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CPU MIDTERMS 6969 > CARE OF MOTHER 11-24 > Flashcards

CARE OF MOTHER 11-24 Flashcards

1
Q

Postpartum care This period constitutes a physical and psychological
adjustment to the process of childbearing and is
sometimes referred to as the

A

fourth trimester of
pregnancy.

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2
Q

medical and nursing care given to a
woman during the puerperium, which is the 6-week
period after delivery, beginning with termination of labor
and ending with the return of the reproductive organs to
the nonpregnant state.

A

Postpartum care

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3
Q

Risk factors for postpartum complications, risk factors
may include:

A

may include:
Preeclampsia or eclampsia
Diabetes
Cardiac problems
Uterine overdistention (as a result of multiple
births or hydramnios)

Abruptio placentae or placenta previa

Precipitous or prolonged labor, difficult delivery, or
extended time spent in stirrups

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4
Q

Goals of Postpartum Care

A

period following labor during which the maternal
body in general, and the genital organs, in particular
return to the pre-pregnant condition

Duration - 40 days or 6-8 weeks.
Another 4-6 weeks is needed for complete involution

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5
Q

The puerperal period is much shorter after abortion.

A

First 10 days - early postpartum
days after - late postpartum

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6
Q

B. U. B. B.. L. E. - H. E. Maternal Assessment

A

B - Breast size, shape, and engorgement
U - Uterus: firm or boggy
B - Bladder: tender or distended
B - Bowel movement
L - Lochia: amount, odor, color, clots
E - Episiotomy location, stiches, edema and redness
H - Homan’s sign - positive
E - Emotional status and bonding

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7
Q

DVT and Homan’s Sign

A

A positive Homan’s sign is indicative of a DVT

The patient’s leg is positioned at a 90° angle (either
while in supine or sitting)

Dorsiflexion of the foot reveals pain in the calf if
positive|

: redness, sudden sharp pain, and
warmth in the leg

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8
Q

Postpartum Biophysical Changes

The uterus contracts firmly after delivery of the
newborn, reducing its size by _____. It
remains this size for about ____days, then decreases in
size (involution) and descends about ____
fingerbreadth per day.

A

more than half
2

one

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9
Q

Reproductive System changes

At _____ postpartum days, the uterus cannot be
palpated abdominally.

A

10 to 14

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10
Q

Reproductive System changes

It returns to near its
prepregnant size by ______ postpartum weeks.

A

4 to 6

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11
Q

Reproductive System changes|

The
site of placental attachment requires ____weeks
to heal;

A

6 to 7

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12
Q

Reproductive System changes

endometrial regeneration requires ___
weeks.

A

6

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13
Q
  • discharge from the uterus lining during
    the first 3 weeks after delivery
A

Lochia

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14
Q

Lochia - discharge from the uterus lining during
the first 3 weeks after delivery, occurs in three
types.

A

Lochia rubra
Lochia serosa
Lochia alba

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15
Q

Lochia:
|

  • dark red discharge occurring in
    the first 2 to 3 days.
A

Lochia rubra

It contains epithelial cells,
erythrocytes, leukocytes, and decidua, and has
a characteristic human odor.

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16
Q

Lochia:
|

  • pink to brownish discharge,
    occurring from 3 to 10 days after delivery.
A

Lochia serosa

. It is a
serosanguinous discharge containing decidua,
erythrocytes, leukocytes, cervical mucus, and
microorganisms; lochia serosa has a strong
odor.

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17
Q

Lochia:
|

  • almost colorless to creamy
    yellowish discharge occurring from 10 days to 3
    weeks after delivery
A

Lochia alba

It contains leukocytes,
decidua, epithelial cells. Fat, cervical mucus,
cholesterol crystals and bacteria. Lochia alba
should have no odor.

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18
Q

Complete cervical involution may take

A

3 to 4 months.

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19
Q

Rugae reappear by ____postpartum
weeks.

