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Antepartum > Postpartum And Newborn > Flashcards

Postpartum And Newborn Flashcards

0
Q

Sub involution
definition
cause
treatment

A

When the process of uterine contractions does not take place as it should and it’s either prolonged or stops
Retained placental fragments, myomata, infection
Ergotrate or Methergine by mouth for two weeks then reevaluate in two weeks

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1
Q

Endometritis
definition
symptoms

A

Postpartum inflammation of the endometrium
Fever to 104, tachycardia, chills, uterine tenderness extending laterally, pelvic pain with bimanual exam, subinvolution, scanty odorless lochia or malodorous seropurulent lochia, variable onset depending on the organism, GBS presents earlier with increased white blood count

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2
Q

Kernicterus
Definition
signs and symptoms

A

A form of brain damage caused by excessive jaundice
Bilirubin is so high that it moves out of the blood and into the brain tissue
Excessive lethargy, high-pitched cry, decreased muscle tone with periods of increased tone, arching of head and back backwards, jaundiced in extremities, fever

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3
Q

Additional therapy for thrombophlebitis that the midwife can provide

A

Maintaining strict bedrest, monitoring pedal pulses, applying moist heat to affected area

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4
Q

Women are predisposed to UTIs postpartum because of:

A

Trauma to the trigone of the bladder

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5
Q

Compared with mature breastmilk colostrum contains less:

A

Fat and carbohydrates

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6
Q

Breast milk is produced in the:

A

Alveoli

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7
Q

What birthweight is the established norm for a diagnosis of a large gestational age baby

A

4000 grams

Between 8 lbs. 13 oz. and 8 lbs. 14 oz.

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8
Q

What would be the most helpful in confirming clinical suspicion of IU GR

A

To ultrasound measurements of abdominal circumference at least four weeks apart

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9
Q

Failure of tissue perfusion caused by changes in the circulation that occur as a result a severe infection is called:

A

Septic shock

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10
Q

Postpartum psychosis

A

Manic or depressive episodes of confusion or disorientation, delusional thinking, suicidal or infanticidal behaviors
Mothers with history of bipolar disorder have increased risk

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11
Q

Postpartum blues

A

70% of women, begins 2 to 3 days postpartum, associated with hormonal swings, sleep deprivation, impending lactation

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12
Q

Homan’s sign

A

Have the mother sit in bed with her legs straight, then gently press on her knee and dorsiflex her foot. She has pain in her calf the test is positive for thrombophlebitis

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13
Q

2–0 chromic suture

A

External anal sphincter, cervical lacerations, lateral vaginal wall, and deep interrupted stitches of pelvic muscles
Muscle requires a stronger suture

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14
Q

Hematoma
primary concern
treatment

A

Pooled blood readily permits the growth of bacteria, primary danger is infection
This could lead to breakdown of the repair, because surfaces will not adhere and close properly once sepsis develops
Immediately Refer to the physician, as antibiotic therapy should begin ASAP

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15
Q

Hematoma
definition
cause

A

And asymmetrical and painful swelling in the perineal area
Caused by soft tissue trauma and second stage and a faulty repair job, where bleeding vessels continue to seep below the skin. The blood takes time to reabsorb

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16
Q

How much water should a nursing mother drink daily ( to meet her own needs and produce sufficient breast milk)

A

3 quarts

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17
Q

What time should the midwife refer to the pediatrician if the newborn has not had a bowel movement?

A

48 hours

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18
Q

What is a normal temperature increase when the new mothers milk comes in?

A

101°

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19
Q

Circumoral cyanosis refers to:

A

Bluish discoloration around the mouth

can indicate heart problems

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20
Q

The newborns head is__the size of the body

A

1/4

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21
Q

Acrocyanosis in the newborn

A

Usually temporary with rubbing of foot/hand, should pink up

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22
Q

Beefy redness color in newborn

A

Normal for the first 24 hours

if prolonged polycythemia

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23
Q

Harlequin color

A

Half body pink, half red or paler, normal variation

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24
Q

Stork bites

A

Smooth flat red marks on base of neck, eyelids, bridge of nose
Fades by two years

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25
Q

Erythema toxicum

A

Read spotty rash, fades naturally

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26
Q

Transient mottling of skin in newborn

A

Temperature, should not persist

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27
Q

Anterior fontanelle size and shape

A

Diamond shape, peripheral pulses, 2 1/2 to 4 cm length

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28
Q

Posterior fontanelle

size and shape

A

1/2to 1 cm

triangle

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29
Q

Fontanelles
depressed
bulging

A

Depressed =dehydration

Bulging equals increased intracranial pressure or meningitis urgent

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30
Q

Epstein’s pearls

definition

A

Small white cysts along the hard palate
Normal
Will resolve with sucking

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31
Q

Newborn lungs

Common variations

A

Momentary apneic spells, should not last longer than 15 seconds
Rales and rhonchi shortly after birth
Rate up to 80 within the first half an hour

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32
Q

Transient tachypnea of newborn

A

Very rapid respiration rate 80 to 120 usually during first 24 hours
Use o2, BF
If not resolved and baby unable to eat in reasonable amount out of time, TP

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33
Q

What percent of newborn heart murmurs are normal?

