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
