T3 - Advance Organizers (Josh) Flashcards by Josh Miller

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

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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)

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

Caput Succedaneum

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An infant may normally lose up to — of birthweight.

5-10%

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What happens during the second period of reactivity?

Tachycardia

Tachypnea

Increased muscle tone (Jumpy)

Increased mucous production (monitor for chocking/gagging)

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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

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Normal bilirubin levels?

direct bilirubin at birth = 0-1 mg/dL

**cord blood bilirubin should be

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The baby’s head will be — than his chest.

0.5 in larger

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PP blues start around — and last —

PP day 2-3

2 wks

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REEDA stands for:

Redness
Edema
Echymosis
Drainage
Approximation

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Normal newborn heart rate is —

Normal newborn respiratory rate is —

120-140

30-60

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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

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

hypoglycemia

***obtain blood glucose (

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What does the posterm newborn’s skin look like?

dry and cracked

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The baby’s head will be — than his chest.

0.5 in larger

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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

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— causes milk production

— causes milk letdown.

Prolactin

Oxytocin

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Most common symptom of perineal hematoma is —

pain

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

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Which glucose level require intervention?

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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)

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

evaporation

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SGA =

LGA =

AGA =

SGA = 90th %

AGA = 10th-90th %

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What constitutes a dangerous level of bilirubin?

15 mg/dL at any time

***kernicterus (irriversable)

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Why is erythromycin given on eyes?

prophylactic protection from blindness caused by gonorrhea

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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

The client is best receptive to teaching during which phase?

Taking Hold Phase

Best prevention for thrombus formation is ---

early ambulation

Best time for bonding is ---

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

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

Cephalhematoma

When would Rhogam be administered?

within 72 hrs after delivery

Scant lochia = Light lochia = Moderate lochia =

10 cm

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

Circumcision: ---- requires no ointment ---- is bloodless and requires petroleum jelly or antibiotic ointment.

Plastibell Yellen Mogen clamp

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

convection

What is a good APGAR score?

7-10 ***less than 3-4 will require resuscitation

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

0.5 - 1 mg 5/8 in needle

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)

S/S of PP shock

Tachycardia Tachypnea BP decreases Skin cool, clammy with pallor Restlessness and Dyspnea

What is important about the process of exfoliation?

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

What is a good APGAR score?

7-10 ***less than 3-4 will require resuscitation

Normal newborn RR

30-60 w/ short periods of apnea (

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

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

What is heavy lochia?

one pad within 2 hrs

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

Pathologic ***within 24 hrs

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

24 hours darker red ***retained placental fragments

Normal WBC value during PP period?

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

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

Oxytocin is released from the --- pituitary

posterior

Normal blood glucose is --- Treatment is required if blood glucose falls below ---

60-70 mg/dL 45 mg/dL

What do the sole creases look like in postterm newborn?

deep sole creases

How is congenital hip dislocation identified?

Positive Ortoloni test Asymmetry of gluteal folds Limited hip abduction Apparent shortening of femur

Interventions for episiotomy discomfort?

warm sitz bath after 24 hrs anesthetic spray witch hazel pads peri hygiene

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

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

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

multigravidas breastfeeders

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

24 hours darker red ***retained placental fragments or infection

Normal cord blood bilirubin

What is number one cause of a boggy uterus?

full bladder

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

conduction

When should postpartum assessments be done?

q15 * 4 q30 * 2 q1hr * 4 q8hr

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

Physiologic

When is PKU screening done?

after ingesting sufficient milk ***phenylalanine is an essential amino acid found in milk

Normal newborn HR

120-140 ***4th ICS MCL

Normal cord blood HGB and HCT

HGB = 17 g/dL HCT = 55%

--- jaundice occurs after 24 hrs --- jaundice occurs within 24 hrs

Physiologic (self-limiting and self-resolves) Pathologic (requires phototherapy, etc)

Which enzyme is necessary to conjugate (breakdown) bilirubin?

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

What is number one cause of excessive bleeding?

uterine atony

Sign of Down's Syndrome

low set ears simian hand crease palpable fissures of eyes

What happens during the second period of reactivity?

Tachycardia Tachypnea Increased muscle tone (Jumpy) Increased mucous production (monitor for chocking/gagging)

S/S of DVT

Reddened, warm area over affected vein Pain/Tenderness on ambulation

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

check consistency and location of fundus

Diffuse swelling that crosses suture lines is ---- Swelling from blood confined within suture lines (doesn't cross) is ----

Caput succedaneum Cephalhematoma

What are risk factors for a PP thrombosis?

Increased clotting factors Immobility Sepsis Maternal age > 35 Multiparity Smoking History of CVD or Diabetis

When would the fundus be nonpalpable?

by 2 wks

What bilirubin levels will lead to staining of body?

4-6 mg/dL ***starts first in head and face then progresses to trunk

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

Which glucose level require intervention?

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

radiation

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

Normal WBC levels in newborn

9,000 - 30,000 (slightly elevated)

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

24 hours bright red ***lacerations

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

uterine infection - foul odor as well

Normal newborn heart rate is --- Normal newborn respiratory rate is ---

120-140 30-60

Normal WBC value during PP period?

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

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)

Why suction mouth before nose?

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

Nursing interventions for afterpains

NSAIDs before breastfeeding Self-resolves in 3-7 days Good sign that uterus is contracting

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

Hgb and HCT Urinalysis sometimes Rubella and Rh if unknown

What days? Lochia Rubra = Lochia Serosa = Lochia Alba =

Days 1-3 Days 4-9 Days 10 and up

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

How can a Cephalhematoma lead to increased bilirubin?

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

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)

What stools are a sign of sickness?

constipation or diarrhea

A newborn needs --- cal /day

110 cal/day

Treatment for DVT

Bedrest Moist heat Heparin

What is initial treatment of hypoglycemia?

feeding (breastmilk) bottle feeding (D5W)

Calories for lactating mom

2700 total ***450-500 more than recommended pregnancy calories

Suction --- before ---

mouth nose

When is Sitz Bath given for episiotomy care?

after first 24 hrs TID for 20 mins

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

hypoglycemia ***obtain blood glucose (

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

Hgb and HCT Urinalysis sometimes Rubella and Rh if unknown

T3 - Advance Organizers (Josh) Flashcards

(102 cards)