A

90%

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34
Q

Hypospadias

A

Urethral opening on the lower side of penis

corrective surgery at three months

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35
Q

Newborn femoral pulses

A

Right above hip crease
Check both at once. Should be strong and equal
Weak could be a congenital heart defect
If uneven contact pediatrician, coarctation of the aorta

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36
Q

Tonic neck reflex

A

Turn babies head to one side, extremities on same side straighten and on opposite side flex
Fencing position

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37
Q

Babinski reflex

A

Stroking foot upward, toes hyperextend

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38
Q

Lanugo in the newborn
term
preterm
postterm

A

Term: thinning over lower back
Preterm: covered over body no lanugo thinning with some parts still covered
Postterm: half back devoid of lanugo

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39
Q

Esophageal atresia
Definition
symptoms

A

Serious birthday defect in which the esophagus is segmented and closed off at any point
Usually occurs with TEF, unlikely to survive without surgery
Signs and symptoms; excessive drooling, and immediately regurgitate after eating, choking, coughing, aspirations, pneumonia

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40
Q

Which assessment finding indicates that phototherapy has been effective for the neonate

A

Elimination of green urine and greenish loose stools

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41
Q

What umbilical cord stump finding is considered normal at three days postpartum

A

Dryness and atrophy at the stump

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42
Q

Which muscle would not be cut in the midline episiotomy

A

Pubococcygeus

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43
Q

What is the main significance of lobulated and succenturiate placentas?

A

Placenta lobes may be retained and not expelled with the rest of the placenta

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44
Q

What is the last step of manual removal of the placenta

A

Administration of oxytocin

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45
Q

A sulcus is which of the following types of laceration?

A

Second-degree

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46
Q

Which hormone stimulates and maintains milk production after childbirth?

A

Prolactin

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47
Q

Shock patients are often thirsty

true or false

A

True

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48
Q

After shoulder dystocia, once the baby is out you should be prepared for
1.
2.
3.

A

Hemorrhage
full resuscitation
maternal sepsis

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49
Q

A temperature rise may occur up to 24 hours after birth as a result of dehydration or exertion associated with labor
true or false

A

True

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50
Q

Late postpartum hemorrhage can occur in the fourth week following delivery
two or false

A

True

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51
Q

Birth of the head occurs through which of the following mechanisms for an OP delivery?

A

Flexion then extension

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52
Q

Newborn exam on a three week old baby, reflexes (one or more) of the reflex are not present and they were at birth what is the most appropriate response?

A

Note it as an alarming variation from normal that merits immediate attention by a pediatrician

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53
Q

At which of the following times is maternal cardiac output highest?

A

Immediately postpartum

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54
Q

How soon after full-term delivery can a woman who is not breast-feeding safely start taking combined oral contraceptives?

A

three weeks

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55
Q

About how many times should a healthy, well hydrated infant void during a 24 hour time period?

A

Six times

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56
Q

What woman is the most likely to suffer from mastitis?

A

A breast-feeding woman more than a week postpartum

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57
Q

Positive pressure ventilation of the newborn she continue until?

A

There are spontaneous respirations

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58
Q

In what days surrounding childbirth is it most likely the maternal Varcella infection will be passed to the newborn?

A

Day six before birth to day 2 afterbirth

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59
Q

How long after birth just complete regeneration of the endometrium at the placental site take?

A

6weeks

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60
Q

Sign of intracranial trauma and the newborn

A

Bulging anterior fontanels

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61
Q

Ductus arteriosis

definition

A

A short broad vessel in the fetus that connects the pulmonary artery with the aorta and conducts most of the blood directly from the right ventricle to the aorta bypassing the lungs

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62
Q

Foramen ovale
definition
when/why does it close

A

Most oxygenated fetalblood bypasses the lungs and instead flows through the opening between the right and left atria called the Foramen ovale
With the newborns first breasts the combo of pressure that is increasing in the systemic circulation causes increase in the pressure of blood flow to the heart. The pressure from increased blood flow into the left side of the heart causes the foreman ovale to shut

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63
Q

What does sunlight do for excess bilirubin?

A

Helps the liver conjugate and eliminate

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64
Q

Neonatal infection

signs and symptoms

A

Lethargy-especially if mother had signs and symptoms of infection during labor
irritability, jitteriness,
fever- Chorioamnionitis, GBS plus post partum infection
dehydration, tachypnea, cyanosis

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65
Q

Lochia Alba

A

Starts 10 days postpartum resolves over a period of 2 to 4 weeks
Creamy white
Consists of leukocytes and decidual cells
Scant amount

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66
Q

Lochia serosa

A

Paler than rubra. Serous and pink
Days 3 to 10 or 12 days postpartum
Contain serous fluid, decidual tissue, leukocytes, erythrocytes
Small amount

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67
Q

Lochia rubra

A

Contains blood, decidual tissue
Immediately after delivery continues for 2 to 3 days postpartum
Heavy to moderate amount

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68
Q

Newborn weight in grams
SGA
AGA
LGA

A

SGA up to 2500 g
AGA 3,000 to 3,500 g
LGA 4,000 g

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69
Q

Velamentous cord insertion

A

The three vessels attached to the placenta via the membranes rather than staying in the cord. Not protected by Wharton’s jelly.

