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MATERNITY > EXAM 2 > Flashcards

EXAM 2 Flashcards

1
Q

3rd stage of labor hallmark signs

A
  • signs of placental separation –> expelling placenta –> inspect placenta –> dispose
  • inspect vagina and cervix for lacerations
  • use oxytoxics
  • immediate care of newborn
  • AGPAR
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2
Q

Signs of placental separation

A
  • firmly contracting uterus
  • palpate uterus to check for ballooning
  • sudden gush of dark blood
  • lengthening of umbilical cord protruding from vagina
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3
Q

4th stage of labor hallmark signs

A
  • considers physical and emotional factors
  • promote maternal comfort and rest
  • education and support
  • facilitate attachment behaviors
  • assess
    - vaginal bleeding
    - perineum q 15 min
    - palpate fundus q 15 min
    - episiotomy
    - uterine atony
    - vitals
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4
Q

How can you promote maternal comfort and rest in the 4th stage?

A
  • heated blankets and warm drinks for tremors
  • provide food
  • encourage rest
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5
Q

How should the mom lie during perineum assessment

A

On the side of the episiotomy or either side if its midline

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6
Q

Episiotomy assessment

A
  • REEDA (redness, ecchymosis, edema, discharge, approximation)
  • offer ice packs
  • warm sitz baths after 24 hrs
  • pain meds PRN
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7
Q

Uterine atony

A
  • clots or boggy or higher than expected

- massage fundus if there are clots

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8
Q

How often should vitals be taken in the 4th stage?

A

Q 15 min for the first hour then q 30 min for the 2nd hr

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9
Q

How should the fundus be immediately following birth?

A
  • firm and palpable

- mid line or 1-2 fingers below umbillicus

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10
Q

How can you tell if the bladder is full?

A

The fundus is palpable to the right

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11
Q

Fundal assessment

A
  • palpate q 15 min for 1 hr

- encourage women to void before assessment

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12
Q

Prophylaxis for any infections that may have been picked up when going through vaginal delivery

A

eye drops

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13
Q

What do eye drops protect against

A

STDs, chlamydia, gonorrhea

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14
Q

What antibiotic ointment can prevent opthalmia neonatorum

A

Erythromycin and Tetracycline within 1-2 hrs of birth

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15
Q

Why is Vitamin K given?

A
  • Infants have not yet formed enough vitamin K to sufficiently clot their blood –> injections help to not bleed out
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16
Q

Vitamin K dosage

A

0.5-1 mg IM in the anterior thigh vastus lateralis

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17
Q

What vaccine is given before discharge from nursery or by one month of age?

A

Hep B

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18
Q

What is administered within 12 hrs of birth if the mother is hep B positive

A

HBIG

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19
Q

What should be done when giving Hep B vaccine?

A

Wash the leg!

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20
Q

Is the hep B vaccine required?

A

No, it is optional

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21
Q

Variability

A

Amount of beat to beat fluctuation in the fetal heart rate

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22
Q

What is the most important prognostic indicator of fetal oxygenation?

A

Variability!

  • implies that both branches of the heart are working
  • heart is receiving adequate oxygen and good neurologic response
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23
Q

Normal variability

A

Moderate: 6-25 bpm

THIS IS GOOD (healthy baby!)

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24
Q

Absent variability

A

Flat line

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25
Q

Minimal variability

A

< 5 bpm

- fetus is sleeping

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26
Q

Marked variability

A

> 25 bpm

- fetal movement

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27
Q

What can you do if the FHR is anything OTHER than moderate variability?

A
  • Turn the mother on the left lying position
  • O2
  • Notify the provider
  • Discontinue oxytocin drip
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28
Q

Periodic variability

A

occurs with uterine contractions

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29
Q

Episodic variability

A

due to environmental problems or external stimulus - not associated with uterine contractions

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30
Q

Accelerations

A

Increase of 15 bpm in 15 seconds

  • benign
  • observed for in non-stress test
  • 2 in 20 min = reassuring
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31
Q

What is observed for in a non-stress test?

