maternity- FOCUS: postpartum & neonatal complications Flashcards

Question

PPH evaluation ??

Answer 1

• How much blood was lost (EBL)? • Is the patient well oxygenated, perfused, are they short of breath on exertion? Are VS within normal limits? • Did your nursing care allow for rest, successful feeding? • Do the family understand the increased needs for iron rich foods, rest, and support in general? • Does the family know the signs and symptoms of PPD and who to contact if they are concerned? Has the mother had her need for rest and sleep protected while receiving nursing care? If not, what needs to be done now and what needs to change?

Answer 2

- most often caused by streptocci and anaerobic organisms | - ex. endometritis, UTI, resp infections

Answer 3

- >24 ROM - Retained POC - PPH -Pre-existing anemia -Prolonged labour - Use of instruments - Internal fetal monitoring -repeated vaginal exams - ++ manual exploration of uterus after delivery -Unsterilized equipment and gloves - Improper or no pericare after delivery § Use squirt bottle and change pad frequently - Poor handwashing - Shared supplies between patients -Cleaning between patients limited or poorly done -Bedding soiled (think PV losses, moisture, feet in the bed, guests on the bed)

Answer 4

- signs vary as per infection - assessments: uterine pain, malaise, foul smelling lochia, fever, increased PV losses, discolored lochia, usually starting 3-4 days after delivery, WBC count, erythema, edema, swelling at site of C section or tear in perineal area

Answer 5

o 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 o Education is important aspect Know postpartum triggers that could causes psych disorders

Answer 6

- superficial venous thrombus - deep venous thrombus - pulmonary embolism

Answer 7

-venous stasis, extra volume and weight, caesarian, trauma, varicose veins, history of VT, diabetes, multiparidy, increased maternal age, obesity, cigarette smoke

Answer 8

- warmness, red enlarged veins calf tenderness and swelling with pain - dyspnea, chest pain, tachycardia, apprehension for PE

Answer 9

encourage early movement fluids compression stockings, elevated legs blood work

Answer 10

- New normal - ADPIE for high risk newborns with a focus on prematurity and macrosomia - Common infection and health promotion strategies Foci of Nursing Care • Respirations and Extrauterine Circulation o How does fetus transition to external world • Temperature • Fluids and Electrolytes • Nutrition and Waste • Preventing Infection • Bonding and Attachment • Assessments are extremely important

Answer 11

* Ineffective airway clearance r/t the presence of mucous or amniotic fluid in the airway * Ineffective tissue oxygenation r/t breathing difficulty * Ineffective thermoregulation r/t immature status * Risk for deficient fluid volume r/t insensible water loss * Risk for imbalanced nutrition, less than body requirements r/t the lack of strength for effective sucking * Risk for infection r/t lowered immune response due prematurity * Risk for impaired parenting r/t illness in newborn at birth * Deficient diversional activity (lack of stimulation) r/t to illness at birth * Readiness for developmental care to decrease overstimulation easily caused by necessary lifesaving procedures

Answer 12

• Review the pregnancy, labor, and birth history and consider what effects these might have on the infant. o Review maternal history for illnesses, bloodwork, risk factors (GBS, TORCH infections, smoking, substance use, HIV, Hepatitis B, gestational diabetes). o Review the APGAR. What can it tell you? § Done at 1, 5 and 10 min § Heart rate, tone, reflex and resp effort • Know the norms for VS and fetal development/gestational age. • Perform a physical assessment. • Include a review of the feeding and elimination patterns. Assessing The Birth History · C/S vs. Vaginal · Long vs. Rapid · Use of forceps or vacuum · Fetal size and maturity · Environment · Need for resuscitation VS normal • Respirations 30-60 • Temperature 36.5-37.2 C axilla • Pulse 110-160 Sugars • Done on babies who are too large or too small • 3.2-6 Respirations • Normal rate going • We should not see ‘see-saw’ respirations, intercostal indrawing, xiphoid retractions, flared nares, or grunting! Gestational Age • Resting Posture • Recoil of Extremities • Extremities • Sole (Plantar) Creases • Breast Tissue

