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PCC IV > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Involution definition

A

return to non-pregnant size/condition

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2
Q

Boggy uterus definition?

A

occurs when uterus is prevented from contacting

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3
Q

Normal descent of fundus?

A

1 finger-breadth = 1cm

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4
Q

Sub involution definition?

A

failure of the uterus to at expected rate

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5
Q

At what level should the uterus be at after birth?

A

umbilical line

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6
Q

After birth, when should the uterus be involuted?

A

non-palpable 1 week postpartum

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7
Q

Appearance of lochia 1-3 days postpartum?

A

rubra-blood appearance
red/brown small clots

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8
Q

Appearance of lochia 3-10 days postpartum?

A

serosa-pink or brown-tinged; amount decreased

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9
Q

Appearance of lochia 10 days up to 3-6 weeks postpartum?

A

alba-yellowish-white

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10
Q

What characteristics should the nurse not when assessing lochia?

A

color, amount, clots, odor

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11
Q

When should the nurse be worried about the appearance of a woman’s lochia?

A

when tough fragments in the clot are present

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12
Q

Due to hormonal changes (low estrogen), lactating women may experience?

A

vaginal dryness

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13
Q

How long do episotomy/lacerations take to heal?

A

2-4 weeks

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14
Q

How long does it take for sutures to dissolve?

A

4 weeks

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15
Q

What are dermoplast/tucks?

A

numbing agents

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16
Q

What is 1st degree perineal laceration?

A

injury to tissue of perineum and vagina, no injury to muscle

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17
Q

What is 2nd degree perineal laceration?

A

injury extends to fascia and muscle-anal sphincter intact

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18
Q

What is 3rd degree perineal laceration?

A

injury extends into anal sphincter

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19
Q

What is 4th degree perineal laceration?

A

injury extended through anal sphincter and rectal mucosa

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20
Q

What is a hallmark sign of vulvar hematoma?

A

perineal pain

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21
Q

When do vulvar hematomas need to be surgically drained?

A

> 10cm

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22
Q

GI changes postpartum?

A

increases thirst/hunger
bowels sluggish

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23
Q

Urinary changes postpartum?

A

increased urine output initial 24hrs

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24
Q

What can a full bladder and displaces uterus cause?

A

uterine atony

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25
Q

Are headaches/vision changes common postpartum?

A

no may indicate complications

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26
Q

If not lactating when does menstruation begin again?

A

6-8 weeks

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27
Q

If lactating when does menstruation begin again?

A

6 months

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28
Q

When should moms void postpartum?

A

3-4hrs after birth

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29
Q

What is the treatment for spinal headache?

A

blood patch procedure

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30
Q

What acronym is used for the postpartum assessment?

A

BUBBLEHED

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31
Q

BUBBLEHED?

A

Breasts
Uterus
Bowel
Bladder
Lochia
Episiotomy (incision)
tHrombus
Emotions
Discomfort level

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32
Q

REEDA?

A

Redness
Edema
Ecchymosis
Discharge
Approximation

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33
Q

What happens to temperature in the 1st 24hrs postpartum?

A

can reach up to 100.4F

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34
Q

What happens to the pulse in the 1st hour after delivery?

A

increases

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35
Q

If low BP postpartum what is the concern?

A

hemorrhage

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36
Q

If high BP postpartum what is the concern?

A

preeclampsia

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37
Q

Why might a postpartum pt experience orthostatic hypotension?

A

lots of fluid volume changes

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38
Q

What are the step to administering Rhogam?

A
  1. verify blood type of mom & baby
  2. verify provider order
  3. double check
  4. administer IVP or IM
  5. admin ASAP
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39
Q

How long are IV fluids and foleys utilized after C/S?

A

24hrs

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40
Q

What does a larger-vertical incision for a C/S usually indicate?

A

emergency/multiple fetuses

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41
Q

Bonding =

A

attraction

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42
Q

Attachment =

A

affection

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43
Q

What are factors that affect bonding & attachment?

A

car practices
visitors
unmet expectations
separation from infant

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44
Q

What are the 3 stages of maternal adaptation?

A

Taking in
Taking hold
Letting go

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45
Q

How long is the taking-in (dependent) phase?

A

24-48hrs

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46
Q

What is involved in the taking-in (dependent) phase?

A

mom is focused on her own person
relives birth experience
dependent on others for immediate needs
decreased ability to make decisions

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47
Q

What is involved in the taking hold (dependent-interdependent) phase?

