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Flashcards in T3 - Advance Organizers (Josh) Deck (102):
1

Patient education r/t circumcision:

do NOT clean off yellow exudate

watch for gauze that could wrap around and cut off circulation

not bath until heals

Plastibell will fall off in diaper

2

What happens during the first period of reactivity?

HR increases then falls back to b/t 100-120

RR is 60-80

Audible grunting, nasal flaring, and chest retractions (should clear within 1 hr)

3

Vacuum assisted birth babies can have a --- that crosses suture lines.

Caput Succedaneum

4

An infant may normally lose up to --- of birthweight.

5-10%

5

What happens during the second period of reactivity?

Tachycardia

Tachypnea

Increased muscle tone (Jumpy)

Increased mucous production (monitor for chocking/gagging)

6

What are characteristics of postterm newborn?

deep sole creases

skin dry and cracked

long nails

meconium staining of skin, nails and cord

loss of subq fat and muscle mass

7

Normal bilirubin levels?

direct bilirubin at birth = 0-1 mg/dL

****cord blood bilirubin should be

8

The baby's head will be --- than his chest.

0.5 in larger

9

PP blues start around --- and last ---

PP day 2-3

2 wks

10

REEDA stands for:

Redness
Edema
Echymosis
Drainage
Approximation

11

Normal newborn heart rate is ---

Normal newborn respiratory rate is ---

120-140

30-60

12

Interventions to decrease perineal edema?

Ice Pack (first 24 hrs)

Sitz Bath (after 24 hrs)

Blot dry, wipe from front to back

Apply new pad after each void

13

What could be a possible cause of a high-pitched cry?

hypoglycemia

***obtain blood glucose (

14

What does the posterm newborn's skin look like?

dry and cracked

15

The baby's head will be --- than his chest.

0.5 in larger

16

Nursing care for baby just circumcised?

Hold feeding until procedure

Document first voiding post procedure

Not tub bath until heals

Check for healing or drainage

17

--- causes milk production

--- causes milk letdown.

Prolactin

Oxytocin

18

Most common symptom of perineal hematoma is ---

pain

***retroperitenial hematoma can be life-threatening b/c of tear in hypogastric artery

19

Which glucose level require intervention?

20

Breasts:

What should they feel like on PP day 1-2?

What should they feel like on PP day 3-4?

soft (ear)

filling (nose)

21

An infant loses heat via --- when they are covered with a wet gown or AF.

evaporation

22

SGA =

LGA =

AGA =

SGA = 90th %

AGA = 10th-90th %

23

What constitutes a dangerous level of bilirubin?

15 mg/dL at any time

***kernicterus (irriversable)

24

Why is erythromycin given on eyes?

prophylactic protection from blindness caused by gonorrhea

25

What should we teach about Rubella vaccine?

Two doses

Avoid pregnancy for 1 mth after each dose

Safe for breastfeeding
***May cause rash if allergic to duck eggs

26

The client is best receptive to teaching during which phase?

Taking Hold Phase

27

Best prevention for thrombus formation is ---

early ambulation

28

Best time for bonding is ---

breastfeeding

***NICU baby will miss this due to being in taken immediately to NICU

29

--- is a collection of blood b/t skull and peritosteum that does NOT cross suture lines

Cephalhematoma

30

When would Rhogam be administered?

within 72 hrs after delivery

31

Scant lochia =

Light lochia =

Moderate lochia =

10 cm

32

How can mastitis be prevented?

wash nips w/ water only

air dry for 20 mins

apply expressed milk or non-alcohol cream to prevent drying/cracking

empty engorged breasts

33

Circumcision:

---- requires no ointment

---- is bloodless and requires petroleum jelly or antibiotic ointment.

Plastibell

Yellen Mogen clamp

34

An infant loses heat via --- when they remain uncovered in a cold room.

convection

35

What is a good APGAR score?

