Exam 2 Flashcards
(358 cards)
1
Q
toddler age
A
1-3
2
Q
how many deciduous teeth for toddler?
A
20
3
Q
how to measure toddler during exam
A
supine for height, weight, head circumference
4
Q
toddler weight gain (same, slow, or fast?)
A
slows
5
Q
toddler posture
A
lordosis until abdomen tone increases at 2 yo
6
Q
toddler hr
A
90-110
7
Q
toddler respiration
A
20-40; belly breathing still
8
Q
toddler BP
A
99/64 if you can take it
9
Q
toddler brain growth has reached what proportion of adult size
A
90% of adult size
10
Q
why can toddlers tolerate 3 meals a day?
A
increased stomach acid
11
Q
how to know child is ready to toilet train
A
when shows interest and stays dry for 2 hours; DO NOT RUSH
12
Q
toddler well child visit schedule
A
15, 18, 24, and 30 months
13
Q
immunization schedule for toddler
A
15 & 18 months
14
Q
screenings @ well child (7)
A
*vision
*health
*ASD
*height
*weight
*BMI
*observe speech, interactions, nutrition, home life
15
Q
toddler lab screenings
A
*lead
*H and H at 15 and 30 months
*TB, UA, Dyslipidemia
16
Q
Anticipatory guidance for parents of toddlers (5)
A
*safety
*poison / unintentional injury
*G&D
*play
*tantrums/behavior
17
Q
age of separation anxiety
A
6 months - preschool
18
Q
chain of infection
A
- reservoir
- portal of exit
- mode of transmission
- portal of entry
- susceptible host
19
Q
incubation
A
time period between exposure to infectious agent and symptoms manifesting
20
Q
prodromal period
A
early signs and nonspecific symptoms of infection before diagnostic symptoms present
21
Q
5 stages of infection
A
- incubation
- prodromal
- illness
- decline
- convalescence
22
Q
incubation period for hepatitis A
A
25 days
23
Q
when is hepatitis A communicable
A
about 2 weeks before symptoms appear
24
Q
3 common reservoirs of hepatitis A
A
- fecal contaminated water
- shellfish
- daycare (changing tables)
25
how to acquire immunity from HAV (2)
1. natural (one past infection)
2. artificial (HAV vaccine)
26
when HAV recommended (3)
*12-23 months
*daycare employees
*international travelers
27
where in body pinworms live at first
cecum
28
where pinworms lay eggs, causing itching
anal and perineal area
29
treatment for pinworms
one dose of anthelmintic
30
examples of anthelmintic meds (3)
*mebendazole
*albendazole
*pyantel
31
acute otitis media (AOM) age most likely to occur
6-36 months
32
default goal of labor & delivery
vaginal delivery
33
factors that increase incidence of otitis media (5)
*more likely with males
*Alaskan and Native Americans
*children w/ cleft palate
*formula fed infant
*smokers in household
34
separates false pelvis from true pelvis
brim/inlet
35
labor typically starts when
37 - 42 weeks
36
guidelines for inducement
41 weeks
37
the 5 Ps (factors affecting vaginal birth)
passageway
passenger
power
position
psyche
38
passageway
path for baby to be delivered
39
passenger
baby and placenta
40
psyche
if mother believes she can do it
41
true pelvis
where baby actually goes through to be delivered
42
parts of uterus
*upper uterine segment
*physiologic retraction ring
*lower uterine segment
43
upper uterine segment
where baby is during pregnancy
44
physiologic retraction ring
separates upper and lower uterine segment
45
lower uterine segment
baby moves into during quickening
46
introitus
where baby actually comes out
47
cervix def
narrow opening to uterus
48
fontanelle shape in front
diamond
49
fontanelle shape in the back
triangle
50
ideal baby position to be delivered
vertex (head first, chin tucked)
51
molding
overlap/sliding of bones to change shape of baby's head during vaginal delivery
52
fetal attitude
position of baby's head
53
ideal fetal lie
longitudinal lie
54
breech birth
baby's bum comes out first
55
frank breech
baby is tucked, but coming out breech
56
fetal position (3 letters)
1. right or left of mother's pelvis
2. specific presenting part of fetus
3. anterior, posterior, or transverse
57
fetal station
1. assessed on vaginal exam
2. how many cm above or below presenting part is to ischial spines
3. 0 is at ischial spines, +1 cm is 1 cm below
58
3 parts of vaginal exam
1. dilation
2. effacement
3. fetal station
59
engagement
fetal station is 0 (at ischial spines
60
the power related to uterine contractions
frequency
duration
61
the power related to cervical changes
1. effacement
2. dilation
62
effacement measured
0-100% (a subjective measurement)
63
dilation
widening of cervical canal
64
opening of the cervix
the os (there's an external os and an internal os)
65
dilation is measured how
0-10 cm
66
frequency of contractions
start of one contraction to start of the next contraction
67
duration measured
start to end of one contraction
68
contraction strength
felt by feeling fundus
69
cardinal movements of labor
*descent
*flexion
*internal rotation
*extension
*external rotation
*expulsion
70
descent
head touches vaginal floor
71
flexion
