Final Exam Blueprint Flashcards

Question

Variable decelerations and what they look like | if problem, what can help with these

Answer 1

- abrupt descent (<30 seconds) from baseline to the nadir - usually V or U shaped - occur with cord compression - occasional variables are common - recurrent stress a baby - sometimes amnioinfusion works to cushion cord

Answer 2

suppress ovulation, thicken cervical mucus, and thin the uterine lining

Answer 3

6-25 BPM changes - oxygenated fetus - neurologically intact - normal, reassuring

Answer 4

- ***counterpressure*** - changing positions for back pain - hydrotherapy - relaxation - hypnotherapy - acupressure

Answer 5

- about meds, sex, exercise and appropriate guidance: - exercise to moderate intensity 3-5x a week - take a vitamin that contains folic acid and iron - consume extra protein and calcium and about 300 extra calories a day - follow recommended schedule of visits - cook food thoroughly - report danger signs DONT: - ingest alcohol, illicit drugs - consume raw or undercooked meat or fish - consume unpasteurized dairy, deli meat (unless reheat deli to 165F)

Answer 6

Decreases risk of eclampsia (seizures) Normal levels of magnesium: 1.5-2.5 Therapeutic for preeclampsia: 4-7 Risk of toxicity: levels above 8 - hyporeflexia - decreased RR - oliguria - decreased LOC Can lead to: - respiratory depression - pulmonary edema - renal failure - coma/death

Answer 7

- vasectomy - tubal ligation

Answer 8

- migraine with aura - HTN - history of DVT, PE, stroke - >35 smoker

Answer 9

- variable or prolonged decelerations, usually deep - visible loop of cord outside vagina - cord palpable with vaginal exam - mother states she felt something come out of her

Answer 10

- stimulates uterus to contract - most effective if cervix is already ripe - start slowly, titrate based on maternal/fetal response Risks: - tachysystole (hyperstimulation) - uterine rupture - fetal hypoxia (bc of tachysystole) Safe administration: - continuous monitoring -- FHR - contractions = decreased blood flow -- uterine activity: watch for tachysystole - use of a checklist - SBAR if complications arise

Answer 11

- nausea - breast tenderness - mood swings - weight gain - headaches Progestin methods: irregular bleeding

Answer 12

- more than 6 uterine contractions in an hour w/ or w/out pain - cramping - pressure - leaking fluid - backache - increased discharge, esp. pink tinged - "just not feeling well"

Answer 13

- 21 hormone pills; 7 placebo pills -- can have extended cycle (Seasonale) of 84 hormone pills; 7 placebo - miss a dose: take as soon as you remember and next at regular time - not great for those who forget to take pills - failure rate: 9%

Answer 14

- NO VAGINAL EXAMS! (nothing in vaginal until 6 weeks postpartum too) Actively bleeding: - maintain large- bore IV access (2 18G) - volume expanders: LR or NSS (bolus) - obtain CBC, T&S, H&H - frequent monitoring of VS - fetal monitoring If first bleed and resolves: expectant management: - bedrest - VS every 4 hours - IV fluids - maintain current type and crossmatch - magnesium sulfate (protect fetal brain) and betamethasone (helps lungs mature)

Answer 15

terbutaline - slows contractions

Answer 16

Grade 0: all is fine Grade 1: - mild separation - VS and FHR stable (at the moment) Grade 2: - partial separation - elevated maternal HR, BP stable - uterus "irritable" - low fibrinogen levels Grade 3: - fetal death common - frequent, hypertonic contractions - coagulopathy - maternal shock, DIC, death possible

Answer 17

- pills (combined and progestin only) - patches - shots - rings - implants

Answer 18

***fluid and electrolytes*** Management: - replace fluid and electrolytes, esp K - NPO until vomiting stops - anti-emetics: Zofran, Reglan, Phenergan, Diclegis - TPN via central line may be necessary - measure I&O - provide emotional support

Answer 19

Long-acting REVERSIBLE contraception

Answer 20

nose: mild chin: moderate forehead: strong

Answer 21

- must be inserted by provider; may not be accessible - paraguard: may cause heavier bleeding and cramping - Mirena and skyla: can cause amenorrhea - small risk of perforating uterus

Answer 22

- levonorgestrel (Plan B) -- use within 72 hours; OTC -- works by preventing ovulation -- no effect on established pregnancy - Ulipristol (Ella) -- prescription only -- use within 120 hours -- works as progestin blocker -- may affect established pregnancy

Answer 23

- LARC - use of 3 years - more effective than sterilization (failure less than 0.05%) - unscheduled bleeding is common - ovulation resumes within one month - removal can be tough, leave scars

Answer 24

protect against STIs; adherence may be poor though - male condoms - female condoms - diaphragm: device covers cervix (can last 2 years) - contraceptive sponge: foam disk that covers cervix (cannot stay in longer than 30 hours)

