Chapter 17-20 objectives Flashcards
Uterine Involution
The uterus deflating
after birth U+2
6-12hr after birth: U
Lowers 1cm per day
Day 7: between U and symphisis pubis
Day 14; non palpable
Subinvolution
Involution doesnt occur properly
Can cause PP hemorrhage
Risk factors
LGA, Multipara, multifetal pregnancy Chorioamnionitis Retained placental fragments Polyhydraminos Prolonged/precipitous labor Drugs
Normal Lochia time
Rubra: 1-3 days, red, small clots
Serosa: 4-10 days, pink/brown, serosanguinous
Alba: 1-3+ weeks, yellow-white or clear
Should be decreasing in amount each day.
What constitutes heavy lochia/bleeding
Saturated in 1hr = heavy
Epesiotomies
Heal in 3-4 weeks
Observe for Redness Swelling Ecchymosis Discharge Approximation
Watch for hemorrhoids; if there use ice, sitz bath, perineal care, topical anesthetics
Epesiotomy healing interventions
Clean area after each void or defecation
Pat dry front to back
Clean hands before and after changing pads
Epsom salts to sitz baths
Remove/apply pads front to back
Kegels
Protein and vit. C
Change pads q2-3 hr
How is excess plasma vol. removed in pregnancy
Diuresis: up to 3,000mL/day for a couple days PP
Diaphoresis: sweaty hoe
How do blood values change in pregnancy
WBC increase during labor and PP
Hgb and Hct drop from blood loss
Normal blood loss birth
500mL vaginally
1000mL C section
Whats the deal with clotting factors in delivery
ELEVATED- RISK FOR DVT IN PP MOTHERS
Use ted hose and SCDs !!!!
Assess for edema, heat, tenderness and fever
Messed up GI in delivery/PP
constipation: MOBILIZE
Assess bowel sounds, pain, tone
Watch for Paralytic Ileus or distention post C section
High fiber, fluids, stool softeners
Stop narcotics duh
Diastatis Recti
Separation of L side of abs w R side(OOF)
Can heal in ~6 weeks PP with exercise
Melasma
Spots on face, will fade after birth
PP ovulation
Ovulation can occur before first menses- early as 3 weeks PP, all ovulation returns by 6 months
Breastfeeding delays return of menstruation
What hormone is responsible for milk production
ProLACTin
What hormone is responsible for milk ejection
Oxytocin
Signs of mastitis
Pain on one side of breast
Elevated WBC (hard to tell tho cuz elevated normally PP)
High temp (38C+)
Breast care if breastfeeding
No soap on nips
Rub milk into nipple
Air dry nipples
Ensure proper latch
Breast care if not breastfeeding
Well fitting bra/sports bra
Ice
No breast stimulation
Milk analgesic
How frequently should PP mom be assessed
Hour 1: Q15min
Hour 2: Q30min
Hours 3-24: Q4 hours
Puerperal phases of developmental tasks for mothers
Taking In: 1-2 days. Focused on her own physiological needs. Very dependent. Must integrate birth experience into real life- designate pregnancy is over.
Taking Hold: 3-7 days. Become more independent. Attention transitions to newborn. May become anxious. Very teachable period.
Letting go: >7 days. Letting go of pre-baby life, fully accepting baby. Relationship with partner refocused.
Postpartum blues
First week, ends within 2 weeks.
Irritability, mood swings, anxiety.
Let mother know that it is normal and validate feelings.
How are postpartum blues differentiated from postpartum depression
SCREENING
Edinburgh Postnatal Depression Screen EDPS before discharge!