head is tucked
72
internal rotation
rotation to get through pelvis
73
extension
head goes under pubic bone and extends out of introitus
74
external rotation
provider can tell where shoulders are
75
expulsion of torso
providers pull top shoulder out first by pulling down, then pull up to get posterior shoulder out
76
false contractions
irregular and stay irregular
77
hallmark of labor
active cervical change
78
number of stages of labor
3
79
first stage of labor
1. latent phase (0-3 cm dilated)
2. active phase (4-7 cm dilated; admission to unit; )
3. transition phase (8-10 cm dilated); increased bloody show
80
second stage of labor
period from full dilation and cervical effacement to crowning and birth of infant
81
third stage of labor
*placental separation
*placental expulsion
82
cervix less than 10 cm
do not push until 10 cm; can tear and bleed profusely
83
placenta out in how long and why
within 30 minutes to get it out before cervix begins to close
84
done once placenta is delivered
start Pitocin
85
effects of labor on cardiac output
increases by 40-50%
86
effects of labor on BP
increase about 15 pts.
87
epidurals effect on BP
possible hypotension
88
effects of labor on hematopoietic system
increase in WBC
89
effects of labor on respiratory system
increased rate like exercise
90
effects of labor on temp
slight increase
91
effects of labor on fluid
npo because of risk of aspiration if c section; lots of fluid loss
92
effects of labor urinary system
won't know if have to urinate if epidural, may need cath; should go to bathroom every 2 hrs. if no epidural
93
effects of labor on musculoskeletal
relaxin
94
effects of labor on GI
constipation
95
effects of labor neurological and sensory systems
pain
96
psychological effects of labor
pain
fatigue
fear
97
fetal response to labor cardiovascular
reduced blood flow; if cannot compensate well, something is wrong
98
fetal response to labor integumentary
bruising or petticciae possible
99
fetal response to labor respiratory
*baby's chest is squeezed during birth, clearing the lungs and signaling to baby that will have to breath on own
*c-section does not get the squeeze
100
measuring progress of labor
VS
pain
fetal HR
contraction freq
cervical dilation
rupture of membranes
101
if water breaks in hospital
immediately check fetal HR because umbilical cord can come out through vagina (cord prolapse) causing fetal HR to drop
102
Danger signs of labor for pregnant person (3)
*systolic BP>140, or diastolic BP >90
*tachycardia (may just be pain)
*inadequate or prolonged contraction (can cause fetal stress)
103
Fetal danger signs (4)
*HR should be 110-160
*meconium staining (should not be in utero)
*hyperactivity (sudden abnormal movement) may be sign of hypoxia
*low O2 sat (not usually checked)
104
leopold maneuver
check position of baby
105
pregnant person labs
CBC
urine
106
assessment of uterine contractions
length
intensity
frequency
107
fetal assessment in labor
*fetal hr
*monitor for variability
*periodic changes occur in response to contractions and fetal movement
108
external monitoring tools
*tocodynamometer (freq and duration of contractions)
*ultrasound (hr)
109
must happen before internal monitoring
water broken
110
tools for internal monitoring
*spiral electrode
*intruterine pressure cath (IUPC) (measures pressure of contraction)
111
length of time to get hr baseline
10 minutes
112
variability can be _____ (4)
*absent
*minimal (+/- 5bps)
*moderate (+/- 6-25 bps; desirable)
*marked (>25 beat change)
113
variability can be caused by
sleep (minimal)
narcotics (minimal)
hypoxia
114
cause of variable deceleration
cord compression
115
early decelerations
occur with contractions from compression of the head
116
late deceleration
after each contraction; placental deficiency; very bad
117
fetal deceleration and acceleration mnemonic
118
Fetal Heart tracing
Category 1
ALL criteria must be met
*baseline hr: 110-160
*moderate baseline FHR variability
*no late or variable decelerations
*early decelerations may or may not be present
*accelerations may be present or absent
119
Fetal Heart tracing
Category II
does not meet criteria for either category I or Category III
120
Fetal Heart tracing
Category III
Predict abnormal fetal acid-base status and requires immediate intervention
*absent baseline FHR variability and any of the following: recurrent decelerations, recent variable decelerations, bradycardia
*sinusoidal pattern
121
Nurse interventions for decelerations (7)
*Change person's position
*Stop Oxytocin
*O2
*IV fluids
*monitor
*notify MD
*prepare for C-section if FHR does not return to normal
122
nursing assessment during 1st and 2nd stage of labor (7)
temp
pulse
respirations
BP
voiding
FHR
contractions
perineum
123
nursing during first stage of labor: provide ____ (5)
*ambulation / position change
*support
*encourage to void every 2 hrs.