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70
Q

Three stages of transition of newborn

A

First period of reactivity birth to first 30 minutes
Period of unresponsive sleep 30 minutes to two hours
Second period of reactivity two hours to six hours

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71
Q

Recognizing failure to thrive

A

Poor weight gain, lethargy, poor feedings, behind on developmental milestones

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72
Q

How many cotyledons are there in a healthy term placenta

A

15 to 20

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73
Q

Caput

A 
"does not stay put"
Collection of fluid causing swelling of scalp at birth, trauma
Reabsorbed in  12 hours 
can cross suture line 
appear shortly after birth
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74
Q

Cephalohematoma

A

Collection of blood between cranial bone and periosteal membrane
Does not cross suture lines
Appears 1 to 2 days, disappears 2 to 3 weeks or months
Bruising under the skin

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75
Q

Most appropriate management for retained placental membranes

A

Methergine to achieve rapid expulsion of the retained fragments

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76
Q

What is the most appropriate management of placenta accreta?

A

Contact the physician and prepare the woman for immediate surgery

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77
Q

Following birth a woman’s bowels tend to be sluggish due to
1.
2.

A

Dehydration from the birth

effects of progesterone and decreased abdominal muscle

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78
Q

Why does the umbilical cord evulse with minimal pressure after the birth or while waiting for the placenta

A

Velamentous insertion
infection in womb
prematurity
fetal death

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79
Q

Percent of diabetic mothers that give birth to LGA babies

A

40%

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80
Q

What factors can increase the incidence of jaundice?

A 
Pitocin 
IV during labor 
vitamin K 
Cephalohematoma 
liver malfunction 
neonatal infection 
ABO incompatibility
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81
Q

Kernicterus

Lab values

A

Over 20 for unconjugated bilirubin

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82
Q

Newborn reflexes should be present through

A

The first three months

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83
Q

Sepsis in the newborn

symptoms

A

Lethargy, irritability, jitteriness, fever, dehydration, tachypnea cyanosis

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84
Q

When does the cervix completely close afterbirth?

A

The external os has assumed it’s nonpregnant form by the fourth week postpartum

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85
Q

Judging hematocrit by blood loss

A

Two percentage points is roughly equivalent to a unit 500 mL of blood loss

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86
Q

Continuous stitching

when used

A

Closure of the subcutaneous layer

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87
Q

Continuous mattress stitch

when used

A

Subcuticular closure of an episiotomy or perineal laceration

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88
Q

Three associations of SGA babies

A

Mental retardation, visual and hearing defects, poor infant growth and development

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89
Q

What can an elevated pulse or temperature indicate postpartum in the mother
1-5

A

Dehydration, UTI, uterine infection, breastmilk coming, hematoma

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90
Q

Hypoglycemia
normal range
when to refer
risk factors

A

50 to 60 is normal for a newborn
below 30 is of serious concern
Infants at risk
LGA, SGA, premature, postmature, those with diabetic mothers,
Otherwise healthy babies who suffered hypoxia during labor or were depressed at birth

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91
Q

Describe IUGR

Asymmetrical

A

Normal head circumference

With decreased weight and decreased body length

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92
Q

Deep thrombophlebitis
symptoms
treatment

A

High fever, severe pain, edema, tenderness along the entire length of the leg
Stay in bed, keep the leg elevated contact a physician immediately

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93
Q

Uterine infection postpartum
puerperal infection or Endometritis
risk factors
symptoms

A

Anemia, compromised immune system, premature rupture of membranes, many vaginal exams in labor, maternal exhaustion, delayed placental delivery, hemorrhage, uterine exploration, postpartum dehydration, improper perineal hygiene
Fever over 101, elevated pulse, pelvic pain, subinvolution of the uterus

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94
Q

Newborn general measurements

head chest abdomen weight length

A 
Head 12 1/2 to 14 1/2 inches
Chest 11 1/2 to 14 inches
Abdomen in line with umbilicus
Wait 5.8 to 8.13 pound
Length 18 to 22 inches
95
Q

How long does it normally take for the newborns temperature to stabilize

A

8 to 12 hours

96
Q

Findings in placenta previa

A 
Onset: quiet and sneaky 
bleeding: external
 color of blood: bright red 
anemia: =blood loss
Shock: = blood loss
Toxemia:absent
Pain: only contraction
Uterine tenderness: absent
Uterine tone: soft and relaxed
Uterine contour: normal
Fetal heart tones: usually present
Engagement: absent
Presentation:  May be abnormal
97
Q

