Exam 2 Flashcards

1
Q

Postpartum HR

A

> 100 is a red flag after 48hrs - possible hemorrhage

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2
Q

Postpartum Temp

A

Slight fever okay within 24 hours due to dehydration- increase fluids
AFTER 24hrs if over 100.4, possible infection

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3
Q

Postpartum BP

A

Low BP sign of hemorrhage

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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)

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5
Q

Bladder r/t uterus

A

Full bladder will displace uterus and make uterus feel boggy

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6
Q

Lochia findings

A

If clot bigger than a dime (1cm)- maybe hemorrhage
Many clots smaller than a dime are okay

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7
Q

Electrolytes to check after giving birth

A

Chloride and Na

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8
Q

Most frequent cause of postpartum bleeding

A

Uterine atony- failure of uterine muscle to contract firmly

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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)

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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

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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

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12
Q

Interventions with hemorrhagic shock

A

Call for help
Start IV
Ensure airway

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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

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14
Q

Subinvolution

A

Uterus is not shrinking

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15
Q

Rubra

A

Deep red/brown
1st: 3-4 days

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16
Q

Serosa

A

Lighter brown/ pink
2nd: up to 4-10 days

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17
Q

Alba

A

Lighter white/ creamy
3rd: 10 and more days

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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

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19
Q

NO bright red blood (lochia) means

A

Active and continuous bleeding

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20
Q

Endometritis

A

Infection of lining of uterus

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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

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22
Q

Interventions for Endometritis

A

Broad spectrum Abts (Cephs, PCN, -mycins)
Hydration
Abts d/c’d 24hrs after asymptomatic

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23
Q

Follow up for placenta accreta

A

Possible hysterectomy depending on how deep placenta is adhered

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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

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25
Q

Hematomas r/t episiotomy

A

Painful
Monitor H/H and replace fluids
No sex until stitches heal
Nurse baby on side

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26
Q

Risk factors for Hematomas r/t episiotomy

A

Use of epidural
Prolonged 2nd stage of labor
Forceps delivery

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27
Q

Uterine inversion

A

Fundus collapses into uterine cavity (turns inside out)
S/s: hemorrhage, shock and pain

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28
Q

Mastitis S/S

A

Flu like symptoms
Localized breast pain and tenderness- localized reddened area
Tender axillary lymph nodes

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29
Q

Risk factors of mastitis

A

Inadequate breast emptying
Sore cracked bleeding nipples
Not washing hands

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30
Q

Tx for mastitis

A

Bed rest
Abts
Continue lactation - empty breasts every 3-4hrs
Apply heat
Analgesics

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31
Q

Engorgement

A

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

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32
Q

Engorgement IF breastfeeding

A

Feed/pump regularly and apply warm water before feedings

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33
Q

Engorgement IF NOT breastfeeding

A

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

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34
Q

Postpartum blues

A

Considered normal due to hormones
Tx not necessary
Symptoms should subside <2 wks

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35
Q

Postpartum depression

A

Occurs first few months after giving birth
Lasts more than 2 weeks
Tx is similar to regular depression

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36
Q

Postpartum psychosis

A

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

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37
Q

Fundal height after pregnancy

A

1st hours after birth: 1cm above umbilicus
By day 10, fundus not palpable
Prepregnancy uterine state by 2 weeks after birth

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38
Q

Fundal assessment

A

Have mom void first
Massage fundus
Mom lies flat with knees flexed

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39
Q

If uterus boggy after 24hrs

A

Possible Placenta fragments

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40
Q

COLA assessment for Mom

A

Color, odor, last void/BM, and Amount

BM not necessary before discharge
Must hear flatulence before advancing diet

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41
Q

Neurogenic bladder

A

Loose ability to feel when they have to go to the bathroom

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42
Q

Scant/light lochia

A

1-4 in

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43
Q

Moderate lochia

A

6 in

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44
Q

Severe lochia

A

Bigger than dime clots - Bad hemorrhage

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45
Q

Episiotomy assessment

A

REEDA
redness, edema, ecchymosis, discharge and approximation

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46
Q

Hemorrhoids

A

Prevent constipation
SIMS position best view
Signs of infection: painful, bleeding, itchy and can’t sit

