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Maternal Health > EXAM #3 > Flashcards

EXAM #3 Flashcards

1
Q

What to assess on mother in the first 24 hours after birth

A

-Temp: normal to drop 2 hours after birth. Normal to raise for 24 hours
-Pulse
-Respirations
-BP
-Fundus: Midline, firm at umbilicus
-Lochia
-Episiotomy
-Hemorrhoids
-Bladder
-Homan’s sign neg. DVT
-Mood
-Bonding and attachment

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2
Q

How long is severe pain expected postpartum & what nursing interventions should be implemented?

A

-2-3 days
-Prone position with pillow under the abdomen, sitz bath, ambulation, mild analgesics (Ibuprofen & naproxen) up to 30 mins before breast feeding

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3
Q

BUBBLE HE (B) assessment:

A

Breast
Uterus
Bladder
Bowels
Lochia
Episiotomy (perineum & hemorrhoids)
Homans sign (legs)
Emotions
Bonding

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4
Q

When do the breast begin to fill and what do they fill like?

A

Day 3, full, tight an heavy

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5
Q

When does engorgement occur?

A

Day 4

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6
Q

What prevents milk production?

A

No nipple stimulation, bra and ice packs

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7
Q

What are normal findings on the breast assessment?

A

-Flat, everted, inverted nipples
-Tissue is soft, filling and firm
-Temperature and color

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8
Q

What are normal findings on the uterus assessment?

A

-Involution: Describes the process by which the uterus returns to the nonpregnant state
-Mid-line, not deviated
-Firm
-Afterpains
-Assess in supine position

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9
Q

How to palpate the fundus:

A

-One hand above the pubic sympysis
-the other hand at the umbilicus, press inward and downward

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10
Q

What are normal findings for the bladder assessment?

A

-Spontaneous voiding within 6/8 hours
-Output: 150ml/hr
COLA: Color, odor, last void, amount

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11
Q

What are normal assessment findings for the bowel assessment?

A

-More active after childbirth
-Bowel movement around day 2 or 3
COLA: Color, odor, last void, amount

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12
Q

Nursing interventions to help facilitate normal bowel function:

A

-Drink fluids
-High-fiber
-Avoid ignoring urges & straining
-Early ambulation
-Stool softener and laxatives

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13
Q

What are normal assessment finding for lochia?

A

-Color: Rubra, Serosa, alba
-Amount: Scant, light, moderate, heavy (saturated in 1hr)
-Odor
-Clots v tissue

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14
Q

What are normal assessment finding for Episiotomy incision (perineal assessment)?

A

-No REEDA with incision (redness, edema, ecchymosis, discharge, WITH approximation)
-Assess for hemorrhoids, Tearing, Hematomas

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15
Q

Episiotomy care:

A

-Ice pack for 24/48 hours
-After, Sitz bath for 20 minutes
-Witch hazel pads

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16
Q

What is the first-line medications used to help with discomfort in postpartum?

A

NSAIDs

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17
Q

What position should be avoided for the 1st 3 weeks?

A

-Knee-chest position puts added pressure

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18
Q

+ Homan’s Sign:

A

Indicative of DVT
-Legs are extended and relaxed and kness are flexed
-Sharply dorsiflex the foot and if there’s resistance with discomfort, it is positive

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19
Q

What clinical manifestations are indicative of DVT?

A

Varicose veins, pain, pulselessness, warmth, edema, sensation.

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20
Q

How to prevent DVT:

A

-Early ambulation
-Active/passive ROM
-Avoid prolonged sitting
-Elevate legs
-Drink fluids

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21
Q

What 4 signs are looking for during emotional bonding?

A

-Talking to baby
-Holding the baby
-Gazing at the baby
-Pointing out features

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22
Q

What Hematological and Metabolic changes occur after pregnancy?

A

-Decrease in blood volume (lots of voiding)
-Estrogen Progesterone decrease and Prolactin is produced

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23
Q

What neurological changes occur after pregnancy?

A

Fatigue & discomfort

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24
Q

What changes occur to the renal system, fluids and electrolytes after pregnancy?

A

-Naturesis
-Diuresis (500 to 1000ml in one go)

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25
Q

What changes occur to the respiratory system after pregnancy?

A

Decrease in intra-abdominal pressure

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26
Q

What changes occur to the integumentary system after pregnancy?

A

Stretch marks

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27
Q

What changes occur to the Cardiovascular system after pregnancy?

