Quiz Units E & F Flashcards
(129 cards)
1
Q
What is defined as “the return of the uterus to the non-pregnant state?
A
Involution
2
Q
How fast does the uterus shrink in size?
A
The fundal height decreases about 1-2cm per day
3
Q
At what time postpartum is the fundus below the pelvic bone and unpalpable?
A
At about 2 wks postpartum
4
Q
Should the fundus be firm or boggy?
A
Firm/midline
5
Q
When does the placental scab pass?
A
About 10-14 days post delivery
6
Q
What can the passing of the placental scab cause?
A
A temporary increase in lochial flow
7
Q
At the end of the 3rd stage of labor, where is the fundus located, and how much does it weigh?
A
It is about 2cm below the umbilicus and weighs about 1000 g
8
Q
What is it called if the uterus fails to return to normal size, and what causes it?
A
Subinvolution and it is caused by hemorrhage, infection, or placental fragments left in the uterus
9
Q
What are the 3 types of lochia and describe each?
A
Rubra = red and consists of blood/debris and lasts 3-4 days; Serosa = pink/brown, consists of old blood/debris and lasts about 4-10 days; Alba = yellow/white, consists of debris/serum/bacteria and lasts about 10 days to 6 wks
10
Q
What can cause lochial flow to increase?
A
Ambulation and breastfeeding
11
Q
Is it normal for bleeding to reoccur at about 10 days postpartum?
A
Yes. It is from the healing placental site
12
Q
If the lochia has an offensive odor, is it normal?
A
No. It may be a sign of infection
13
Q
What are the 4 levels of lochia on the pad and over what time frame is it determined?
A
Scant = 2” (10mL) stain; Small/light = 4” (10-25mL) stain; Moderate = 6” (25-50mL) stain; Large = >6” (50-80mL) stain; Excessive = 1 pad in 15 min
14
Q
How long does postpartum bleeding last and what size clot requires MD notification?
A
3-6 wks. If a clot is larger than a silver dollar, then MD must be notified
15
Q
What are some s/s of placental fragments left in the uterus?
A
Pelvic pain/heaviness, backache, malaise, prolonged lochial discharge, irregular/excessive discharge, uterus is larger and softer
16
Q
How is postpartum hemorrhage defined?
A
SVD = bleeding >500mL or C-section = bleeding >1000mL; 10% drop in Hct; May need a transfusion
17
Q
How are early and late postpartum hemorrhage defined?
A
Early is in the 1st 24hrs postpartum and late is after that
18
Q
What can be given to help the uterus contract and stop postpartum bleeding?
A
Pitocin - 10-40 units in 100mL of LR (ok for lactating moms); Methergine - 200-400mcg q2-7 doses (not for lactating moms); Hemabate - (hospital use only) 250mcg IV 2mL max; Cytotech (prostaglandin E)
19
Q
When can’t you use Hemabate (a prostaglandin E)?
A
If there is a uterine scar (ie, C-section)
20
Q
What is uterine atony?
A
Failure of the uterus to properly contract. #1 cause of PP hemorrhage
21
Q
What are some predispositions to uterine hemorrhage?
A
Lack of muscle tone, over-distension of the uterus due to multiples, LGA, hydramnios, multiparity >5, use of tocolytic drugs, precipitous or prolonged labor, c-section, use of extraction tools, manual removal of the placenta, previa, accreta (abnormally deep placental attachment), drugs, DIC, clotting factors
22
Q
When performing fundal massage, what is it important to always do?
A
Support the fundus at the symphysis pubis
23
Q
What is the 2nd most common cause of early hemorrhage?
A
Trauma to the birth canal due to lacerations and hematomas
24
Q
What are some good pain control techniques for postpartum?
A
Change position every 1-2hrs, distraction, walking
25
What is the first pain med given postpartum and why?
Ibuprofen 800mg/dose (2400mg max per day); Reduces inflammation
26
What causes afterbirth pains and who doesn't usually get them?
They are caused by constriction of the intramyometrial blood vessels, brought on by an increase of Oxytocin due to breast feeding, or by admin of Pitocin. 1st time moms generally don't have them due to good uterine muscle tone
27
What happens to the external cervical os after a baby is born?
It gradually closes over 2wks, but never regains it's circular shape
28
How soon does the os return to normal size?