A

focus moves from self to infant
increased ability to make decisions
eager to learn
gives up pregnancy role for the maternal role

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48
Q

What is involved in the letting go (independent) phase?

A

incorporating the newborn into her life
baby becomes separate identity
giving up fantasy of what would/could have been
accepting newborn as they are
independence returning
reconnection with partner

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49
Q

What are clinical manifestations of postpartum depression?

A

inability to sleep
reduced appetite
reduced energy
irritability
feeling inadequate in infant care
feels like a failure as a mother
anxiety
thoughts of harming self or infant

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50
Q

What is the difference btw baby blues and postpartum depression?

A

postpartum depression involves more physical symptoms

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51
Q

What is the timeline for postpartum depression?

A

lingering, present around 2 weeks postpartum

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52
Q

What hormone is elevated when breastfeeding?

A

oxytocin

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53
Q

What anxiety/depression scales are used with postpartum pts?

A

Edinburgh Postnatal Depression Scale (EPDS)
PHQ-9
GAD-7

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54
Q

How long should postpartum pts wait to engage in activity/sex again?

A

6 weeks

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55
Q

What are 3 examples of postpartum complications?

A

thromboembolic disease
infection
postpartum hemorrhage

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56
Q

What is Virchow’s triad?

A

indicated risk of DVT
stasis, endothelial injury, hypercoagulability

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57
Q

S/S of DVT?

A

unilateral swelling, erythema, edema, and induration

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58
Q

Why isn’t Homan’s sign performed anymore to assess for possible DVT?

A

can create emboli

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59
Q

Why aren’t D-dimer labs drawn to assess for DVT?

A

it is not reliable because it is usually elevated after birth

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60
Q

Diagnostics for DVT in postpartum pt?

A

ultrasound (doppler)

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61
Q

What are supportive measures for DVT?

A

elevate
warm/cold compresses
early ambulation
TED hose

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62
Q

What are S/S of PE?

A

Dyspnea
Tachypnea
Tachycardia
Chest pain
Cough
Orthopnea
Wheezing
Hemoptysis

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63
Q

What is the normal WBC for postpartum pt?

A

elevated up to 30,000

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64
Q

What amount of blood loss indicates hemorrhage post vaginal delivery?

A

> 500mL

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65
Q

What amount of blood loss indicates hemorrhage post C/S?

A

> 1,000mL

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66
Q

When does primary postpartum hemorrhage become secondary?

A

after 24hrs following delivery

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67
Q

What is a common risk factor for postpartum hemorrhage?

A

stress on the uterus

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68
Q

What are the 4 T’s of postpartum hemorrhage?

A

Tone
Tissue
Trauma
Thrombin

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69
Q

What is the treatment for uterine atony?

A

bimanual uterine massage or oxytocin

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70
Q

What is the treatment for retained products of conception?

A

uterine evacuation or antibiotics if endometritis is present

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71
Q

What is the treatment for DIC?

A

replace coagulation factors

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72
Q

90% of the time ____ is the cause of hemorrhage

A

soft, boggy uterus

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73
Q

When would be considered late postpartum hemorrhage?

A

1-2 weeks post-delivery

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74
Q

What can be the result of retained placental fragments?

A

may lead to infection & bleeding may need D&C and antibiotics

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75
Q

What are the nursing implications for postpartum hemorrhage?

A

control bleeding
continuous fundal massage
empty bladder to straight cath

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76
Q

S/S of hypovolemic shock

A

AMS
Tachycardia
Dyspnea
Cool, clammy skin
Decreased urine output
Hypotension

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77
Q

Moderate shock?

A

20-40% loss in blood volume

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77
Q

Mild shock?

A

20% loss in blood volume
1,300mL

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78
Q

S/S of moderate shock?

A

decreased perfusion to vital organs
oliguria or anuria

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79
Q

Severe shock?

A

> 40% loss in blood volume
2,600mL

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80
Q

S/S of severe shock?

A

decreased perfusion to heart & brain
restlessness, coma, cardiac arrest

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81
Q

What meds are used in the treatment of uterine atony?

A

oxytocin (pitocin)
misoprostol (cytotec)
Methylergonivine (Methergine)
Prostagladin (Hemabate)

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82
Q

Why can’t TXA be a secondary line?

A

interacts with many things

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83
Q

What is a bimanual exam/massage?

A

provider inserts fist into cervix and manually massages uterus

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84
Q

What is JADA?

A

suctioning mechanism to remove blood

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85
Q

What is the priority intervention with postpartum hemorrhage?