A

3 to 4

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20
Q

The estrogen index returns in

A

6 to 10 weeks

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21
Q

The abdomen remains _______ for some time
after delivery

A

soft and flabby

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22
Q

(separation of abdominal recti
muscles)

A

Diastasis recti

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23
Q

Breasts changes include the following:

A

Rapid drop in estrogen and progesterone, increase in secretion of prolactin after delivery

Colostrum is present at the time of delivery; breast
milk is produced by the third or fourth postpartum
day.

Larger and firmer breasts occur with lactation
(primary engorgement). 1-2 congestion subside

In the breast, prolactin stimulates alveolar cells to
produce milk.

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24
Q

Sucking of the newborn triggers a
release of _______of the
myoepithelial cells, which stimulate milk flow; this
is known

A

oxytocin and contractility

|

asthe let down-down reflex

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25
Q

The average
amount of milk produced in 24 hours increases
with time.

First week –
1 to 4 weeks –
After 4 week –

A

6 to 10 oz
|
20 oz

30 oz

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26
Q

Estrogen and progesterone levels ______ rapidly
after delivery

A

decrease

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27
Q

45% of lactating women resume menstruation by

A

12
week

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28
Q

The cervix becomes thicker and firmer; by the end of
the first postpartum week, it is still dilated about 1 cm,
Complete cervical involution may take

A

3 to 4 months

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29
Q

Complete cervical involution may take 3 to 4 months.
Childbirth results in a permanent change in the
cervical os from round to

A

elongated.

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30
Q

The vagina is ____
after delivery.

A

smooth and swollen, with poor tone

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31
Q

Rugae reappear by ____ postpartum
weeks.

A

3 to 4

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32
Q

The estrogen index returns in ____ weeks

A

6 to 10

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33
Q

Ovulation and resumption of menstruation are
influenced by whether or not the client breast feeds

45% of lactating women resume menstruation by ___
weeks; 80% have one or more anovulatory cycles
before the first ovulation

A

12

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34
Q

Ovulation and resumption of menstruation are
influenced by whether or not the client breast feeds

40% of nonlactating women resume menstruation
by ___ after delivery; 65% by ___; and 90%
by ___ s. Fifty percent ovulate during the first
cycle.

A

6 weeks

12 weeks

24 week

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35
Q

Transient bradycardia (_____beats per minute)
occurs for ____hours after delivery and may
persist for_____days.

A

50 to 70

24 to 48

6 to 8

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36
Q

Blood volume decreases to nonpregnant levels by ____
weeks after delivery.

A

4

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37
Q

Hematocrit rises by the ______ postpartum
day

A

third to seventh

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38
Q

Leukocytosis (______) continues for several days after delivery

A

20,000 to 30,000 white blood cells per
mm*

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39
Q

Blood pressure remains stable and the pulse returns
to nonpregnant rate by ____ months postpartum.

A

3

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40
Q

Any mother whose temperature reaches ______
in any_____, during the
first ___ postpartum days, excluding the first 24
postpartum hours, is considered to be febrile.

A

38C (100.4F)

two consecutive 24-hour periods

10

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41
Q

Pulmonary functions return to nonpregnant status by
___ months after delivery.

A

6

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42
Q

A full bladder displaces the uterus and can cause

A

postpartum hemorrhage;

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43
Q

bladder distention can
lead to

A

urinary retention.

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44
Q

Adequate bladder emptying generally resumes in
______ days after tissue swelling and bruising
resolve.

A

5 to 7

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45
Q

the glomerular filtration rate remains elevated for
about _____ days after delivery

A

7

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46
Q

Dilated ureters and renal pelvis return to their
nonpregnant states within _____ weeks after delivery

A

6 to 10

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47
Q

Puerperal diaphoresis and diuresis occur within the
first ____ hours after delivery.

A

24

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48
Q

Gastrointestinal motility and tone return to the
nonpregnant state within ___ weeks after delivery.

A

2

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49
Q

Constipation commonly occurs during the _______ period due to decreased intestinal muscle
tone, perineal discomfort, and anxiety.

A

early
prepartum

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50
Q

he client may return to her prepregnant weight in_____ weeks, if weight gain during pregnancy was
within the normal range.

A

6
to 8

51
Q

are a common problem in the early
postpartum period, due to pressure on the pelvic floor
and straining during labor.