Findings in placental abruption

A 
Onset: sudden and stormy
Bleeding: external and/or concealed
Color of blood: dark Venous
Anemia: larger apparent blood loss
Shock: larger apparent blood loss
Toxemia: May be present
Pain: severe and steady
Uterine tenderness: present
Uterine tone: firm to stony hard
Uterine contour: May enlarge and change shape
Fetal heart tones: present or absent
Engagement: May be present
Presentation: zero relationship
98
Q

Conditions under which fetal asphyxia is likely:

A

Cord prolapse, placenta previa, abruptio placentae, cord compression, fetal isoimmunization, placental insufficiency, maternal vascular disease, maternal hypotension, uterine overstimulation

99
Q

Signs of normal newborn transition

A

Tone: flexed
sucking reflex: intact
behavior: alertness alternating with sleep
Bowel sounds: present after 30 minutes
Heart rate: 120 to 160, 100 to 180 with sleep or crying
Respirations 30 to 60, diaphragmatic with abdominal movement
Temperature: 97.7 to 98.6 axillary 96.8 to 97.7 skin

100
Q

Puerperal infection

definition

A

A bacterial infection originating from the reproductive track during labor or the puerperim
Historically known as childbed fever
Still responsible for a significant percent of puerperal morbidity

101
Q

What is the most frequent reason for seizures in the neonatal period

A

Hypoxic ischemic encephalopathy

102
Q

Bulbocavernosus muscle

A

Arise in the perineum, pass around the vagina and embed in the clitoris

103
Q

The pelvic floor

superficial muscle layer

A

Smaller than Levatol ani, but important in maintaining the overall strength of the pelvic floor
Includes:ishiocavernosus muscles
Bulbocavernosus muscles
Transverse perineal muscles

104
Q

The pelvic floor

deep muscle layer

A

More important of the two muscle layers
directly supports the vagina
indirectly supports the uterus
collectively known as the levator ani muscles

105
Q

What is the leading cause of perinatal mortality and morbidity as it accounts for 75% of all perinatal deaths and up to 50% of the neurological handicaps found in infancy?

A

Preterm labor

106
Q

Any woman had one preterm birth in the past pregnancy, has ___ percent risk of reoccurrence

A

20 to 40%

107
Q

Define puerperal morbidity

A

A fever of 100.4- the temp to occur on any two of the first 10 days postpartum except for first 24 hours and to be taken PO at least four times a day
Morbidity may be caused by infections and conditions other than puerperal infection- such as dehydration, UTI, upper respiratory infection, and mastitis

108
Q

Transient tachypneaof the newborn

TTN

A

Inadequate absorption of lung fluid after the birth
signs and symptoms: tachypnea, rales or rhonchi, nasal flaring, intercostal retractions
Only last 48 to 72 hours, newborns may need assistance with feedings and extra 02

109
Q

Levels of uterine involution postpartum

A

Immediately after delivery: 2/3 to 3/4 of the way between pubis and umbilicus
Day of delivery and day one: at umbilicus
Day 2 to 10: gradually descends
Day 10+: nonpalpable above the symphysis pubis

110
Q

Crown stitch
when used
purpose

A

To reunite the cut bulbocavernosus muscle
To reduce gaping of the vagina introitus and to facilitate the return of good muscle tone by deliberate approximation of this muscle
Facilitates enjoyable sex

111
Q

Treatment for colic

A

Massage and warm compresses on belly
chiropractic/craniosacral therapy
fennel, Caraway, chamomile, gripe water

112
Q

Newborn appearance

recognize glucose disorders

A

If chest is the same or larger than the head, and the baby is over 9 pounds the mother may have some degree of glucose intolerance and the baby should be checked for hypoglycemia
jittery
Lethargic

113
Q

Newborn appearance

recognize polycythemia

A

SGA
LGA
beefy redness color, prolonged (normal in first 24 hours)
check hematocrit and refer to pediatrician

114
Q

Postpartum trickle bleed

response

A 
Assess origin 
assess fundal height and uterine size
 fundal massage
 assess vital signs 
BF or nipple stem 
express clots 
nonallopathic treatment
115
Q

What inhibits ovulation during breast-feeding

A

The hormone prolactin

116
Q

What is the most appropriate time to cut an episiotomy in relation to contractions

A

As the contraction ends, position two fingers inside the perineum to protect the head, insert scissors between them and as the next contraction brings the head forward, cut straight down about a half to 1 inch
Give counterpressure and support the wound to prevent any extension

117
Q

A woman’s vitals should be monitored how often during the normal fourth stage of labor

A

At least every 15 minutes until stable at prelabor levels

118
Q

To elicit the plantar reflex you should:

A

Press the ball of the newborn’s foot

119
Q

What is the most likely cause of asymmetrical IUGR?

