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Mat p3 Flashcards

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1
Q

what is the focus of postpartum nursing care? (acronym)

A 
BUBBLE
B-breasts
U- uterus
B-bladder
B-bowel
L-legs
E-emotions
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2
Q

what focus do you have in regards to breasts (BUBBLE) in postpartum nursing care?

A

breast feeding problem, mastitis tends to occur when you’ve gone home r/t poor latch

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3
Q

what focus do you have in regards to the uterus (BUBBLE) in postpartum nursing care?

A

PPH-uterine atony, cervical or vaginal alcerations, hematomas or retained POC, endometritis/perineal cellulitis

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4
Q

what focus do you have in regards to the bladder (BUBBLE) in postpartum care?

A

UTIs (from trauma to the urethra and sweeps up bacteria and repeated exams and catheterizations)

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5
Q

what focus do you have in regards to the legs in postpartum nursing care?

A

thrombophlebitis, DVTs

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6
Q

what is considered early postpartum hemorrhage? late?

majority are?

A

<24 hours is early
>24 hours- 6 weeks is late

early

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7
Q

what are the risks of hemorrhage (4 T’s)

A

Tissue (things left inside the uterus), Tone (uterine atony), trauma (tears to cervix or vagina, rectum), thrombin (clotting issue)

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8
Q

what other risks are there for postpartum hemorrhage?

A 
Prolonged labour
Polyhydramnios
Macrosomia
Shoulder dystocia
Multiple gestation
Use of forceps
Retained products of conception (POC)
Endometritis
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9
Q

what assessments do you do for determining postpartum hemorrhage?

A

-fundus- palcement, timing
-lochia- amount, timing, colour, clotting
-perineum- are there tears, sutures, bruising, swelling
VS
-pallor and fatigue or SOBOE, cap refill
-has the pt voided?
-risk factors?
-IV? meds (oxytocin)

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10
Q

if your patients fundus is not one finger below after the following day and pushed to one side, what might be your first action?

A

is her bladder full? instruct her to empty her bladder and full bladder is preventing it from involuting (contracting down)

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11
Q

what is living ligature?

A

tightening motion of vessels around the uterus causing it not to bleed

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12
Q

what is one action you might do to stop a hemorrhage?

A

fundal massage, lower bed to promote oxygenation to brain

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13
Q

if blood is tricking out, can this be a hemorrhage?

A

might be a tear in the perineum

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14
Q

what is the drug you want to give for hemorrhage?

A

Mesd are oxytocin, misoprostil, ergometrine (IM injection causes uterus to contract), carboprost/hemabate (smooth muscles contract) causes bowels and uterus to cramp, will have uncontrolled diarrhea from hemabate!!

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15
Q

how much blood loss during vaginal delivery is considered hemorrhage? C/s?

A

vaginal >500ml

C/s ~1000ml

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16
Q

how much blood is a fully saturated pad?

A

around 100ml

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17
Q

what are some nursing diagnosis for postpartum hemorrhage?

A

Deficient fluid volume r/t increased lochia flow
Ineffective peripheral tissue perfusion r/t circulating volume losses
Situational low self-esteem r/t postpartum fatigue and inability to feed infant
Risk for impaired role transition r/t fatigue d/t PPH
Ineffective breastfeeding r/t fatigue d/t PPH

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18
Q

Interventions during PPH

A

Fundal massage, support and express clots
Call for help, alert physician
VS
Lower HOB
IV normal saline or Ringer’s Lactate as ordered
Administer medications as ordered (oxytocin, misoprostil, ergometrine, carboprost)
Catheter or void if able

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19
Q

risks for postpartum infection?

A

> 24 hours ROM, retained POC, pre-existing anemia, prolonged labor, internal fetal monitoring, repeating exams, inc manual explooration of uterus after delivery, unsterilized equipment, improper or no peri care after delivery, poor HH, shared supplies between pt, cleaning between pt limited or poorly done, PPH, use of instruments

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20
Q

Postpartum infection- assessments?

A

uterine pain, malaise, foul smelling lochia , fever, PV losses, discoloured lochia(green, frothy), usually starting 3-4 days after delivery, WBC count elevation

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21
Q

if a uterus is infected, how will this affect it contracting?

A

it can’t contract bc it is inflamed and the muscle is inflamed (can’t involute)

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22
Q

if a women is diaphoretic and says she feels hot/has the flue. how will you differentiate lactogenesis from infection. milk comes in around day 3-4 same with infection?

A

check her discharge, look at loch and ask about it, palpate uterus that it is 2-3 finger bowl umbilicus

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23
Q

interventions for PP infection?

A

Teach signs and symptoms of infection prior to discharge, abx, analgesia, oxytocic agent may be needed to support involution, strict asepsis and infection control measures to prevent spread of microorganisms to others

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24
Q

if mom has GBS (group B streptococcus) and baby gets it through delivery, what is the baby at risk for?