*pain management
*amniotomy (breaking the water)
124
Second stage of labor tasks (7)
*prepare for birth
*positioning for birth
*pushing
*perineal cleaning
*episiotomy
*birth
*cutting and clamping cord
125
3rd and 4th stages of labor nurse/ provider tasks
*give oxytocin
*placental delivery
*perineal repair
*assessment
*immediate postpartum
126
if ear drainage
culture
127
% of AOM that resolve w/out antibiotics
80
128
S/S of AOM
*Upper Respiratory Infection
*pain
*fever
*nasal discharge
*tugging at ear
*infants may have difficulty feeding
129
otoscope technique for <2 y.o.
down and back
130
otoscope technique for child over 2
up and back
131
seen in otoscopic exam of AOM
*hyperemia
*bulging tympanic membrane
132
if conductive hearing loss
evaluate for ear infection or OME (otitis media with effusion
133
typanic membrane color if healthy
blue or yellow
134
Management of AOM/OME
-steroids
-allergy tx
-surgery if hearing loss of 25-40 dB
-tubal myringotomy for hearing loss of 12 dB
135
hearing loss that indicates likely surgery
25-40 dB
136
hearing loss that indicates likely tubal myringotomy
12 dB
137
tympanostomy tube in what situation
fluid in ear >6 months
138
at risk from AOM/OME
language development
139
adjunct tx to enhance TT effectiveness
adenoidectomy
140
can you use hydrocortisone while patch testing?
no. can skew results
141
to do if allergens causing contact dermatitis found (4)
-remove the allergen from child's environment
-use topical creams/ointments to reduce itch
-oatmeal or baking soda baths
-document sensitivities in chart
142
possible allergic responses
-allergic rhinitis
-eczema
-asthma
143
allergic rhinitis and asthma are ______
often diagnosed together (especially older children)
144
eczema or atopic dermatitis may indicate __________
food allergies
145
therapeutic management of atopic dermatitis
-decrease exposure to allergen
-trim nails (reduce damage from scratching)
-topical meds
-rarely steroids
146
germs that cause impetigo
- beta-hemolytic streptococcus, Group A
- Staphylococcus aureus (including MRSA)
147
how impetigo looks
scabby, honey -crusted infection on face and hands
148
impetigo incubation
7-10 days
149
communicability of impetigo
from outbreak of lesions until healed
150
impetigo mode of transmission
direct contact with lesions
151
most common age of infection
2-5 yeas old
152
medication tx of impetigo
-mupirocin for 7-10 days
or
-retapamulin BID for 5 days for kids >9 months old
or
-oral antibiotics for severe cases
153
home ed for impetigo
-not sharing towels
-bathing children alone
-not sharing tub water
154
coxsackievirus (A6 & A16) (HFMD, or hand, foot, and mouth disease) presentation
-rash with erythematous papules on hands, feet, and mouth w/ sore throat
-can be confused with herpangina virus, which causes oral lesions and fever
155
pediculosis
lice
156
pediculosis ed
teach children not to share combs, barrettes, etc
157
pediculosis tx
1) permethrin wash
2) comb nits
3) wash and vacuum room
158
Lyme disease causative agent
Borrelia burgdorferi
159
Lyme disease incubation period
3-5 days
160
mode of transmission
deer tick
161
artificial and passive immunity
artificial: none
passive: immune globulin
162
deer tick bite presentation
large target like erythematous papule
163
3 stages of Lyme disease
1) early localized Lyme disease: bullseye rash around bite, flu like sx within one month
2) early disseminated Lyme disease: malaise, pain, flu sx days to weeks after infection
3) late disseminated Lyme disease: long term joint inflammation, other serious complications
164
implications of untreated Lyme disease
skin d/o
joint d/o
nervous system d/o
heart d/o
165
dx of Lyme disease
1) Enzyme Linked Immunosorbent Assay (ELSA)
2) confirmatory Western Blot
166
Lyme disease tx