Answer 25

Risks: - fetal head or face injuries, brain injury - 4th degree laceration of perineum - perineal hematoma, bladder injury - anal incontinence What is it? - about 1% of vaginal deliveries - require specialized training - outlet: baby is crowning, low: +2 station or more, midforceps: engaged

Answer 26

change positions

Answer 27

- know about supine position and changing position with towel under hip to relieve pressure on vena cava - H&H: 11 and 33% Low risk patients: - appts ev 4 weeks until wk 28 - ev 2 weeks 28-36 weeks - 36 weeks: weekly first prenatal is most in depth: screenings and assessments, lab tests, patient education

Answer 28

minimize infection by wearing mask and hat fluid bolus b/c hypotension risk monitor VS positioning

Answer 29

blood clots

Answer 30

- treat PCOS - relieve PMS - lighter periods - no impact on spontaneity - reduce acne - less cramping

Answer 31

- head: hard and round - butt: soft and squishy - back: smooth, long surface - limbs: knobby

Answer 32

- nadir AFTER contraction -- start after the contraction begins, gradual descent to nadirs which happens AFTER contraction - stressed by contraction - can be subtle, but are not good - are a sign of uteroplacental insufficiency - if recurrent or accompanied by minimal variability: require intervention -- intrauterine resuscitation; pit off - one late with moderate variability is worrisome; usually can get baby to recover

Answer 33

Risks: - cephalhematoma - fetal brain injury - fetal brain death What is it? - application of suction to fetal head to affect delivery - mom still has to push! no fundal pressure - should see progressive descent within 2 pulls - no more than 3 pop-offs

Answer 34

Nuva Ring and Annovera - flexible silicone ring; estrogen and progestin - inside vagina for 3 weeks, removed for week for bleeding, then replace with new one - can be removed for sex and left out up to 3 hours per day - placement not important - teach checking placement b/c can come out during BM - not great for those who don't like touching their body

Answer 35

those of advanced maternal age, chronic conditions (DM, HTN), taking meds that could be teratogenic, substance use, smoking

Answer 36

Excessive vomiting during pregnancy - interferes with nutrition - can cause serious fluid/electrolyte imbalances

Answer 37

- more than a third of all births - is a major abdominal surgery - involves higher morbidity and mortality - may be safety option for mother and baby nurse responsibilities: - pre-op education - positioning for spinal - positioning patient and monitoring FHR during epidural/spinal placement - insertion of Foley to prevent bladder injury - maintaining and monitoring of sterile field - managing equipment and obtaining supplies (suction, bovie, sutures, laps) - counts

Answer 38

Passage Passenger Powers Psyche Position

Answer 39

1-5 BPM change - insufficient uteroplacental blood flow - fetal sleep or maternal medications - can be bad, but brief periods can indicate fetal sleep or maternal medications

Answer 40

assessing maternal and fetal response 1 milunit/min = 1ml/hr usually increasing by 2 want moderate-strong contractions every 2-3 minutes lasting about 60 seconds

Answer 41

- educate patient - assist with positioning - minimize risk of infection by wearing mask and hate - monitor VS, pain, dermatome level, and fetal heart tracing -- dermatomes chart: should be around T10; indicates level of anesthesia (wet vs dry; soft vs sharp) -- good epidural at about T9-T10 - assess bladder for distention and catheterize PRN

Answer 42

- turtle sign - rest of baby fails to deliver

Answer 43

- uterine displacement with compressions - AFE (amniotic fluid embolism) could result in cardiac arrest

Answer 44

Placenta partially or completely covers the os (opening of the cervix)

Answer 45

First stage (Latent phase and active phase): all about the cervix Second stage: all about birth of baby Third stage: All about the placenta Fourth stage: recovery and bonding

Answer 46

(15x15): 15bpm above baseline x 15 seconds - under 32 weeks: 10x10 - indicate good oxygenation and that baby's CNS is intact - are very reassuring - show baby can respond to stimulation or increased demand - if concerned about a tracing, vaginal exam is done and tickle baby's head to elicit accel: scalp stim

Answer 47

G = gravida - how many times she has been pregnant T = term births - (twins count as one) >/= 37 weeks P = preterm births (twins=1) - births or losses from 20-36 6/7 weeks gestation A = abortions/miscarriages - any loss <20wks L = living children

Answer 48

Could be attributed to other causes, but probably pregnant: - positive pregnancy test -- could be pituitary tumor or menopause - Chadwicks, Hegar's, or Goodell's signs -- bluing cervix, softening of cervix - maternal perception of fetal movement

Answer 49

*painful, dark red bleeding in smaller amounts than previa* - blood pools behind presenting part: trickle instead of gush - increased uterine activity (contracts to put pressure on bleeding) - later stages: -- maternal hemodynamic instability -- maternal shock -- fetal distress -- absence of fetal heart tones comparison to previa: - *dark red bleeding* - smaller amounts of blood - moderate to severe pain - maternal VS may deteriorate even when measurable blood loss is small (can't see blood pooling) - ultrasound unreliable

