Exam 2 Flashcards
What should be assessed immediately after birth on the mother?
Vitals
uterine firmness & location
amount of vag bleeding
What could happen if BP drops & HR increases?
Shock, bleeding
Temperature elevated to what in the first 24 hours post delivery is normal?
100.4
How many days can it take for mom’s milk to come in?
3-5 days
Where should the uterus be post-delivery?
midline with the umbilicus
What should you as the nurse do if the uterus is boggy?
fundal massage in circular motions
What medications can be given for a boggy uterus?
oxytocin or methylergonovine to promote uterine contraction & prevent hemorrhage
How many days can bowel movements be delayed for post-delivery?
2-3 days
What can cause urinary retention after birth?
loss of bladder elasticity
meds/anesthesia
What can cause uterine atony & displacement after birth?
urinary distention
What is the normal amount of urine output in the first 2-3 days?
> 3,000 ml
What should the lochia look like in the first 2 hours after delivery?
heavy period and then steadily decrease
How would you classify heavy lochia?
one pad saturated in 2 hours
What is rubra lochia?
blood with small clots no bigger than a nickel
day 1-3
What is serosa lochia?
pinkish brown
day 4-10
What is alba lochia?
yellowish-white discharge
day 10-28
If the lochia is heavy with clots you should do what?
Assess for hemorrhage
First-degree laceration?
skin only
Second-degree laceration?
skin & muscle
Third-degree laceration?
skin, muscles, perineum, external anal sphincter muscle
Fourth-degree laceration?
skin, muscles, anal sphincter & anterior rectal wall
What can you do as the nurse to help with the pain from an episiotomy/laceration?
ice packs
Dermoplast
sitz bath
stool softener (docusate sodium)
If the mom had an epidural, what should you assess for first?
maternal hypotension
A warm sitz bath can help what?
decrease pain
promotes circulation
decreases risk for infection
A cold sitz bath can help what?
reduce perineal edema
reduce the response of the nerve ending causing pain
After receiving the rubella vaccine what should you avoid for the first month after the immunization?
getting pregnant
If mom is Hep B positive what must the baby get within 12 hours post-delivery?
Hep B vaccine & immunoglobulin
What can the WBC be elevated to in the first 4-7 days to protect the body from infection?
20,000-25,000
When is the taking-in phase?
first 24-48 hours
What should you not do in the taking-in phase?
teaching
only teach how not to kill the baby like feeding
When is the taking-hold phase?
begins on 2-3 day and can last 10 weeks
What should you do in the taking-hold phase?
teach everything!!!
they want to learn
What should you administer to a mom with pregnancy-induced hypertension?
Magnesium sulfate
What should you assess for with pregnancy-induced hypertension?
vaginal bleeding
signs of hypovolemic shock
What amount of blood is classified as a PPH after vaginal delivery?
> 500 ml
What amount of blood is classified as a PPH after C-section?
> 1,000 ml
What should the nurse do for a mom with a PPH?
firmly massage fundus
assess lochia
assess bladder
Initiate IV fluids
O2
elevate legs
What medications can help a mom with a PPH?
oxytocin
Methylergonovine (NOT for HTN moms)
What is a laceration?
continuous slow oozing of blood with or without clots
What is a hematoma?
collection of 250-500 ml of clotted blood within the tissues
What does a hematoma look like?
should not see any blood
bulging blue mass or area of red-purple discoloration on the vulva, perineum, or rectum
How can small hematomas be treated?
ice packs
What are some expected side effects from magnesium sulfate?
flushed
hot
sedated
(esp for a bolus)
What are the signs of mag sulfate toxicity?
loss of DTRs
urinary output < 30ml/hr
Respiratory depression (< 12/min)
pulmonary edema
chest pain
dysrhythmias
When does endometritis begin?
2nd to 5th day PP
Does a mom with endometritis have to worry about it affecting her baby?
No, this infection does not harm baby and mom should still bond with the baby
What should you as the nurse do for a mom with endometritis?
Culture
Antibiotics
teach HH
What are some signs of endometritis?
pelvic pain
systemic effects (chills, fever, fatigue)
dark profuse lochia
Tachycardia
uterine tenderness
What is Mastitis?
a clogged milk duct that gets infected
What are some signs of mastitis?
a painful, red, localized hard mass
axillary adenopathy
What should you as the nurse do for a mom with mastitis?
give antibiotics
increase fluids
What should you teach a mom with mastitis about?
DON’T stop breastfeeding!!