A

-cardiac output returns to normal

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28
Q

What changes occur to the Immune system after pregnancy?

A

-WBCs are elevated
-RhD neg mothers who had a baby that is RhD pos, should recieve RhoGAM within 72 hours
-If non rubella immune, give MMR after birth
-Give Tdap after birth

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29
Q

What changes occur to the Reproductive system after pregnancy?

A

Menstrual occurs 6 to 8 weeks after
-Breast feeding mothers will return in 3 months
-Ovulation will follow

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30
Q

What changes occur to the GI system after pregnancy?

A

-Muscle fatigue
-Diastasis Rect-abdominis (modified sit ups and posture)

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31
Q

Postpartum nursing care for tubal ligation:

A

Air may enter the abdominal cavity which can cause should pain, encourage walking

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32
Q

Postpartum nursing care for C-section:

A

-BUBBLEHE
-Prevent DVT
-Promote bonding
-Foley discontinued after 12hrs
-Diet as tolerated
-Try NSAIDs over opiates

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33
Q

Education/intervention teaching for tubal ligation:

A

-Medicaid, need signed paper 30 days before prodecure
-NOT reversible
-Tubes are not tied but are removed
-Get consent

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34
Q

Nursing education for formula feedings:

A

-Handwashing
-Prepare as instructed
-Fomula should constituted with tested source of water
-Boiling will not get rid of harmful things
-Wash in hot, soapy water & air dry or dishwasher
-Do NOT microwave or prop bottle
-Burp frequently
-Can be fed cold, warmed or room-temp. Heat with pan or electric device

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35
Q

When should you throw out formula that was prepared?

A

24 hours

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36
Q

Benefits of breastfeeding for mother:

A

-Decreased risk of cancers, osteoporosis, & type 2 diabetes
-Uterine contractions occur due to the release of oxytocin (involution)
-Weight loss
-Budget-friendly
-infant bonding

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37
Q

Benefits of breastfeeding for baby:

A

-Enhanced immunity & maturity of the GI tract
-Decreased risk of SIDS, obesity, asthma, & type 1 diabetes
-Decreased pain
-Jaw development
-Protection againt childhood cancers

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38
Q

What conditions/procedures in risk of infection with c-section?

A

Prolonged procedures, choreo, DM, obese pt, poor diet. Clean with chlorahexidine wipes

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39
Q

What hormone makes the alveoli in the breast secrete milk?

A

Prolactin

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40
Q

When and what kind of milk is produced during stage 2 of milk production?

A

Occurs after delivery
The breat produce colostrum (sticky yellow milk)

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41
Q

What important things does colostrum contain?

A

Fats and immunoglobulin

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42
Q

When and what is occuring during stage 3 of milk production?

A

Occurs about 4 days after giving birth
Establishment and maintainance of milk supply
Milk appears thin and watery

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43
Q

What types of milk are produced what is their purpose for the baby?

A

-Foremilk: quinches thirst
-Hindmilk: satiety

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44
Q

What is the let down reflex?

A

Movement of milk into the large lactiferous ducts
-tingling in breasts

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45
Q

What can be done for women who do not experience the let-down reflex?

A

-Frequent stimulation of the breast
-Increased frequency of feedings
-Applying warmth to the breast
-Relaxing music

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46
Q

Should breast feeding ever be painful?

A

NO, should feel strong tugging sensation with occasional mild discomfort

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47
Q

What should be avoided regaruding nipple care?

A

Soap, breast creams, oils that contain Vitamin E
ONLY WATER or breast milk rubbed into the nipple

48
Q

When is the optimal time to start breast feeding?

A

ASAP and/or within 1 hour after birth

49
Q

Nursing education for breast feeding:

A

-Observe for hunger cues and act on it
-Show different positions
-Show correct latch
-Look to see if the bottom lip is “flanged”, and the cheek, nose and chin all touch the breast
-Never force the baby’s head, wait for infant to open their mouth
-1st week after birth, may feel after pains (multipara)

50
Q

What signs show the baby has a good latch and is getting milk?

A

-Infant sucks and swallows
-2:1 or 1:1 suck/swallow
-milk can be seen at the corners of the mouth

51
Q

What ratio is considered nonnutritive sucking?

A

5:1 suck/swallow

52
Q

Infant-feeding readiness cues:

A

-Begin to stir
-Bob the head
-Hand-to-mouth or hand-to-hand movements
-Sucking, lip-smacking, licking
-Rooting
-Increased activity: arms and legs flexed and hands in a fist

53
Q

How many wet diapers should we have a day?