A

meningitis

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25
when do they screen for GBS?
around 35-37 weeks
26
what do you do if mom goes into labour early and has not been tested for GBS?
goes on penicillin and clundomicin and baby only if its symptomatic after its born
27
can herpes be contracted to fetus?
yes, it can cross the placenta if mom has a primary infection during pregnancy/ more often contracted from vaginal secretions at birth
28
what is the therapy for baby that contracts herpes?
antretroiviral drug such as acyclovir (zoviraz) a drug that inhibits DNA synthesis that is effective in combating overwhelming infection
29
can babies contract hep B?
can be transited thru contact with infected vaginal blood when
30
what do you do if mom is Hep B pos?
ask if they infant would like vaccination t birth should be bathed ASAP to get secretions off gentle suctioning to avoid trauma to mucous membrane infant administered serum immunglobulin (HBIG)
31
can Hep B get into breast milk?
yes but if it has immune globulin baby is safe
32
when is apgar done?
1,5, 10 minutes
33
what does apgar look at?
HR, tone, reflex irritability, colour, resp effort
34
what effect does mom smoking have on baby?
tiny placenta and tiny baby and baby will have unusual od our
35
how does the baby look (size)in a women with diabetes mellitus? how does their face look?
macrosomia (bigger) from overstimulation of growth hormone and extra fat deposits created by high levels of insulin during preg. baby is often immature so size doesn't say much face is cushingoid (fat and puffy)
36
why does a baby that goes through C/S have poor gut health?
because the vaginal flora helps with gut
37
VS for baby? sugars?
resp 30-40 temp: 36.5-37.4 pulse 110-160 sugars: 3.2-6
38
do premature babies have more or less flexion?
lesss flexion in upper extremities and partial flexion on lower extremities.
39
what do the sole creases on a newborn look like?
premature have very few or no creases
40
genitalia of premature babies?
male- tests are v high and inguinal canal and there are few rug on scrotum. full term are lower in the scrotum and rugae developed female- when on back with hips abducted, clitoris is prominent and labia major are small and widely separated. full term labia minora and clitoris are covered by majora
41
what does the foramen ovale do?
connects between right and left atrium
42
what does ductus venosus do?
these ducts allow blood to go from placenta to heart and bypasses from lungs
43
what does ductus artercosus do?
allows blood back into main circulation and to lungs to service as organs
44
what can cause us to go back to extrauterine circulation?
lack of surfactant, inc acidosis and being cold. if we are in an acidotic state or cold, the ducts stay open and flutter open.
45
what factors lead to resp distress in preterm infants?
-dec surfactant and lung maturity -susceptibility to cold stress and metabolic disturbances -immature organ development -immature CNS -decreased fat deposits and no brown fat decreased ability to eat and absorb nutrition
46
what are the 4 methods babies use to lose height?
convection, radiation, conduction, evaporation
47
how can we prevent heat loss?
Remove wet linens, and place Skin to Skin if healthy | Incubators, dry linen, plastic wrap, warmed stethoscopes, warmed beds
48
if baby is too hot and forced to dec metb, to spare o2 for essential body, what will the body do to cause it to go back to intrauterine circulation?
vasoconstriction of the peripheral vessels pushing into torso and continues for so long, pull vessels become lax and pulm perfusion dec and pO2 drops and fetal shunts will remain open. surfactant also dec. and anerobic resp causes acidosis, inc risk of acute bilirubin encephalopathy or kenricterus
49
when you're assessing for fluid and electrolyte balance, where do you look?
assess anterior fontanel (if sunken and soft-dehydrated), urine and fees, feeding, acidosis at birth.
50
fluid volume excess can result in what?
returning to fetal circulation
51
why is it so difficult to restore sick infants fluid losses?
unable to restore through eating, kidneys are very immature and have difficulty concentrating urine
52
how does breastfeeding help with nutrition and waste?
stabilizes resp, temp, and blood sugar colostrum loosens up mucus and clears airway
53
why is sucking difficult for preterm?
because neuro not fiully developed ? not able to co-ordinate suck, shallow breath
54
why might a pre-term infant require a TF
because they have difficulty breathing with the suck, swallow, breath pattern- energy calories and inc effort
55
bowels in re: nutrition and waste for newborn?
may not be mature enough to absorb (NEC)
56
what is necrotizing enterocolitis?
intestinal dysfunction. bowel deelops necrotic patches, interfering with digestion and possibly leading to paralytic ileus, perforation and peritonitis. occurs d/t anoxia to bowel- may result as complication of exchange of transfusion or episode of breathing didiculty
57
how does colostrum help with the cells in the bowel? do you give more or less colostrum to a preterm?
cells in bowel are loosely aligned and proteins slip through these gaps and get into the blood stream. when you give bb colostrum it helps to tighten these cells more-- may give a weeks worth of colostrum to a preterm
58
does the moms milk production differ depending on when baby is born?
yes. has lots of protein in it and essential fatty acids and mom will produce more immune preserving properties in her milk if she delivers prematurely. only lasts about 2 weeks.
59
when else does a baby present preterm, even if baby is not preterm?
when macrocosmic
60
if mom is diabetic, what happens to baby in terms of sugars and insulin in utero and then when delivered?
high level of glucose coming to them in utero and therefore produces high levels of insulin so once baby supply is cut off and baby is delivered, insulin persists in the body for several hours and sugars drop to low levels
61
what BG do we intervene for baby?
2.8
62
how can we intervene to help hypoglycaemic babies?
Nursing care of these babies centres on frequent BS checks and ensuring adequate intake. Supplementation with formula is usually necessary until breastmilk supply is established
63
low BS contribute to alkalosis or acidosis ? why? | what does this impede?
acidosis which then impedes respiratory function
64
how closely do you need to care for macrocosmic babies? what types of interventions/monitoring?
1:! care for their unstable status | frequent BS, supplemental feeds, possible IV, o2, skin t skin
65
why are premature babies at higher risk of infection?
compromised or immature immune systems
66
how can we prevent infection for babies?
breastmilk has immunologic properties | strict infection control and visiting policies
67
what are symptoms of neonatal abstinence syndrome?
``` Irritability Disturbed sleep pattern Constant movement, tremors Frequent sneezing Shrill, high-pitched cry Possible hyperreflexia and clonus Convulsions Tachypnea Vomiting and diarrhea ```
68
what is hyperbilirubinemia?
hemolytic disease of the newborn excess RBC breakdown caused by ABO or Rh incompatibility mom builds Ab against fetal RNC- lead to hemolysis, severe anemia and hyperbilirubinemia

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