OB exam 3 Flashcards
(163 cards)
1
Q
What is it called when the uterus returns to its normal size?
A
uterine involution
2
Q
Where should the fundus be on the day of birth
A
at the level of the umbilicus
3
Q
How fast does the uterus go back down
A
1 cm every 24 hours
4
Q
if the client is 3 days pp, where would the fundus be palpable
A
3 cm below umbilicus
5
Q
When the uterus fails to return to its non pregnant state, what is this called
A
subinvolution
6
Q
what keeps the uterus from returning to its nonpregnant state
A
retained placental fragments, infection
7
Q
is subinvolution noticed right after birth
A
NO
8
Q
What stops the bleedings after birth
A
compression of the blood vessels from uterine contraction
9
Q
What hormone stimulates uterine contractions
A
oxytocin
10
Q
What may make afterpains worse
A
breastfeeding
11
Q
Why does breastfeeding make afterpains worse
A
causes a release of oxytocin, which stimulates uterine contractions more
12
Q
What are the stages of lochia
A
1: Rubra
2: Serosa
3: Alba
13
Q
what is the rubra stage of lochia? how long does it last?
A
heavy period, red, that lasts the first 3-4 days
small clots
14
Q
what is the serosa stage of lochia? How long does it last?
A
pink or brownish
Old blood, serum, WBC, and debris
usually lasts 10-14 days
15
Q
what is the alba stage of lochia? how long does it last?
A
white, mostly white blood cells that lasts up to 2 months, may be mistaken for yeast so educate (should not have a foul smell)
16
Q
How to know if lochia is a normal amount?
A
clots the size of a dime is normal
17
Q
Amounts of lochia
A
scant
light
moderate
heavy
18
Q
what is too much lochia
A
more than 1 full saturated pad in an hour
19
Q
What area is the most trauma located pp
A
the perineum
20
Q
What do we do for normal perineal swelling
A
ice
21
Q
how long does it take for an episiotomy to heal?
A
4-6 months
22
Q
Hormones drop suddenly, what happens:
A
reverse of GD
type 1 DM require less insulin
low estrogen = diuresis
menopause symptoms
23
Q
non lactating women can ovulate as soon as 4 weeks postpartum
A
they can get pregnant
24
Q
What happens to the bladder after pregnancy
A
decreased sensation
25
Diruesis occurs within 12 hours of birth, what does this place the pt at risk for
URINARY RETENTION
26
Bladder distention can cause
excessive bleeding because it displaced the uterus
27
What is the normal expected blood loss
250-500 ml Vaginal
500-100 ml C section
(above these indicates hemorrhage)
28
What happens to vital signs after birth
return to normal but may have some orthostatic hypotension
29
What does an elevated pulse indicate postpartum
impending shock
30
What vital sign may we need to watch with opioid or anesthesia
respirations
31
what happens with temperature postpartum
elevation over 100.4 is not uncommon in the 1st 24 hours
after first 24 hours, should not be >100.4 (infection)
32
What changed in the blood PP
WBC count is elevated for 4-7 days
20,000-30,000
33
what happens to coagulation factors pp
they go back down after about 3 weeks
34
what does the increase in fibrogen after birth put the mom at risk for
thromboembolism
35
When caring for a postpartum c section, what reduces the risk for DVT?
apply SCD in bed
administer heparin if ordered
inspect the lower extremities for heat, redness, or swelling at least once per day
36
What do we do for suspected DVT?
do not massage the legs
d dimer and venous duplex ultrasound
don't have the pt walking around until evaluated
37
What is diastasis recti
gap in muscles above the umbilicus gets bigger
38
The immune system reboots after pregnancy, this causes...
