Exam 2 Flashcards
What are the interventions for postpartum bleeding?
#1 fundal massage*** oxytocin, prevent bladder distention
What are some of the most common causes of postpartum hemorrhage?
- uterine atony–failure of uterus to contract firmly***
- vaginal or vulvar hematomas
- unrepaired laceration of cervix or vagina
Consider a client that is unable to void during the postpartum period, what are some reasons?
What are some interventions?
Reasons- epidural, episiotomies, lacerations, foley caths
Interventions- in and out cath best option***
assist to the bathroom offer bedpan if unable to ambulate, running water, place hand in water, pour water over perineum, shower, sitz bath, or sterile in/out cath as last resort
With labor anesthesia, what are some of your postpartum concerns?
respiratory depression and reduced motility, constipation
overall generalized weakness***
Discuss the administration of Rhogam during the postpartum period, what is the process?
Who gets it?
process - it is given preventatively at 28 weeks
it is also given between birth and 72 hours*** to enhance lysis of Rh positive blood that may be released from an Rh + fetus - multiple reasons
who - moms who are Rh-, not jehovah witnesses without consent
What are some key considerations when you are teaching discharge instructions to a postpartum client?
2 week follow up after c-section
6 week follow up after vaginal birth
sex again - 6 weeks, or when they feel comfortable with resuming - not bleeding- wait until alba, minimal damage at delivery
fever - sudden, persistent
pain- laceration, episiotomy or abd
bleeding - changes to red, clots, too much, light headed dizzy
infection - odor, redness, swelling, pain
DVT - red, hot, pain, edema, unilateral
UTI- pain, frequency, urgency, burning, odor
mastitis - pain, redness, malaise
depression
unable to care for self or baby
Develop an example of ebl measurement.
math question***
estimated blood loss
1 g = 1 mL, 1000 g = 1kg
ex. 2.3 kg (2300 g) wet chuck less dry chuck of 75 g = 2225 g
Review your Punnett squares, be able to answer questions related to all scenarios. Pay close attention to autosomal recessive traits/disease, carriers, autosomal dominant disease
5 questions, look at it NOW!!
Develop a chart of the different stages of postpartum lacerations
stage 1- least severe goes into the skin above the muscle
stage 2 - into the muscle
stage 3 - into anal sphincter muscles
stage 4 - completely through the anal sphincter and mucosal membrane
What is a normal hemoglobin during the postpartum period?
less than 10 post partum is concerning educate on diet and supplements
less than 7 need to transfuse call the dr for an order
Discuss the LAM and all the components for successful contraception
Lactational Amenorrhea method
from birth to 6 months for moms breastfeeding and menstrual cycle has not returned
1-2% failure rate
-must feed every 2-3 hours during the day
-every 6 hours at night
-no bottle supplementations/pumping - must be baby to breast
be careful to schedule disruptions
When does ovulation and menses return for non-breastfeeding mothers?
What about breastfeeding mothers?
non breastfeeding - can occur as early as 4 weeks, usually occurs between 7 to 9 weeks, can take as long as 12 weeks
breastfeeding moms - around 6 months, is dependant on hormone prolactin r/t frequency of breastfeeding
breast feeding delays menses’ return***
Develop a list of all reportable STI’s in the USA.
HIV gonorrhea syphilis chlamydia chancroids Hep B Lymphogranuloma venereum
Make a chart of normal newborn vital signs.
RR- 30*** to 60 T- 97.7*** to 99.5 F HR - 110-160*** WT - 2700 TO 4000 gr*** CC - 30 to 33 cm or 11.8 to 13 in
What are the specifics of HIV testing during pregnancy?
test at the 1st prenatal visit
test again in the 3rd trimester for high risk patients
We test every patient every time
What are specifics of HSV and pregnancy?
c-section only if they have an active lesion
medications are given to prevent outbreaks
vaginal delivery without prodromal symptoms or lesions
Diagram the pathophysiology, symptoms and treatment of hypoglycemia in newborns
if it is less than 40 treat it, especially if symptomatic
s/s - irritable, jitters, tremors, exaggerated moro reflex,
apnea, high pitched cry, seizure, lethargy, cyanosis,
floppy, poor feeding
Above 40 - mildly symptomatic- breastfeed***
Know normal APGAR scores and be able to score a baby
We will have the APGAR scoring system and a description of the infant
severely depressed score 0-3
moderately depressed 4-6
excellent condition 7-10
What are some causes of amenorrhea?
What would a diagnostic workup look like?
causes - primary genetic issues
no secondary sex characteristics
athletes - eating disorders -female triad***
stress, pregnancy, menopause, thyroid disease, medications
Think about STI’s that would require a c-section, what are the reasons?