A

Uteroplacental insufficiency

120
Q

Ortolani’s sign

definition

A

A test of hip laxity used, to diagnose hip dysplasia

A positive sign is a snap as the head of the femur moves back into the acetabulum after being moved to the rim of the acetabulum

121
Q

Direct Coombs’ test versus indirect Coombs test

A

Direct: for newborn (direct anti-globulin test)

Indirect: for mom
antibody screen

122
Q

What does it mean if the neonates wrists and ankles looks cracked and wrinkly

A

Baby is dehydrated needs to nurse more often

123
Q

Ways to facilitate perineal wound healing postpartum:

A

Diet high in protein and vitamin C
perineal cleanliness
warm sitz bath
these actions are aimed at: infection prevention, provision of tissue building and healing, increased circulation to the area

124
Q

Treatment for a plugged breast duct

A

Apply warm moist heat to area before and during feedings
feed first from the sore breast
Press from behind the sore area toward the nipple during feedings massage breasts while showering
Change nursing positions to change pressure from babies mouth check fit of bra and baby carrier

125
Q

Care of uncircumcised penis

A

Regular bathing will keep the area clean

do not try to pull back the foreskin

126
Q

Rectocele

A

Bulging at the lower (vulvar) end of the posterior vaginal wall by bulging upward into the vagina and outward toward the introitus
First, second, third degree
Ask the woman if she has difficulty with bowel elimination

127
Q

Treatment of thrush

A

Dry nipples after nursing
wash hands
nonallopathic topical acidophilus swabs three times a day gentian violet and calendula
allopathic antifungal nipple cream

128
Q

Care of cradle cap

A

Apply a natural oil to the scalp before bed and leave it on all night
the scales can then be removed with a soft toothbrush and natural shampoo

129
Q

A condition in the newborn that is commonly associated with Polyhydramnios is:

A

Urinary problems

130
Q

Interrupted stitches

when used

A

For deep muscle repair

131
Q

Blanket stitch

when used

A

Closing the vaginal mucosa

132
Q

Levator ani muscles
definition
main groups

A

They are attached anteriorly to the pubic bone laterally to the ischial spines and posteriorly to the coccyx and sacrum
Three main muscle groups make up levator ani
Pubococcygeus muscle
Iliococcygeus muscle
Ishiococcygeus muscle

133
Q

Pubococcygeus muscles

A

Extend from inner aspect of pubic bone to the coccyx
three main bands
surrounds urethra
surrounds vagina, vaginal walls, perineum
surrounds anus into anal canal
most vital of deep muscles supports urethra, lower one third of vagina and rectum

134
Q

During the newborn exam the midwife would expect the chest circumference to be_____ related to the head circumference

A

1inch smaller

135
Q 
Cystocele 
identification 
first-degree 
second-degree 
third-degree
A

Evidence by bulging of the anterior vaginal wall. Nearly every woman who has born a child has first-degree
First-degree: bulging of anterior vaginal wall
Second degree: bulging reaches The vaginal orifice, without stress incontinence/sexual problems, it is considered asymptomatic
Third-degree: bulging extends beyond the introitus requires physician consultation for possible surgical repair

136
Q

What muscle group is the most likely to be damaged during birth

A

The perineal body

137
Q

External sphincter of the urethra

A

Arises and embeds in the pubic bone, having passed above and below the urethra

138
Q

Regardless of whether the postpartum woman has received RhoGAM during pregnancy, any postpartum woman who meets the following criteria or should receive RhoGAM:

A

She is Rh negative
she is not sensitized to Rh D antibodies based on a current screen
the infant is Rh+
that infant had a negative Coombs test

139
Q

Perineal body

definition

A

Muscles and connective tissue situated between the vaginal and rectal canals
Triangular with the base being the skin lying between the vaginal and anal orifices, and the apex the point where the vagina and rectum are in close proximity. Each side of the triangle is 3.5 to 4 cm long

140
Q

Breast milk culture

when and why

A

Culture may be done in the cases of stubborn breast infections that are recurrent, don’t respond to the usual nonallopathic remedies, or in cases that the milk is lumpy, chunky, discolored or foul-smelling

141
Q

Physiologic jaundice

definition

A

Wollin you to Rosa, the babies need for O2 is often met by a high percentage of red blood cells in it’s bloodstream, higher than in most adults. Once the baby is born and breathing, it no longer needs all the red cells, so the excess are broken down for illumination. A byproduct of the breakdown is billirubin which imparts a yellow tinge to the baby skin.
Manifests on the second to third day

142
Q

Jaundice from ABO incompatibility

Definition

A

If blood from an O type mother transfers to her A or B type baby during the birth, the baby will have more trouble illuminating excess red blood cells and so will have excess billirubin

143
Q

4.0 chromic suture

A

For repair of anterior rectal wall, clitoral laceration
delicate areas
very fine suture

144
Q

3.0 chromic suture

A

Repair of vaginal mucosa, subcutaneous stitches, subcuticular stitches, periurethral lacerations