Answer 50

- initiate for women 35 or younger after trying for year - initiate for women over 35 after trying for 6 months

Answer 51

- copper (Paraguard) - progestin-releasing (Mirena and Skyla) - do not affect pregnancy or cause abortion - work by thinning lining of uterus and create environment not good for sperm -- hormonal also prevent ovulation - no chance of user error and completely reversible - long acting! -- Skyla: 3 years (failure rate 0.2%) -- Mirena: 5 years (failure rate 0.2%) -- Paraguard: 10 years (failure rate 0.8%)

Answer 52

angry cat -- pushing out vertebrae (shrimp shape)

Answer 53

- ***Biophysical profile (BPP)***: done with ultrasound -- 5 criteria; 2 points or 0 -- assess fetal wellbeing -- fetal movement, tone, breathing, amniotic fluid, NST -- 8-10/10: reassuring; 6/10 monitor; lower = deliver

Answer 54

- ***non-stress test:** look for 2 accelerations of the fetal heart in 20 minutes*

Answer 55

(in addition to list from 1st trimester) - uterine contractions - new onset back pain - leaking of fluid from vagina - vaginal bleeding - decreased fetal movement - sudden weight gain - swelling of face, hands, eyes (sign of preeclampsia) - epigastric pain - severe headache unrelieved by tylenol or rest - visual changes (floaters, double vision, blurred vision)

Answer 56

- forceps - vacuum

Answer 57

- medication injected into the epidural space - superior pain relief w/out systemic side effects - can be bolus (C-section; increased discomfort) - impairs motor and sensory function (can't get out of bed; urinary catheterization) - ***side effect: hypotension*** -- ***may cause decreased uteroplacental perfusion (watch fetal monitoring strip)*** - can facilitate OR slow labor progress

Answer 58

"laughing gas" - does not necessarily reduce pain - increases relaxation: "i felt pain, i just didn't care" - no systemic effects on fetus, minimal maternal side effects - effects easily reversed by breathing room air - increases maternal sense of control over labor (-something she can do and use PRN) *mom needs to be able to hold mask on face on inspiration and expiration herself

Answer 59

Cervix 6-10cm; progressive effacement to 100% - contractions are moderate to strong in intensity, get closer together - patients need to focus in order to cope -- will not usually talk through contractions -- use of prepared childbirth techniques - about 8cm: patient may be overwhelmed -- shaky, nauseous, may be unable to cope well -- increase in "bloody show" - **ends with complete cervical dilation and effacement**

Answer 60

Cervical Dilation: 0-5cm, effacement: 0-50% - patience is key - contractions are uncomfortable but bearable - patient usually copes well - may be talkative and excited - longest phase: may take 12hr+ in primes - distraction, ambulation, education about normal labor - some patients will look like they are in active phase at 3-4cm (epidural most often at 3-4cm)

Answer 61

- begins when cervical dilation is complete and ends with birth of baby - "laboring down": wait for spontaneous urge esp with epidurals, primips - contractions become stronger, longer, closer together - fetal descent through vagina -- contractions -- maternal expulsive efforts: pushing - position and coordination of pushing with contractions - instruct mom in pushing efforts - WATCH THE FETAL HEART PATTERNS - cardinal movements: fetus rotates to align with pelvis

Answer 62

- **begins with delivery of newborn and ends with expulsion of placenta** -- want to shorten length to reduce risk of hemorrhage - delayed cord clamping beneficial to baby - signs that placenta is about to deliver: -- change in uterine shape (globular) -- sudden gush of bright red blood -- sudden lengthening of cord - prolonged 3rd stage: increased maternal bleeding - active management: oxytocin, gentle traction on cord, tell mother to push - passive management: let it deliver on its own

Answer 63

Recovery and bonding - begins with birth of placenta; lasts 4 hours or until "clinically stable" - repair of perineal lacerations or episiotomies - *most common time for postpartum hemorrhage* - assess uterine tone and vaginal bleeding (quantitative) - comfort measures: ice, topical meds - Golden hour: skin to skin, breastfeeding, ongoing assessment of newborn

Answer 64

- oxytocin infusion - mechanical dilation (foley bulb)

Answer 65

- need to have tight control; adherence is key - diet, insulin -- diet: carb controlled; spread throughout day -- insulin: usually combo of short and long-acting insulin -- teach healthy diet with 6 small meals - fingerstick glucose monitoring to adjust treatment - surveillance of fetal health -- NSTs, BPPs, fetal kick counts -- fetal echo for pre-gestational

Answer 66

1 hour oral glucose tolerance test for all patients at 24-26 weeks: - *target: fasting <95 mg/dL (some LIPS want <90)* - *target: 2hrs post prandial <120 mg/dL* - if >135 send for 3 hour GTT - some say 135, some say 140 for referral as positive

Answer 67

- call for help while keeping presenting part off cord -- sterile gloved hand in vagina -- apply pressure to head -- don't let go until baby is out - avoid manipulating cord in any way - if cord is protruding, use moistened sterile saline: time permitting - position mom in knees-chest or Trendelenburg - immediate Cesarean - take a "thrill ride" to OR Scenario (basically same thing) The assigned nurse pulls the emergency cord and initiates the correct actions (What are they?) Four more nurses arrive. - One has to mobilize the OR team - there is an overhead “Code Cesarean” protocol. - One has to open the OR and count with the scrub - One has to free the IV lines and initiate a fluid bolus - One has to unplug the bed and wheel the patient down the hall to the OR. Once there, two more nurses are available to assist. - One will assist the nurse who pushed the bed to transfer the patient to the OR table and obtain fetal hearts. - One will insert a foley.

