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Flashcards in mat pt 3 workbook Deck (45):
1

What factors predispose women to DVTs?

what about to thrombophelitis

• are inactive during labor and during early puerperium bc this inc risk of blood clot formation
• spent prolonged time in a birthing rool w legs in stirrus
• preexisting obesity and a preg weight gain greater than recommended weight gain- leading to inactivity and lack o exercise
• preexisting varicose veins
• develop a postpartal infection
• have a hx of previous thrombophlebitis
• older than 35 or have inc parity
• high incidence of thrombophlebitis in family
• smoke cigrettes bc nicotine causes vasoconstriction

• Inflm w formation of blood clots. When in postpartal period its gen extension of endometrial infect that occurs d/t
o Inc fibrinogen from preg
o Dilatation of lower extremitiy veins from P of fetal head

2

strategies to dec risk of DVTs

Ambulation, limiting time in stirrups or make sure they are well padded, support stockings for first 2 weeks after birth can help inc VR, instruct her to remove them twice daily to look at skin for mottling or inflm, ight be prescribed aspirin q4h

i imagine hydration
leg exercises

3

Why is it dangerous to massage the skin over a clotted area?

Because it can loosen the clot causing a pulmonary or cerebral embolism

4

what is mastitis

• Infect of breast that might occur between 7th day puerperium to when babe is several months old

5

how does the infection get in with mastitis

what are the different types and which is gen unilateral

gen gets in through cracked nipple


• Sometimes the infectious org comes from the infant-epidemic mastitis. & spreads to others
• Gen unilateral but epidemic mastitis is bilateral

6


how can you prevent mastitis

o Pos babe well on nipple so it has areola in mouth too
o Help babe release grasp on nipple before removing babe from breast
o Hygiene after touching peri pads or before touching breasts
o Expose nipples to air for part of day
o Vit E ointment
o Enc to begin breastfeeding (when babe sucks most forcefully) on unaffected nipple

7

what might need to be ruled out with mastitis

take sonogram to rule out breast abscess

8

What organisms are associated with nosocomial mastitis?

Infant usually acquired staphylococcus aureus, a methicillin resistant infection (MRSA) or candidiasis while in the hospital

9

Describe assessment findings associated with mastitis.

Usually unilateral, although epidemic mastitis bc originates from infant may be bilateral. Feels painful and appears swollen and red. Fever comes within first hours and breast milk becomes scant.

10

t or f since the woman has an infection it is a bad idea for her infant to drink her breastmilk and also causes an inc in amount of microorgs

• Keep breastfeeding as this empties them of milk to prevent growth of bact. Might prefer hand expressing

11

Describe medical and nursing interventions to treat mastitis.

Abx effective against penicillin resistant staph such as dicloxacillin or a cephalosporin. Usually outpatient treatment. Breastfeeding should be continued if possible bc keeping breast empty prevents growth of more bacteria. Sometimes hurts from sucking so wants to express milk until abx works (3 days or so). Cold or ice compresses and a supportive bra help with pain reflief. Warm, wet compresses dec inflm and edema

12

Why are women prone to UTIs after delivery

Because often woman are catheterized at the time of childbirth or during postpartal period and bacteria are introduced there.
o Pushing w labor also might let secretions enter the urethra

might also be d/t not getting peri care after delivery
maybe not using their squirt bottle every time after toileting

13

Describe the assessment findings and therapeutic management of a UTI after delivery.

Symptoms of burning on urination, possibly blood in the urine (hematuria) and a feeling of frequency or that she always has to void. Pain is so sharp she may resist voiding. May have low-gradefever and lower abdm pain. Obtain a urine specimen but use a sterile cotton swab to tuck into vagina to avoid lochial discharge. Therapeutic mgmt.: broad spectrum anx such as amoxicillin or ampicillin. Make sure it is safe for breast feeding. Encourage mom to drink lots of fluids to help flush the infection (a glass/hr) may need Tylenol for pain. Make sure she takes abx for full amount of time

14

If a child is born with an illness or physical challenge, when should the child be shown to the parents? Why at this time? What are some common responses to delivering a child with an illness or physical challenge? What are some helpful nursing interventions and responses for a family whose newborn has died?

