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
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
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
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
5
Q
How should the mom lie during perineum assessment
A
On the side of the episiotomy or either side if its midline
6
Q
Episiotomy assessment
A
- REEDA (redness, ecchymosis, edema, discharge, approximation)
- offer ice packs
- warm sitz baths after 24 hrs
- pain meds PRN
7
Q
Uterine atony
A
- clots or boggy or higher than expected
- massage fundus if there are clots
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
9
Q
How should the fundus be immediately following birth?
A
- firm and palpable
- mid line or 1-2 fingers below umbillicus
10
Q
How can you tell if the bladder is full?
A
The fundus is palpable to the right
11
Q
Fundal assessment
A
- palpate q 15 min for 1 hr
- encourage women to void before assessment
12
Q
Prophylaxis for any infections that may have been picked up when going through vaginal delivery
A
eye drops
13
Q
What do eye drops protect against
A
STDs, chlamydia, gonorrhea
14
Q
What antibiotic ointment can prevent opthalmia neonatorum
A
Erythromycin and Tetracycline within 1-2 hrs of birth
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
16
Q
Vitamin K dosage
A
0.5-1 mg IM in the anterior thigh vastus lateralis
17
Q
What vaccine is given before discharge from nursery or by one month of age?
A
Hep B
18
Q
What is administered within 12 hrs of birth if the mother is hep B positive
A
HBIG
19
Q
What should be done when giving Hep B vaccine?
A
Wash the leg!
20
Q
Is the hep B vaccine required?
A
No, it is optional
21
Q
Variability
A
Amount of beat to beat fluctuation in the fetal heart rate
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
23
Q
Normal variability
A
Moderate: 6-25 bpm
THIS IS GOOD (healthy baby!)
24
Q
Absent variability
A
Flat line
25
Minimal variability
< 5 bpm
| - fetus is sleeping
26
Marked variability
> 25 bpm
| - fetal movement
27
What can you do if the FHR is anything OTHER than moderate variability?
- Turn the mother on the left lying position
- O2
- Notify the provider
- Discontinue oxytocin drip
28
Periodic variability
occurs with uterine contractions
29
Episodic variability
due to environmental problems or external stimulus - not associated with uterine contractions
30
Accelerations
Increase of 15 bpm in 15 seconds
- benign
- observed for in non-stress test
- 2 in 20 min = reassuring
31
What is observed for in a non-stress test?
Accelerations (increase of 15 bpm in 15 seconds)
32
Early Deceleration
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
33
Variable Deceleration
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
34
Late Deceleration
due to UTEROPLACENTAL INSUFFICIENCY
- most CONCERNING decel
- neurologic delay between stress of contraction and baby's response to decreased O2
35
Late Decel interventions
- turn to L side
- increase IVF
- O2
- Stop Pitocin
- Notify MD
36
Sign of fetal distress
Meconium + late decel
37
What is the most accurate method of FHR?
Internal via fetal scalp electrode
38
How should the membranes be for internal monitoring?
Ruptured, 2 cm dilated
39
For whom is internal monitoring recommended for?
Higher risk women
40
Advantages of Internal Monitoring
- continuous record
- ongoing assessment, "trend over time"
- less personnel intensive
41
Disadvantages of Internal Monitoring
- limitation of maternal movement
- limited data on improved outcomes
- potential loss of patient contact
- can't detect variability or certain decels
42
External Monitoring procedure
Assess with doppler for 1 full minute AFTER a contraction
43
How do you hear FHR?
- best heard over fetal back --> Leopold's maneuvers and knowing position of baby are important!
44
How often should you check FHR for low risk external?
Q 30 min during active labor
| Q 15 min during 2nd stage
45
How often should you check FHR for high risk external?
q 15 min during active
| q 5 during 2nd stage
46
Reassuring signs for FHR
- baseline 110-160
- moderate variability (6-25)
- accelerations with fetal movement
- no late or variable decels
47
Non-Reassuring signs for FHR
- late decel
- absent, minimal or marked variability
- decrease from baseline
- bradycardia (<110 for 10 min or longer)
48
What kind of meds are often used in labor for pain management?
Sedatives
49
What is the best choice for combined pain relief and low risk of side effects?
Fentanyl - PCA
50
Primary risk with pain meds
Respiratory depression (and neonatal respiratory depression)
51
What should you have ready if the pt is on fentanyl?