A

fundal massage

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86
Q

MOA of misoprostol?

A

binds to myometrial cells to cause contractions

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87
Q

MOA of oxytocin?

A

increases amplitude and frequency of uterine contractions causing dilation and effacement of the cervix

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88
Q

MOA of methergine?

A

increases the intensity, frequency, amplitude of contractions by stimulating smooth muscles

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89
Q

MOA of hemabate?

A

stimulates smooth muscle contraction

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90
Q

What is another name for precision medicine?

A

personalized medicine

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91
Q

What is genotype?

A

genetic makeup of individual

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92
Q

What is phenotype?

A

physical traits of an individual

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93
Q

Autosomal Dominant?

A

1 parent affected: 50% chance for offspring

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94
Q

Autosomal Recessive?

A

Both parents affected: 25% chance for offspring

95
Q

What are examples of autosomal recessive diseases?

A

cystic fibrosis
sickle cell disease

96
Q

X-linked?

A

Mother carries: 50% chance for offspring
male offspring will have disorder

97
Q

Mitochondrial?

A

mother: all children will inherit

98
Q

What are females represented as on pedigrees?

A

circles

99
Q

What are males represented as on pedigrees?

A

squares

100
Q

What is pharmacogenetics?

A

how variation in single gene can influence response to single drug

101
Q

What is pharmacogenomics?

A

how variation in genome can influence reactions to drugs

102
Q

What is the GINA act?

A

Genetic information and non-discrimination act: doesn’t inform employment or insurance agencies of results

103
Q

A pt presents to ED and is not perfusing well… what are the priorities?

A

EKG
Oxygentation/Airway
IV access
Hook up to defib
Meds
Versed if use defib
VS

104
Q

Cardioversion?

A

elective procedure
pt awake & frequently sedated
synchronized

105
Q

How many Joules are used with cardioversions?

A

50-200 J

106
Q

Debrillation?

A

Emergency
V-Fib/V-Tach
No CO
Pt unconscious

107
Q

How many Joules used with defibrillation?

A

200-360 Joules

108
Q

How do you admin Adenosine?

A

Lift arm above head and slam med
Flat line before return to normal sinus rhythm
dizzy, drowsy, feel like crap

109
Q

What do they use for sedation for cardioversions?

A

versed, fentanyl

110
Q

What are the 5 T’s of ACLS?

A

Tamponade
Toxins
Tension Pneumothorax
Thrombosis (pulm)
Thrombosis (coronary)

111
Q

What are the 5 H’s of ACLS?

A

Hypovolemia
Hypoxia
Hydrogen Ion Excess (Acidosis)
Hypo/Hyperkalemia
Hypothermia

112
Q

What is the primary nurse’s role during a code?

A

check pulse and start CPR
tell code team pt’s story

113
Q

What are 2 examples of antiarrhythmics?

A

amiodarone
lidocaine

114
Q

What is one small square on ECG paper??

A

0.04sec

115
Q

What is one large square on ECG paper?

A

0.20sec

116
Q

How to calculate HR?

A

count R-R intervals in 6 second and multiply by 10

117
Q

What is a normal QT interval?

A

0.34-0.43sec

118
Q

What is stable angina?

A

chest pain goes away at rest

119
Q

What is unstable angina?

A

Chest pain is constant

120
Q

What is the common response of older females having MI?

A

might not have symptoms, may feel like acid reflux

121
Q

What is silent ischemia?

A

no symptoms
usually DM pts

122
Q

What is Prinzmetal’s (Variant) angina?

A

occurs when pt is at rest (smokers, alcohol abuse)

123
Q

What is Microvascular angina?

A

no history of CAD, related to atherosclerosis, more common in women (provoked by exercise)

124
Q

At what rate are smokers more predisposed to developing CAD?

A

2-6x higher

125
Q

What cholesterol level is a risk factor for CAD?

A

> 200

126
Q

What fasting triglyceride level is a risk factor for CAD?

A

> 150

127
Q

What BMI is a risk factor for CAD?

A

> 30

128
Q

At what rate are DM pt more predisposed to developing CAD?

A

2-4x higher

129
Q

Which population is most at risk for CAD?

A

white, middle-aged men

130
Q

At which age are genders at the same risk for developing CAD?

A

65

131
Q

Which race is more predisposed to CAD?

A

African Americans

132
Q

What does PQRST stand for?

A

precipitating events
quality of pain
region
severity of pain
timing

133
Q

When is a EKG supposed to completed when angina emergency?

