Exam 2 Flashcards
1
Q
Postpartum HR
A
> 100 is a red flag after 48hrs - possible hemorrhage
2
Q
Postpartum Temp
A
Slight fever okay within 24 hours due to dehydration- increase fluids
AFTER 24hrs if over 100.4, possible infection
3
Q
Postpartum BP
A
Low BP sign of hemorrhage
4
Q
What to do if a lot of lochia
A
Check fundus FIRST- could be boggy
If boggy- massage it
If still boggy- empty bladder
If STILL boggy- could be neurogenic bladder (REPORT)
5
Q
Bladder r/t uterus
A
Full bladder will displace uterus and make uterus feel boggy
6
Q
Lochia findings
A
If clot bigger than a dime (1cm)- maybe hemorrhage
Many clots smaller than a dime are okay
7
Q
Electrolytes to check after giving birth
A
Chloride and Na
8
Q
Most frequent cause of postpartum bleeding
A
Uterine atony- failure of uterine muscle to contract firmly
9
Q
Nursing interventions for uterine atony
A
Massage fundus if boggy
Full bladder displacing uterus can prevent normal contractions
Meds- oxytocin, misoprostol, methergine, meth prostaglandin (ASSESS BP W/ ALL)
10
Q
Possible causes of postpartum bleeding
A
Overdistended uterus
General anesthesia
Prolonged labor
Hx of uterine atony
Retained placental fragments
Trauma during labor/ birth
Unrepaired lacerations
Ruptured uterus
Placenta accreta -previa- abruption
Coag disorders
HTN
11
Q
S/S of hemorrhagic shock
A
Rapid/shallow respirations
Rapid weak pulse
Low BP (late sign)
Cool, pale, clammy skin
Decreased UO
Lethargy
Light headedness
Anxiety
Dyspnea
12
Q
Interventions with hemorrhagic shock
A
Call for help
Start IV
Ensure airway
13
Q
Involution
A
Uterus returns to pre-pregnancy state
Should not feel fundus after 2 weeks
Fundal height decreases 1-2cm q24hrs
Uterus at umbilicus by 24hrs
14
Q
Subinvolution
A
Uterus is not shrinking
15
Q
Rubra
A
Deep red/brown
1st: 3-4 days
16
Q
Serosa
A
Lighter brown/ pink
2nd: up to 4-10 days
17
Q
Alba
A
Lighter white/ creamy
3rd: 10 and more days
18
Q
Lochia pads
A
Pad that’s soaked in 15 min or less or pooling of blood under butt means EXCESSIVE BLOOD LOSS
Avg 6 peripads/day is NORMAL
19
Q
NO bright red blood (lochia) means
A
Active and continuous bleeding
20
Q
Endometritis
A
Infection of lining of uterus
21
Q
S/S of Endometritis
A
Fever, chills
Tachycardia
Anorexia
Pelvic pain/back ache
Prolonged after pains
Uterine tenderness
Foul smelling lochia
Increased RBC sedimentation rate
High WBC
22
Q
Interventions for Endometritis
A
Broad spectrum Abts (Cephs, PCN, -mycins)
Hydration
Abts d/c’d 24hrs after asymptomatic
23
Q
Follow up for placenta accreta
A
Possible hysterectomy depending on how deep placenta is adhered
24
Q
Perineal care for episiotomy
A
Topical lidocaine cream
Ice packs 1st 24hrs
Witch hazel
Peri bottle (cold water)
Sits bath connected to cath and basin
25
Hematomas r/t episiotomy
Painful
Monitor H/H and replace fluids
No sex until stitches heal
Nurse baby on side
26
Risk factors for Hematomas r/t episiotomy
Use of epidural
Prolonged 2nd stage of labor
Forceps delivery
27
Uterine inversion
Fundus collapses into uterine cavity (turns inside out)
S/s: hemorrhage, shock and pain
28
Mastitis S/S
Flu like symptoms
Localized breast pain and tenderness- localized reddened area
Tender axillary lymph nodes
29
Risk factors of mastitis
Inadequate breast emptying
Sore cracked bleeding nipples
Not washing hands
30
Tx for mastitis
Bed rest
Abts
Continue lactation - empty breasts every 3-4hrs
Apply heat
Analgesics
31
Engorgement
Breasts are too full
Firm, tender and hot - appear shiny or taut
If milk isn’t removed, milk production is reduced
Usually occurs within 72-96 hrs after birth and resolves within 24-36hrs
32
Engorgement IF breastfeeding
Feed/pump regularly and apply warm water before feedings
33
Engorgement IF NOT breastfeeding
1st: pump milk OUT and do not touch breasts
2nd: apply cold water and cabbage leaves
Wear tight form-fitting bra
Keep husband off breast for 3-4 days
34
Postpartum blues
Considered normal due to hormones