A

Accelerations (increase of 15 bpm in 15 seconds)

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32
Q

Early Deceleration

A

due to FETAL HEAD COMPRESSION

  • occurs prior/early in contraction
  • vagal stimulation by head compression slows HR
  • move mom’s position to fix, fixes itself
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33
Q

Variable Deceleration

A

due to CORD COMPRESSION

  • occurs without uterine event
  • happens at any point of the contraction
  • concerning if < 70 bpm for > 60 bpm
  • move mom to side
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34
Q

Late Deceleration

A

due to UTEROPLACENTAL INSUFFICIENCY

  • most CONCERNING decel
  • neurologic delay between stress of contraction and baby’s response to decreased O2
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35
Q

Late Decel interventions

A
  • turn to L side
  • increase IVF
  • O2
  • Stop Pitocin
  • Notify MD
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36
Q

Sign of fetal distress

A

Meconium + late decel

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37
Q

What is the most accurate method of FHR?

A

Internal via fetal scalp electrode

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38
Q

How should the membranes be for internal monitoring?

A

Ruptured, 2 cm dilated

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39
Q

For whom is internal monitoring recommended for?

A

Higher risk women

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40
Q

Advantages of Internal Monitoring

A
  • continuous record
  • ongoing assessment, “trend over time”
  • less personnel intensive
41
Q

Disadvantages of Internal Monitoring

A
  • limitation of maternal movement
  • limited data on improved outcomes
  • potential loss of patient contact
  • can’t detect variability or certain decels
42
Q

External Monitoring procedure

A

Assess with doppler for 1 full minute AFTER a contraction

43
Q

How do you hear FHR?

A
  • best heard over fetal back –> Leopold’s maneuvers and knowing position of baby are important!
44
Q

How often should you check FHR for low risk external?

A

Q 30 min during active labor

Q 15 min during 2nd stage

45
Q

How often should you check FHR for high risk external?

A

q 15 min during active

q 5 during 2nd stage

46
Q

Reassuring signs for FHR

A
  • baseline 110-160
  • moderate variability (6-25)
  • accelerations with fetal movement
  • no late or variable decels
47
Q

Non-Reassuring signs for FHR

A
  • late decel
  • absent, minimal or marked variability
  • decrease from baseline
  • bradycardia (<110 for 10 min or longer)
48
Q

What kind of meds are often used in labor for pain management?

A

Sedatives

49
Q

What is the best choice for combined pain relief and low risk of side effects?

A

Fentanyl - PCA

50
Q

Primary risk with pain meds

A

Respiratory depression (and neonatal respiratory depression)

51
Q

What should you have ready if the pt is on fentanyl?

A

Narcan

52
Q

Neuraxial Anesthesia types

A
  • spinal
  • epidural
  • combined epidural spinal
53
Q

Epidural

A
  • good analgesia
  • woman is fully awake during labor and birth
  • continuous technique allows different blocking for each stage of labor
  • dose can be adjusted
54
Q

Disadvantages of epidural

A
  • hypotension
  • potential FHR late decel
  • headaches, seizures, meningitis
  • analgesia onset may not be for up to 30 min
  • can slow contractions
  • can interfere with fetal descent and rotation
55
Q

Combined Epidural Spinal advantages

A
  • rapid onset
  • can last up to 3 hours
  • allows motor function to remain active with preservation of ability to walk, bear down
56
Q

Combined epidural spinal adverse reactions

A
  • hypotension
  • palpitations
  • tinnitus
  • headaches, dizziness
  • metallic taste
  • itching, severe reactions
  • N/V
57
Q

Epidural nursing care

A
  • assessment
  • pain management
  • HOB 25 degrees
  • assist patient to remain still
  • Sitting or side lying
  • BP q 15 min during labor
  • bladder status (if unable to void spontaneously, straight cath)
58
Q

What is local anesthesia used for?

A

Episiotomy repair

59
Q

Disadvantage of local anesthesia

A

Burning sensation with injection

60
Q

Advantage of local anesthesia

A

Least amount of anesthetic agent

61
Q

Pudendal Nerve block

A

Administered directly to pudendal nerve to provide relief in the lower vagina, vulva, and perineum

62
Q

Is it ______ for the infant to lose _____% of birth weight in first 3-5 days

A

normal to lose 5-10% of birth weight in first 3-5 days

63
Q

In the first 24 hours, expect ___ wet diapers and ___ dirty diapers

A

1 wet diaper, 1 dirty diaper

64
Q

Poop should be what size?