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47
Q

H/H postpartum

A

Decreases slightly during 1st 48hrs
Returns to normal after 4-8wks

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48
Q

WBC postpartum

A

Increases (12-25k)
Returns to normal after 1-2wks

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49
Q

CBC postpartum

A

Clotting factors and fibrinogen increases
Plts: 150-450k
Hct 37-47

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50
Q

Skin to skin contact

A

ASAP for at least an hour

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51
Q

Cultural considerations after birth

A

Jewish newborn- circumcision
Asian- doesn’t emphasize touch, delayed breastfeeding

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52
Q

Latching on for breastfeeding

A

Mouth over nipple, areola and breast
If not latched on correctly- dry cracked nipples can occur

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53
Q

Postpartum DM

A

Lower glucose lvls
Needs much less insulin after birth- especially if breastfeeding

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54
Q

Benefits of breastfeeding

A

Aids in contracting uterus and prevents hemorrhage
Baby sick less
Less expensive

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55
Q

Breastfeeding teaching

A

Additional 500 calories
Breastfeed within 1-2hrs after birth

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56
Q

How to know breast feeding is successful

A

Mom reports firm tugging, no pinching or pain
Baby sucks with rounded cheeks, NO dimpling
Baby’s jaw glides smoothly
Swallowing is usually audible

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57
Q

Colostrum

A

First milk 1-3 days

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58
Q

MMR vaccine postpartum

A

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

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59
Q

Rh isoimmunization

A

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
Q

Care for newborn from diabetic mother

A

Increased risk for birth injuries, congenital abnormalities, and hypoglycemia
Maintain thermoregulation

61
Q

Glucose in newborns

A

Normal: 70-150
Critical: 35-45
If <45: feed baby first! (Tremors)
If <30: IV dextrose

62
Q

Hypospadias

A

Dorsal urethra on bottom of penis

63
Q

Epispadias

A

Ventral urethra on top of penis

64
Q

Abnormal signs in initial assessment of newborn

A

Cyanosis
Jaundice
Low set ears (Down syndrome)
Dimple on back (spina bifida)
Bulging fontanelles
CALL DR

65
Q

Baseline measurements in newborns

A

Wt: 5lb5oz-8lb8oz
Length: 18-22 in
Head circumference: 12.9-13.7 in or 32-38 cm

66
Q

Tonic neck reflex

A

Fencing position
Baby’s head turned and arm straight out with other arm bent
Disappears by 3-4 months

67
Q

Grasp/Palmer reflex

A

Place finger in baby hand- hand will close
Lessens by 3-4 months

68
Q

Plantar reflex

A

Finger under toes- toes curl downward
Lessens by 8 months

69
Q

Step reflex

A

Hold baby upright and they will take a step
3-4 months

70
Q

Crawl reflex

A

Place on stomach- pressure on sole and moves arms
Disappears by 6 weeks

71
Q

Babinski reflex

A

Stroke foot and toes fan out
Up to 1yr

72
Q

Rooting reflex

A

Stroke cheek - head turns towards that cheek
Disappears after 3-4 months

73
Q

Sucking reflex

A

Touch infant mouth and baby will suck
Up to 4 months

74
Q

Startle (moror) reflex

A

Sudden loud noise- arms fling out and fingers fan out
Up to 6 months

75
Q

Breastfeeding schedule

A

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
Q

Newborn eye prophylaxis

A

Erythromycin ointment for gonorrhea and chlamydia

77
Q

Vitamin K in newborns

A

Needed for clotting - IM injection in vastus lateralis
Start to make own vit k by day 8
Sufficient supply by 4 months