< 8: amoxycillin
> 8: doxycycline
167
Lyme disease prevention (6)
-wear protective clothing in the woods
-tuck bottom of pants in socks
-wear light colored clothes
-inspect skin daily
-remove ticks with tweezers at head
-report inflammation to HCP
168
congenital heart defects classified as (3)
-embryonic
-structural
-physiological
169
leading cause of Acquired Heart disease
Kawasaki disease aka mucocutaneous lymph node syndrome
170
how Kawasaki disease causes heart disease
1) fever and inflammation of blood vessels/vasculitis
2) vasculitis affects all body's blood vessels
3) vasculitis can cause coronary aneurysm and thrombus formation, leading to MI
171
risk factors for Kawasaki disease
-no person to person transmission
-more males
-occurs more often in spring and fall
-Asian and Pacific Islander descent
-not diagnosed with labs or imaging
172
Kawasaki disease criteria
1) acute (week 1) and subacute phases (weeks 2 & 3)
2) fever of 100.4 for 5 or more days
3) 4 or more from below list:
-changes to feet & hands, redness, edema, peeling
-polymorphous exanthem (diffuse maculopapular rash of trunk & extremities
-bilateral conjunctivitis w/out exudates
-changes to lips, mouth, erythema, strawberry tongue, cracked lips
4) cervical lymphedema >1.5 cm
5) lab changes are possible: thrombocytosis, leukocytosis, elevated ESR, CRP, liver enzymes, mild anemia
173
rule out to diagnose Kawasaki (5)
-viral illness
-scarlet fever
-JRA (juvenile rheumatoid arthritis)
-staphylococcus scaled skin syndrome
-Rocky Mountain spotted fever
174
Kawasaki disease phases
1) acute (first 10 days): fever, irritability, discomfort
2) subacute (after about 10 days): peeling hands and feet (watch platelet count)
175
Tx of Kawasaki disease
-mostly supportive: IV fluids, antipyretic, IV immunoglobin, aspirin therapy
-cardiology referral
176
sickle cell disease microbiolgy
amino acid valine present in hemoglobin instead of glutamic acid, causing elongated, sickle shaped RBCs
177
sickle cell implications
-low blood pH, increased blood viscosity like in hypoxia or dehydration
-when the RBC sickle, they can get stuck causing a sickle cell crisis
178
sickle cell does not present until 6 months because ____
fetal hemoglobin contains alpha chain instead of beta (where sickle cells are)
179
why no contact sports with sickle cell
spleen is enlarged
180
medical specialty that treats sickle cell anemia
hematology
181
often first sign of respiratory distress
tachypnea
182
respiratory check (3)
-retractions
-restlessness
-cyanosis
183
longterm hypoxia signs
-pigeon chest
-clubbing
184
causes of epiglotitis (4)
-influenza
-pneumococci
-streptococci
-RSV
185
vaccine that has decreased incidence of epiglotitis
HIB vaccine
186
croup physiology
inflammation of larynx, trachea, and major bronchi
187
croup tx
-corticoid steroids
-racemic epinephrine via nebulizer (in healthcare setting only)
188
GI assessment (7)
-skin turgor
-dry mucous membranes
-lack of tears
-look at amount of diapers wet in last 24 hrs or # of times child voided
-clarify spitting or vomiting
-diarrhea, # of stools, observation of stools
-weight
189
giardia caused by
protozoan
190
common viral infections that cause diarrhea
rotavirus
adenovirus
191
common bacterial infection that cause diarrhea
-campylobacter jejuni
-salmonella
- c.dif
-e. coli
192
when should stool culture be done for diarrhea
after 24 hrs
193
assess pt w/diarrhea
- lab work
- weight
- I/O
-weigh diapers
-1g stool = 1 mL fluid
194
check stool for ________ (5)
ph<7.0
sugar
color
volume
form
195
nephrotic syndrome def
an immunological d/o resulting in altered glomeruli permeability
196
nephrotic syndrome sx
proteinuria
edema
decreased albumin
high cholesterol
197
nephrotic syndrome risk factors (2)
-age 3 y.o.