Answer 68

fluid bolus anesthesiologist can give *ephedrine* to increase BP

Answer 69

- Past History of PPH (doubles risk) - Overdistention of uterus (polyhydramnios, macrosomia, twins) - Prolonged/dysfunctional labor - Grand multiparity (5+ kids -> trouble maintaining tone) - Preeclampsia (low platelets, HELLP) - Medications that relax smooth muscle - Obesity - Asian or Latina heritage - Birth procedures - oxytocin, operative vaginal delivery, cesarean section | anemia or low platelets makes the hemorhage worse

Answer 70

**Call 911: POST** - P: pain in chest - O: obstructed breathing or shortness of breath - S: seizures - T: thoughts of hurting yourself or your baby **Call provider: BIRTH** - B: bleeding, soaking through one pad/hour, or blood clots the size of an egg or bigger - I: incision that is not healing - R: red or swollen leg, that is painful or warm to touch - T: temperature of 100.4F or higher - H: headache that does not get better, even after taking medicine or bad headache with vision changes

Answer 71

A- appearance P-Pulse (heart rate) G-Grimmace (reflex/irritability) A- Activity (tone) R- Respiratory Effort If less than 7 min- repeat the assessment every 5 min until stable

Answer 72

A term baby has: * Flexed tone, resistance to extension, well-developed creases and folds, thicker skin, little vernix, firmer cartilage A preterm baby has: * More flaccid tone, more flexibility, thinner skin, visible veins, few creases, lots of vernix, softer cartilage A post-term baby has: * Lots of cracking, leathery skin, possibly meconium staining, no vernix

Answer 73

Nasal Flaring * Grunting * Tachypnea * Substernal Retractions * SeeSaw Respirations

Answer 74

Retinopathy of prematurity NEC BPD

Answer 75

Pathologic - hemolysis - Coombs positive babies (Or Rh+ babies) - Levels climb high and fast - Increased risk (esp for brain damage) Physiologic - immature liver Ineffective breastfeeding= higher risk - Low intake - Less stooling (less excretion of bili) - Higher levels Treatment: - Supplementation - Phototherapy - Overhead or blanket - Eye protection - Temp probe if in isolette - Monitor bilirubin levels

Answer 76

- incorporating old self into new role as a mom - acquiring role of motherhood - taking care of kid - independent - knows resources this phase happens after several weeks of adjustment. The mother reestablishes her previous relationships, functions in her new role with confidence, and builds a lifestyle that includes the infant. She relinquishes the "fantasy infant" and her idealized concepts about parenting and motherhood and accepts her role.

Answer 77

Signs and symptoms - Lack of bowel movements - Abdominal distention - Increase in abdominal circumference of 1 to 2 cm since last feed - Irritability - Lethargy - Can lead to respiratory difficulties Diagnosis: X-ray will show free air in abdominal cavity, distended loops of bowel Prevention of NEC: - Human milk feeding for infants <32 weeks - mom’s or donor - Measure and record abdominal circumferences - Auscultate bowel sounds before every feeding and observe for abdominal distention - Before any gastric tube feeding, check for aspirates of undigested formula or breast milk - Record all bowel movements for amount, consistency, and frequency If you suspect a problem: HOLD FEEDINGS AND SBAR THE NEONATOLOGIST!

Answer 78

To promote normal blood clotting Vitamin K is produced by bacteria in the gut and promotes normal blood clotting. The gut of a newborn infant is sterile, and incapable of producing Vitamin K. A one-time injection of phytonadione (Vitamin K) will prevent abnormal bleeding in newborn infants.

Answer 79

- if medication/least invasive methods fail: prepare for OR - exploration of uterus - placement of balloon for tamponade - suture - ligation of arteries - hysterectomy

Answer 80

- knowledge is power - highest risk is early in treatment - low energy = desire without energy - increased energy = ability to carry out plan - assess suicide risk

Answer 81

Splinting of incision Ambulation to prevent gas Binders

Answer 82

Online: Many conditions screened for, such as cystic fibrosis, sickle cell disease, and endocrine diseases, do not have obvious symptoms at birth, making early detection crucial for preventing long-term health problems or even death.