145
Q

What size suture is used to repair cervical laceration

A

20 chromic strongest suture for muscle

146
Q

Ishiocavernosus muscles

A

Extend from each ischial tuberosity to the clitoris

147
Q

Ishiococcygeus muscles

A

Arise from the ischial spines and pass to the lower sacrum and upper coccyx
these muscles help support the sacroiliac and sacrococcygeal joints of the pelvis

148
Q

External anal sphincter

A

Surrounds the anal orifice, with some fibers extending back through the perineal body to attach to the coccyx

149
Q

Perineal body

function

A

To assist in the process of birth and defecation

maybe torn during birth and need suturing

150
Q

Iliococcygeus muscles

A

Extends from the inner aspect of the iliac bone, and fibers from each side meet in the middle in the perineum, before extending into the coccyx

151
Q

Average total amount of lochial discharge ____ ounces

A

8 to 9 ounces

152
Q

Postpartum sudden reoccurrence of bright red bleeding

A

Not a normal finding requires evaluation

Causes: excessive physical activity, retained placental/membranous product, uterine atony

153
Q

In shock, a person’s pulse: and the respirations?

A

Rises

rise

154
Q

In shock a person’s blood pressure:

A

Rises then falls

155
Q

As the blood pressure falls, the perfusion of vital organs falls with it; the best indication of whether the brain is being adequately perfused is the:

A

Level of consciousness

156
Q

if there is arterial bleeding the blood will:

A

Spurt

157
Q

Defined the fourth stage of labor

A

The period beginning with the birth of the placenta and ending one hour later

158
Q

Breastmilk jaundice

definition

A

Non-threatening condition caused by a hormone in the mothers milk that can interfere with the babies ability to process billirubin. It manifests after the milk comes in

159
Q

Perineal body

consists of

A

Place where many of the muscles of the pelvic floor join
consists of
one layer of skin that the base
bulbocavernosus and transverse perinei of the superficial muscles
the pubococcygeus of the deep muscles

160
Q

Transverse perineal muscle

A

Extend from the ischial tuberosities to the perineum, where they intermingle with the muscles of the perineal body

161
Q

Postpartum if the mother complains of chronic fatigue, nervous irritability, or upper respiratory infection prescribe______

A

More protein, more calories, good sources of vitamins B and C, and trace mineral supplements

162
Q

Symptoms of hypoglycemia in the newborn

risks

A 
Apathy
 irregular respirations 
inability to regulate body temperature
 refusal to nurse 
irritability
 tremors 
CNS damage can result if levels are insufficient. Consulting physician is levels dip below 45
163
Q

Separation of symphysis pubis

management

A

A wide lateral stance must be avoided for 2 to 3 months

if the condition does not gradually improve improve refer care

164
Q

Meconium aspiration syndrome

signs and symptoms

A

Uneven breath sounds
barrel chested appearance
rails and rhonchi
cyanosis

165
Q

Hematoma

risk factors

A

Unrepaired laceration of a blood vessel
rough handling of tissues
operative delivery
causes extreme pain

166
Q

Hematoma

Management

A

Small and moderate sized hematoma may be spontaneously absorbed
if the hematoma continues to enlarge, the midwife should notify physician
there may be a need for surgical intervention, blood replacement, antibiotics
vulvar are most obvious
vagunal are generally identifiable with care inspection

167
Q

Iron supplementation
low dose
how taken

A

Low dose: 20 mg/day, from week 20 to birth

Taken by mouth best when taken with vitamin C as this enhances absorption and should not be taken with calcium this decreases absorption

168
Q

What substances can be used to relieve postpartum cramping

A 
Ibuprofen 
acetaminophen
 Blackhaw
Comfort measures: heat, pressure on uterus
Motherwort tincture
169
Q

Predisposing factors to puerperal infection

A

Prolonged labor, prolonged rupture of membranes, lots of vaginal exams, poor aseptic technique, poor handwashing, intrauterine manipulation, extensive tissue trauma, hematoma, hemorrhage greater than 1000 mL, operative delivery, C-section, retention of placental fragments and membranes, improper perineal care, untreated vaginal/cervical infection or STD

170
Q

Organism in puerperal infection come from three sources

A

Those that normally exist in the lower genital tract or in the bowel infections of the lower genital tract
bacteria that are in the nasopharynx or on the hands of the attending personnel or in the air and dust of the environment

171
Q

Treatment for an infected episiotomy or laceration

A

First removing the sutures, opening the debriding and clearing the wound, and administering a broad spectrum antibiotic, resuturing the laceration

172
Q

Signs and symptoms of infected episiotomy, lacerations, or other trauma:

A

Localized pain, dysuria, low-grade temp seldom above 101, edema, red and inflamed repair edges, oozing or pus, separation or dehiscence

173
Q

Signs and symptoms of Endometritis

A

Persistently elevated fever to 104, tachycardia, chills with severe infection, uterine tenderness extending laterally, pelvic pain with bymanual exam, sub involution, scanty, odorless lochia, or malodorous lochia, variable onset depended on organism, GBS early, elevated white blood count