A

Hemorrhoids

52
Q

Most women ambulate _____ hours after delivery;

A

4 to 8

53
Q

early ambulation is encouraged to avoid

A

complications, promote involution, and improve
emotional outlook.

54
Q

Relaxation and increased mobility of pelvic
articulations occur ____ weeks after delivery.

A

6 to 8

55
Q

Visible vascular changes of pregnancy disappear as

A

estrogen levels decreases.

56
Q

decreases gradually after delivery, causing a
decrease in hyperpigmentation

A

Melanin

57
Q

Taking-in period

A

occurring 1 to 2 days after delivery

58
Q

Taking-hold period

A

extending from 2 to 4 days after
delivery

59
Q

Letting-go period

A

This period generally occurs after the new mother
returns home; it involves a time of family
reorganization.

60
Q

Factors Influencing Successful Transition to
Parenthood During the Postpartum Period:

A

Response and support of family and friends

Relationship of the birthing experience to
expectations and aspirations

Previous childbearing and childrearing experiences

Cultural influences

61
Q

Within 24 hours after birth, the newborn’s _____ must function sufficiently for
progression to, and maintenance to extrauterine life.

A

renal,
gastrointestinal (GI), hematologic, metabolic, and
neurologic systems

62
Q

This is a phase of instability during the first 6 to 8
hours of life through which all the newborns pass,
regardless of gestational age or nature of labor and
delivery.

A

Transition Period

63
Q

Transition Period

In the first period of reactivity, (immediately after
birth),

A

respiration is rapid, (may reach 80 breaths per
minute), and transient nostril flaring, retractions and
grunting may occur. The heart rate may reach 180
beats per minute during the first few minutes of life

64
Q

this first sleep (known
as ____) occurs within ____hours of birth and
lasts from a few minutes to several hours’

A

sleep phase. 2

65
Q

Transition Period

The second period of reactivity, starting when the
newborn awakes, is marked by

A

hyperresponsiveness
to stimuli, skin color changes from pink to slightly
cyanotic, and a rapid heart rate

66
Q

Respiratory Adaptation

Initial respirations are triggered by physical -
sensory-
and
chemical factors-

A

Physical factors include the effort required to expand
the lungs and fill the collapsed alveoli (e.g. change in
pressure gradients)

Sensory factors include temperature, noise, light,
sound, and a drop in temperature.|

Chemical factors include changes in the blood (e.g.
decreased O2 level, increased CO2 level, and
decreased pH) as a result of the transitory asphyxia
during delivery.

67
Q

The newborn respiratory rate ranges between _____ breaths per minute.

A

30 and
60

68
Q

Oral mucous secretions may cause the newborn to
_____, especially during the first 12 to 18
hours.

A

cough and gag

69
Q

Newborns are obligatory nose breathers. The reflex
response to nasal obstruction, opening of the mouth
to maintain an airway, is not present in most
newborns until ____ weeks after birth.

A

3

70
Q

(cyanosis of the hands and feet and
around the mouth).

A

acrocyanosis (

71
Q

Cardiovascular Adaptation

A

acrocyanosis

PR IS 120-160
100(SLEEP)
BP - 80/46

72
Q

Respiratory Adaptation

A

physical, sensory,
and chemical factors

rr 30-60 breath/pm\

ORAL MUCOS 12-18 HRS OF BIRTH

obligatory nose bleeders

73
Q

Cardiovascular Adaptation

A

limited supply of subcutaneous fat

Rapid heat loss in a cool environment occurs by
conduction, convection, radiation, and evaporation.

74
Q

Neurologic adaptation

A

neurologic system is not fully
developed

uncoordinated movements

labile temperature regulation
Newborn reflexes- for development

75
Q

Gastrointestinal adaptation

A

Digestive enzymes are active at birth can supp 36 to 38 weeks’ gestation

muscular and reflex for transporting food are present at birth.

Digestion of protein and carbohydrates is readily
accomplished

Salivary glands are immature at birth, little saliva until the newborn is 3 months old

meconium bowel movement contains occult blood is excreted
within 24 hours in 90% of normal newborns.