Completely empty breast when feeding
feed on unaffected breast first
wash hands before feeding
allow nips to airdry
increase breast pad changes
What are some manifestations of vulvovaginitis?
thick, white vaginal discharge
can smell fishy
severe itching, dysuria & dyspareunia
What med can be administered for vulvovaginitis?
Metronidazole gel
-intravaginally 1x/day for 5 days
OR
-orally (take on empty stomach & no ETOH)
What are the risks to the neonate with vulvovaginitis?
preterm birth/low birth weight
PROM
2nd trimester miscarriage
What should you teach a mom with vulvovaginitis?
bathe daily
wear loose fitting clothing
finish all antibiotic regimens
What are some signs of gonorrhea?
yellow/green discharge
endocervical bleeding
spotting
Dysmenorrhea
What are some risks to the neonate with gonorrhea?
Miscarriage
amniotic fluid infection
PROM
increased risk of endometritis after delivery
What medication should be given to baby once born from a mom with gonorrhea?
Erythromycin eye drops
What are some signs of baby blues?
sad
crying easily
headache
Anxiety
anger
restless
What is the treatment for baby blues?
there is no treatment
symptoms should resolve in 10 days without interventions
What are some signs of PP depression?
feeling guilt or inadequate
severe anxiety
extreme fatigue
flat affect
anorexia
rejection of infant
intense mood swings
panic attacks
What is the treatment for PP depression?
Antidepressants
What should you teach mom & family about for PP blues or depression?
rest when the baby naps
time time for self
Schedule follow-up visit before normal PP visit for ar-risk pts
seek counseling
What should you encourage a mom with HIV to do during pregnancy?
get vaccines against Hep B, PNA, & the flu
What should be done after birth to the baby for a mom with HIV?
bathe the baby before remaining with mother
What medication should be given to both mom and baby with HIV?
Retrovir
When should the mom receive retrovir?
14 weeks gestation
throughout pregnancy
before onset of labor or c-section
When should the baby receive retrovir?
at delivery
6 weeks following birth
What does colostrum contain?
IgA immunoglobulin, provides passive immunity
If you have sore, cracked, or dry nipples what should you do?
apply breast milk to the nipples and allow it to sir dry
Non-lactating mothers should wear what type of bras for the 1st 72 hours?
well-fitting supportive bras
What should non-lactating mothers do to prevent lactation?
Avoid running warm water over breasts
put fresh cold cabbage leaves in bra (also helps with engorgment)
You know that your baby is getting enough milk if they are having how many diapers a day?
6-8
How should you lay your baby after feeding?
on their back-supine
Why is the basal body temp method not very reliable?
because outside variables can alter the temperature
What time should you take your temp when using the basal temp method?
before you get out of bed in the morning
What birth control method must you use spermicide gel with?
Diaphragm
What contraceptive requires a prescription, provider visits, and fitting?
diaphragm
How many hours before sex do you have to insert the diaphragm?
up to 6 hours before sex
How long do you have to leave the diaphragm in after sex?
at least 6 hours but no more than 24
What are some contraindications for the diaphragm?
hx of toxic shock syndrome
frequent UTIs
What are some adverse effects of combination and progestin-only BC?
HA
nausea
breast tenderness
Breakthrough bleeding
What are some advantages to combined oral BC?
highly effective
decreases blood loss
regulates menstration
protects against endometrial, ovarian and colon cancer
What are some advantages to progestin-only pills?
fewer adverse effects than with combined
safe to use while breastfeeding
What is one disadvantage to progestin-only pills?
less effective at suppressing ovulation than combined
Can an emergency oral contraceptive terminate an already-established pregnancy?
NO
What is something you should teach your patient receiving injectable progestin?
maintain an adequate intake of calcium & vitamin D
Which contraceptive can cause discomfort during sex?
vaginal ring
What contraceptives can be inserted immediately after abortion, miscarriage, childbirth, or breastfeeding?
Implantable progestin
IUD
How long is an implantable progestin effective for?
3 years
how long is an IUD effective for?
1-10 years
How long after childbirth can female sterilization be performed?
within 24-48 hours
What is hysterosalpingography and what is it used for?
it is a diagnostic procedure that uses dye to assess the patency of the fallopian tubes that helps determine the woman’s ability to bare children
When using a bulb syringe, what should you always suction first?
mouth first then nose!!!
What is classified as bradypnea in a newborn?
<30/min
What is classified as tachypnea in a newborn?