When is RhoGam indicated
Mother Rh-, baby Rh +
When should baby have adequate surfactant
34-36 weeks
Non shivering thermogenesis in baby
Metabolism of brown fat to produce heat
Evaporation heat loss baby
Air drying of skin=cooling
Dry infant asap
Conduction heat loss baby
Direct contact w/ cold object
Skin to skin contact important to keep babie warm
Convection heat loss baby
COLD AIR MAKE BABY COLD
Radiation heat loss baby
Heat to cooler objects not in direct contact
Don’t put baby by cold window
Cold stress
Increases metabolic rate, metabolism of brown fat causing inc. need for O2
Low surfactant- exacerbation of respiratory distress
Hypoglycemia from using glucose to heat body–> glucose metabolization–>metabolic acidosis and can interfere w/ bilirubin transport-> jaundice
ToRCHeS infection
Toxoplasmosis
Rubella
Cytomegalovirus (CMV)
Herpes/HIV
Syphillis
Toxoplasmosis signs symptoms effects
From cat feces/raw meat
Maternal Sx: Lymphadenopathy
Newborn Sx: Blueberry muffin lookin ass head
Hydrocephalus
Intracranial calcification
Rubella signs symptoms effects
Respiratory droplets
Maternal Sx: Rash, lymphadenopathy, arthritis
Newborn Sx: Blind, deaf
Cataract/deafness
Blueberry muffin head
CMV signs symptoms effects
Sexually transmitted, organ transplant
Mother Sx: Like Mono
Newborn Sx:Blueberry muffin Hearing loss, Seizures Petechia Periventricular calcifications
HIV signs symptoms effects
Mother Sx: AIDS
Newborn Sx: Recurrent infections (SCID- severe combined immune deficiency), chronic diarrhea
Herpes 2 signs symptoms effects
Mother: Herpetic lesions
Newborn: herpetic lesions, encephalitis
Syphilis signs symptoms effects
Maternal: 3 stages syphilis
Newborn: Hyrops fetalis, deafness, short maxilla, hutchinson teeth (two spikes per tooth)
Hyperthermia
Babies too warm, use brown fat can get metabolic acidosis. Use more O2 than can take in
Normal newborn vitals
Temp: 97.7-99.5 (36.5-37.5C)
Pulse: 120-160
RR: 30-60
Physiologic Jaundice
Transient hyperbilirubinemia
Not present in first 24 hr of life
Bili level over 5
Rate of bili level rise fall important
Non-physiologic jaundice
Can be first 24 hr.
Abnormalities causing excess destruction of erythrocytes
Breastfeeding and Jaundice/Early onset jaundice
Breastfeeding can cause high bilirubin levels if not fed enough.
Risks: poor suck, not enough colostrum intake (colostrum is a laxative, cant expel bilirubin via meconium)
What immunoglobulin crosses the placenta for da baby
IgG!
Newborn urinary
Kidneys immature
Void in first 12-24hr life
Uric acid present, risk for dehydration, fluid imbalance
First period of reactivity
Begins at birth, lasts for 30min.
Infant active, lookin at wtf goin on
go to sleep after
Second period of reactivity
Lasts 4-6 hours
Active, poopin, may regurgitate.
APGAR
Activity Pulse Grimace (reflex) Appearance Respiration
Activity APGAR
0 points; Absent
1 point; Flexed arms and legs
2 points; Active
Pulse APGAR`
0 points; absent
1 point; below 100bpm
2 points; over 100bpm
Grimace APGAR
0 points; floppy
1 point; Minimal response to stimulus
2 points; proper response to stimulus
Appearance APGAR
0 points; blue, pale
1 point; Pink body, blue extremities
2 points; Pink
Respiration APGAR
0 points; absent
1 point; Slow, irregular
2 points; Loud cry
Normal newborn weight and size range
19-21 inches (48-53cm)
~7lbs 8oz
Head 33-35 cm, 13-14in circumference
SGA
below 10th percentile
Under 2500g
AGA
Between 10th and 90th percentile
between 5lb 2 oz to 8lb 12 oz
LGA
Weight above 90th percentile
Over 4000g
IUGR
Deviation in expected growth pattern caused by adverse conditions