-boys more likely
198
nephrotic syndrome most common type
mostly ideopathic
199
vesicoureteral reflux def
urine flows from the ureters to the bladder with no flow backs because a valve obscures the end of the ureters
200
non-medical professionals who provide comfort and pain relief measures
Doula
Labor Coach
201
complementary / alternative birthing tx (8)
-relaxation
-focusing and imagery
-prayer
-breathing techniques
-heat or cold applications
-hydrotherapy
-massage
-hypnosis
202
pharma pain relief for labor (6)
-opioid analgesics
-nitrous oxide
-local anesthesia (local/pudendal nerve block
-epidural anesthesia
-spinal anesthesia
-general anesthesia
203
method of administration for butorphanol tartrate (for labor) (2)
IM or IV
204
effect on mother from butorphanol tartrate (for labor) (2)
-effective analgesia
-if woman is opioid dependent, then withdrawal possible
205
effect on labor progress from butorphanol tartrate (for labor)
may slow progress of labor if given early
206
effect on fetus from butorphanol tartrate (for labor)
some respiratory depression
207
Nalbuphine method of admin (labor) (2)
IM or IV
208
nalbuphine effect on mother (labor) (2)
-effective analgesic
-slows respiration rate
209
nalbuphine effect on labor progress
mild maternal sedation
210
nalbuphine effect on fetus or newborn
some respiratory depression
211
morphine (labor) route of administration
intrathecal prior to anesthesia
212
effect of morphine on mother (labor) (2)
-effective analgesia
-pruritis
213
effect of morphine on progress of labor
may slow contractions
214
fetal heart tracing variability level that is good
moderate
215
variability level in Category 3
absent
216
variable decelerations look like ________ on fetal heart tracing
V
217
acceptable decelerations
early (happen with contractions)
218
O2 level needed if Category 2
8-10 liters
219
causes variable decelerations
cord compression
220
pattern for pushing during birth
deep breath
push
wait 10 seconds
repeat
221
third stage begins _____ and ends______
-delivery of baby
-delivery of placenta
222
third stage of birth should last _________ long max
30 minutes
223
oxytocin after birth given what route
IV over 2 hrs or IM
224
opioids must be given at least _____ (amount of time) from delivery
3 hours
225
most common pain relief measure for labor & delivery
epidural
226
epidural affects what part of body typically
umbilicus down
227
spinal anesthesia numbs what part of body
nipple down
228
when general anesthesia
emergency or c-section with contradictions to spinal
229
nurse role in epidural
-educate pt.
-position pt
-documentation
-pregnant person assessment
-fetal assessment
-IV hydration (1 liter PREVENT HYPOTENSION)
-labs (watch platelets: should be at least 70k)
-monitor pain labs
230
nurse role during spinal
-education
-positioning (arch back usually
-documentation
-pregnant person assessment
-fetal assessment
-IV hydration (1 liter to PREVENT HYPOTENSION)
-labs
-monitor pain levels
-monitor for CSF leak (very bad headache, will feel fine lying flat and terrible if upright)
231
CSF leak headache treatment
blood patch
232
concerns with spinal anesthesia (3)
-hypotension
-headache
-respiratory depression (increased risk if duramorph (24 hour-acting morphine, cannot get more opioid until wears off)
233
general anesthesia for
emergency or spinal or contraindication
234
Risk for delivery with general anesthesia
aspiration
235
risk postpartum if general anesthesia used for delivery (2)
-uterus not contracting
-fetal respiratory depression
236
define postpartal period
6 weeks after birth
237
internal electronic monitoring devices for fetus
-intrauterine pressure monitor
-FSE: fetal scalp electrode
238
2 kinds of C-section
-scheduled
-emergent/unplanned due to issue with pregnant person, labor, or baby
239
ASAP vs STAT
-ASAP is as soon as possble, can wait for next room
-STAT is now
240
Emergent C-section issues
-increased risk of complications
---post-op
---emotional
---bonding
241
C-section increased risk of
-infection
-injury to surrounding organs
-amniotic embolism
-bleeding
-risk of complications for future pregnancies (invasive placenta)
-risk to infant
242
Risk to infant from C-section (2)
-cuts
-respiratory depression
243
nurse tasks immediate preop (9)
-informed consent
-hygiene
-GI tract preparation
-baseline I/O
-hydration
-preoperative medication
-surgical checklist
-transport
-support person
244
preoperative meds for c-section
-antibiotic iv
-anesthesia
245
types of surgical incision on uterus for c-section
-transverse (horizontal, most common)
-classical incision (vertical)
246
if classical incision, can never have __________
vaginal birth because can dehisce
247
why classical incision usually done
preterm baby and lower uterus not firm enough still
248
primary dressing after C-section for how long
24 hours
249
how to remove dressing after 24 hours
allow patient to shower so dressing comes off easy
250
REEDA
Redness
Edema
Echymosis
Discharge
Approximation
251
Post Op care for c-section
-Pain management
-Incision (REEDA)
-fundus
-bleeding
-I/O
-circulation
-VS
-Ambulation
-Parenting/Bonding
252
Pt. ed warning signs (pt. should call (5)
-Redness or drainage at incision site
-Lochia heavier than normal period