A

within 10min

134
Q

What is the golden standard marker for cardiac damage?

A

troponin

135
Q

What does CK-MB lab value indicate?

A

heart muscle damage

136
Q

What does myoglobin lab value indicate?

A

muscle damage anywhere in body

137
Q

What is included in BMP?

A

electrolytes
kidney function
glucose

138
Q

What does Homocysteine lab value indicate?

A

risk for HF

139
Q

When is a stress test positive?

A

if ST segment changes

140
Q

What does an echocardiogram tell?

A

ejection fraction

141
Q

What is the normal ejection fraction?

A

60-70%

142
Q

What ejection fraction is concerning?

A

40%

143
Q

What is electrophysiology studies?

A

Catheter through femoral artery to look at heart rhythm

144
Q

Which arteries are insertion sites during angiograms?

A

femoral/radial

145
Q

What does the EKG demonstrate with chronic stable angina?

A

ST depression or T wave inversion

146
Q

What is chronic stable angina provoked by?

A

physical activity
emotional distress

147
Q

How often do you check trop levels?

A

q6hr

148
Q

When are calcium channel blockers given during angina treatment?

A

when beta-blockers aren’t tolerated

149
Q

What is the etiology of acute coronary syndrome?

A

plaque rupture

150
Q

What is STEMI?

A

completely blocked vessel = medical emergency

151
Q

Treatment for STEMI?

A

PCI (percutaneous coronary intervention) within 90 minutes

152
Q

What are the options for percutaneous coronary intervention?

A

cardiac catheterization within 90min
OR
thrombolytic therapy within 30min

153
Q

What is NSTEMI?

A

partially blocked vessel
may or may not have ST depression and/or T wave inversion

154
Q

When should cardiac catheterization be implemented when NSTEMI is present?

A

within 12-72hrs

155
Q

What are EKG changes with unstable angina?

A

may be normal or ST depression and/or T wave inversion

156
Q

Manifestations of MI?

A

Severe pain 20min or longer that is not relieved with rest
SNS stimulation
Clammy, cool
Decreased urine output
Crackles
Edema
N/V
Fever

157
Q

Emergency care of ACS?

A

12-lead EKG
sit upright
O2 application
IV access (2 18G in AC)
Nitro

158
Q

Morphine’s MOA with ACS?

A

decreases cardiac workload/contractility (specific to heart)
Decrease BP, HR
Decrease anxiety

159
Q

What is a CABG?

A

bypass blockage by taking vein out somewhere else in body (saphenous)

160
Q

What is the gold standard procedure to identify and localize CAD?

A

cardiac catheterization

161
Q

What is the nurse assessing after cardiac catheterization?

A

insertion site for bleeding
have to remain flat for hours after

162
Q

What is the emergency first-line treatment for STEMI?

A

PCI

163
Q

Reperfusion dysrhythmias?

A

PVCs= good thing

164
Q

How often do you want to monitor BP when administering nitro IV?

A

q3-5min

165
Q

How often do you draw labs with ACS?

A

q3-6hr

166
Q

How long is activity limited post ACS?

A

12-24hr

167
Q

S/S of papillary rupture?

A

systolic murmur
SOB, pulmonary edema
EMERGENCY

168
Q

Which wall of heart is more predisposed to aneurysm or rupture?

A

Left ventricular

169
Q

When does pericarditis present itself after an MI?

A

2-3days

170
Q

S/S of pericarditis?

A

chest pain with inspiration
cough
relieves pain when sitting forward
hypotension
fever
friction rub

171
Q

What is Dressler syndrome?

A

pericarditis 1-8weeks after MI
autoimmune reaction

172
Q

S/S of Dressler syndrome?

A

joint pain
fatigue
fever
friction rub

173
Q

What is the treatment for Dressler syndrome?

A

high dose of aspirin

174
Q

When does sudden cardiac death occur?

A

within 1hr of chest pain onset

175
Q

After sudden cardiac death when is pt referred for ICD?

A

40days of medical therapy

176
Q

When is ICD implanted (defibrillator)?

A

when ejection fraction <30%

177
Q

What is placed on baby to prevent heat loss and help stabilize body temp?

A

hat

178
Q

An injection of _________ is given to the newborn to prevent bleeding

A

vitamin K

179
Q

APGAR score stands for?

A

Appearance
Pulse
Grimace
Activity
Respiration

180
Q

Apgar score of 0-4 would be considered?