A

6 to 8

54
Q

How often does a breast-feeding baby need to eat?

A

2-3 hours, 15 minutes on each breast

55
Q

Positions for breast feeding:

A

Cradle, cross-cradle, football and side-lying

56
Q

Breast engorgement: definition and when it occurs

A

Excessive swelling and congestion in the breast
3/4th day

57
Q

What are symptoms of severe engorgment?

A

Pain, tenderness, hardness, and warmth to the touch

58
Q

How to fix engorgment:

A

-Express the milk via pump or feeding
-Warm soaks and ice after
-Massage

59
Q

What meds are used for engorgment?

A

Ibuprofen before feedings

60
Q

What causes sore nipples?

A

Poor latch

61
Q

How to help fix sore nipples:

A

-Alt position
-Express milk and rub it in to the nipples
-Air dry and some sunlight
-Cabbage leaves

62
Q

Fresh breast milk can stay out for how long?

A

4 hours room temp

63
Q

How long can breast milk be refrigerated?

A

4 days

64
Q

How long can breast milk be frozen?

A

6months to 1 year

65
Q

How to thaw milk:

A

-In a collection container in the fridge
-Under warm water or water basin
-NEVER in hot water or room temp

66
Q

What time-frame is considered an early PP hemorrhage?

A

within first 24 hours caused by uterine atony (most common)

66
Q

What are signs of early PPH?

A

tachycardia, 15% drop in BP, decrease in O2 sats less than 95%

67
Q

What time-frame is considered a late PP hemorrhage?

A

24 hours to 12 weeks

68
Q

What are the 4 Ts?

A

-Tone
-Trauma
-Tissue
-Thrombin

69
Q

What does a continuous trickle of bright red blood mean?

A

Lacteration (uterus will be contracted) or hemorrhage (uterus wiil be boggy)

70
Q

What is a cardinal sign of a hematoma?

A

Unrelieved pain or pressure

71
Q

What medications are we going to give for PPH?

A

-Oxytocin (pit): 20 U in 1000ml of LR. Bolus them
-Cytotec: rectally
-Hemabate: IM up to 8 doses. NO asthma due to bronchospasm & horrible diarrhea (give immodium)
-Methergine: IM. Do NOT administer if hypertensive

72
Q

What is a common cause of late PPH?

A

retained placenta

73
Q

What occurs during the takin-in phase?

A

The mother is consumed with relieving and reorganizing their birth experiences

74
Q

What occurs during the taking-hold phase?

A

The mother feels better and is ready to assume the mothering role

75
Q

What occurs during the letting go phase?

A

The mother starts to see the infant as separate from herself. Starts adapting to parenthood

76
Q

What are the post partum blues?

A

A normal reaction to the dramatic changes that occur after birth and lasts for 2 weeks.
-R/t hormones
-Symptoms are mild and do NOT impair the ability to care for herself or the baby

77
Q

What is uterine atony?

A

Failure of the uterine myometrium to contract and retract following birth

78
Q

What is the hallmark sign of uterine atony?

A

Boggy uterus filled with clots and blood

79
Q

What are risk factors for PPH?

A

-Prolonged or precipitous labor
-History
-Mutiple gestations
-large infant
-Polyhydramnios
-Trauma
-Chorio
-Retained placenta
-Agumentation or induction of labor with oxytocin

80
Q

Nursing interventions for PPH:

A

-Vs
-Fundal massage
-Uterine location
-Palpate bladder
-Weight blood loss
-Measure how long it takes to saturate a pad
-LOC changes, pain level and behavior
-2 large bore IVs
-medications Oxygen 30 U
-Foley
-I & Os
-Oxygen 10 to 12L

81
Q

What is it called in late PPH where the uterus cannot contract down due to retained placenta?

A

Subinvolution

82
Q

What are ss of hypovolemic shock in PPH?

A

Tachycardia, restlessness, anxiety, pallor, cool clammy skin, hypotension

83
Q

What is a sign of early hypovolemic shock?

A

tachycardia

84
Q

What is a hematoma?

A

A localized collection of blood in connective or soft tissue under the skin

85
Q

What is a hallmark sign and other signs of a hematoma?

A

acute unrelenting pain
-other: pressure in the rectal and or vaginal area, bluish color, tachycardia, hypotension, fullness.