-severe abdominal pain
-temp > 100.4
-urinary frequency or burning
253
preschool age group
3-5
254
preschool weight development
4.5-6.5 lbs (2-3 kg) per year
255
preschool height development
2.5 - 3.5 inches (6.5 -9 cm) per year
256
key factor in preschool
growth and coordination
257
Toddler fine motor ability (3)
dress, color, copy figures
258
3 year old new motor skills
-ride tricycle
-jumps off steps or step
-balance on one foot for short time
259
4 year-old new motor skills
-hops and skips
-throws a ball
-can catch a ball
260
5 year old motor skills
-jump ropes
-walk backwards
-able to throw and catch ball
261
Erickson for preschool
initiative vs. guilt: love to learn, try new things
-guilt may come if non-mastery
262
Piaget stage
preoperational
263
preoperational stage (Piaget)
-understand world around them, begin to understand other view points
-magical thinking (Santa, etc)
-time
-animism
-centration (focus on one point)
264
preschool language
-sentences, increasing to 4-5 words per sentence by age 5
-2100 words by age 5
- like talking
265
preschool self concept (5)
-allow for independence, self-care, praise talents
-compares self to peers
-keep a schedule
-pretend play
-less fear of strangers
266
preschool activities
puzzles, puppets, books, musical instruments, dress up, playing ball, coloring, drawings, tricycle riding, sand boxes, kiddie pools
267
preschool immunizations
-4 - 6 years of age: DTap, MMR, Varicella, IPV;
-yearly flu vaccine
268
preschool nutrition
-all 5 food groups
-limit fruit juices (water, milk instead)
269
preschool sleep needs
12 hours plus nap (which decreases);
-night light, favorite toy
-ROUTINE
270
preschool dental
-all deciduous teeth present
-supervise brushing and flossing
-bruxism may happen
271
preschool hygiene
tub or shower, always supervised
272
common fears preschooler
-darkness
-bleeding
-physical exams
-separation anxiety
273
safety for preschooler
-lock cabinets
-firearms locked at all times
-helmets for bike riding
-stranger danger
-car seat
-street safety
274
common safety issues preschool (3)
-burns
-drownings
-motor vehicle accidents
275
broken fluency in preschool
secondary stuttering, resolves on its own
276
potty talk
correct and move on
277
school and guidance
-help family find approriate school
-screen for developmental lags
278
components of physical exam (9)
-vital signs
-general appearance
-MS assessment
-body measurements
-head to toe sequence
-vision
-hearing
-Denver developmental or Bright Futures AAP tool
-Goodenough-Harris Drawing test which can be used to assess intelligence in 3-10 year old
279
Postpartum Hemorrhage (PPH)
-leading cause of pregnancy related mortality and morbidity
-life threatening complication
-no universally accepted definition of PPH
280
definitions of Post Partum Hemorrhage
-loss of over 500 cc of blood following vaginal birth
-loss of 1000 cc of blood following C-section
-unresponsive to massage or medication
-10% decrease in HCT between admission and postpartum
281
time period considered early PPH
first 24 hrs
282
time period considered late PPH
between 24 hrs. and 6 weeks
283
4 T's of PPH
Tone: uterine atony
Trauma: to Genital track
Thrombin: coagulation disorder
Tissue: retained placental tissue
284
what happens in uterine atony
uterus fails to contract
285
risk factors for uterine atony (9)
-overdistension
-traumatic birth
-MgSO4
-precipitous labor
-augmented labor-oxytocin
-infection: chorioamnionitis
-retained placental fragments
-high parity (multiple babies)
-hx of uterine atony
286
MgSO4 as related to uterine atony
Magnesium sulfate used to inhibit contractions and delay delivery
287
high parity def:
multiple previous births
288
Tx of uterine atony (5)
-firm massage
-manual expression of bladder distension
-IV infusion of oxytocin and LR or NS (see process on next card)
-Bi-manual compression and exploration for fragments (sterile technique with antibiotics after expulsion
289
Bi-manual compression and exploration for fragments
sterile technique with antibiotics after expulsion
290
if IV oxytocin and LR or NS fails
-methergine 0.2 mg IM OR hemabate (contraindicated if pt. has asthma)(carboprost tromethamine) 0.25 mg IM
-if that is ineffective or if HTN, prostaglandin E2 (cytotec) rectal suppository (800-1000 mg)
-crystalloid solution and blood products
-O2, urinary cath, labs, VS, and repeated fundal assessment
291
Trauma to the Genital Tract common ex.
Lacerations to the cervix, vagina, or perineum
292
Risk Factors for trauma to genital tract (7)
-precipitous birth
-congenital abnormalities
-contracted pelvis
-infant size
-abnormal presentation/position
-previous scars from infection, injury, operations
-vulvar, perineal, or vaginal varicosities
293
1st degree perineal laceration
vaginal mucosa torn
294
2nd degree perineal laceration
perineal muscles torn
295
3rd degree perineal lacerations
anal sphincter torn
296
4the degree perineal laceration
rectum torn
297
Tx of trauma to genital tract (7)
-identify site of bleeding
-control of bleeding
-analgesia
-monitor hemodynamics
-ice
-diet
-stool softeners
298
how serious is uterine inversion
life threatening
299
risk factors for uterine inversion
-fundal pressure
-short cord
-cord traction
-uterine atony
-fibroids
-multips.