Herpes with active lesions or prodromal symptoms
HIV if viral load is greater than 1000
What are some ways that nurses can help fathers transition to parenthood
skin to skin
pointing out entrainment***
allow participation in care
claiming
Develop a chart for the stages of syphilis- think about the presentation of the disease process.
stage 1 - chanchers
stage 2 - rash(wart like lesions on palms and soles), condyloma lata
stage 3 - no symptoms
stage 4 - gummatous lesions, CV, CNS
If a mother is not demonstrating attachment with her infant, what are some ways that the nurse can intervene?
Ask questions to find out why they are not bonding. en face entrainment claiming reciprocity
What medications do we give to newborns? Why?
erythromycin ophthalmic ointment 0.5% to prevent blindness
Vitamin K is given IM based on weight and gestational age, premature sterile gut at birth, k is made in the gut
Review the ballard assessment and be able to classify a baby based on assessment (you will have a chart available).
will be given a chart and a growth curve to establish normal parameters
looking for two things–
1– length, weight, height are symmetrical
2– growth chart percentage, SGA, LGA, AGA
Develop some case scenarios of complex newborns- be able to triage.
Who would you see first—
billi >15 mg/dl is symptomatic concerning see billi curve
billi <10 not as concerned
positive coombs test asymptomatic
What is a coombs test? do not need to memorize
used to detect antibodies that act against the surface of your red blood cells. The presence of these antibodies indicates a condition known as hemolytic anemia, in which your blood does not contain enough red blood cells because they are destroyed prematurely.
What are some instructions that we provide to bottle-feeding mothers to care for their breast?
cabbage leaves avoid stimulation air dry supportive bra no hot shower on the breast
Develop a teaching plan for post circ care
petroleum jelly
keep it clean
What are hunger cues?
rooting
hand to mouth
crying is a late cue
What is the cause of nipple pain for breastfeeding mothers?
What are some ways to prevent nipple pain?
poor latch
take in the whole areola
flanged the lips
keep dry - air, clean nursing pads
Create a teaching plan for symptom management of dysmenorrhea.
What are some causes of primary dysmenorrhea? What about secondary
take NSAIDS to suppress the prostaglandin 2-3 days before period to suppress bleeding
Differentiate between primary and secondary amenorrhea
primary- no period by age 14, absence of secondary sexual characteristics, no period by age 16 even if they have secondary sexual characteristics
secondary - absence of menses for 6 months after normal periods for at least 3 cycles
How do you know if a baby is getting enough breastmilk?
frequent feedings 8-12 times per day rhythmic sucking with audible swallows 6-8 wet diapers a day 3-4 bowel movements each day 1 tbsp each or more avg wt gain is 15-30 g daily*** back to birth wt by day 10***
What are some complications of endometriosis?
pain
infertility
ovulatory versus nonovulatory bleeding- be able to differentiate between the two.
ovulating - regular cycled periods every 28 days
middleschmertz pain mid cycle
spinnbarkeit mucus
normal bleeding 4-7 days
mid cycle thermal shift
cramping with menses
non ovulating - irregular, heavy period, build up
What are the symptoms of jaundice?
What are the risk factors for jaundice?
What are normal bilirubin levels?
Probably SATA
symptoms - yellowing of the skin and mucosal membranes risk factors - cephalohematoma*** preterm asian or native american RH incompatibility*** breastfeeding bruising*** polycythemia previous sibling with high billi
normal levels - normal is less than 15 always, but is plotted on a curve based on age
What are normal stool patterns for newborns?
meconium until day 3 then it turns yellow/green, milk stool by day 4
When should a baby return to birth weight?
2 weeks
What are the four phases of Rubin’s adjustment to motherhood?
taking inmom is in recovery, let her tell you about it
taking hold mom is ready to parent, teach her
letting go*** moving forward as a mom, letting go of old plans making new ones
know interventions for each
What are the differences between pathological and physiological jaundice?
physiological - appears on day 2-3, peaks at day 4-5, disappears from days 10-14, levels less than 15 mg/dl
pathological - appears in first 24 hours, increases by more than 5 mg/dl/day, higher than expected normal ranges needs treatment
What are the four types of heat loss in newborns?
What are examples of each?
evaporation - from skin when wet or breathing
convection- movement of air, warm air escaping the infants body r/t drafts, fans, ventilation systems
conduction- surface area, heat leaves baby and goes into what it is touching, into table
radiation- cold from a solid surface but not touching
standing next to an ice block