Answer 83

The patient has preeclampsia with severe features

Answer 84

Bladder: - if fundus is 3cm above umbilicus and displace: ask patient when last voiding, if only small amounts or not voiding help them empty - run water - run water over perineum - have her lean over - if can't relieve: straight cath Bowel: - can get very constipated postdelivery; have some sluggish peristalsis - encourage fluids, ambulation, fiber, and stool softener (Colace)

Answer 85

S/S: - Redness at incision - Foul-smelling discharge - Edema - Induration (hardness) at incision - Pain Most likely culprit: Staph Aureus (can be MRSA) Contributory/Risk factors: - obesity - presence of staples (two portals w each staple) - compromised health status, lower SES - poor hygiene Tx: - culture, sensitivity, antiobiotics - may need opening and packing - wound vac may be needed; pain relief

Answer 86

DVT prevention: * Lovenox/heparin * Sequential Compression Device * Ambulation ASAP Prevention of respiratory complications: * Incentive Spirometry * Cough and Deep Breathe * Ambulation ASAP Prevention of wound infection - Hand hygiene before touching incision - Shower daily, use clean towels - Patient teaching - wound care, inspect daily - REEDA - it’s not just for episiotomies! Promoting Peristalsis - Early ambulation - Dulcolax, milk of magnesia

Answer 87

Ice for 24-48 hours Warmth - sitz baths, peri-bottle, warm pack to abdomen for cramping Constipation: Common after vaginal and C-section births Offer Colace (docusate sodium) Ambulation Fluids Fiber Bring it up before they ask- Embarassment + fear factor = needless suffering

Answer 88

Pharmacological: Vaginal: - Ibuprofen/acetaminophen - Topical agents for perineal discomfort, sore nipples Cesarean: - Narcotic analgesia - Ketorolac/ibuprofen - Acetaminophen - IV or PO - Simethicone Non-pharmacological: Vaginal: - Ice for 24-48 hours - Warmth - sitz baths, peri-bottle, warm pack to abdomen for cramping Cesarean: - Splinting of incision - Ambulation to prevent gas - Binders Non-pharmacological: Breastfeeding mothers - sore or cracked nipples: - Proper latch - Topical lanolin - Gel discs Non-breastfeeding mothers - engorgement: - Supportive bra - Ice - Cabbage leaves in the bra

Answer 89

Repair of lacerations

Answer 90

Removal of placental fragments

Answer 91

so they don't develop BPD or ROP, and are able to breathe without the ventilation rather than becoming dependent on it

Answer 92

Lochia signifies endometrial healing/exfoliation Rubra: bright red bleeding - usually in moderate amounts Need to find out when pad last changed: keep an eye if heavy - alert if clot passed that is larger than egg Lochia serosa is pinkish or brownish - starts on the 3rd or 4h day postpartum lasting up to ten days. Lochia alba is a creamy vaginal discharge - can persist for the remainder of the postpartum period (6 weeks). there is a risk for infection; no sex for 6 weeks

Answer 93

Massage the breasts prior to nursing or pumping Breast engorgement can happen in both breastfeeding and non-breastfeeding mothers. It is a result of increased blood supply to the breasts under the influence of prolactin, a hormone that stimulates milk production, and can be exacerbated by ineffective or infrequent emptying of the breasts. In engorgement, the breasts will be tender bilaterally and will feel warm and firm to palpation. They will appear tight because they are edematous, and the mother will complain that they are heavy. There may be redness. This can be differentiated from mastitis because it is generalized to the entire breast area bilaterally, whereas mastitis is usually a localized area on only one breast. Frequent feedings help relieve discomfort by emptying the breast. Ice between feedings will reduce edema and pain. Massaging the breast or applying warmth just prior to feeding will help soften them and facilitate milk flow. Cabbage leaves and tight binding applications or sports bras suppress lactation. They can be used in mothers who are not breastfeeding but are not indicated for this patient. The patient should shower with her back to the warm water, not her chest, between feedings. Warmth brings blood to the surface and can exacerbate this problem, unless the woman is planning to empty the breast immediately.

Answer 94

Affects 10-20% of women after giving birth; stigma prevents women from getting help; can interference with bonding and infant development Risk factors: - history of mood disorder - stressful life events - unplanned pregnancy - lack of social support! - complications during pregnancy or delivery - body image issues

Answer 95

- Pt. will complain of sudden, excruciating pain - Swelling at the site - discoloration, fluctuant mass - Can fill with 250-500 mL blood

Answer 96

- If tone: uterus will be boggy; "high" above U because not contracting -- try straight cath first b/c suspect urinary retention - If tissue: may have "trailing membranes" - If trauma: continuous trickle with firm fundus at umbilicus OR s/s perineal hematoma - If thrombins: -- lab values (platelets) abnormal -- history of PPH, heavy periods, etc -- coagulopathy may be secondary to primary cause

Answer 97

Perform urinary catheterization. ## Footnote Displacement of the uterus from the midline to the right and frequent voiding of small amounts suggests urinary retention with overflow. Catheterization may be necessary to empty the bladder to restore tone. An IV and oxytocin are indicated if the client experiences hemorrhage due to uterine atony from being displaced. The health care provider would be notified if no other interventions help the client. Standard interventions are less invasive than urinary catheterization and include having the woman lean forward while sitting on the toilet, running tap water to provide "the power of suggestion", pouring warm water over the perineum with a peri-bottle, placing the patient's hand in warm water, having the patient blow bubbles through a straw, and having the patient inhale a few drops of peppermint oil on a piece of gauze or diluted in a cup of warm water. When these are not effective, it's important to empty the patient's bladder to prevent uterine atony.