Tx not necessary
Symptoms should subside <2 wks
35
Postpartum depression
Occurs first few months after giving birth
Lasts more than 2 weeks
Tx is similar to regular depression
36
Postpartum psychosis
Can be related to previous depression and bipolar diagnoses
2-4 wks after birth
Can lead to suicide of infanticide
NEEDS TO BE TREATED AND RECOGNIZED
Delusions, hallucinations, panic, delirium
37
Fundal height after pregnancy
1st hours after birth: 1cm above umbilicus
By day 10, fundus not palpable
Prepregnancy uterine state by 2 weeks after birth
38
Fundal assessment
Have mom void first
Massage fundus
Mom lies flat with knees flexed
39
If uterus boggy after 24hrs
Possible Placenta fragments
40
COLA assessment for Mom
Color, odor, last void/BM, and Amount
BM not necessary before discharge
Must hear flatulence before advancing diet
41
Neurogenic bladder
Loose ability to feel when they have to go to the bathroom
42
Scant/light lochia
1-4 in
43
Moderate lochia
6 in
44
Severe lochia
Bigger than dime clots - Bad hemorrhage
45
Episiotomy assessment
REEDA
redness, edema, ecchymosis, discharge and approximation
46
Hemorrhoids
Prevent constipation
SIMS position best view
Signs of infection: painful, bleeding, itchy and can’t sit
47
H/H postpartum
Decreases slightly during 1st 48hrs
Returns to normal after 4-8wks
48
WBC postpartum
Increases (12-25k)
Returns to normal after 1-2wks
49
CBC postpartum
Clotting factors and fibrinogen increases
Plts: 150-450k
Hct 37-47
50
Skin to skin contact
ASAP for at least an hour
51
Cultural considerations after birth
Jewish newborn- circumcision
Asian- doesn’t emphasize touch, delayed breastfeeding
52
Latching on for breastfeeding
Mouth over nipple, areola and breast
If not latched on correctly- dry cracked nipples can occur
53
Postpartum DM
Lower glucose lvls
Needs much less insulin after birth- especially if breastfeeding
54
Benefits of breastfeeding
Aids in contracting uterus and prevents hemorrhage
Baby sick less
Less expensive
55
Breastfeeding teaching
Additional 500 calories
Breastfeed within 1-2hrs after birth
56
How to know breast feeding is successful
Mom reports firm tugging, no pinching or pain
Baby sucks with rounded cheeks, NO dimpling
Baby’s jaw glides smoothly
Swallowing is usually audible
57
Colostrum
First milk 1-3 days
58
MMR vaccine postpartum
If received, don’t get pregnant for at least 1 month after due to risks of teratogenic effects
Birth control for at least 3 months
59
Rh isoimmunization
When mom is Rh negative and baby is Rh positive, Rhogam given within 72 hrs to prevent complications in future pregnancies
Baby is jaundiced if maternal isoimmunization
60
Care for newborn from diabetic mother
Increased risk for birth injuries, congenital abnormalities, and hypoglycemia
Maintain thermoregulation
61
Glucose in newborns
Normal: 70-150
Critical: 35-45
If <45: feed baby first! (Tremors)
If <30: IV dextrose
62
Hypospadias
Dorsal urethra on bottom of penis
63
Epispadias
Ventral urethra on top of penis
64
Abnormal signs in initial assessment of newborn
Cyanosis
Jaundice
Low set ears (Down syndrome)
Dimple on back (spina bifida)
Bulging fontanelles
CALL DR
65
Baseline measurements in newborns
Wt: 5lb5oz-8lb8oz
Length: 18-22 in
Head circumference: 12.9-13.7 in or 32-38 cm
66
Tonic neck reflex
Fencing position
Baby’s head turned and arm straight out with other arm bent
Disappears by 3-4 months
67
Grasp/Palmer reflex
Place finger in baby hand- hand will close
Lessens by 3-4 months
68
Plantar reflex
Finger under toes- toes curl downward
Lessens by 8 months
69
Step reflex
Hold baby upright and they will take a step
3-4 months
70
Crawl reflex
Place on stomach- pressure on sole and moves arms
Disappears by 6 weeks
71
Babinski reflex
Stroke foot and toes fan out
Up to 1yr
72
Rooting reflex
Stroke cheek - head turns towards that cheek
Disappears after 3-4 months
73
Sucking reflex
Touch infant mouth and baby will suck
Up to 4 months
74