flare ups of autoimmune disorders
39
What blood type is concerning from mom and baby
mom rh -
baby rh +
40
what do we give to mom with Rh - and baby with Rh +
rhogam within 72 hours of birth to be most effective
41
no woman should be discharged until:
recovered from anesthesia
hemodynamically stable
no excessive bleeding
42
routine pp labs
H/H
Rh blood type
rubella immunity
43
most common cause of excessive bleeding
uterine atony
44
what is the actions for boggy fundus
massage the fundus, empty the bladder, administer oxytocin
45
what are signs of hypovolemic shock
pad saturated less than an hour, feel funny, nausea, see stars
tachycardia at first
hypotension later
46
what are the interventions for hypovolemic shock
FIRST- assess and massage the uterus
call for help
uterotonic med
indwelling catheter
VS
admins oxygen, HOB down
blood products
47
What statement indicates kegels are done correctly
i pretend that i am trying to stop the flow of urine midstream
48
if we are getting a patient up to go to the bathroom what would be the most concerning
i feel dizzy
49
if a patient is dizzy, what do we assess first
fundus and amount of bleeding
50
if the fundus is boggy and right of the midline, with steady red bleeding, what actions should we do
massage the uterus
catheterize bladder
notify charge nurse
51
TdaP explanation post birth
Pertussis, or whooping cough, is a severe infection for a newborn, and newborns can't be vaccinated. This vaccine will keep you from giving pertussis to your baby
52
Danger signs at home pp
fever chills, foul vaginal odor, abdominal pain, heavy bleeding, pp depression, no sex until healed after checkup
53
when should moms follow-up be
3 weeks for vaginal birth, and then at 3 months
54
when should baby's follow-up be
within 48 hours of discharge
55
What is EBL criteria in pp hemorrhage with c section
100ml and more
56
what is the EBL criteria for a pp hemorrhage with a vaginal delivery
greater than 500 ml
57
actions for postpartum hemorrhage
palpate and massage fundus until firm
make sure clots are out
empty the bladder
administer oxytocin
replace fluids
flat or trendelenburg
58
What meds can be used to make the uterus contract to stop the bleeding?
oxytocin
methylergonovine
misoprostol
carboprost tromethamine
59
what should we monitor for with oxytocin
water intoxication
60
what is water intoxication a risk with oxytocin
similar to ADH
61
what is the mechanism of action of oxytocin
stimulates uterus to intermittently contract
62
what is the risk with misoprostol
can cause diarrhea and fever
63
what is the mechanism of misoprostol
prostaglandin that contracts the uterus
64
what does methylergonovine do to the uterus
causes tonic contraction, which means it clamps down and stays that way
65
what is the risk with methylergonovine
hypertension because it is a systemic vasoconstrictor
66
what is carboprost tromethamine used for
contracts the uterus and blood vessels
67
what are the side effects of carboprost tromethamine
causes fever, nausea, diarrhea, chills and hypertension
68
with what patient should carboprost methylergonovine be avoided with
patients with asthma or pre existing hypertension
69
what medications can cause postpartum hemorrhage
oxytocin and magnesium sulfate
70
why does oxytocin cause postpartum hemorrhage
receptors become desensitized if it is a long induced labor with pitocin
71
Pt states "I don't know what happened, it all just came when I stood up. I am so dizzy and lightheaded." What do you assess?
72
Risk factors for postpartum hemmorrhage
long or short labor
big baby
induced with pitocin
more than 5 pregnancies
over distended uterus
traumatic birth
magnesium sulfate
uterine infection
previous pregnancy with uterine atony
73
What are the coagulopathies that can cause postpartum hemorrhage?
idiopathic thrombocytopenia purpura
von Wiledbrans disease- hemophilia
DIC
74
What are signs of thromboembolic disease
unilateral leg pain, swelling, warmth
75
What is the biggest concern with a DVT
development of a pulmonary embolism
76
what are signs of a pulmonary embolism
sudden dyspnea, chest pain, tachypnea, tachycardia, syncope, cough
77
what do we do if we suspect a pulmonary embolism
call a code
administer oxygen and fluids
heparin administration
78
what are labs to confirm thromboembolic disease
PT/PTT, fibrogen, d-dimer
79
prevention of DVT
early ambulation, do not massage the leg
80
what are risk factors for dvt
c section, history of clots, obesity, c section, sedentary
81
What are the signs of endometritis
high fever, chill, severe uterine tenderness
82
if we suspect endometritis, what is our first action
palpate the uterus for tenderness- want to make sure that is where the infection is
83
what is the treatment for endometritis
pain management and antibiotics
84
What are signs of infection in the c section incision site?