Answer 98

K for Klotting factors

Answer 99

- first day - mother focusing on her self and the birth experience - not in a great teaching space - they are hard to teach; need to assist them and give info in chunks from delivery to approximately 24-48 hours after: the mother is preoccupied with her birth experience and recounts the story of her delivery repeatedly. Her focus is on physical recovery, getting rest, and having her needs met by supportive people and nursing staff.

Answer 100

Medications that control PPH from uterine atony: - Oxytocin (Pitocin)- first line agent - Methylergonovine (Methergine) - CHECK BP FIRST - Misoprostol (Cytotec) -- SL, PO, rectal route of administration - Tranexamic Acid (TXA) - for any cause of PPH -- Inhibits fibrinolysis - allows normal clotting - Carboprost (Hemabate)- promotes strong contractions - used after oxytocics fail

Answer 101

- **TONE: Uterine atony (failure of the uterus to contract adequately following delivery; #1 cause, 50% of all hemorrhages)** - Tissue: Retained placental fragments (increased blood flow b/s body thinks there is still a baby) - Trauma: Unrepaired lacerations or hematoma - Thrombins: Thrombocytopenia or coagulopathy

Answer 102

can last up to 6 weeks after birth. Teach mom S/S of hypertension

Answer 103

Usually large (esp. If maternal glucose poorly controlled) - “Ruddy” - extra RBC’s - increased risk for jaundice - Increased abdominal circumference, fatty tissue - Thick umbilical cord, large placenta - Lungs may be slow to mature - RDS and PDA more common - Congenital birth defects (Pre-gestational diabetes) - Maternal glucose leads to hypersecretion of fetal insulin HYPOGLYCEMIA! Signs of hypoglycemia: - Jittery - Low temp - Disorganized, poor feeders - Glucose via heelstick < 40 Treatment for hypoglycemia: - Feed the baby! - Glucose Gel - Dextrose IV - Monitor until stable

Answer 104

**Maternal ** Preterm Labor r/t uterine distention (bigger fetus, polyhydramnios) Increased risk for preeclampsia/eclampsia Dystocia Increased risk for UTIs and vaginal infections GDM- increased risk of T2 Pregestational - Increased risk for DKA - less common in GDM Worsening of diabetic retinopathy **Fetal/Neonatal** Macrosomia Birth injuries Neonatal Hypoglycemia Hyperbilirubinemia Preterm birth Pregestational: Increased risk of congenital anomalies, IUGR IUFD - chronic hypoxia

Answer 105

Term infants - 37 weeks/0 days to 41 weeks/6 days Pre-term: Extremely preterm: <25 weeks Very preterm: 26 - 31 6/7 weeks Moderately preterm: 32-33 6/7 weeks Late preterm: 34-36 6/7 weeks Post-term: 42 weeks and over

Answer 106

Cervical Insufficiency - Cerclage IV hydration Bedrest Tocolysis: Magnesium Sulfate Terbutaline (can help with tachysystole) Nifedipine

Answer 107

1st goal: Stop the bleeding at its root cause! 2nd goal: Replace fluid volume - Support hemodynamic stability *FIRST THING to do IS FUNDAL MASSAGE* Prevention of complications from PPH: - identify patients at risk; notify blood bank - frequent assessment of pt - active management of third stage labor - administration of oxytocin immediately after delivery - early intervention when bleeding is heavy

Answer 108

Colace (docusate sodium)

Answer 109

- mother realizing she needs to care for infant and for herself - coming to terms with birth; full of questions - great time to teach - usually discharged at this time - usually the 2nd day this phase lasts for several weeks and is concerned with learning how to function in the role of mother. At this time, the postpartum patient frequently asks questions and is eager to learn the tasks of self and newborn care.

Answer 110

Delivery room - polystyrene bag, warm chemical mattress, In NICU or ICN: isolette or warmer with temp probe Wean slowly to open crib Evaporation: - Dry the baby! Conduction: - Skin to skin - Warmed blankets Radiation: - Hat - Cover with blankets, clothing - Radiant warmer Convection: - Keep out of drafts - Warmer away from door Low temp = low glucose and Risk for respiratory distress

Answer 111

S/S: - Foul Smelling Lochia - Temperature 100.4 or greater (usu. 101.0 to 104.0 F) - Tachycardia - Chills, aching - Lower abdominal pain, uterine tenderness Most common post C/S; especially if not treated prophylactically; other risks: - PROM - multiple vaginal exams in labor - compromised health status; low SES - instrumental deliveries Management: (idk when to call dr, prob w/ sign of foul smelling lochia if that appears first) - cephalosporins/penicillin - aggressive infection: broad spectrums (vanco, gentamicin, clindamycin)

Answer 112

- asphyxiation - meconium aspiration syndrome - hypothermia - polycythemia

Answer 113

Must be correct size for newborn Rear-facing in the back seat Watch buckle!!! Level of armpit!!! No more than 2 fingers between baby And straps No snowsuits, bulky jackets under straps Make sure that it is level in car Anchor with tether and use base

Answer 114

Preeclampsia can persist and cause complications in the postpartum period for up to 4 weeks; the patient should be taught to report headache, visual disturbance, epigastric pain immediately to her provider.