Helpful nursing interventions: let mom see the baby and clean the bab and wrap it up in a blankey. Remain with them but give them time to handle and inspect the child as they wish. Parents may want photos or a lock of hair

15

Which babies are at risk for RDS?

what is the cause

Most often occuts in preterm infants!!!
infants of diabetic mothers,
infants born by c/s or those who have dec blood perfusion of the lungs for whatever reason (ie. meconium aspiration).
also low birth wt

gen d/t dec in surfactant

16

when does surfactant gen form

what is being deposited in RDS

Surfactant usually forms in the 34th week of gestation.

hyaline like deposition of hardened exudate in terminal bronchioles

17

when do these s/s of RDs often first appear?


often they have challenge initiating resps at birth BUT then after resuscitation they seem to have a period of hrs or a day when theyre free of symptoms d/t an initial release of surfactant..they might have subtle s/s at this time
S&S- difficult resps at birth. After resuscitation they have hours or days of no symptoms bc initial release of surfactant but will have subtle symp such as: low boy temp, nasal flaring, sternal and subcostal retractions, tachypnea (more than 60RR), cyanotic mucous membranes. Within hours, expiratoy grunting occurs caused by the closure of the glottis,aas it tries to inc the p in alveoli on expiration in order to keep them from collapsing. Infants become cyanotic and their po2 and o2 sat level fall on RA. Auscultation- fine rales and diminished breath sounds bc of poor air entry. As distress inc an infant may exhibit

-seesaw resps (inspiration- ant chest wall retracts and abdomen protrudes and expiration the sternum rises)
-Heart failure, evidenced by dec output and edema of the extremities
-Pale gray skin
-Periods of apnea
-Bradycardia
-Pneumo

18

what are mnfts of RDS for infant (initial and then later)

after a few hrs to days will have subtle symp such as: low body temp,
nasal flaring,
sternal and subcostal retractions,
tachypnea (more than 60RR),
cyanotic mucous membranes.

Within hours, expiratoy grunting occurs caused by the closure of the glottis,aas it tries to inc the p in alveoli on expiration in order to keep them from collapsing. Infants become cyanotic and their po2 and o2 sat level fall on RA. Auscultation- fine rales and diminished breath sounds bc of poor air entry. As distress inc an infant may exhibit

-seesaw resps (inspiration- ant chest wall retracts and abdomen protrudes and expiration the sternum rises)
-Heart failure, evidenced by dec output and edema of the extremities
-Pale gray skin
-Periods of apnea
-Bradycardia
-Pneumo

19

Describe the action of surfactant and CPAP or PEEP oxygen administration. What is a risk of oxygen administration for very immature infants?

CPAP ior PEEP (positive end-expiratory pressure)- exert pressure on the alveoli at the end of expiration and help keep alveoli from collapsingand also supply o2. Risk of too much o2 when immature is ROP or bronchopulonary dysplasia

20

how is RDS managed

surfactant replacement
02
ventilation
muscle relaxntts to inc pulm blood flow..other weird things eg extracorporeal membrane oxygenation

21

what is transient tachypnea of the newborn and why does it occur


Rapid rate of 80 braths/min and (normally) slows down to 30-60 but here it stays at 80-120rr/min.

it is a direct result of retained lung fluid which limits the amount of alveolar surface that is available for oxygen exchange.

22

cause of Transient Tachypnea of the Newborn?

Slight decrease in the production of phosphatidylglcerol or ature surfactant, it is a direct result of retained lung fluid which limits the amount of alveolar surface that is available for oxygen exchange.

23

What is a normal newborn heartrate and what is a rate seen with TTN? (i assume they meant resp rate)

normal 30-60 but now 80-120 resps/min

24

how distress is a TTN infant and how do they present

. Doesn’t appear distressed other than tiring effort of respirations; can’t feed as can’t suck + breath at same time; may see mild retractions + some nasal flaring
• CXR shows fluid in central lung but aeration of lungs overall adequate

25

what criticl activity does a TTN babe struggle with and why

feedin is difficult bc chuld cannot suck and breath rapidly at the same time.

26

which babies are more at risk of TTN

Occurs more often in infants who are born by c/s (their thoracic cavity wasnt compressed like it wouldve been in vag birth)
,
in infants whose mothers received extesnsive fluid admin during labor

preterm infants.

27

What nursing actions are required if an infant has TTN? ..more?

Close observation is priority. Watch carefully to be certain the inc effort is not tiring and other signs of resp distress such as nasal flaring or retractions are not occurring bc rapid resp rate is often first sign of resp obstruction. O2 may be necessary. Mild glucosteroid to reduce resp tract inflm

28

When should TTN resolve

Onset is about 6 r and peaks in 36 hrs and then begins to fade around 72 hours as lung fluid is absorbed and resp activity is effective

29

what is meconiu aspiration syndrome

.

30

-What causes MAS

Mec is present in fetal bowel as early as 10 weeks of gestation. If hypoxia occurs, a vagus reflex is stiulating resulting in relaxation of rectal sphincter- releasing mec into amniotic fluid.

31

? Why is MAS a concern

Cau cause serious resp distress in 3 ways:--inflm of bronchioles bc foreign substance,

bloc small bronchioles b y mechanical plugging, and it can dec surfactant prod through lung trauma. Hypoxemia, co2 retention and inrapulmonar and extrapulmonary shunting can occur.

