OB Final Flashcards
1
Q
Involution
A
the return of the uterus to a non pregnant state after birth; begins immediately after the expulsion of the placenta with contraction of the uterine smooth muscle.
2
Q
Subinvolution
A
the failure of the uterus to return to a non pregnant state due to ineffective uterine contractions; most common cause is retained placental fragments and infection.
3
Q
About how much does the uterus weigh at the end of the third stage of labor? About how much is the non pregnant weight?
A
approximately 1000 g
approximately 100 g
4
Q
About how long does it take the uterus to return to its prepregnancy size and weight?
A
4 weeks postpartum
5
Q
About how fast is the progression of involution?
A
Involution progresses rapidly during the days following birth. The fundus descends 1 to 2 cm every 24 hours.
6
Q
How long does it take for the endometrium to regenerate after birth?
A
Endometrial regeneration begins within 3 days after birth and is completed by the third week.
7
Q
How long does it take for the placental site to regenerate after birth?
A
Regeneration at the placental site is complete by the sixth week.
8
Q
What is the appearance and contents of rubra lochia and at what time after birth is it expected?
A
Appearance: bright red
Contents: blood from placental site; trophoblastic tissue debris, vernix, lanugo, meconium.
Timing: 1-3 days after birth
9
Q
What is the appearance and contents of serosa lochia and at what time after birth is it expected?
A
Appearance: pinkish brown
Contents: blood, wound exudate, RBCs, WBCs, trophoblastic tissue debris, cervical mucus, microorganisms.
Timing: 4-10 days after birth
10
Q
What is the appearance and contents of alba lochia and at what time after birth is it expected?
A
Appearance: whitish-yellow
Contents: WBCs, trophoblastic tissue debris
Timing: 10-14 days after birth (can last 3-6 weeks)
11
Q
How long can it take supportive tissues of the pelvic floor that are torn or stretched during birth to regain tone?
A
up to 6 months
12
Q
What does the hormone prolactin do?
A
stimulates milk production
13
Q
When does prolactin decrease in non-lactating women?
A
3 weeks postpartum
14
Q
When does ovulation occur again postpartum in non-lactating women?
A
27 days after birth
15
Q
When does ovulation occur again postpartum in lactating women?
A
70-75 days after birth
16
Q
What can cause bladder distention after birth?
A
decreased voiding combined with postpartal diuresis (increased production of urine) can result in bladder distention.
17
Q
What problem is associated with bladder distention after birth?
A
excessive bleeding because it pushes the uterus up and to the side and prevents it from contracting firmly.
18
Q
With adequate bladder emptying, about how long does it take for bladder tone to be restored after birth?
A
5-7 days
19
Q
stress incontinence
A
unintentional loss of urine
20
Q
About how long does it take to have a BM after birth?
A
2-3 days
21
Q
When can colostrum be expressed from the breasts?
A
During the first 24 hours after birth
22
Q
About how long does it take for the colostrum to transition to breast milk?
A
72 to 96 hours
23
Q
What are normal changes that can be noted in vital signs after birth?
A
Temp: increase to 100.4
Pulse: elevated for the first hour then gradually decreases over the first 48 hours postpartum; Puerperal bradycardia is common.
Respirations: normal
Blood pressure: can show a transient increase over the first few days after birth
24
Q
What sign might indicate gestational hypertension or preeclampsia?
A
two blood pressure readings of >140/90 at least 4 hours apart
25
What might be some causes of headaches after birth within the first postpartum week?
preeclampsia, stress, cerebrospinal fluid leakage into extradural space from epidural placement.
26
Melasma persists in about what percentage of women after birth?
30%
27
Which vital sign deviates from the normal reading as a result of sepsis?
a. Temperature
b. Respirations
c. Blood pressure (BP)
d. Pulse
a. Temperature
A Correct: A diagnosis of puerperal sepsis is suggested if a rise in maternal temperature to 38° C is noted after the first 24 hours after childbirth and recurs or persists for 2 days. Other possible causes are mastitis, endometritis, and urinary tract or other systemic infections.
B Incorrect: Hypoventilation may follow an unusually high spinal block or epidural narcotic after cesarean birth.
C Incorrect: A low or decreasing BP may reflect hypovolemia secondary to hemorrhage. An increased reading may result from excessive use of vasopressor or oxytocic medications.
D Incorrect: A rapid pulse rate or one that is increasing may indicate hypovolemia as a result of hemorrhage.