Answer 115

lowers surface tension prevents atelectasis

Answer 116

S/S: - Red lump in the breast - superficial - Mild fever, chills, feeling “unwell” - Pain - Yeast - ground glass in nipples sensation when feeding; will need to treat mom and baby - Abscess - collection of pus, may be very discolored Contributory/risk factors: - cracked nipples - compromised health status - antibiotic therapy (candida/yeast) leads to yeast infection - inconsistent nursing pumping: milk can crystallize and clog Treatment: - **Don’t stop nursing!** - **Pump if nursing is too painful** - Use heat and massage to encourage milk expression, every 2-3 hours - For lump: try to massage from lump towards nipple and heat - antibiotics

Answer 117

Vaginal: - ibuprofen/acetaminophen (tylenol) - topical agents for perineal discomfort, sore nipples Cesarean: - ketorolac/ibuprofen - acetaminophen IV or PO - simethicone (GasX)

Answer 118

detected by eye exam - caused by high levels of oxygenation Most common in infants born <31 weeks or <1250 g Can cause retinal detachment, blindness Eye exam at 4-9 weeks post-birth May require surgical intervention May be caused by unstable oxygenation

Answer 119

- Get a second IV site - pref. 18 gauge - Crystalloid Fluids - LR or NSS - Frequent monitoring of VS, -- Hypovolemic shock - tachycardia, hypotension, decreased O2 sat (late), - Administer Oxygen if needed - Elevate legs 30 degrees - perfuse vital organs - Foley catheter - monitor output - Transfusion if indicated, massive transfusion protocol (MTP) may be needed

Answer 120

ibuprofen (Motrin)

Answer 121

The first vaccine offered to infants is the Hepatitis B vaccine. The schedule includes a vaccine within 24 hours of birth, 1-2 months, and 6 months of age. Passive immunity offers some protection against vaccine-preventable infants, but this is limited to about 2 months of age, and is not an excuse not to vaccinate children according to the schedule. Hep B vaccination is important to prevent severe liver disease in infants who may be exposed to the virus.

Answer 122

- Hand hygiene! - Front-to-back for perineal care - Foley out ASAP, void frequently - Shower daily, use clean towels - Nothing in the vagina for 6 weeks - Incisional Care - Address cracked nipples -- Improve latch and position -- Creams, soaks, gel discs - Regular nursing to prevent plugged ducts

Answer 123

Baby Blues: - Normal - may occur at home or in hospital - Weepiness, mood swings, irritability, disappointment - “Comes and goes” - Usually resolve in 10-14 days without treatment Screening is a 13 question tool used for mothers. Under 10 is considered normal.

Answer 124

DVT or thromboembolism because pregnancy is hypercoagulable state - watch for complaints of calf pain on one side, swelling, redness, palpable cord - signs of DVT What to do: contact provider; anticipate Doppler studies, D-Dimer, mom cannot get out of bed because risk of dislodging clot

Answer 125

Apply ice. ## Footnote Ice is applied to perineal edema within 24 hours after birth. Cold applications constrict blood vessels and reduce swelling. Use of ointments is not effective for perineal edema, although hydrocortisone may be used for hemorrhoids if that is the woman's complaint. Warmth brings blood flow to the area, which can increase swelling. Moist heat and a sitz or tub bath are encouraged to promote healing to the area 24 hours after birth until no longer needed.

Answer 126

Erythromycin is an antibiotic that helps prevent bacterial eye infections, particularly those caused by Neisseria gonorrhoeae (gonorrhea)

Answer 127

Taking In - from delivery to approximately 24-48 hours after: the mother is preoccupied with her birth experience and recounts the story of her delivery repeatedly. Her focus is on physical recovery, getting rest, and having her needs met by supportive people and nursing staff. Taking Hold - this phase lasts for several weeks and is concerned with learning how to function in the role of mother. At this time, the postpartum patient frequently asks questions and is eager to learn the tasks of self and newborn care. Letting Go - this phase happens after several weeks of adjustment. The mother reestablishes her previous relationships, functions in her new role with confidence, and builds a lifestyle that includes the infant. She relinquishes the "fantasy infant" and her idealized concepts about parenting and motherhood and accepts her role.