7-10

***less than 3-4 will require resuscitation

36

How much Vit. Ka is given and which size needle?

0.5 - 1 mg

5/8 in needle

37

What does cold stress lead to?

Cyanosis (uses up O2)

Jaundice/Kernicterus (due to buildup of bilirubin levels)

Hypoglycemia (due to use of glucose for heat production)

38

S/S of PP shock

Tachycardia

Tachypnea

BP decreases

Skin cool, clammy with pallor

Restlessness and Dyspnea

39

What is important about the process of exfoliation?

tissue regeneration at site of implantation w/out scar tissue formaion

40

What is a good APGAR score?

7-10

***less than 3-4 will require resuscitation

41

Normal newborn RR

30-60 w/ short periods of apnea (

42

When is the first period of reactivity?

When is the second period of reactivity?

First = Birth to 30 mins

Second - 2-8 hrs after birth and lasts 10 mins to several hrs

43

What will we see as unconjugated bilirubin is broken down under phototherapy?

stools become more frequent and loose and change color as bilirubin is broken down

urine will be darker as bilirubin is broken down

44

What is heavy lochia?

one pad within 2 hrs

45

Which type of jaundice is caused by increased levels of uncongjugated bilirubin?

Pathologic

***within 24 hrs

46

Late PPH is after --- and blood looks ---

24 hours

darker red

***retained placental fragments

47

Normal WBC value during PP period?

20,000 - 25,000 mm3 (slightly elevated)

48

When is the first period of reactivity?

When is the second period of reactivity?

First = Birth to 30 mins

Second - 2-8 hrs after birth and lasts 10 mins to several hrs

49

Oxytocin is released from the --- pituitary

posterior

50

Normal blood glucose is ---

Treatment is required if blood glucose falls below ---

60-70 mg/dL

45 mg/dL

51

What do the sole creases look like in postterm newborn?

deep sole creases

52

How is congenital hip dislocation identified?

Positive Ortoloni test

Asymmetry of gluteal folds

Limited hip abduction

Apparent shortening of femur

53

Interventions for episiotomy discomfort?

warm sitz bath after 24 hrs

anesthetic spray

witch hazel pads

peri hygiene

54

Where should fundus be after birth?

firm, midline, and 1-2 cm below umbilicus

***rises in first 12 hrs before dropping 1-2 cm every 24 hrs

55

Which phase?

a. Focused on forward mvmt of family as a unit w/ interacting members
b. Reassertion of relationship w/ partner
c. Resumption of sexual intimacy
d. Resolution of individual roles

Letting Go Phase

56

Afterpains are more common with --- and ---

multigravidas

breastfeeders

57

Late PPH is after --- and blood looks ---

24 hours

darker red

***retained placental fragments or infection

58

Normal cord blood bilirubin

59

What is number one cause of a boggy uterus?

full bladder

60

An infant loses heat via --- when they come into direct contact w/ a cold scale.

conduction

61

When should postpartum assessments be done?

q15 * 4
q30 * 2
q1hr * 4
q8hr

62

Which type of jaundice is self-limiting (resolves in 1-2 wks) and occurs after 24 hrs (peaks at days 3-5)?

Physiologic

63

When is PKU screening done?

after ingesting sufficient milk

***phenylalanine is an essential amino acid found in milk

64

Normal newborn HR

120-140

***4th ICS MCL

65

Normal cord blood HGB and HCT

HGB = 17 g/dL

HCT = 55%

66

--- jaundice occurs after 24 hrs

--- jaundice occurs within 24 hrs

Physiologic (self-limiting and self-resolves)

Pathologic (requires phototherapy, etc)

67

Which enzyme is necessary to conjugate (breakdown) bilirubin?

glucornyl transferase

***newborn liver is immature and doesn't produce enough

68

What is number one cause of excessive bleeding?

uterine atony

69

Sign of Down's Syndrome

low set ears

simian hand crease

palpable fissures of eyes

70

What happens during the second period of reactivity?