174
Q

Parametritis

A

Bacterial infection of parametrium
Extension of infection via the blood vessels and lymphatics from a primary wound infection in the external genitalia , perineum, vagina,cervix, or uterus

175
Q

Parametritis
s/s
Treatment

A

Fever, uterine sub involution, chills, sweats, abdominal pain that spreads laterally, and if untreated, the formation of a large abscess and signs of peritonitis, it occurs btw the 3-9th day
Antibiotics, bed rest, IV fluids, and drainage of any abscess
Possibly oxytocics to augment involution

176
Q

Peritonitis
Def
s/s

A

Sepsis that affects not only the uterus, but the pelvic ligaments, connective tissue, and the Peritoneal cavity from untreated uterine sepsis
Acute onset of severe steady pain in abdomen, pain worsened by movement or pressure on abdomen. Board like rigidity of abdomen, swollen, bloated, chills and fever, profuse sweating, and N & V, weakness, pale cold skin and shock

177
Q

Peritonitis
Diagnosis
Treatment

A

Diagnosis based on exam in which the abdomen is tender to the touch. Abdomen is also rigid, usually bowel sounds are absent
Treatment: massive antibiotic therapy, nothing by mouth, analgesics, surgery may be needed

178
Q

Superficial thrombophlebitis

A 
Leg pain
 localized heat
 tenderness
 inflammation at site 
palpation of a knot/cord
179
Q

Deep venous thrombophlebitis

signs and symptoms

A

Possible temp elevation
mild tachycardia
abrupt onset of severe leg pain worsening with motion or when standing
edema of ankle, leg, and thigh
positive Homan’s sign
pain with calf pressure
tenderness along the entire course of that involved vessel and palpable cord

180
Q

Treatment for thrombophlebitis

A 
Bed rest 
elevation of extremity
 hot packs
 elastic stockings
 analgesia if needed
 referral for antibiotics anticoagulant 
 no massaging
181
Q

Which organism is the most common cause of mastitis

A

Staph aureus

182
Q

` Course of healing of the vagina perineum from birth and on

A

Immediately after delivery of the vagina remains stretched open, may have edema and bruising
1 to 2 days postpartum it regains enough tone that it does not gate open, is now smooth walled and generally lax
Size decreases with the return of the vaginal rugae by approximately three weeks postpartum

183
Q

Mastitis
cause
Prevention

A

Non infective may result from plugged ducts
Infective is associated with nipples fissure or other trauma creating an entryway. The most common organism is staff aureus
Ensure adequate drainage of the breast, continued on demand breast-feeding
Avoid milk back up and open wounds on nipples/areolas

184
Q

After delivery, A cardiac patient should not breast-feed if she is

A

Receiving warfavin Coumadin therapy

185
Q

Battledore placenta

A

The umbilical cord inserts in the edge or margin of the placenta

186
Q

A condition caused by failure of the uterine muscle to stay contracted after delivery is

A

Uterine atony

187
Q

Average weight loss following delivery

A

Women lose an average of 12 lbs at the time of delivery
Represents weight a baby, placenta, amniotic fluid
Another 5 pounds maybe lost during the first week postpartum as a result of fluid loss

188
Q

Maternal mortality refers to death attributed to complications of pregnancy per ______women

A

100,000

189
Q

Rubella vaccine

Timing

A

Women should have dependable birth control for three months after vaccine to prevent CRS

190
Q

Wound healing

three phases

A

Inflammation
proliferation
maturation

191
Q

Amniotic fluid embolism

symptoms

A 
Usually during hard labor 
gasping for air 
drop in blood pressure
 depressed cardiac function
 hypoxia 
seizures 
DIC
192
Q

For non-breast-feeding women menstruation typically resumes in

A

8-12 weeks

193
Q

When does the bladder, urethra, rectum return to normal function postpartum

A

Immediate postpartum the bladder is edematous, congested and hypertonic which may result in over distention, incomplete emptying
Urethra maybe sensitive as a result of prolonged labor with the fetal head in the pelvis
Unless a woman develops a UTI, the effects of labor on the bladder and urethra diminish in the first 24 hours postpartum

194
Q

Immediate postpartum

respirations

A

Resolves to the woman’s normal range during the first hours postpartum
SOB, rapid respiration or other changes warrant valuation for conditions ranging from fluid overload to an asthma exacerbation to pulmonary embolism

195
Q

Immediate postpartum

pulse

A 
Resolves  over the first few hours postpartum to its normal level 
Affects the normal decrease:
hemorrhage
 fever during labor
 acute/persistent pain
196
Q

Pulmonary embolism

Signs and symptoms

A 
Tachypnea 
 Dyspnea
sharp chest pain of sudden onset 
altered lung/heart sounds 
apprehension as the woman's blood O2 level decreases

urgent physician a valuation

197
Q

Mastitis

signs and symptoms

A 
Severe engorgement
 flu like symptoms 
rapid increase of temp up to 103/104
 increased pulse 
chills 
general malaise 
painful swollen and inflamed hard area of the breast
198
Q