28
Newborns and Mothers Health Protection Act of 1996 provides for lengths of stay of up to how long?
96 hours
29
What is the average length of stay for a vaginal delivery?
48 hours
30
What is the average length of stay for a cesarean delivery?
96 hours
31
What do nursing interventions for a postpartum woman focus on in regards to bladder distention?
helping the woman empty her bladder spontaneously as soon as possible.
32
When is the ideal time to initiate breastfeeding?
within the first 1 to 2 hours after birth.
33
What vaccines are suggested for postpartum women if they have not had them previously?
Rubella
Varicella
Tdap
Rh imune globulin
34
When is Rhogam given?
within 72 hours after birth prior to discharge
35
What is the dosage of Rhogam given?
300 mcg IM
36
What does Rhogam do?
prevents sensitization in the Rh-negative woman who has had a fetomaternal transfusion of Rh-positive fetal red blood cells; promotes lysis of fetal Rh-postiive blood cells before the mother forms her own antibodies against them.
37
Postpartum fatigue (PPF) is more than just feeling tired; it is a complex phenomenon affected by a combination of physiologic, psychologic, and situational variables. Which of these is not a contributing factor to PPF?
a. Long labor or cesarean birth
b. Infant care demands
c. Social isolation due to lack of visitors
d. Anemia or infection
c.Social isolation due to lack of visitors
A Incorrect: Physical fatigue or exhaustion may be associated with long labors or cesarean births.
B Incorrect: Hospital routines and infant care demands such as breastfeeding may contribute to maternal fatigue.
C Correct: Well-intentioned visitors can interrupt periods of rest both in the hospital or at home. Nurses may be asked to limit visitors and phone calls in order for the woman to rest. PPF is recognized as a risk factor for postpartum depression.
D Incorrect: Fatigue is associated with anemia, infection, and thyroid dysfunction.
38
How much blood loss defines a postpartum hemorrhage after a vaginal delivery?
>500mL
39
How much blood loss defines a postpartum hemorrhage after a cesarean delivery?
>1000mL
40
How is early postpartum hemorrhage classified?
occurs within 24 hours of the birth
41
How is late postpartum hemorrhage classified?
occurs more than 24 hours but less than 6 weeks after the birth
42
subinvolution
a medical condition in which after childbirth, the uterus does not return to its normal size.
43
How is subinvolution treated?
It depends on the cause. Ergotrate or Methergine is often recommended; Dilation and curettage may be performed to remove retained placental fragments or debride the placental site; Antibiotic therapy may be needed if the cause is infection.
44
What is the most common cause of late postpartum hemorrhage?
subinvolution - delayed return of the enlarged uterus to non pregnant size and function
45
What is the most common cause of early postpartum hemorrhage?
uterine atony
46
What factors put you at the highest risk of uterine atony?
preeclampsia and on mag
47
What conditions are associated with uterine atony?
```
high parity
polyhydramnios
fetal macrosomia
obesity
multiple gestations
```
48
retained placenta
When the placenta has not been expelled within 30 minutes after birth despite an upright posture of the woman, gently traction on the umbilical cord, and uterine massage.
49
How is a non adherent retained placenta treated?
Manual evacuation by nurse-midwife or physician
50
What do tocolytics accomplish?
relaxation of the uterus
51
What is the cause of an adherent retained placenta?
Placenta accreta - slight penetration of the myometrium
Placenta increta - deep penetration of myometrium
Placenta percreta - Perforation of myometrium and uterine serosa, possibly involving adjacent organs
52
What are some causes of lacerations of genital tract during labor and birth?
* Operative birth (use of forceps or vacuum)
* Precipitous or rapid birth
* Congenital abnormalities of maternal soft tissue & contracted pelvis
* Abnormal fetal presentation
* Previous scarring from infection, injury or operation
53
Inversion of the uterus
turning inside out of the uterus after birth
54
What are the two most likely causes of uterine inversion?
excessive umbilical cord traction with a fundally attached placenta and fundal pressure in the setting of a relaxed uterus.
55
What medications are used to treat postpartum hemorrhage?
Oxytocin - IV infusion of 10 to 40 units of oxytocin added to 1000 mL IV fluid
Methergine - IM, intrauterine, orally
Hemabate - IM or intrauterine injection
56
What is the incidence of Venous thromboembolic disorders in pregnancies?