Tachycardia

Tachypnea

Increased muscle tone (Jumpy)

Increased mucous production (monitor for chocking/gagging)

71

S/S of DVT

Reddened, warm area over affected vein

Pain/Tenderness on ambulation

72

What is the priority intervention when a PP client is bleeding excessively or if they pass a clot?

check consistency and location of fundus

73

Diffuse swelling that crosses suture lines is ----

Swelling from blood confined within suture lines (doesn't cross) is ----

Caput succedaneum

Cephalhematoma

74

What are risk factors for a PP thrombosis?

Increased clotting factors

Immobility

Sepsis

Maternal age > 35

Multiparity

Smoking

History of CVD or Diabetis

75

When would the fundus be nonpalpable?

by 2 wks

76

What bilirubin levels will lead to staining of body?

4-6 mg/dL

***starts first in head and face then progresses to trunk

77

Which phase?

a. First 1-2 days
b. Introspective and preoccupied w/ own needs rather than baby
c. Passive/dependent behavior
d. Excited & talkative
e. Touches and explores infant
f. Needs to verbalize L&D experience

Taking In Phase

78

Which glucose level require intervention?

79

An infant loses heat via --- when they are placed too close to a cool wall.

radiation

80

What would breast fed baby stool look like?

What about bottle fed?

breast fed = seedy, mustard colored, loss and aromatic

bottle = pale yellow to brown; more firm

81

Normal WBC levels in newborn

9,000 - 30,000 (slightly elevated)

82

Early PPH is with --- and blood looks ---

24 hours

bright red

***lacerations

83

If Lochia reverts to previous state or lasts longer than should, what do we suspect?

uterine infection

- foul odor as well

84

Normal newborn heart rate is ---

Normal newborn respiratory rate is ---

120-140

30-60

85

Normal WBC value during PP period?

20,000 - 25,000 mm3 (slightly elevated)

86

What does cold stress lead to?

Cyanosis (uses up O2)

Jaundice/Kernicterus (due to buildup of bilirubin levels)

Hypoglycemia (due to use of glucose for heat production)

87

Why suction mouth before nose?

to prevent infant from inhaling pharyngeal secretions by gasping as the nares are touched

88

Nursing interventions for afterpains

NSAIDs before breastfeeding

Self-resolves in 3-7 days

Good sign that uterus is contracting

89

What maternal labs are drawn 12-24 hrs post delivery?

Hgb and HCT

Urinalysis sometimes

Rubella and Rh if unknown

90

What days?

Lochia Rubra =

Lochia Serosa =

Lochia Alba =

Days 1-3

Days 4-9

Days 10 and up

91

What are parameters for infection in the PP client?

eleveated temp of 100.4 or more 2 SUCCESSIVE DAYS during first 10 PP days

***Not counting first 24 hrs

92

How can a Cephalhematoma lead to increased bilirubin?

as RBCs in the bruise break down, they increase bilirubin levels

93

What happens during the first period of reactivity?

HR increases then falls back to b/t 100-120

RR is 60-80

Audible grunting, nasal flaring, and chest retractions (should clear within 1 hr)

94

What stools are a sign of sickness?

constipation or diarrhea

95

A newborn needs --- cal /day

110 cal/day

96

Treatment for DVT

Bedrest

Moist heat

Heparin

97

What is initial treatment of hypoglycemia?

feeding (breastmilk)

bottle feeding (D5W)

98

Calories for lactating mom

2700 total

***450-500 more than recommended pregnancy calories

99

Suction --- before ---

mouth

nose

100

When is Sitz Bath given for episiotomy care?

after first 24 hrs

TID for 20 mins

101

What could be a possible cause of a high-pitched cry?

hypoglycemia

***obtain blood glucose (

102

What maternal labs are drawn 12-24 hrs post delivery?

Hgb and HCT

Urinalysis sometimes

Rubella and Rh if unknown