Broad ligament hematoma

A 
Lateral uterine pain sensitivity to 
Extension of pain into the flank
Painful swelling with high rectal exam
Ridge of tissue just above the pelvic brim extending 
Abdominal  distention
Contact physician
199
Q

Care of circumcised penis

A

Vaseline gauze covered for 24 hours

Watch for bleeding, inability to urinate, or swelling

200
Q

The new Ballard scale

newborn maturity

A

Assessed neuromuscular activity and physical maturity
Can date newborns of gestational age as low as 20 weeks
Accurate within a range of two weeks
Newborn is either: preterm, term or postterm

201
Q

Normal range of newborn respirations is ___ to ___ 1 min

A

30-60

202
Q

In CPR for the newborn, you should compress the heart ____ timed per min

A

90

203
Q

Square window, popliteal angle, and scarf sign are all tests that refer to

A

Neurological maturity

204
Q

During phototherapy for neonatal jaundice, the midwife should cover up ____ and _____ on a baby boy and also ___________

A

Eyes and genitals

Turn him frequently

205
Q

Mongolian spots

A

More common with darker skin pigmentation
usually over sacrum
fade by two years

206
Q

Petechiae in NB

A

Pinpoint, flat, round, red spots

clears in first weeks

207
Q

Milia

A

Blocked sebaceous glands on face

Clears in first month

208
Q

The first period of newborn reactivity is

A

First 30 minutes after the birth

209
Q

When is maternal to infant (vertical) transmission of HIV most likely to happen

A

Labor and delivery

210
Q

Gastroschisis

A

Intestines on the outside of the body

newborn most at risk for dehydration

211
Q

What percent of infants born with only one umbilical artery will have multiple, severe malformations

A

30%

212
Q

What is the effect on the newborns cardiovascular system of clamping of the umbilical cord

A

Interesting systemic vascular resistance

213
Q

The effects of cold stress on the newborn

A

Metabolic acidosis
pulmonary vasoconstriction
hypoglycemia

214
Q

Which is most directly responsible for closure of the Foramen ovale

A

Increased pressure in the left atrium

215
Q

Delee

Steps

A

Check that the lid is screwed on tight
insert tubing 4 1/2 inches into babies mouth
withdraw slowly while sucking sharply and repeatedly

216
Q

Normal weight gain in the newborn is between______ and _____ oz. per week

A

Four and eight

217
Q

Desquemation

A

Peeling skin

218
Q

An abnormal inability to retract foreskin

A

Phimosis

219
Q

What is the largest diameter of the fetal head

A

Occipitomental

220
Q

Breast-feeding and HIV

A

HIV can be transmitted through breastmilk about 15% rate
Mother can start breast-feeding or bottlefeeding, but cannot start bottlefeeding and then switch to breast-feeding
Formula creates microfissures. in the intestines, making the baby more susceptible to infection if then exposed breast milk

221
Q

What is the function of surfactant in the lungs of the newborn

A

Reducing the pressure needed for respiration by stabilizing the walls of the alveoli

222
Q

Newborn ears

normal findings

A

A direct horizontal line with the eye and top of the ear

223
Q

Newborn female genitalia

common findings

A 
Swelling of labia and clitoris
 majora should be covering minora at full-term
 hymenal tag 
urethral meatus just below clitoris 
Vernix between labia
224
Q

Newborn male

Common findings

A 
Urethral opening at tip of penis 
testes palpable on both sides 
scrotum large, edematous, pendulous
 deeply pigmented in non-Caucasians
Rugae
225
Q

Newborn extremities

usual finding

A

10 fingers 10 toes
full ROM
nailbeds pink
crease on anterior two thirds soles of feet
symmetry of crease on back of legs and hips
bilaterally equal muscle tone

226
Q

Popliteal angle
Preterm
term
postterm

A 
Thigh held in the knee chest position
 knee will naturally bend 
leg extended toward head
Pre180 degrees
Term 130
Post 90
227
Q

Scarf sign
Pre
Term
post

A

NB hand, try to put towards back of neck on opposite side of the baby
where does elbow lineup with newborns midline

Pre- elbows across midline
Term- elbow at midline
Post-elbow does not reach, closer to arm being flexed

228
Q

Which reaction would indicate possible esophageal atresia in the neonate?
a baby ingesting colostrum

A

Choking

229
Q

At what age should a newborn receive her initial dose of the dtap vaccine

A

Two months

230
Q

Baby boy is undergoing phototherapy for jaundice, covering the genitals prevents

A

Priapism-sustained painful erection

231
Q

In a neonatal with erythoblastosis fetalis, it is known that the disease results from

A

Destruction of red blood cells

232
Q

Unequal bilateral femoral pulses in the neonate typically indicates

A

Coarctation of the aorta

233
Q

To assess the integrity of the neonate spinal nerves the midwife should attempt to elicit the

A

Crossed extension reflex

234
Q

Breast milk while feeding a term infant who is 2 weeks old typically looks

A

Bluish white and thin

Antepartum (3 decks)

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