A

poor condition

181
Q

Apgar score of 5-7 would be considered?

A

fair condition

182
Q

Apgar score of 8-10 would be considered?

A

good condition

183
Q

The baby is scored on the APGAR two different times ____ and ______ minutes after birth

A

1, 5

184
Q

Term for blue extremities

A

acrocyanosis

185
Q

What is bilirubin?

A

a by-product made by hemoglobin in the liver

186
Q

Why do newborns often have jaundice?

A

immature liver

187
Q

What 4 general measurements are taken at birth?

A

wt, length, temp, BS

188
Q

What is the Babinski Reflex?

A

big toes flex backward and toes fan out

189
Q

What is another name for the Moro Reflex?

A

startle response

190
Q

How do the benefits of breastfeeding relate to primary care?

A

initiates prophylaxis for baby later on in life

191
Q

Infant cold stress causes?

A

increased O2 consumption, which can lead to increased respiratory rate, which can lead to metabolic acidosis

192
Q

When thinking about a newly delivered infant, what are your priority concepts?

A

gas exchange
thermoregulation
perfusion

193
Q

Priority nursing actions with newborn?

A

keep baby warm
ensure patent airway
provide stimulation

194
Q

What potential problems may occur when caring for a newborn infant?

A

hyperbilirubinemia
hypothermia
respiratory distress
infection

195
Q

What stimulates the production of milk?

A

prolactin

196
Q

What stimulates the release of milk?

A

oxytocin

197
Q

_____ in the receptor sites produces colostrum

A

progesterone

198
Q

Why does progesterone decrease after birth?

A

delivery of placenta

199
Q

If not breastfeeding, when can mothers expect to lose their supply?

A

within a week

200
Q

Lactose is a ______

A

carbohydrate

201
Q

Human milk contents

A

high in water, low in protein and fat

202
Q

Colostrum for ______ days

A

1-3

203
Q

Transitional milk for _______ days

A

2-4

204
Q

Mature milk after _____ days

A

7

205
Q

How many breastfeedings should their be per day?

A

12

206
Q

How often do you bottle fed?

A

q3-4hrs

207
Q

How often do you breastfed?

A

q1-3hrs

208
Q

Wet diapers?

A

1 wet for everyday old until 7 days.
Then 6-7 a day

209
Q

Dirty diapers?

A

1 q24hrs

210
Q

When should the nurse assist the mother in breastfeeding her newborn after delivery?

A

within 1hr of life

211
Q

Breastmilk can be stored at room temp for

A

6hrs

212
Q

Breastmilk can be stored in an insulated cooler for

A

1 day

213
Q

Breastmilk can be stored in a refrigerator for

A

5 days

214
Q

Breastmilk can be stored in a freezer for

A

3-6 months

215
Q

Breastmilk can be stored in a deep freezer for

A

6-12 months

216
Q

When is the newborn most reactive?

A

first 1-2 hrs after birth

217
Q

How long do they delay cord clamping?

A

until the onset of respirations

218
Q

PPHN

A

Persistent pulmonary HTN
lungs and vessels have low pressure

219
Q

TTN

A

Transient Tachypnea
self limiting, fluid retention in lungs, common in C/S babes

220
Q

What should BG be during the first 24hrs?

A

40

221
Q

What should BG be after 24hrs?

A

50

222
Q

What is the name of the condition brought on by bilirubin encephalopathy?

A

kernicterus

223
Q

Physiologic jaundice appears

A

after 24hrs

224
Q

Pathologic jaundice appears

A

before 24hrs

225
Q

Risk factors for hyperbilirubinemia?

A

+ Coombs test
hemolytic disease
cephalohematoma
extensive bruising
asian

226
Q

What is the worry for newborns with hyperglycemic mom?

A

hypoglycemia

227
Q

What is the most common sign of hypoglycemia?

A

jitteriness

228
Q

At 1min of life, a newborn will have O2 sat of

A

60-65%

229
Q

After birth, a newborn’s O2 sat will increase __% per min of life?

A

5

230
Q

At 10min of life, a newborn will have O2 sat of

A

85-95%

231
Q

A cephaohematoma _____ cross the sagital suture

A

doesn’t

232
Q

Newborns can lose _____% of wt in the first few days of life

A

8-10% will gain back in a week or so

233
Q

Umbilical cord falls off at ____ days

A

7-10

234
Q

What is the term used for parental feeding?

A

gavage

235
Q

What Finnegan score is very severe?

A

> 12

PCC IV (4 decks)

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