Birth weight is less than 2500 grams
115
what is LGA
Birth weight is above the 90th percentile;
Birth weight is more than 4000 grams
116
4 common problems with LGA
Birth trauma due to cephalopelvic disproportion (CPD) = Depressed skull fracture, cephalohematoma, fracture of the clavicle or humerus, brachial plexus injuries, or facial palsy
Hypoglycemia:
Blood glucose level below 40 mg/dL
Polycythemia:
A venous hematocrit over 65%
Jaundice secondary to hyperbilirubinemia:
Usually due to the breakdown of increased numbers of RBCs in circulation
117
4 common problems with SGA
Perinatal asphyxia
Hypothermia (due to no “brown fat”)
Hypoglycemia
Meconium aspiration
118
preterm is what and term is what
<37 and then 37-42
119
7 characteristics of postterm newborn
Dry, cracked, wrinkled skin
Creases cover entire soles of feet
Abundant hair on scalp
Thin umbilical cord
Limited vernix and lanugo
Meconium-stained skin
Long nails
120
5 characteristics of preterm baby
Minimal creases in foot
Pinna folded
Translucent skin with floppy extremities (less flexion)
Foreskin may not cover tip of penis
Labia majora may not fully cover minora
121
Transient Tachypnea of the Newborn (TTNB)
>60 rr
122
education about breastfeeding and csection vs vaginal
There is no difference in who is most successful with breastfeeding in regards to vaginal or cesarean delivery!!!***
123
What does a “boggy” uterus mean and what should the nurse do?
not contracted, nurse should massage
124
4 abnormal perineal findings
Moderate - severe pain
Excessive edema
Excessive ecchymosis
Purulent drainage
125
sign of subinvolution
Prolonged or heavier lochia
126
Why is Pitocin given postpartum?
To encourage uterine involution and contraction
127
What condition is Hemabate contraindicated in?
asthma
128
Name the nursing intervention during the taking in phase
talking about birth experience
129
what is normal for newborn resp
irregular breathing but not labored or cooing
130
cyanosis in the newborn
generalized is not normal but hands and feet is called acrocyanosis
131
if APGAR is abnormal what to do
repeat 10 minutes
132
what does less surfectant mean
less ability to breathe
133
4 ways baby respond to the cold
- increase metabolic
- increase muscle activity
- vascular constriction
-brown fat metabolism
134
if bilirubin is > then what , then its pathologic
15
135
if someone is breastfeeding hwo to know if baby is getting enough
output and weight - pee and poop
136
when is baby most at risk for jaundice
cephalohematoma and it is when crosses suture line
137
if mom is GBS pos
mom gets abx, can still have vaginal BABY DOESNT GET ABX
138
study APGAR
!!!!