A

Size of a quarter

65
Q

Feeding for first 24 hrs of life

A

5 mL or 1 tsp

66
Q

Post circumcision care

A
  • observe for first void
  • observe for bleeding
  • careful diaper change
  • APPLY vaseline/neosporin
  • heals within 10 days
  • teach parents how to irrigate the area
67
Q

Umbilical Cord care

A
  • heals naturally
  • soap and water OR alcohol OR povidone-iodine
  • clamp is removed once the stump is dry
  • falls off approximately 10 days
68
Q

Normal vital findings

A

HR 110-160
Temp 36.5-37.2
RR 30-60 abdominal breathing

69
Q

anterior fontanelle shape

posterior fontanelle shape

A

anterior: diamond
posterior: triangular

70
Q

Normal newborn reflexes

A
  • rooting
  • sucking and swallowing
  • grasp
  • moro
  • babinski
  • stepping
  • tonic neck
71
Q

Fundal involution

A

Return of uterus to non-pregnant state

72
Q

Where should the fundus be at the end of the 3rd stage of labor?

A

2 cm below umbilicus

73
Q

In how long should the fundus return to the umbilicus level?

A

Within 12 hours

74
Q

Fundus involution progresses ____. Descends ____ every 24 hrs

A

Progresses rapidly - descends 1-2 cm every 24 hrs

75
Q

How long does it take for the fundus to lie in true pelvis?

A

2 weeks

76
Q

Sub-involution

A

Failure of uterus to return to non-pregnant state

77
Q

Lochia

A

Post birth uterine discharge

78
Q

Lochia Rubra

A

Blood + decidual + trophoblastic debris

  • for 3-4 days
  • see less in C section than vaginal
79
Q

Lochia Serosa

A

Old blood + serum + leukocytes + debris

  • begins day 3 or 4
  • lasts up to 2 weeks
80
Q

Lochia Alba

A

Leukocytes + decidua + epithelial cells + mucus + serum + bacteria
- 2-6 weeks

81
Q

Excessive lochia

A
  • saturation of pad within 15 min
  • pooling of blood under butt
  • required immediate assessment and intervention !
82
Q

What shouldn’t you find in assessment of lochia?

A
  • odor

- clots

83
Q

Perineal care

A
  • ice packs for first 24 hrs
  • then warm sitz bath
  • peribottle
  • sitz bath after bowel movement
  • avoid straining for bowel movement
84
Q

Rhogam

A

Rh negative mothers must be evaluated for RhoGAM need post delivery
- if baby is Rh + then mother needs RhoGAM WITHIN 72 HRS OF DELIVERY to prevent Rh isoimmunization

85
Q

Rh isoimmunization

A

Sensitization of maternal blood and development of antibodies to Rh positive blood (problems with future pregnancies)

86
Q

Post Partum Depression

A

Depressed mood interferes with interest, pleasure for majority of day nearly every day for 2 weeks

  • anxiety
  • anger, irritability
  • panic
  • guilt
  • overwhelmed
87
Q

What can appear with pospartum depression?

A

Psychosis - hallucinations, delusions, disorganized thoughts
***MEDICAL EMERGENCY

88
Q

What can help before feeding?

A
  • warm compress

- massage

89
Q

Nipple care

A
  • expose to air after feeding
90
Q

Formula feeding

A

q 3-4 hrs

91
Q

Initial feed should be…

A

no more than 1/2 oz

92
Q

Feed should be the ___ type of formula _____

A

same type of formula consistently

93
Q

Breast feed exclusive for how long?

A

6 months, continue for 1 year

94
Q

If weaned off breast feeding before 12 months then …

A

iron-fortified infant formula

95
Q

Mature milk comes in

A

3-5 days post delivery

- day 10 = final stage of mature milk

96
Q

How does the composition of milk change?

A
  • composition changes during each feeding
  • fat content increases
  • lactose, protein, and water-souble vitamins
97
Q

Day 1 = _____ mL of colostrum

Day 10 = _____ mL

A

day 1 - 30 mL

day 10 - 750 mL

98
Q

Colostrum

A

clear yellowish fluid present for first 3 days

99
Q

breast milk has what major antibody?

A

IgA

MATERNITY (2 decks)

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