Secondary infection of injured lung tissue can lead to pneumonia

32

What signs and symptoms (assessment findings) will the nurse note with MAS

-difficulty establishing resps at birth. Apgar is low. Almonst immediately, tachypnea, retractions and cyanosis begin. After initiation of resps, an infants resp rate may remain rapid (tachypnea) and coarse bronchial sounds may be heard on auscultation. May continue to have retractions bc the inflm of the bronchi tends to trap air in the alveoli, limiting the entrance of oxygen. Air trapping may also cause englargement of anteroposteriod diameter of the chest. Poor gas exchange wth po2 and blood gases. CXR will show bilateral coarse infiltrates in the lungs with spaces of hyperaeration (peculiar honey comb effect) diaphragm will also be pushed downward by over-expanded lungs

33

Hemolytic Disease of the Newborn aka

(Hyperbilirubinemia)-

34

how does Rh incompatabilty work for the babe and when does this gen occur

Rh incompatibility- if moms blood type is Rh neg and fetal is pos this causes sensitization fo mom to form antibodies against the D antigen. Most form in first 72 hours after birth bc of active exchange of blood. So in secondary pre high level of ab D in bloodstream which destroy fetal RBC. Not as often because caught early and rhogam.

35

hw does ABO incompatability work in r/t ABO incompatability

ABO incompatibility- maternal blood type O and fetal is A or B or AB. Fortunately they do not cross the palcenta (ab). Hemolysis of blood begins after birth when blood and ab exchange as long as placenta is loosened, destr may continueu as long as 2 weeks. Preterm are not affected.

36

hw does ABO incompatability work in r/t ABO incompatability

ABO incompatibility- maternal blood type O and fetal is A or B or AB. Fortunately they do not cross the palcenta (ab). Hemolysis of blood begins after birth when blood and ab exchange as long as placenta is loosened, destr may continueu as long as 2 weeks. Preterm are not affected.

37

What does the term hydrops fetalis mean?

Hydrops fetalis means the appearance of a severely involved infant at birth; hydrops refers t the edema and fetalis to the lethal state.

38

Why are high bilirubin levels dangerous?

High bilirubin levels are dangerous because the liver cannot convert all the indirect bilirubin produced to direct bilirubin so jaundice is extreme. High levels above 20mg/dl in a term infant causes brain damage from bilirubin-induced neurlogic dysfunction, a wide spectrum of disorders can occur from mild dysfunction to ABE (invasion of bilirubin into brain cells)

39

what are good Tx of hyperbilirubinemia.

phototherapy and breastfeeding

40

Explain the mechanism of action of early and successful feeding and phototherapyto treat hyperbilirubinemia.

Initation fo early feeiding (urge mom to BF 8-10 times a day for first 2 days)- bilirubin is removed from the body by being incorporated into feces- sooner the elimination the sooner it is removed.

41

phototherapy as treatment of hyperbilirubinemia.

Phototherapy- exposure to light triggers liver to assume function. Infant is exposed to liht such as quartz halogen, cool white daylight, or special blue fluorescent light. Placed 12-30 in above newborns bassinet or incubator. Generally scheduled for phototherapy when the total serum bilirub level rises to 10-12 mg/dl at 24 hours of age preterm is lower than this. Might admin iV immunoglobulin with phototherapy. Infants eyes are covered cause exposure to retina is damaging. Cover with dressing or cotton balls over a mask. Stools will be bright green and loose urine may be dark fro urobilinogen formation.

42

What are normal total serum bilirubin (TsB) levels? What TsB level becomes dangerous?

Normal I think? Is 0-3mg/100ml in cord blod? It is dangerous if it rises above 20mg/dl or as low as 12mg/dl in term infants

43

Why does hemorrhagic disease of the newborn happen?

What medication is given to newborns to prevent this condition?

Results from a def of vit k . vit essential for formation of prothrombin by the liver. Lack of causes impaired blood coagulation. Formed by action of bacteria in the intestine but babys intestine is sterile at birth w minimal amonts of vit k until normal flora is established. Admin vit k to mom often protexts newborn.

Give 1mg of vit K IM to baby

44

What is NEC (Necrotizing Enterocolitis)?

Intestinal dysfunction that develops in 5% of infants in ICY nurseries. The bowel develops nectroic patches interfering with digestion and possibly leading paralytic ileus, perforation and peritonitis. Occurs bc of anoxia to the bowel and may result as a complication of exchange transfusion or an episode of dyspnea.

45

cause of retinopathy of prematurity

Caused by vasoconstriction of immature retinal blood vessels. Happens bc of high conc of oxygen exposure and vessels constrict, endothelial cells in the periphery of the retina proliferate causing retinal detachment and possible blindness