2 weeks
29
What happens to the vagina postpartum?
It is never the same again! Rugae may disappear, bruised and edematous, lacks estrogen, dry
30
How long does it take the vagina to return to normal?
6-8 weeks
31
What can happen to the abdominal wall with LGA or muliparity?
Diastasis recti abdominus (separation)
32
When doe postpartum diuresis begin? What urinary labs increase/decrease?
Within 12hrs of birth. BUN increases and +1 proteinuria is common for a couple of days
33
When does mom usually have her first BM postpartum?
It is usually delayed 2-3 days
34
If a breast is infected, can breastfeeding be continued? What about an abscess?
Yes. Probably not. Will have to pump and dump
35
What does the acronym BUBBLE HER stand for?
Breast, Uterus, Bowel, Bladder, Lochia, Extra (episiotomy/epidural sites), Homan's, Emotions, Rh
36
What is a convenient way to assess for Homan's sign?
If they are walking pain free, then it is negative (Most modern studies show this to be a very inaccurate test, and may even help dislodge the DVT!)
37
When does colostrum change to milk?
After a few days
38
What does colostrum look like and what does it contain?
It is more yellow in color and contains immunoglobulins
39
What is the difference between foremilk and hindmilk and how does it differ from colostrum?
Foremilk is suckled for the 1st 10-15min and is lower in fat then the hindmilk. Milk is bluish in color
40
When is an H&H done and why?
The morning after delivery an H&H is done to check Hgb & Hct levels. More than a 4 point drop is considered PP hemorrhage
41
What other immunizations can be given before they go home?
Rubella, if indicated, is given right before going home, in case they spike a fever, and Rhogam, if mom is Rh-/baby is Rh+/baby's direct Coomb's is neg. Tdap can be given any time
42
How do we differentiate between "the baby blues" and PPD?
PPD may include loss of control, and/or feelings of worthlessness, and/or lack of pleasure
43
How can you differentiate between PP blues and everyday female mood swings?
Anxiety, crying, exhaustion r/t physiological changes after birth; intensified with sleep deprivation/postpartum or newborn complications
44
What separates PPD from PPP?
Depression is when mom threatens to kill dad if he ever touches her again. If it's psychosis, she does it. PPP can include hallucinations, paranoia, and most importantly, she can't take care of the baby
45
What risk factors exist for PPD? What is done if these are known?
No FOB available (prison/etc), <20yrs old, fast delivery, financial difficulties, hx of PPD, family strife. She will need to be followed closely for 6mo
46
When does the "baby blues occur"?
Usually in the first 1-2wks PP
47
When does PPD happen?
Usually begins after 1mo, but within 3mo of delivery and can last up to 1yr
48
When does PPP occur?
It can begin up to 2yrs PP
49
What are some s/s of proper parent/child attachment?
Call infant by name, identifies who infant looks like, body contact, do they avoid touching baby, do they comfort?
50
When is the peurperium?
It begins with the delivery of the placenta and ends when the body returns to its pre-pregnant state
51
Does BS go up or down during the PP period?
It goes down due to decreasing hormone levels (estrogen, progesterone, and the enxyme insulinase)
52
What else do decreased estrogen levels cause?
Breast engorgement, diaphoresis, and diuresis
53
What are the 3 phases of maternal adjustment? How long does each last?
Dependent/Taking-in phase (into self/let others do for her) 1-2 days; Dependent/Independent/Taking hold phase (start to take charge and learn, important to reteach before discharge, blues set in). May last for weeks; Interdependent/Letting go phase (family, partner, sex) 6wks +
54
What are dad's stages of adjustment?
Stage 1 = Expectations (preconceptions, pre-birth); Stage 2 = Reality (ambivalence/sadness/jealousy, more involved w/baby); Stage 3 = Transition to mastery (take control/become involved)
55
What does APGAR stand for?
Appearance, pulse, grimace, activity, respirations
56
What do we do if the baby has an APGAR score of 7-10?
We monitor
57
What do we do if the APGAR score is 4-6?
We intervene. Vigorous drying warm, suction
58
When are APGAR's done?
1 & 5 minutes, and 10 & 20 minutes if necessary
59
Which score is more predictive of survival and neuro deficits?
5 min score
60
When do we start timing for APGAR?