Startle (moror) reflex
Sudden loud noise- arms fling out and fingers fan out
Up to 6 months
75
Breastfeeding schedule
Q2-3hrs if breastfeeding (30-40 min or 15-20 min each breast)
Q3-4hrs if formula feeding
After 2-4 days, 6 wet diapers a day
No cows milk until 1yr old
76
Newborn eye prophylaxis
Erythromycin ointment for gonorrhea and chlamydia
77
Vitamin K in newborns
Needed for clotting - IM injection in vastus lateralis
Start to make own vit k by day 8
Sufficient supply by 4 months
78
Suctioning newborn
Suction mouth then nose
Squeeze bulb then insert
79
APGAR scoring
1st min, then 5 min, then 10 min of score less than 7
0-3: chest compression and medication
4-6: oxygen, intubation, bag valve mask
7+: stimulation, warm, dry, position, suction
80
Universal newborn screening (heel stick)
Tests for sickle cell, PKU, thyroid issues, hearing loss, congenital heart disease, galactosemia
81
Respiratory assessment in newborns
Periodic apnea up to 15 sec normal
Irregular or pausing is normal
RR: 30-60/ min
ABNORMAL: Tachypnea, retractions: distress grunting and flaring
82
Cardiovascular assessment in newborns
HR: 110-170 bpm
BP: 60-85/40-55
83
NORMAL findings on newborn
Vernix
Lanugo- fine hair
Mongolian spots
Acrocyanosis- bluish discoloration of hands and feet or mouth
Milia- tiny white raised spots on skin
Epstein pearls- yellow or white nodules on baby’s gums
Plantar creases
Edema in genitals
84
Sleep in newborns
16-18 hrs
85
Vision in newborns
Can see up to 2.5 ft away
See black and white
Color in 2 months
Can track/follow
86
Vision in newborns
Can see up to 2.5 ft away
See black and white
Color in 2 months
Can track/follow
87
Assessing hydration status in newborn
Days 1-4: 1 wet diaper/day
After 4 days: minimum of 6 wet diapers/day
88
Vernix
Protects skin from amniotic fluid
More vernix= younger gestational age
89
Signs of respiratory distress in newborns
Apnea >15 sec
Retractions
Nasal flaring
Grunting with respirations
Cyanosis
Decreased O2
90
Meconium
If not passed after 24 hrs- red flag
Dark green/black, sticky, tarry
Releases bilirubin
91
Jaundice in newborns
Feed! Promotes peristalsis for passage of meconium
Phototherapy- expose as much skin as possible (cover eyes, reposition q2hrs, temp q2hrs, feed q2hrs)
92
Physiological jaundice
In 1st 24hrs
Cause by Rh and blood incompatibility
If left untreated- kernicterus (bilirubin >25) (bilirubin spreads to brain causing encephalopathy/perm brain damage)
93
First bath in newborns
Start with head- cleanest areas first
94
1st A in APGAR
Appearance and color
0: blue/pale
1: acrocyanosis
2: pink
95
P in APGAR
Pulse
0: 0
1: <100
2: >100
96
G in APGAR
Grimace
0: no response
1: grimace (face changes to stimuli or irritation)
2: full cry
97
2nd A in APGAR
Activity, muscle tone
0: limp
1: some flexion
2: well flexed
98
R in APGAR
Respiration
0: no breathing
1: weak, sporadic, gasping
2: strong cry or easy, irregular
99
Cord care
Don’t use alcohol- dries it up
Soap and water q2-3 days
Dont submerge In water until it falls off naturally
Do not manually pull cord off
100
Circumcision care
1st 24hrs: dry blood and milky discharge (yellow exudate) is normal
NPO 2-3hrs before
Moderate bleeding- pressure dressing
Every time change diaper- gauze and petroleum jelly on tip of penis
Let coating fall off on its own
101
Fractured clavicle
Feel/hear crepitus
Don’t lay on affected side
No other Tx needed
102
Erbs palsy
Injury to brachial plexus
Usually seen with shoulder dystocia
Usually temporary
Startle reflex= only one side will engage
103
Fetal alcohol syndrome
Microcephaly
Small eyes
Thin upper lip
Growth restriction
Neurodevelopment deficits
104
Nursing interventions for Fetal alcohol syndrome
Low stimuli
swaddle
Cluster care
Only touch/hold when necessary
105
Evaporation
Heat loss when wet - nurse should dry infant
106
Conduction
Cold from fan or a/c
Should use blanket
107
Convection
Cold from cool surfaces
Use warmer
108
Radiation
Cold from window