1 in 1500
57
What is the major cause of venous thromboembolic disorders in pregnancies?
venous stasis and hypercoagulation
58
What are the symptoms of superficial venous thrombosis?
pain and tenderness in the lower extremity
59
How is superficial venous thrombosis treated?
with analgesia, support from elastic compression stockings, heat, and rest
60
How is deep vein thrombosis treated?
DVT is initially treated with IV anticoagulant therapy, bed rest with the affected leg elevated, and analgesia.
61
What does nursing care of the woman with a thrombosis consist of?
ongoing assessments: inspecting and palpating the affected area; palpating the peripheral pulses; checking the Homans sign; and measuring and comparing leg circumferences.
62
postpartum infection (puerperal infection)
any clinical infection of the genital tract that occurs within 28 days after miscarriage, induced abortion, or birth.
63
What is postpartum infection defined by? (what symptom?)
the presence of a fever of 38 degrees celsius (100.4 F) or more on 2 successive days of the first 10 postpartum days (not including the first 24 house after birth).
64
A physician orders methylergonovine (Methergine) 0.2 mg IM for a postpartum client. Which intervention should the nurse take prior to administering this medication?
a. Obtain the client’s blood pressure (BP).
b. Determine the client’s blood glucose level.
c. Take the client’s pulse.
d. Have the client empty her bladder.
a.Obtain the client’s blood pressure (BP).
A Correct: Prior to administering Methergine, the nurse must check the client’s BP. If the BP is greater than 140/90 mm Hg, the medication should not be given. In either case, the nurse must continue careful monitoring of vaginal bleeding and uterine tone.
B Incorrect: Methergine promotes contraction of the uterus. Obtaining a blood glucose level is irrelevant in this situation and not necessary.
C Incorrect: Although the pulse is an important vital sign, the nurse’s first intervention prior to giving Methergine should be to obtain a BP reading.
D Incorrect: Having the client empty her bladder prior to administering Methergine is not necessary.
65
What are some parental behaviors that facilitate infant attachment?
- Claims infant, names infant
- Expresses pride in infant
- Hovers, maintains proximity, directs attention
- Looks/gazes, assumes en face position
66
Why is early contact between parents and infant important?
it can facilitate the attachment process between parent and child.
67
What does early skin-to-skin contact between the mother and newborn immediately after birth and during the first hour facilitate?
maternal affectionate and connective behaviors; promotes early and effective breastfeeding.
68
What are Mercer and Walker's (2006) four stages in the process of becoming a mother?
1. commitment, connection to the unborn baby, and preparation for delivery and motherhood during pregnancy.
2. acquaintance to the infant, learning to care for the infant, and physical restoration during the first 2 to 6 weeks following birth
3. moving toward a new normal
4. Achievement of a maternal identity through redefining self to incorporate motherhood (around 4 months)
69
About how many women experience some degree of postpartum blues ("baby blues")?
approximately 50% to 80% of women of all ethnic and racial groups.
70
When do postpartum blues tend to peak? subside?
they peak around the 5th day and subside by the 10th day
71
What are some self management tips for postpartum blues?
–Blues are normal, both parents can experience
–Rest, nap when baby does
–Use relaxation techniques like from birthing class or mediation
–Do something for yourself
–Plan a day out, or go out for walks w/baby
–Talk to partner about feelings
–Seek out community resources
72
What is included in the infant's behavioral repertoire?
gazing
vocalizing
facial expression
body gestures (movements)
73
What is included in the parent's behavioral repertoire?
interactive behavior such as constantly looking at the infant and noting the response.
74
What do behavioral repertoires in infants and parents facilitate?
interactions
75
How can an adolescent mother be supported?
through demonstration of infant care, bathing, feeding, etc.
76
What influences the feelings, reactions, and responses of new grandparents?
the circumstances around the pregnancy
77
Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. What should the nurse do?
a. -Assist the woman with initiating breastfeeding and remain with her as long as necessary.
b. Recognize this as behavior of the taking-hold stage.
c. Record the behavior as ineffective maternal-newborn attachment.
d. Take the baby back to the nursery, reassuring the woman that her rest is a priority at this time.
a.-Assist the woman with initiating breastfeeding and remain with her as long as necessary.
A Correct: This new mother is in the dependent or taking-in phase. She needs to rely on others to meet her needs for comfort and nourishment of her infant. By assisting the mother with lactation and remaining close by, the nurse is nurturing the mother and fostering optimal care of the newborn.