Narcan
52
Neuraxial Anesthesia types
- spinal
- epidural
- combined epidural spinal
53
Epidural
- 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
Disadvantages of epidural
- 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
Combined Epidural Spinal advantages
- rapid onset
- can last up to 3 hours
- allows motor function to remain active with preservation of ability to walk, bear down
56
Combined epidural spinal adverse reactions
- hypotension
- palpitations
- tinnitus
- headaches, dizziness
- metallic taste
- itching, severe reactions
- N/V
57
Epidural nursing care
- 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
What is local anesthesia used for?
Episiotomy repair
59
Disadvantage of local anesthesia
Burning sensation with injection
60
Advantage of local anesthesia
Least amount of anesthetic agent
61
Pudendal Nerve block
Administered directly to pudendal nerve to provide relief in the lower vagina, vulva, and perineum
62
Is it ______ for the infant to lose _____% of birth weight in first 3-5 days
normal to lose 5-10% of birth weight in first 3-5 days
63
In the first 24 hours, expect ___ wet diapers and ___ dirty diapers
1 wet diaper, 1 dirty diaper
64
Poop should be what size?
Size of a quarter
65
Feeding for first 24 hrs of life
5 mL or 1 tsp
66
Post circumcision care
- 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
Umbilical Cord care
- heals naturally
- soap and water OR alcohol OR povidone-iodine
- clamp is removed once the stump is dry
- falls off approximately 10 days
68
Normal vital findings
HR 110-160
Temp 36.5-37.2
RR 30-60 abdominal breathing
69
anterior fontanelle shape
| posterior fontanelle shape
anterior: diamond
posterior: triangular
70
Normal newborn reflexes
- rooting
- sucking and swallowing
- grasp
- moro
- babinski
- stepping
- tonic neck
71
Fundal involution
Return of uterus to non-pregnant state
72
Where should the fundus be at the end of the 3rd stage of labor?
2 cm below umbilicus
73
In how long should the fundus return to the umbilicus level?
Within 12 hours
74
Fundus involution progresses ____. Descends ____ every 24 hrs
Progresses rapidly - descends 1-2 cm every 24 hrs
75
How long does it take for the fundus to lie in true pelvis?
2 weeks
76
Sub-involution
Failure of uterus to return to non-pregnant state
77
Lochia
Post birth uterine discharge
78
Lochia Rubra
Blood + decidual + trophoblastic debris
- for 3-4 days
- see less in C section than vaginal
79
Lochia Serosa
Old blood + serum + leukocytes + debris
- begins day 3 or 4
- lasts up to 2 weeks
80
Lochia Alba
Leukocytes + decidua + epithelial cells + mucus + serum + bacteria
- 2-6 weeks
81
Excessive lochia
- saturation of pad within 15 min
- pooling of blood under butt
- required immediate assessment and intervention !
82
What shouldn't you find in assessment of lochia?
- odor
| - clots
83
Perineal care
- ice packs for first 24 hrs
- then warm sitz bath
- peribottle
- sitz bath after bowel movement
- avoid straining for bowel movement
84
Rhogam
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
Rh isoimmunization
Sensitization of maternal blood and development of antibodies to Rh positive blood (problems with future pregnancies)
86
Post Partum Depression
Depressed mood interferes with interest, pleasure for majority of day nearly every day for 2 weeks
- anxiety
- anger, irritability
- panic
- guilt
- overwhelmed
87
What can appear with pospartum depression?
Psychosis - hallucinations, delusions, disorganized thoughts
***MEDICAL EMERGENCY
88
What can help before feeding?
- warm compress
| - massage
89
Nipple care
- expose to air after feeding
90
Formula feeding
q 3-4 hrs
91
Initial feed should be...
no more than 1/2 oz
92
Feed should be the ___ type of formula _____
same type of formula consistently
93
Breast feed exclusive for how long?
6 months, continue for 1 year
94
If weaned off breast feeding before 12 months then ...
iron-fortified infant formula
95
Mature milk comes in
3-5 days post delivery
| - day 10 = final stage of mature milk
96
How does the composition of milk change?
- composition changes during each feeding
- fat content increases
- lactose, protein, and water-souble vitamins
97
Day 1 = _____ mL of colostrum
| Day 10 = _____ mL
day 1 - 30 mL
| day 10 - 750 mL
98
Colostrum
clear yellowish fluid present for first 3 days
99
breast milk has what major antibody?
IgA