swelling, purulent discharge, increased pain
85
What are the first signs of mastitis
flu like symptoms
86
What is the management of mastitis
empty the breasts, frequent feedings, pain management, warm soaks, rest, safe abx if needed
87
What is the first thing to evaluate with postpartum depression
safety of the mom and baby
88
What are baby blues compared to postpartum depression
usually self limiting, go away on their own in 10 days or so
89
what is the treatment for baby blue
rest, support, reassurance, understanding
90
what is the symptoms of postpartum depression
persistent symptoms for more than 2 weeks for up to 6 months after birth, irritability, anger, somatic syndrome, change in baseline, social withdrawal, does not go away on its own
91
What are the red flags for postpartum psychosis
hallucinations, delusions, thoughts to harm self or baby -- need hospitalization and do not leave alone
92
when to initiate breastfeeding
initiate within an hour
avoid any supplemental feedings
avoid artificial nipples -- wears baby out with pacifier and then don't want to eat
93
how to know if baby is getting enough milk
output - # of wet diapers
94
if mom is having pain with breastfeeding, what is the first thing we check
check the latch -- the nipple should be towards the top of the mouth
95
should the mom make a time limit for the baby who is breastfeeding
no, allow on one side until stop, then burp, then the other side
96
what is the dark milk made during pregnancy and the first few days after birth
colostrum -- has great immunological properties
97
how often do newborns feed
ever 1-3 hours, 10-12 times per day
98
how many wet diapers should there be
minimum of wet diapers as days old
99
What 4 things should the nurse ask as they enter the birthing room
full term baby?
GBS status, meconium fluid
trauma during birth
maternal pain meds- opioids
fetal monitor status
100
what is needed to open the alevoli
surfactant and positive pressure
101
if you could only choose one item to have with known fetal distress, which would you chose and why
positive pressure ventilation bag and mask -- pop those alveoli open to help take that first breath
102
How do you use a bulb syringe
suction the mouth and then each nose- babies nose breath so we want to clear the secretions closest to their lungs first
103
what are the four different types of heat loss
radiation
convection
conduction
evaporation
104
what is radiation heat loss and how do we prevent it
loss of heat from body to cooler solid surface in proximity, keep the baby away from the cold window
105
what is convection heat loss and how do we prevent it
loss of heat from the body to cooler room air, keep the temperature of the room up and avoid drafts
106
what is conduction heat loss and how do we prevent it
loss of body heat to touching a colder surface, skin to skin with mom, preheat radiant warmer, warm blankets
107
what is evaporation heat loss and how do we prevent it
loss of heat when liquid on the body evaporates, dry the baby off
108
How to check the heart rate when they are fresh out
listen over the left chest for 6 seconds and multiply by 10 -- we want a quick HR because it is changing so rapidly
109
central cyanosis
not normal
110
acrocyanosis
normal
111
what should we do to prevent low blood sugar in newborn
initiate feedings during the first hour
112
what is physiologic jaundice
appears after the first 24 hours of life
resolves without treatment
bilirubin decreases between 4-10 days
113
what causes physiologic jaundice
immature liver
extra RBC
114
what is pathologic jaundice
appears in the first 24 hours
115
what causes pathologic jaundice
maternal NB blood incompatability
sepsis
trauma
liver disease
116
kernicterus
long term irreversible neuro changes from the neurotoxic high bilirubin levels in pathologic jaundice
117
A mother asks what the erythromycin is for, how would you best explain this medicine and how it will feel to the baby?
It is an oil based drop that goes in the eye to prevent any infections from bacteria, it does not hurt or burn the eyes but it may make their vision blurry for a little while
118
Why is vitamin k given to newborns
vitamin k is given so it can go to the newborns liver in order to make clotting factors, before birth, the newborn gets their vitamin k from mom, as adults we get it from our gut microbiome and a baby's bowel is sterile, a few days after birth, they will begin to make their own vitamin k
119
what are risk factors for pathologic jaundice
dehydration, H/H high
120
how to prevent pathologic jaundice
feeding (prevent dehydration, early BM to get rid of meconium - which has a high amount of bilirubin)
121
how is jaundice treated
phototherapy -- light breaks down the bilirubin to be excreted
keep their eyes covered
122
what are the 4 newborn screenings
universal newborn screen
jaundice
newborn hearing
congenital heart defect
123
what to do before a heal stick for a PKU
warm the heal up
124
where to do a heal stick
to the side of the heal, not the center (where there are lots of nerve endings)
125
what should we do before giving the baby a hep b vaccine
give the parent the info packet and get informed consent
126
if baby hasn't been bathed yet, what should the nurse do prior to handling them
don gloves -- amniotic fluid carried bloodborne pathogens
127
what is another name for aquamephyton
vitamin k
128
how to care for a jittery baby
initiate feeds, usually because of hypoglycemia -- baby may also be irritable, sleepy, with a high pitch cry
129
how should the nurse care for the baby post circumcision
treat pain, monitor bleeding, make sure baby is peeing (check swelling), keep it clean, visually check diaper ever 15 minutes for bleeding
130
how to care for the umbilical cord
no full baths until it falls off, keep it dry, fold the diaper down below it
131
132
what are common causes of SGA IUGR
lack oxygen, maternal hypertension, maternal diabetes, genetic anomaly, maternal drug use
133
what is the highest risk of SGA
stillbirth
134
What are the common complications with maternal diabetes that affect the nb
macrosomia
birth injuries
hypoglycemia
congenital anomalies (sugar is toxic)
RDS- late surfactant
135
How do we manage a newborn from a mom with gestational DM
initiate feedings
monitor blood glucose 24-28 hours
136
what do we want the blood glucose in a nb to be
at least 45
137
what are the 2 common complications of shoulder dystocia
fractured clavicle
peripheral nerve injury
138
what is the first sign of a peripheral nerve injury
arm is limp at birth
139
what do we do for a fractured clavicle
immobilize the arm, prevent pain, allow it to heal
140
What do we do if the amniotic fluid is green?