Some newborns nurse immediately when put to the
breast, others take up to 48 hours for effective
feeding

Random hand-to-mouth movement and finger
sucking have been observed in utero

76
Q

fat digestion and absorption are poor
due to the inadequacy of

A

pancreatic enzymes and
lipase.

77
Q

Immune system adaptation

A

cannot limit an invading organism at
the portal of entry.

The immaturity of a number of protective systems increases the risk of infection

inflammatory response is reduced qualitatively
and quantitatively

Phagocytosis is sluggish.

The acidity of the stomach and the production of
pepsin and trypsin are not fully developed until 3 to 4
weeks of age

Immunoglobulin A (IgA) is missing from the respiratory
and urinary tracts, unless the newborn is breast fed.

Infection represents a leading cause of morbidity and
mortality during the neonatal period.

3 immunoglobins:
IgA
IgG
IgM

78
Q

Immune system adaptation

IgA
IgG
IgM

A

IgG crosses the placenta and is found in the fetus by
the 3rd trimester. It [protects the newborn against
bacterial and viral infections the mother has
developed antibodies for (tetanus, measles, mumps)

IgM is found in the blood and lymph nodes and is the
first immunoglobin to respond to infection. Production
starts at birth. If elevated at birth may indicate
exposure to intrauterine infection

IgA is found in colostrum and can contribute to
passive immunity. It limits bacterial growth in the GI
trac and is produced gradually.

79
Q

Skin Appearance of Newborn

Pale and cyanotic

A
  • poor central nervous system
    control
80
Q

Gray color

A
  • indicates infection
81
Q

Cyanosis

A

– newborn’s lips, hands and feet are likely to
appear cyanotic from immature peripheral circulation

82
Q

Acrocyanosis

A

– a line seems to be drawn across the wrist
or ankle with pink skin on one side and blue on the othernormal 24 to 48 hours after birth.

83
Q

Jaundice

A

e - the skin and the eyes appear to be yellow

immature liver function-

84
Q

Physiologic jaundice occurs ___ day of life in
about 50% of all newborn as a result of

A

2nd or 3rd

breakdown of
fetal RBC.

85
Q

in terms of jaundice

More than 7 mg/100ml -

More than 10 to 12 mg/100ml

Above 20mg/100ml -

A

can cause jaundice

treatment is considered.
Phototherapy is a common therapy.

damage to the brain( kernicterus)

86
Q

Cephalhematoma -

A

a collection of blood under the
periosteum of the skull bone

87
Q

Intestinal obstruction

A

stool cannot be evacuated,
intestinal flora may break down bile leading to the
release of indirect bilirubin into the bloodstream again.

88
Q

Kernicterus

A

form of brain damage caused by excessive
jaundice

89
Q

Phototherapy -

A

exposure of the infant to light to initiate
maturation of liver enzymes

90
Q

Pallor

A

– a result of anemia caused by excessive blood
loss during the cutting of the cord

90
Q

Harlequin sign

A

reddish appearance on the dependent
side of the body and pale on the upper side because of
immature circulatio

91
Q

Hemangiomas

A

vascular tumors of the skin

92
Q

Hemangiomas

Nevus flammeus

A

called portwine stain

macular purple or dark-red lesion that is
present at birth

stork’s beak marks or telangiectasia
(occur as
lighter, pink patches at the nape of the neck.)

93
Q

Hemangiomas

Strawberry hemangioma

A

refers to elevated areas formed by immature
capillaries and endothelial cells

high estrogen
levels of pregnancy

, may appear up to 2 weeks

after the first year ,they tend to be absorbed
and shrink in size

hydrocortisone ointment-may speed the
disappearance by interfering with the binding
of estrogen to its receptor sites
surgery rarely recommended

94
Q

Hemangiomas

Cavernous hemangioma

A

dilated vascular spaces

usually raised and resemble a strawberry
hemangioma in appearance

steriods,interferon-alfa-2a ,or vincristine –used
to reduce size

surgical removal of lesion

Assess hematocrit levels for possible internal
blood loss / bleeding of lesion located maybe
on the internal organs