B Incorrect: This behavior describes that of the taking-in phase, which occurs during the first 24 hours. The woman’s focus remains on herself and she relies on others to meet her basic needs.
C Incorrect: The behavior described is typical of the taking-in stage and not evidence of ineffective maternal-newborn attachment.
D Incorrect: Removing the infant to the nursery is unlikely to provide the mother with more rest than if the infant remains in her room. During this phase, the client has a strong desire to review her birth experience. This can easily be done if the nurse remains close by.
78
How long do doctors have to do their initial newborn assessment (physical)?
24 hours
79
When should an infant have their first void?
within 24 hours of life
80
If a newborn does not void within 48 hours of life, what might it indicate?
renal impairment
81
What type of assessment do nurses do?
an ongoing shift assessment
82
What are the three stages of newborn transition?
1. first period of reactivity
2. period of decreased responsiveness
3. second period of reactivity
83
What happens during the first period of reactivity and how long does it last?
The infant is alert and active for up to 30 minutes.
- the newborn's heart rate increases rapidly to 160-180 bpm;
- respirations are irregular, with a rate of 60-80 bpm;
- fine crackles can be auscultated and audible grunting, nasal flaring, and retractions of the chest can also be present (but should cease within the first hour)
84
What happens during the period of decreased responsiveness and how long does it last?
The newborn either sleeps or has a marked decrease in motor activity for 60-100 minutes.
- infant is pink with rapid respirations that are shallow but unlabored
85
What happens during the second period of reactivity and how long does it last?
occurs approximately between 2 and 8 hours after birth and lasts from 10 minutes to several hours.
- brief periods of tachycardia and tachypnea occur
- increased muscle tone
- changes in skin color
- mucus production
- passing of meconium
86
What is the most critical adaptation an infant goes through that is necessary for survival?
establishment of effective respirations
87
What should be observed and noted as abnormal in the health assessment of a newborn?
observe for respiration abnormalities; nasal flaring, retraction, grunting, trying to use external muscles to breathe is abnormal
88
What is the average heart rate for a newborn while awake?
120-160 beats per minute
89
What timeframe does the neonatal period include?
the time from birth through day 28 of life.
90
When do neonates attempt to achieve thermal balance?
during the first 12 hours after birth
91
What anatomic and physiologic characteristics place neonates at risk for heat loss?
- thin layer of subcutaneous fat
- blood vessels are close to the surface of the skin
- larger body surface to body weight (mass) ratios than children and adults
92
What test examines the newborn for hip dysplasia?
the Barlow test
93
The nurse is assessing a newborn at 5 hours of age and finds a soft mass over the infant’s occiput. The soft mass crosses the suture line. The nurse documents this finding as which of the following?
a. Subgaleal hemorrhage
b. Caput succedaneum
c. Cephalhematoma
d. Hydrocephalus
b. caput succedaneum
A Incorrect: It is not uncommon to see edematous areas on a newborn’s head after birth. Caput succedaneum and cephalhematoma are seen most often and usually resolve without treatment. A much more serious injury is subgaleal hematoma.
B Correct: Caput succedaneum is a generalized, easily identifiable edematous area of the scalp, most commonly found on the occiput. With vertex presentation, the sustained pressure of the presenting part against the cervix results in compression of local vessels. The slower venous return causes an increase in tissue fluids and edematous swelling. This swelling, present at birth, extends across the suture lines of the skull and disappears spontaneously within 3 to 4 days.
C Incorrect: Cephalhematoma is a collection of blood between a skull bone and its periosteum; therefore, cephalhematoma does not cross a cranial suture line. This can occur simultaneously with a caput succedaneum.
D Incorrect: This presentation is not an indication of hydrocephalus in the newborn.
94
What 5 things does the apgar score test for?
1. heart rate
2. respiratory rate
3. muscle tone
4. reflex irritability
5. generalized skin color
95
What is the normal respiratory rate of a newborn?
30-60 breaths per minute
96
What assessment is the apgar score part of?
the initial assessment after birth
97
What is the normal heart rate for a newborn?
>100
98
What is measured as baseline measurement of physical growth and what are normal ranges?
weight: 2700-4000 g (6-9 lbs)
head circumference: 32.5-37.5 cm (12.5-14.5 in)
body length: 48-53 cm (19-21 in)
99
Appropriate fo gestational age (AGA)
birth weight between the 10th and 90th percentile; the infant can be presumed to have grown at a normal rate regardless of the length of gestation - preterm, term, or postterm.