Answer 13

• Healthy infants will simply need to be rubbed dry and kept warm. They sometimes need suctioning, but we try to keep a “hands off” approach. • High risk infants struggle with this first critical step in life. • APGAR scores – lower the number the more support baby needs Fetal to neonatal circulation - Changes occur when baby exits mother - Watch video relating on D2L Factors leading to respiratory distress in preterm infants • One or more signs of increased effort and breathing o Tachypnea, nasal flaring, chest retraction, grunting • Decreased 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

Answer 14

- Assess for signs of rep distress - Ongoing assessment every 30 min for first 2 hours of life - Suction if necessary - Resp rate counted for full minute - Temp checks - Fluid status - Oxygen and 02 sat Nutritional support, glucose testing

Answer 15

• Prevent Heat Loss o Convection, Radiation, Conduction, Evaporation • Remove wet linens, and place Skin to Skin if healthy • Incubators, dry linen, plastic wrap, warmed stethoscopes, warmed beds Fluids and Electrolytes • Assess anterior fontanel, urine and feces, feeding, acidosis at birth • Query blood loss from placenta previa or abruptio? • Insensible losses from increased respiratory efforts (RR) • Consider the impact of radiant warmers, incubators, skin to skin and over bundling • Remember that neonates have decreased circulatory blood volumes and that dehydration or FVD can happen very easily, even 15 mL blood loss is significant • Frail or sickly infants are not able to restore fluid losses through eating, kidneys are very immature and have difficulty concentrating urine Conversely, FVE can happen very quickly with an IV, and result in a return to fetal circulation (opening of ductus arteri

Answer 16

-healthy--> baby needs to be able to eat and suck -high risk: premature--> need more calories, suck might take more to get going -macrosomia--> blood sugars, get enough food -infection BREAST MILK= high protein and rich in fat

Answer 17

• Babies born to GD mothers are used to a high level of glucose coming to them • The baby produces high levels of insulin to cope with the high sugars • After birth the sugar “supply” is cut off, but insulin persists in the body for several hours, causing neonatal blood sugars to drop to low levels • Nursing care of these babies centers on frequent BS checks and ensuring adequate intake. Supplementation with formula is usually necessary until breastmilk supply is established o Milk usually comes in day 3 or 4 Babies need to suck at breast for milk to come in

Answer 18

in the SCN due to their unstable status (tendency to low blood sugars and respiratory distress) Macrosomia and Respiratory Distress · The workload of supplying a large body mass with oxygenated blood is can prove too much for baby’s lungs and heart. · Additionally, a newborn may not feed well in the first hours of life, worsening the risk for low sugars. Low BS contribute to acidosis and impede his respiratory function. · Macrosomic babies in distress need 1:1 nursing care for their unstable status in the SCN · Macrosomic babies are supported with frequent BS monitoring, supplemental feeds, possible IV, and oxygen Preventing Infection · Compromised or immature immune systems · Moms with group B streptococci can infect neonates in utero-meningitis · Breastmilk has immunologic properties · Strict infection control and visiting policies

Answer 19

* Nursing care supports bonding and attachment no matter what the circumstances. * Parents are enabled to be partners in care, no matter how complex the infant’s condition. * Babies are encouraged to be skin to skin and spend time with parents. * Babies in the nursery do suffer, but when we allow for attachment, bonding, and contact with the mother (parents), they do better.

Answer 20

``` - Various symptoms · Irritability · Disturbed sleep pattern · Constant movement, tremors · Frequent sneezing · Shrill, high-pitched cry · Possible hyperreflexia and clonus · Convulsions · Tachypnea Vomiting and diarrhea ```

Answer 21

• Consider teamwork, collaboration, and informatics when preparing a family for discharge after they have experienced a maternal or neonatal complication. Top “Take Homes” and Summary • ABC problems always take priority in moms and babies • Thermoregulation and blood sugars influence ABC status • All babies (healthy and high-risk) are cared for with a focus on respirations and circulation, temperature, fluids etc. but high risk babies often develop problems in these areas • Preterm, postterm, macrosomia(LGA), SGA, or neonatal infections place babies in a high-risk category: unstable • Know hyperbilirubinemia, meconium aspiration syndrome, transient tachypnea of the newborn, definitions of preterm, macrosomia (LGA)

maternity- FOCUS: postpartum & neonatal complications Flashcards

(45 cards)