95
Q

Mongolian spots

A

gray patches across the sacrum or buttocks and
possibly on the arms and legs

They disappear by school age without treatment

Be sure to inform parents that these are not bruises

96
Q

Vernix caseosa

A

– a white cream cheese-like substance
that serves as a skin lubricant in utero

document color of vernix, because it takes the color
of the amniotic fluid
yellow from bilirubin, green from meconium

97
Q

Lanugo

A

fine downy hair that covers a newborn’s
shoulders, back and upper arms

rubbed away by the friction of bedding and clothes
against the newborn’s skin
by 2 weeks of age, it has disappeared

98
Q

Desquamation

A

within 24 hours the skin of the newborns
becomes extremely dry which may result in peeling
similar to a sunburn

99
Q

Milia

A

– pinpoint white papule that can be found on the
cheek across the bridge of the nose due to plugged
sebaceous gland

Disappear by 2 to 4 weeks of age
Reminder: avoid scratching or squeezing to prevent
infection

100
Q

Erythema toxicum

A

a newborn rash , called flea-bite
rash

Begins with a papule, increase in severity to become
erythema on the 2nd day, and then disappears by the
3rd day

caused by a newborn’s eosinophils reacting to the
environment as the immune system matures

it requires no treatment

101
Q

GI tract is usually sterile after birth, bacteria may be
cultured from the intestinal tract in most babies within ____ hours of life.

A

5
hours to 24

102
Q

Accumulation of bacteria in the GI tract is necessary fo

A

digestion and for the synthesis of Vitamin K

103
Q

Newborn’s stomach holds about _ ml

A

60 to 90 ml

104
Q

Newborn regurgitates easily because of an immature _

A

cardiac sphincter between the stomach and esophagus

105
Q

Immature liver functions may lead to

A

lowered glucose
and protein serum levels

106
Q

First stool of a newborn is usually passed within 24
hours after birth

A

(meconium)

107
Q

If a newborn does not pass a meconium stool by 24 to
48 hours after birth, the possibility of some factor such
as

A

meconium ileus, imperforate anus ,or volvulus
should be suspected

108
Q

Meconium

A

a sticky tar like, blackish-green, odorless
material

fromm

mucus, vernix, lanugo,
hormones and carbohydrates(intra uetrin life)

109
Q

Meconium

2nd or 3rd day of life is termed

A

transitional stool
(green and loose resemble diarrhea to the
untrained eye)

110
Q

4th day of life breastfed babies passes what kind of stool

A

3 or 4 light yellow
stools per day, sweet-smelling

111
Q

Formula fed babies passes what kind of stool

A

2 or 3 bright yellow stools a
day, slightly more noticeable odor

112
Q

A newborn placed under phototherapy lights as a
treatment for jaundice has what kind of stool

A

bright green stools because
of increased bilirubin excretion

113
Q

Newborn with bile duct obstruction have what kind of stool

A

clay-colored
(gray) stools, because pigment are not entering the
intestinal tract

114
Q

Black/Tarry stoo

A

– after 2 or more days indicates
intestinal bleeding

115
Q

flecked stools usually indicate an anal fissure

indicates what

A

Blood

116
Q

Mucus is mixed with stool or stool is watery and loose

indicates what

A

(milk allergy, lactose intolerance )

117
Q

Blink Reflex

A

this reflex serves a protective
function against hurting the eye

118
Q

Rooting Reflex

A

Brushing the cheek or stroking near the mouth of the
newborn will cause the head of the newborn to turn to
that direction.

Dissapear kn 6 weeks

119
Q

Sucking Reflex

A

Touching the newborn’s lips causes the baby to make
sucking motions.

Dissapear 6 months

120
Q

Extrusion Reflex

A

Until 4 months of age, any food placed on the anterior
portion of the tongue of babies will be expelled by
them

121
Q

Palmar Grasp Reflex

A

Objects placed on newborns’ palms will be grasped
by newborns.

Dissapear 6 weeks to 3 months

122
Q

Walk-in-Place Reflex

A

If newborns are held in a vertical position with their
feet touching a hard solid surface, newborns will take
few, alternating steps.

123
Q
A

CPU MIDTERMS 6969 (17 decks)

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