> 60/min
What three shunts close?
foramen ovale- few min
Ductus arteriosus- a few hours
Umbilical vein & ductus venosus- few days
In what order should vitals be taken after delivery?
RR
HR
BP
Temp
How much longer should the head be compared to the chest?
2-3 cm
If the head is >4 cm larger than that could mean what?
hydrocephaly
If the head is <3-2 cm then that could mean what?
microcephaly
How should the fontanels look?
soft & flat
may bulge with cry, cough or vomiting but this is normal
Bulging of the fontanels can indicate what?
increased intercranial pressure
infection
hemorrhage
What shape is the anterior fontanel and how long does it take to close?
diamond-shaped
12-18 months
What shape is the posterior fontanel and how long does it take to close?
triangular shaped
6-8 weeks
What is Caput Succedaneum and what is it caused from?
swelling of the soft tissue of the scalp due to pressure on the head during labor
resolves in 3-4 days
What is cephalohematoma?
collection of blood in the head
appears 1-2 days after birth
resolves in 2-3 weeks
check for jaundice
A low set of ears can indicate what?
chromosomal abnormality (down’s syndrome)
kidney disorders
What can excessive saliva indicate?
tracheoesophageal fistula
trachea & esophagus fuse together
When should meconium be first passed by?
within 24 hours after birth
When should urine first be passed?
within 24 hours
will be rust-colored first few days
what is acrocyanosis?
bluish hands & feet
what is Vernis Caseosa?
thick, cheese-like protective covering over baby’s body when born
What is lanugo?
fine, downy hair usually on pinnas, forehead, shoulders
What is Milia?
small raised white spots on chin, nose & forehead
do not squeeze the spots
what are Mongolian spots?
bluish-purple spots that look like bruises
document these!
What are Telangiectatic Nevi?
stork bite, flat pink or red marks that easily blanch
What are Nevus Flammeus?
port wine stain, capillary angioma
do not go away or blanch
What is erythema toxicum?
newborn rash, pink
appears during the first 3 weeks
no tx needed
What is the sucking & rooting reflex and when does it disappear?
turning head to side that is touched
3-4 months
What is the palmar grasp and when does it disappear?
fingers curl around your finger
3-4 months
What is the Plantar Grasp and when does it disappear?
toes curl around your finger
8 months
What is the Moro reflex and when does it disappear?
startle reflex
baby falls and extends then abducts arms back to core
6 months
What is the tonic neck reflex and when does it disappear?
fencer position
turn head to left and arm & leg on that side will extend and the other side flexes
3-4 months
What is the Babinski reflex and when does it disappear?
stroke foot upward and toes will fan upward & out
12 months
What is the stepping reflex and when does it disappear?
stand baby up and touch feet to surface and they will take a step
up to 4 weeks
At what stages does a baby born to a mom without Hep B receive their vaccines?
at birth
1 month
6 months
At what stages does a baby born to a mom with Hep B receive their vaccines?
hep B immunoglobulin & vaccine at birth
1 month
2 months
12 months
What at birth med HAS TO BE GIVEN?
erythromycin eye ointment to prevent blindness
When can a baby have their first bath?
once their temp has stabilized at 97.7
What temp should the bath water be at?
100.4 and warm room
Prepared formula can be refrigerated for up to how many hours?
48 hours
breast milk can stay at room temp for how many hours?
8 hours
breast milk can be refrigerated for how many days?
8 days
breast milk can stay frozen for how many months?
6 months
breast milk can stay in the deep freezer for how many months?
12 months
thawed breast milk can stay in the fridge for how many hours
24 hours
what percentage of weight is lost after birth and when is it gained back?
5-10% after birth
regain in 10-14 days
baby’s weight it doubled by?
6 months
baby’s weight is tripled by?
12 months
When should you report your baby’s temp?
> 100.4
<97.9
what are some signs of Withdrawing infants?
seizures
high-pitched
shrill cry
trouble feeding
hyperactivity of moro reflex
increased muscle tone
What can you do to help with feeding in a baby with NAS?
switch nipples
nipple confusion is okay!
What should you do to soothe baby with NAS?
swaddle
reduce stimuli
offer paci
What should you not do to a baby who is withdrawing from cocaine?
make eye contact
What are some major complications for preterm babies?
respiratory distress syndrome
lack of surfactant
poor temp control
infection
hemorrhage
retinopathy
apnea
bradycardia
death
What is exstrophy of the bladder?
bladder is on the outside of the body
what is hypospadias?
pee hole is under the penis
what is epispadias?
pee hole on top of the penis