When soles of the feet show (cephalic delivery), or the top of the head is seen (breech delivery)
61
What are our main goals upon delivery?
Respirations/temp/infection
62
What is considered the "neonatal" period?
Birth to 28 days
63
What is the normal temp range for a neonate?
97-99.5 according to the powerpoint (she said 96.6-99 in class)
64
What must be done if baby has to be laid on a warmer?
Temp probe on abdomen
65
What is the primary source of energy/heat in the first few days of life outside the uterus?
Brown fat stored up in the last few wks of pregnancy (babies can't shiver)
66
What is a normal BS for a neonate in the first 2 days?
40 or more. If under 40-treat/feed
67
What are the 4 ways in which heat is lost? Describe each one. Which is most significant?
Convection (skin to ambient air), conduction (direct contact), radiation (proximity to a cold surface), evaporation (liquid to vapor). Evaporation is most significant loss
68
What are some advantages of Kangaroo care (skin to skin)?
It decreases maternal anxiety, warms the baby, and increases breast feeding success
69
What happens (physiologically) when a baby is cold?
O2 consumption/respirations increase, PO2 and Ph decrease, causing metabolic acidosis
70
What is considered normal when it comes to the neonates breathing the first few days?
Rate of 30-60 min, crackles, respiratory assistance in 10%
71
If a neonate is born before _____ weeks gestation, its lungs lack _____, causing respiratory difficulty.
32. Surfactant
72
What are some s/s of RDS?
Nasal flaring, intercostal retractions, grunting/singsong, paradoxical respirations, tachypnea >60 breaths/min (not during the period of reactivity, which is in the 1st 4hrs), inspiratory crackles, cyanosis, hypertonia
73
What are paradoxical respirations?
The 2 sides of the chest don't move together
74
What is done for RDS?
Surfactant is given through the ET tube. Betamethasone is given before RDS develops
75
How is neonatal tachypnea defined?
80-120 breaths/min
76
If the neonate has a temp of 97, which is a little below normal, what would you do?
20min of skin to skin
77
What causes baby to take his first breath?
High CO2 and low O2. Cold, light, touch
78
What pushes moisture out of the baby's lungs?
The birthing process
79
What, besides lack of surfactant, did she mention as a cause of respiratory problems?
Toxemia
80
How often are vitals done on mom after delivery?
q15min for the 1st hr, q30min for the 2nd hr, hourly for the next 2hrs
81
What comfort measures are taken for a woman with a small perineal hematoma?
Ice, sitz bath twice a day, and topical antiseptic cream
82
What effect does cord clamping have on the cardio system?
It increases pressure in the heart, raising PCO2 and decreasing PO2
83
What is and where is the foramen ovale? When does it close?
It is a hole between the atria. Minutes to an hr after birth. Doesn't necessarily stay closed at first.
84
When does the ductus arteriosis close?
Functional closure occurs at about 96hrs, and about 4mo to anatomical (permanent) closure.
85
When does the ductus venosis close?
It closes functionally at 2-3 days. Anatomical at 7 days
86
What is considered a normal BP for a full term neonate? Preterm?
72/47. 64/32
87
When/where should the heart rate be taken on a neonate?
Apical, while resting or asleep. First time at 1 minute
88
What is the normal respiration rate, and what amount of apnea is abnormal?
30-60/min is normal. Normal apnea is up to 15 sec. >20 sec is abnormal
89
When do neonates need iron?
They have enough stored to last 4-5mo. After that they need supplemental iron
90
What is a normal neonatal BS level?
40-60 for days 1 & 2. 60-70 after that
91
What's the difference between unconjugated and conjugated bilirubin?
Conjugated is water soluble, so it can be excreted normally, while unconjugated is fat soluble, and is stored in tissues, turning it yellow
92
What part of the baby's body turns yellow first and what does it mean if his toes turn yellow?
Face/eyes. The further down the body the discoloration happens, the worse the jaundice is
93
What is unconjugated bilirubin bound to?
Albumin
94
At what level is bilirubin visible in pigmentation?
5 (4-6)
95
If jaundice is normal and doesn't need treatment, it is called _____ jaundice.
Physiological
96
Pathological jaundice occurs when bilirubin rises above _____ on the first day.
8
97
After the first 24hrs, if bilirubin levels rise to 8 it is _____, but if they go higher, it is considered _____ jaundice.