make sure the pt is on the fetal monitor
141
Who do we need present at the birth of suspected MAS?
pediatric provider that can intubate pt if they are not crying, use the endotracheal tube to suction the airways out
142
what is the nursing management of meconium aspiration syndrome
chest pt, suctioning, abx, monitor for chemical pneumonia -- irritating substance can cause plugs that lead to partial lung collapse
143
What is early onset sepsis in newborn?
water bag broke and bacteria gets in, goes in baby's mouth and system
within 24-48 hours
rapid progression- been immersed in bacteria
organisms present in mom's system- GBS
144
what babies are at risk for early onset sepsis
preterm
PROM -- more than 12-24 hours
maternal fever -- sign of infection
145
What causes late onset sepsis
infection after birth from environment
first 7-30 days of life
146
What is the #1 way to prevent late onset sepsis
hand washing
147
What are the common signs of newborn sepsis
lethargy, not very active, sleep, don't wake up to eat, low muscle tone, poor feeding, mottling (as progressing), irritability, cannot maintain temp, blood sugar goes down
148
what lab test do we monitor for newborn sepsis
new immature WBC (WBC count in general goes up from the stress of birth, but are the new)
stool
urine
CSF
149
What do we do for treatment of newborn sepsis
IV abx (do not wait on cultures)
initiate breastfeeding ASAP
150
What are more risks beyond withdrawal with illicit or injected drugs?
bloodborne infections (hepatitis, HIV)
blood pressure -- stoke in mom and baby
151
What scoring is done on NAS babies
finnegan scoring
152
What are presenting symptoms of NAS
neuro: seizures, high pitch cry, tremors, hypertonic muscles
GI: poor feeding, diarrhea, vomiting (projectile) -- may act like starving and are sucking so hard, they collapse the nipple of the bottle
skin: excoriations (tremor), diaper rash (diarrhea)
nasal stuffiness, sneezing, tachypnea
153
How do we know for sure baby has been exposed to drugs
newborn urine
hair- longterm
meconium sample- longterm
cord stat- take piece of umbilical cord
154
What is important about the toxicology screen
maintain chain of custody with sample
must be under lock and key
sign them over to person receiving them
155
what are common signs of fetal alcohol syndrome
small head size (microencephaly)
thin upper lip
small eyes
flat midface (bridge of nose is flattened)
156
What is used for treatment of NAS
morphine for severe symptoms -- vomiting crying, loosing weight
tapered as the finnegan score goes down
157
what are non pharmacological methods to treat NAS
avoid overstimulation, special skin care (excoriations), rhythmic motions, low lights and alarms, tight swaddling
BUILD CAREGIVER RELATIONSHIP
158
What does blood incompatability in the mom and fetus eventually lead to
mom's antibodies destroys fetal RBC
causes severe anemia which causes the heart to speed up to compensate which leads to heart failure
hyperbilirubinemia
159
erythromytosis fatalis
with the first baby, the mom becomes sensitized to the antibodies but it doesn't really affect anything because the baby is born, but with the second pregnancy, we may have an issuee
160
prevention and treatment of newborn maternal blood incompatability
administer RhoGAM within 72 hours of birth, amniocentesis, trauma to belly, car accident
161
If blood count is very low in blood incompatibility in the fetus, what treatment is used
exchange transfusions -- high risk
162
What are the 4 signs of NEC
mucous bloody stool, abdominal distention, projectile vomiting
163
What congenital abnormalities are associated with an aspiration risk
tracheoesophageal atresia, cleft palate