78
Q

Suctioning newborn

A

Suction mouth then nose
Squeeze bulb then insert

79
Q

APGAR scoring

A

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
Q

Universal newborn screening (heel stick)

A

Tests for sickle cell, PKU, thyroid issues, hearing loss, congenital heart disease, galactosemia

81
Q

Respiratory assessment in newborns

A

Periodic apnea up to 15 sec normal
Irregular or pausing is normal
RR: 30-60/ min
ABNORMAL: Tachypnea, retractions: distress grunting and flaring

82
Q

Cardiovascular assessment in newborns

A

HR: 110-170 bpm
BP: 60-85/40-55

83
Q

NORMAL findings on newborn

A

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
Q

Sleep in newborns

A

16-18 hrs

85
Q

Vision in newborns

A

Can see up to 2.5 ft away
See black and white
Color in 2 months
Can track/follow

86
Q

Vision in newborns

A

Can see up to 2.5 ft away
See black and white
Color in 2 months
Can track/follow

87
Q

Assessing hydration status in newborn

A

Days 1-4: 1 wet diaper/day
After 4 days: minimum of 6 wet diapers/day

88
Q

Vernix

A

Protects skin from amniotic fluid
More vernix= younger gestational age

89
Q

Signs of respiratory distress in newborns

A

Apnea >15 sec
Retractions
Nasal flaring
Grunting with respirations
Cyanosis
Decreased O2

90
Q

Meconium

A

If not passed after 24 hrs- red flag
Dark green/black, sticky, tarry
Releases bilirubin

91
Q

Jaundice in newborns

A

Feed! Promotes peristalsis for passage of meconium
Phototherapy- expose as much skin as possible (cover eyes, reposition q2hrs, temp q2hrs, feed q2hrs)

92
Q

Physiological jaundice

A

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
Q

First bath in newborns

A

Start with head- cleanest areas first

94
Q

1st A in APGAR

A

Appearance and color
0: blue/pale
1: acrocyanosis
2: pink

95
Q

P in APGAR

A

Pulse
0: 0
1: <100
2: >100

96
Q

G in APGAR

A

Grimace
0: no response
1: grimace (face changes to stimuli or irritation)
2: full cry

97
Q

2nd A in APGAR

A

Activity, muscle tone
0: limp
1: some flexion
2: well flexed

98
Q

R in APGAR

A

Respiration
0: no breathing
1: weak, sporadic, gasping
2: strong cry or easy, irregular

99
Q

Cord care

A

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
Q

Circumcision care

A

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
Q

Fractured clavicle

A

Feel/hear crepitus
Don’t lay on affected side
No other Tx needed

102
Q

Erbs palsy

A

Injury to brachial plexus
Usually seen with shoulder dystocia
Usually temporary
Startle reflex= only one side will engage

103
Q

Fetal alcohol syndrome

A

Microcephaly
Small eyes
Thin upper lip
Growth restriction
Neurodevelopment deficits

104
Q

Nursing interventions for Fetal alcohol syndrome

A

Low stimuli
swaddle
Cluster care
Only touch/hold when necessary

105
Q

Evaporation

A

Heat loss when wet - nurse should dry infant

106
Q

Conduction

A

Cold from fan or a/c
Should use blanket

107
Q

Convection

A

Cold from cool surfaces
Use warmer

108
Q

Radiation

A

Cold from window
Close window/door

109
Q

Mottling

A

Marbling of skin

110
Q

Harlequin sign

A

Unilateral color change where one side of newborns body or ruddy and other is pale

Indicates cardiac problem or sepsis

111
Q

Anterior fontanels

A

Diamond shaped
Close within 18 months

112
Q

Posterior fontanels

A

Triangle shape
Close within 3 months

113
Q

Cephalohematoma

A

Collection of blood
Feels boggy
Doesn’t cross suture line
Absorbed within 6 weeks with no Tx