-Hx placenta accreta/increta
-hx past inversion
300
how many degrees of uterine inversion (and what they are like)
-1st degree: still inside, but small dent
-2nd degree: still inside, larger dent
-3rd degree: inverted enough to stick out al little
-4th degree: fully inverted
301
Tx of uterine inversion
-emergency management necessary
-LR and blood products for shock
-monitor hemodynamics
-fundus repositioned after placenta separated (MgSO4 and analgesia to relax uterus- d/c after repositioned)
-oxytocin medications and bimanual compression
-antiobiotics
302
Disseminated intravascular Coagulation (DIC) def:
over-activation of clotting and anti-clotting processes
303
Disseminated intravascular Coagulation (DIC) causes (7)
disease or injury:
-septicemia
-acute hypotension
-snake bites
-neoplasm
-OB emergencies
-severe trauma
-extensive surgery
304
course of Disseminated Intravascular Coagulation
-initial hypercoagulability
-then deficiency in clotting factors
305
s/s of DIC
-widespread internal and external bleeding (gums, nose, petechiae around pressure sites)
-Lab values
-low platelets
-low fibrinogen and other clotting factors
-prolonged Pt and PTT
-abnormal RBC morphology
306
Tx of DIC
-removal of underlying cause
-volume replacement and blood component therapy
-optimization of O2 and perfusion status
307
Nursing assessment/tasks for DIC (7)
-VS
-insert 2nd line
-observe for s/s of bleeding
-observe for adverse blood reactions
-monitor urinary output
-O2 admin
-Maintain quiet non-stressful environment
308
4 categories of retained placenta
-non-adherent retained placenta (partial separation, entrapped by uterus)
-placenta accreta: adherent to uterus
-placenta increta: adherent and integrated into uterine wall
-placenta percreta: integrated and pierced through other side of uterine wall
309
risk factors for retained placenta
-prior uterine surgery
-mismanagement of 3rd stage of labor
310
Tx of retained placenta if non-adherent (3)
-manual separation and removal
-IV analgesia
-still at risk for PPH and infection
311
Tx of retained placenta if adherent (4)
-attempts to remove may not be successful
-may result in lacerations of the uterus
-blood replacement
-possible hysterectomy
312
subinvolution def:
delayed return of enlarged uterus to normal size and fx
313
subinvolution risk factors (2)
-retained placental fragments
-pelvic infection
314
subinvolution s/s (3)
-prolonged, irregular, or excessive vaginal bleeding
-enlarged uterus by exam
-boggy uterus
315
retained placenta aftercare
hysterectomy strongly recommended because further invasion of placenta through uterus into bladder and other organs very probable
316
subinvolution def
delayed return of enlarged uterus to normal size and function
317
subinvolution risk factors (2)
-retained placental fragments
-pelvic infection
318
subinvolution s/s (3)
-prolonged, irregular, or excessive vaginal bleeding
-enlarged uterus by exam
-boggy uterus
319
TX of subinvolution
-dependent on cause
-methergine 0.2 mg Q 4 hrs for 2-3 days
-antibiotics
-dilation and curette (D&C) for retained placenta
320
postpartum infection def:
-any clinical infection in the first 28 days postpartum
321
common postpartum infections (4)
-endometritis
-wound infections
-cystitis
-mastitis
322
postpartum infection (PPI) risk factors include (18)
-hx of thrombosis, UTI, mastitis, pneumonia
-DM
-alcoholism
-immunosuppression
-anemia
-malnutrition
-C-section or operative vaginal birth
-prolonged ROM (rupture of membrane)
-chorioamnionitis
-prolonged labor
-catheterization
-intrauterine monitoring
-epidural anesthesia
-retained fragments
-PPH
-episiotomy/lacerations
-hematomas
323
endometritis def.