100
Large for gestational age (LGA)
birth weight >90th percentile; the infant can be presumed to have grown at an accelerated rate during intrauterine life.
101
Small for gestational age (SGA)
birth weight <10th percentile: the infant can be presumed to have grown at a restricted rate during intrauterine life.
102
What is considered to be a "term" birth?
37-40 weeks
103
What are the two most important factors to watch after birth?
respiratory and temperature regulation
104
Why is betamethasone given?
To present or reduce the severity of neonatal respiratory distress syndrome by accelerating lung maturity in fetuses between 24-34 weeks of gestation.
105
What is the action of the drug betamethasone?
It stimulates fetal lung maturation by promoting release of enzymes that induce production or release of lung surfactant.
106
Why is erythromycin ophthalmic ointment given to newborns?
to prevent ophthalmia neonatroum or neonatal conjunctivitis
107
Why is vitamin K given to newborns?
to prevent vitamin K deficiency bleeding (hemorrhagic disease) of the newborn
108
What TcB level indicates possible jaundice in an infant?
levels greater than 12-15 mg/dL
109
What are the core disorders included in the universal newborn screening?
- hemoglobinopathies (sickle cell disease)
- inborn errors of metabolism (phylketonuria [PKU], galactosemia)
- severe combined immunodeficiency
- hearing loss
- critical congenital heart disease (CCHD)
110
Prior to discharging a male infant who has just been circumcised, the nurse must evaluate that the parents understand the instructions for care at home. The nurse is reassured when the parents report which of the following?
1. They will check for bleeding with every diaper change.
2. The baby is expected to void at least four times in 24 hours.
3. Soap and water should be used to clean the penis.
4. They will notify the provider if a yellow exudate develops and covers the head of the penis.
1.They will check for bleeding with every diaper change.
A Correct: Bleeding needs to be evaluated at every diaper change. If bleeding occurs, gentle pressure should be applied with a sterile gauze square. If the bleeding does not stop, the primary health care provider should be notified.
B Incorrect: The baby should void after the circumcision prior to discharge. He is expected to void six to eight times within 24 hours.
C Incorrect: The penis should be cleansed with plain water and petroleum applied. Soap should not be used until the circumcision is healed at 5 or 6 days after the procedure.
D Incorrect: This is normal and will remain for 2 to 3 days. The parents should not attempt to remove this exudate. Redness, swelling, or discharge indicates infection, and the physician should be notified.
111
In what culture is breastfeeding customary for 24 months?
Muslim
112
In what culture is rubbing a small piece of softened date on the newborn's palate a ritual before the first feeding?
Muslim
113
In what culture is emphasis placed on modesty so women sometimes will bottle feed in the hospital to preserve it?
Muslim
114
What cultures apply restrictions on breastfeeding for a period of days after birth until a woman's milk comes in? (babies are fed prelacteal food such as honey or clarified butter)
Cultures in southern Asia, the Pacific Islands, and parts of sub-Saharan Africa.
115
Which culture believes in las dos cosas in which they combine breastfeeding with infant formula to receive the benefits of both?
Mexican
116
What is the risk associated with las dos cosas?
the baby may refuse to latch on to the breast
117
What is colostrum?
a more concentrated substance than mature milk that is extremely rich in immunoglobulins; has a higher concentration of protein and minerals but less fat content than mature milk.
118
What is the recommended frequency of feedings for a newborn?
8 to 12 feedings in 24 hours
119
What percentage of their body weight do newborns typically lose in the first couple days?
5-10%
120
What are some feeding readiness cues of the infant?
sucking or mouthing motions
hand to mouth or hand to hand movements
rooting reflex
121
What may help prevent breast engorgement?
Early and frequent feedings; alternating breasts
122
Benefits to the mother associated with breastfeeding include all except which of the following?
a. There is a decreased risk of breast cancer.
b. It is an effective method of birth control.
c. It increases bone density.
d. It may enhance postpartum weight loss.
b.It is an effective method of birth control.
A Incorrect: Women who breastfeed have a reduced risk of ovarian cancer and premenopausal breast cancer.
B Correct: Breastfeeding delays the return of fertility; however, it is not an effective birth control method.
C Incorrect: Women who breastfeed develop an increase in bone density and a decreased risk for postmenopausal osteoporosis.
D Incorrect: Mothers who elect to breastfeed benefit from an earlier return to their prepregnancy weight.