114
Q

Caput succedaneum

A

Localized swelling of soft tissue of scalp
Cone head
Subsides within few days

115
Q

PKU screening

A

Inability to metabolize phenylalanine
Blood test 24 hrs after feeding

116
Q

Factors that increase risk of jaundice

A

Large amounts of bruising from delivery
Infection
Dehydration
Septic

117
Q

S/S of premature infant

A

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
Q

Signs of PE

A

Dyspnea
Tachypnea
Tachycardia
Increased temp
Anxiety

119
Q

Newborn normal temp

A

97.7-100

120
Q

Normal bilirubin

A

<12

121
Q

Intracranial bleeding

A

Bulging fontanels
Keep head midline and HOB slightly elevated to minimize fluctuations

122
Q

Sign of cervical laceration

A

Bright trickle of blood with firm uterus

123
Q

When does ovulation occur after birth

A

Not breastfeeding- 7-9 wks after birth
If breastfeeding- 6 months

124
Q

Hormonal contraceptions and breastfeeding

A

Not recommended because it can reduce milk supply

125
Q

Feeding patterns

A

First 24-48 hrs - 15-30ml /feeding
By end of 2nd week- 90-150ml

126
Q

Sign of Pyloric stenosis

A

Vomiting in large amounts that’s projectile

127
Q

Bilious (green) emesis in newborns indicates what

A

Intestinal obstruction or malformation of the bowel

128
Q

Subgaleal hemorrhage

A

Bleeding into subgaleal compartment
Bld loss can be severe resulting in hypovolemix shock, DIC and death

129
Q

Dysplasia of the hips

A

Asymmetric gluteal and thigh skin folds, uneven knee levels, positive ortolani test and positive Barlow test

130
Q

Umbilical cord has

A

2 arteries
1 vein

131
Q

Perineal discomfort interventions

A

For 1st 24hrs apply ice packs to reduce swelling

After 24hrs- apply warmth by sitz bath

132
Q

Interventions for cracked nipples

A

Expose nips to air 10-20 min after feeding
Rotate baby each feeding
Ensure proper latchment
Express colostrum and moisturize nipple with it

133
Q

Hematoma signs

A

Sensitive, bulging mass in perineal area with discolored skin
Inability to void
Decreased H/H
Restlessness

134
Q

Blood loss that’s considered hemorrhage

A

Vaginal delivery- >500 ml loss
C section- >1000 ml loss

135
Q

Signs of subinvolution

A

Uterine pain on palpating
Uterus larger than expected
More vaginal bleeding than expected
Prolonged rubra

136
Q

Baseline vital signs in newborns

A

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
Q

Telangiec-tatic nevi
Stork bites

A

Pale pink or red flat dilated capillaries on eyelid nose lower occipital bone and nape of neck
Blanch easily
Gone by 2yrs old

138
Q

Nevus flam-meus
Port wine stain

A

Nonelevated, sharply demarcated, red to purple dense areas of capillaries
Mostly on face
No fading with time
May require future surgery

139
Q

Nevus vasculosus
Strawberry mark

A

Raised, clearly delineated, dark red, with rough surface
Common in head region
Gone by 7-9yrs old

140
Q

Barlow’s and ortolani’s signs

A

Assessment for hip dysplasia

141
Q

Respiratory distress syndrome

A

Immaturity and inability to produce surfactant causing hypoxia and acidosis

142
Q

Signs of hyperbilirubenemia

A

Jaundice
Bili >12
Enlarged liver
poor muscle tone
Lethargy
Poor sucking reflex

143
Q

Signs of syphilis in newborn

A

Hepatosplenomegaly
Joint swelling
Palmer rash and lesions
Anemia
Jaundice
Snuffles
Ascites
CSF changes
Pneumonitis

144
Q

Signs of hypoglycemia in newborns

A

Twitching
Apnea
Difficulty feeding
Lethargy
seizures
Cyanosis

145
Q

Signs of hypothyroidism in newborns

A

Protruding thick tongue
Dull look, swollen face
Slowed reflexes
Hoarse cry
Abd distention