Normal. Pathological
98
What is another name for breast milk jaundice? What is done to prevent/alleviate it?
Starvation jaundice. It is from lack of nutrition, and we must encourage mom to feed at least 15-30min each side, 10-12 times a day. No supplements
99
When is vitamin K given? How is it given? Why?
Within 1hr after birth the neonate should get 0.5-1mg of Vit K IM. The gut is sterile and can't supply Vit K
100
Describe the Moro reflex
When startled, arms and legs form a "C"
101
Describe the Babinski reflex.
The toes flex when you run your finger up the sole of their foot
102
What makes newborn reflexes disappear?
Myelenation of nerve tissue replaces reflexes with purposeful movement
103
How many hrs a day should a newborn baby sleep?
16-18 hours
104
How many awake states does a neonate have? Describe each one.
4. Drowsy. Quiet/alert (looking-most pleasant). Active alert-busy. Crying
105
How many sleep states are there in a neonate?
2. Deep and wide
106
How much body weight is lost immediately following birth? When should this be regained?
5-7%. Within 2wks
107
How often does a neonate void?
Once per day of age
108
At what age can a newborn identify someone by smell?
1 week
109
What type of immunity is passed from mom to baby? For what diseases?
Passive acquired. Tetanus, diphtheria, smallpox, measles, mumps, poliomyelitis
110
How can you differentiate between capit succedaneum and a cephalhematoma?
Capit succedaneum can cover suture lines b/c it is an edematous portion of scalp, but cephalhematoma is on the bone, so it doesn't cross suture lines
111
How can you differentiate between a port wine stain and telangiectatic nevi?
Nevi blanch when touched, port wine stains don't
112
What are Mongolian spots, and where are they found?
These are bluish/black skin discolorations found anywhere on the body, but most commonly on the back and buttocks
113
Describe erythema toxicum
Also called flea bite rash. Has papules, macules, and vesicles. Can appear anytime in the first 3wks of life
114
Which of these puts mom at GREATEST risk for infection: Boggy uterus that is not well contracted, PROM and prolonged labor, or LGA baby?
PROM and prolonged labor
115
What are some contributing factors for PPD?
Fatigue, socioeconomic, anxiety, rapid decline in estrogen and progesterone, and discomfort/pain
116
Define AGA, LGA, and SGA.
AGA (Appropriate for gestational age) btwn 10th and 90th percentile. LGA (Large for gestational age) above 90th percentile. SGA (Small for gestational age) below 10th percentile
117
Define LBW
Low birth weight is below 2500 grams
118
Small white nodules on the roof of a newborn's mouth are called _____ _____.
Epstein's pearls
119
For APGAR, what does the A stand for, and how is it determined?
Appearance, Blue all over = 1. Blue body/pink extremities = 1. Pink allover = 2
120
For APGAR, what does the P stand for, and how is it determined?
Pulse. None = 0; 100 = 2
121
For APGAR, what does the G stand for, and how is it determined?
Grimace (irritability). No response to stimulation = 0. Weak/feeble cry = 1. Cry/pull away = 2
122
For APGAR, what does the A stand for, and how is it determined?
Activity/flexion. None = 0; Some flexion = 1; Flexed arms/legs that resist extension = 2
123
For APGAR, what does the G stand for, and how is it determined?
Respirations. Absent = 0; Weak/Irregular/Gasping = 1; Strong cry = 2
124
What 6 areas are assessed on the New Ballard scale?
Skin (transparent to leathery), Lanugo (none to sparse), Plantar surface (creases), Breast (areola and bud), Eye/Ear (lids fused to thick cartilage), Genitals (rugae for males and labia/clitoris for females)
125
Should you suction the mouth first or the nose on a newborn? Why?
You suction the mouth first because suctioning initiates a gasp response that may cause aspiration if the nose is done first
126
Why is a preterm/LBW baby prone to thermoregulation problems?
Early babies don't have enough glycogen stored in the liver, and don't have enough brown fat. This is what it needs to burn for energy/heat the first couple of days
127
Cold _____ milk supply, and warmth _____ it.
Suppresses. Increases
128
When are heart murmurs in a day old neonate a problem?
When they are symptomatic
129
What type of head abnormality can cause bilirubin levels to rise?
A cephalhematoma