infection of uterine cavity muscle
324
endometritis prevalance
- 2% of vaginal births
- 10-20% of C-sections
- elective C-sections have lower rates than non-elective
325
endometritis s/s (9)
-tachycardia
-jagged temp elevation
-chills possible
-uterine tenderness (feeling fundus hurts abnormally)
-prolonged/recurrent afterbirth pains
-subinvolution
-slight abdominal distention
-scanty, odorous lochia, or mod. heavy, foul smelling, bloody seropurulent lochia
-elevated WBC (labor stress normally increases WBC)
326
endometritis nursing interventions
-VS, monito hemodynamics
-obtain blood cultures (anaerobic and aerobic (results in 36-48 hrs))
-pharmacologic tx (broad spectrum antibiotics via IV until afebrile and pain free for 24-48 hrs)
-analgesia
327
Wound infections nursing assessment (3)
-VS
-Wound assessment (red, irritated, warm, tender, oozing, foul smelling, poorly healing, splitting)
-pain assessment- localized
328
Wound infection nursing interventions
-open and cleanse
-antibiotic tx
329
wound infections patient self-care (5)
-hydration
-monitor cesarean incisions, cleanse daily in shower
-increase roughage in diet if 4th degree perineal laceration
-clean perineum from front to back with peri-bottle
-report increases in temperature, drainage, increased pain
330
cystitis def and prevalance
-bladder infection
-occurs in 2-4 %
331
cystitis risk factors (9)
-distension
-dehydration
-poor hygiene
-catheterization
-pelvic exams
-epidural anesthesia
-genital tract injury
-hx of UTIs
- C-section
332
cystitis s/s
-frequency, urgency, burning
-suprapubic discomfort
-CVA tenderness if pyelonephritis
-fever in pyelonephritis
-tachycardia
-n/v
333
cystitis nursing interventions
-notify provider, get orders for UA/UCx
-monitor v/s, hemodynamics
-pharmacologic management (antibiotics as ordered, analgesics as ordered, NSAIDs)
-encourage fluid intake
-encourage frequent voiding
-routine peri-care
334
mastitis def
infection of breast tissue, especially from organisms on postpartum person's skin or infant
335
when mastitis occurs
-typically 2 days - 2 weeks postpartum
-can occur anytime
336
mastitis nursing assessment (6)
-flu like sx first
-breast pain, swelling, tenderness
-elevated temp (102-104 typically)
-axillary adenopathy
-usually unilateral, may be bilateral
-possible purulent drainage
337
mastitis nursing interventions
-antibiotics admin (usually dicloxacillin for almost always staph aureus infection)
-continue to pump/feed/express q 2-4 hrs
-analgesics if ordered
-pump breast milk (baby can have)
338
thrombosis def and location postpartum
formation of blood clots inside blood vessel caused by inflammation or partial obstruction of blood vessels in legs or pelvis;
(increased risk in pregnancy and 6 weeks post partum)
339
2 types of thrombosis of concern postpartum
-DVT
-PE
340
prevalence of thromboembolic disease postpartum
1:1000
341
thromboembolic disease causes (2)
-stasis
-hypercoagulation
342
thromboembolic disease other risk factors
-C/S
-previous history
-obesity
-AMA
-multiparity
-tobacco
-laboring position
-immobility
343
clinical manifestations of PE (6)
-shortness of breath
-chest pain
-anxiety
-cough
-hypoxia
-tachycardia
344
clinical manifestations of deep thromboembolism
-reduced peripheral pulse on affected side
-assess for PE
345
Diagnostic imaging for thromboembolism
-doppler ultrasound for DVT
-CT scan for PE
346
management of DVT
-anticoagulant
-bedrest
-elevation of leg
-analgesia
347
continued evaluation of DVT
-inspect
-palpate
-measurement
-pulses
-DO NOT PERFORM HOMAN'S SIGN
-monitor for PE
-labs
coordinate follow up post hospitalization
348
postpartum sadness prevalance
up to 85% of postpartum women
349
postpartum sadness nursing interventions (6)
-let postpartum person/partners know blues are normal 1-2 days after delivery through 2 weeks postpartum
-encourage communication of needs and fears
-praise them on feeding, assessing infant needs, etc
-encourage rest when baby is sleeping
-continue to monitor parent/infant bonding
-educate re: what is normal, and who to call if postpartum depression
350
postpartum depression prevalence
20% of postpartum women
351
nursing assessment for postpartum depression
-risk greatest during 1st month post delivery
-can occur anytime in 1st year
-check for s/s
352
s/s of postpartum depression
-insomnia
-crying and prolonged sadness
-poor concentration and difficulty making decisions
-obsessive thoughts, not being able to care for baby
-decline in personal hygiene
-SI or HI
353
postpartum nursing interventions
-early assessment and education
-home visitation if possible
-stress rest, especially first few weeks
-provide info on meds and complimentary tx (yoga, aromatherapy, acupressure, massage, ECT, psychotherapy)
-provide contact # for mental health provider
-provider may consider restarting previous meds if stopped during pregnancy
-discharge planning should include info and appropriate contact #s
354
postpartum psychosis prevalence
1-2 per 1000 births
355
postpartum psychosis assessment (4)
-agitation, confusion
-irrational statements or behavior
-delusions, hallucinations
-insomnia and hyperactivity
356
Which of the following is the most frequent reason for postpartum hemorrhage?
Uterine atony
357
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