Close window/door
109
Mottling
Marbling of skin
110
Harlequin sign
Unilateral color change where one side of newborns body or ruddy and other is pale
Indicates cardiac problem or sepsis
111
Anterior fontanels
Diamond shaped
Close within 18 months
112
Posterior fontanels
Triangle shape
Close within 3 months
113
Cephalohematoma
Collection of blood
Feels boggy
Doesn’t cross suture line
Absorbed within 6 weeks with no Tx
114
Caput succedaneum
Localized swelling of soft tissue of scalp
Cone head
Subsides within few days
115
PKU screening
Inability to metabolize phenylalanine
Blood test 24 hrs after feeding
116
Factors that increase risk of jaundice
Large amounts of bruising from delivery
Infection
Dehydration
Septic
117
S/S of premature infant
Large head
Skin bright pink, shiny and translucent
Lanugo abundant all over body
Few sole creases on hands and feet (more smooth)
Slow recoils of pinna (ear)
118
Signs of PE
Dyspnea
Tachypnea
Tachycardia
Increased temp
Anxiety
119
Newborn normal temp
97.7-100
120
Normal bilirubin
<12
121
Intracranial bleeding
Bulging fontanels
Keep head midline and HOB slightly elevated to minimize fluctuations
122
Sign of cervical laceration
Bright trickle of blood with firm uterus
123
When does ovulation occur after birth
Not breastfeeding- 7-9 wks after birth
If breastfeeding- 6 months
124
Hormonal contraceptions and breastfeeding
Not recommended because it can reduce milk supply
125
Feeding patterns
First 24-48 hrs - 15-30ml /feeding
By end of 2nd week- 90-150ml
126
Sign of Pyloric stenosis
Vomiting in large amounts that’s projectile
127
Bilious (green) emesis in newborns indicates what
Intestinal obstruction or malformation of the bowel
128
Subgaleal hemorrhage
Bleeding into subgaleal compartment
Bld loss can be severe resulting in hypovolemix shock, DIC and death
129
Dysplasia of the hips
Asymmetric gluteal and thigh skin folds, uneven knee levels, positive ortolani test and positive Barlow test
130
Umbilical cord has
2 arteries
1 vein
131
Perineal discomfort interventions
For 1st 24hrs apply ice packs to reduce swelling
After 24hrs- apply warmth by sitz bath
132
Interventions for cracked nipples
Expose nips to air 10-20 min after feeding
Rotate baby each feeding
Ensure proper latchment
Express colostrum and moisturize nipple with it
133
Hematoma signs
Sensitive, bulging mass in perineal area with discolored skin
Inability to void
Decreased H/H
Restlessness
134
Blood loss that’s considered hemorrhage
Vaginal delivery- >500 ml loss
C section- >1000 ml loss
135
Signs of subinvolution
Uterine pain on palpating
Uterus larger than expected
More vaginal bleeding than expected
Prolonged rubra
136
Baseline vital signs in newborns
HR resting- 110-160; sleeping- 90-110; crying- up to 180
RR 30-60 breaths
Temp AXILLARY ONLY 97.7-99.5
BP 85/45
BS 50-90
137
Telangiec-tatic nevi
Stork bites
Pale pink or red flat dilated capillaries on eyelid nose lower occipital bone and nape of neck
Blanch easily
Gone by 2yrs old
138
Nevus flam-meus
Port wine stain
Nonelevated, sharply demarcated, red to purple dense areas of capillaries
Mostly on face
No fading with time
May require future surgery
139
Nevus vasculosus
Strawberry mark
Raised, clearly delineated, dark red, with rough surface
Common in head region
Gone by 7-9yrs old
140
Barlow’s and ortolani’s signs
Assessment for hip dysplasia
141
Respiratory distress syndrome
Immaturity and inability to produce surfactant causing hypoxia and acidosis
142
Signs of hyperbilirubenemia
Jaundice
Bili >12
Enlarged liver
poor muscle tone
Lethargy
Poor sucking reflex
143
Signs of syphilis in newborn
Hepatosplenomegaly
Joint swelling
Palmer rash and lesions
Anemia
Jaundice
Snuffles
Ascites
CSF changes
Pneumonitis
144
Signs of hypoglycemia in newborns
Twitching
Apnea
Difficulty feeding
Lethargy
seizures
Cyanosis
145
Signs of hypothyroidism in newborns
Protruding thick tongue
Dull look, swollen face
Slowed reflexes
Hoarse cry
Abd distention