86
Q

Nursing interventions for hematomas:

A

-Listen to the patient’s complaints
-Vs
-Examine vaginal area
-NOTIFY PCP
-Ice for 12 hours
-pain meds
-after 12 hours sitz bath
-Drainage for hematoma over 5cm
-IV fluids
-Oxygen
-I&Os
-Foley

87
Q

Superficial thrombosis:

A

In small veins they may appear like a hard knot

88
Q

Care for superficial thrombosis:

A

Ted hose, ambulation, and keep the legs elevated while sitting

89
Q

DVT:

A

Redness, swelling, heat, unilaterally in the calf.
Pallor & weak pulses

90
Q

What position should a postpartum patient avoid?

A

Knee-chest

91
Q

Who is at the greatest risk of thromboembolic disorders?

A

-Post-op CS
-Hx
-Smoker
-Obesity
-older women

92
Q

Nursing interventions for thromboembolic disorders:

A

-Heparin for 3 mths
-NSAIDS
-Rest & elevation on the affected leg
-Compression socks
-Moist, warm packs
-leg circumference daily

93
Q

T or F. All post partum women are in a hypercoagulable state

A

True

94
Q

Sudden sharp, chest pain, SOB, and anxiety suggests…

A

pulmonary embolus

95
Q

Nursing interventions for PE:

A

-ABCs
-Oxygen
-IV
-ICU
-Morphine
-family support

96
Q

What is endometritis?

A

-Infection of the endometrium

97
Q

Signs and symptoms of endometritis:

A

-Temp over 100.4 for over two days or a temperature of 101.6 in the first 24 hours
-Tachycardia
-Uterine tenderness
-suprapubic pain
-Subinvolution
-Malaise
-Foul-smelling lochia

98
Q

Temp of ____F + is indicative of sepsis

A

102.2 F

99
Q

Risk factors for endometritis

A

-Long labor
-ROM greater than 24 hours
-C-section
-+ GBS
-Operative vaginal delivery
-Prior STI

100
Q

What is mastitis?

A

Infection and inflammation of the mammary glands.

101
Q

signs and symptoms of mastitis:

A

-Fever, chills
-Pain and tenderness in one breast
-Warmth
-Aches
-Nipples with cracks, fissues or sores
-Flu-like

102
Q

If there is abcess formation (pus) what should the nurse do?

A

Notify PCP

103
Q

Nursing interventions for mastitis:

A

-Antibiotics
-Heat or cold
-Hydration
-Pain meds
-Proper latch
-hand hygiene

104
Q

Education for mastitis

A

-Continue breast feeding on the affected side first for at least 15 minutes
-empty breast every 2-4 hours

105
Q

What is PP depression?

A

-Major depressive disorder that develops within 4 weeks
-Characterized by a depressed mood or decreased interest or pleasure

106
Q

Signs and symptoms of PP depression:

A

-depression
-disinterest
-lack of appetite
-insomnia
-restlessness
-anxiety
-hopeless
-inability to cope
-suicidal thoughts

107
Q

Nursing interventions for PP depression:

A

-CBT & IPT
-therapy
-resources
-asking probing questions
-Meds: SSRIs, SNRIs, TCAs, Antidepressants, antipsychotics, mood stabilizer

108
Q

What is PP psychosis?

A

Dramatic sudden onset within 24 hours of birth
Not associated with baby blues or depression

109
Q

Risk factors for PP psychosis:

A

-First time mothers (who are older)
-Hx of bipolar and psychotic disorders

110
Q

Clinical manifestations of PP psychosis:

A

-Auditory hallucinations
-Delusions
-Confusion
-Sleep disorders
-Suicide
-Homicide and infanticide

111
Q

Nursing management of PP psychosis:

A

-Meds
-Therapy
-Electroconvulsive therapy

112
Q

Discharge teaching for warning signs post partum:

A

-Temp
-Bleeding
-Pain: abdominal, breast, Perineal, Headache & epigastric (pre-eclampsia)
-Mood
-Leg cramps

113
Q

Are after pains normal? Nursing interventions?

A

Yes. Apply counter pressure with a small pillow under the abdomen laying prone

114
Q

Education/ discharge teaching for self care:

A

-Pericare
-Breast care
-Contraception
-Work, exercise, sex should only be resumed if they are cleared by the provider

115
Q

Discharge teaching for infant care:

A

-Bathing
-Cord care
-Vaccinations
-Circumcision care
-Pericare

116
Q

What are warning signs in infants?

A

Fever, refusal to feed, abnormal stooling, lack of urine output, fussy, lethargy

Maternal Health (4 decks)

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