Answer 128

The Centers for Disease Control and Prevention (CDC) recommends that all newborns receive the first dose of the hepatitis B vaccine within 24 hours of birth. This is especially important for babies born to mothers who are infected with HBV.

Answer 129

Burning, urgency, frequency, Nocturia If it progresses - - Fever, chills, flank pain, nausea/vomiting - CVA tenderness Call dr with symptoms appearing Contributory/Risk Factors: - urinary cath - urinary stasis - trauma to urinary structures - improper hygiene Dx with “clean catch” specimen Management: - bactrim, Septra, augmentin

Answer 130

Delaying cord clamping for at least 30 seconds up to 5 minutes: ● Increases Blood volume about 33% ● Increases Iron Stores for up to 6 months ● Increases oxygen to vital organs May be contraindicated if neonate needs immediate resuscitation.

Answer 131

- Comfort Care -- Whenever possible, involve mom -- Kangaroo care -- Breastfeeding unless polysubstance use - Swaddling, holding, swinging, rocking - Decreased stimuli - Volunteer “cuddlers” - Pacifiers/non-nutritive sucking - Cream to prevent diaper rash - Administration of morphine or other agent - Monitor growth

Answer 132

- Strict Bedrest - Do not massage the clot - Anticoagulant therapy - Heparin drip - monitor PTT - Convert to warfarin (Coumadin) - PT/INR - Pt. education re: anticoagulants - Monitor for Pulmonary Embolism - assess respiratory status frequently

Answer 133

Administration of misoprostol/ Carboprost/tranexamic acid

Answer 134

Lungs actually change shape - can be due to mechanical ventilation and lungs adapting to the ventilation - online: BPD is a chronic lung condition in premature infants that occurs when their lungs don't develop properly and can be damaged by oxygen therapy or mechanical ventilation.

Answer 135

Vanco- ototoxic, nephrotoxic, hearing screen - need to monitor BUN/Cr Gentamycin? - i think also nephro and oto - monitor labs

Answer 136

Signs and Symptoms: - persistent sadness or lack of joy - disturbances in eating or sleeping - may have significant anxiety component - feelings of worthlessness; inadequacy as a mother - thoughts of hurting self - may have OCD component; unwanted thoughts Treatment: - Therapy (CBT, support groups) - Antidepressants (SSRIs, Brexanolone, most compatible with breastfeeding) - ECT - alternative treatments for milder cases: exercise, exposure to light/sun

Answer 137

For small hematoma- Ice/pressure For Large- Incision/drainage and packing *MONITOR FOR HYPOVOLEMIC SHOCK*

Answer 138

Online: Administering caffeine citrate is a safe, noninvasive way to treat premature infants with persistent apnea. This drug decreases the frequency of apneic episodes, thus reducing the need for mechanical ventilation. It is given once a day, either orally or intravenously.

Answer 139

Frequent assessment and quantifying blood loss by weighing pads

Answer 140

Sudden Infant Death Syndrome (SIDS) Safe sleep includes placing the infant on a firm crib mattress on the back (supine position) without soft or loose bedding. There should be no extra objects in the crib. The infant should not sleep with siblings or adults and should not be exposed to secondhand or thirdhand smoke in the sleeping environment. The infant should not be overheated, and should be wearing only a sleeper and a swaddling blanket that is away from the face. Infants who sleep in prone (on the stomach) or side-lying positions are at risk for SIDS because they rebreathe carbon dioxide. Suffocation from loose bedding, pillows, quilts, or bumper pads is associated with SIDS deaths. Safe sleep environments as described above do not prevent GERD, colic, or plagiocephaly (flattening of the back of the head).

Answer 141

“This sounds like the baby blues. They are common and usually go away in 10-14 days. Let’s review the signs of postpartum depression in case things change.”

Answer 142

Your lochia should slow down and become pinkish or brownish in a day or two “You should wash your hands before and after changing your pad.” “You should call me immediately if you soak a pad in less than an hour or have a clot bigger than an egg.”

Answer 143

Presence of mature milk with hand expression Fundus firm, 6 fingerbreadths below the umbilicus Scant lochia serosa (pinkish or brownish)

Answer 144

lochia rubra ## Footnote Lochia rubra is red; it lasts for the first few days of the postpartum period. Lochia serosa is pinkish or brownish and starts on the 3rd or 4h day postpartum lasting up to ten days. Lochia alba is a creamy vaginal discharge that can persist for the remainder of the postpartum period (6 weeks). Bright red bleeding is fresh - so the take home here is that once it stops, it shouldn't return during the postpartum period.

Answer 145

Encourage fiber-rich foods. ## Footnote Encouraging fiber-rich foods will help with prevention of constipation. The client needs plenty of water, needs to ambulate, and should take stool softeners (not a stimulant laxative) if ordered by the health care provider. Increasing the coffee intake will not assist with preventing constipation. The client should get plenty of rest but it should be balanced with activity to help stimulate peristalsis of the GI tract.

Answer 146

Application of ice packs to the perineum for 24-48 hours.

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