Exam 3 Flashcards
Involution definition
return to non-pregnant size/condition
Boggy uterus definition?
occurs when uterus is prevented from contacting
Normal descent of fundus?
1 finger-breadth = 1cm
Sub involution definition?
failure of the uterus to at expected rate
At what level should the uterus be at after birth?
umbilical line
After birth, when should the uterus be involuted?
non-palpable 1 week postpartum
Appearance of lochia 1-3 days postpartum?
rubra-blood appearance
red/brown small clots
Appearance of lochia 3-10 days postpartum?
serosa-pink or brown-tinged; amount decreased
Appearance of lochia 10 days up to 3-6 weeks postpartum?
alba-yellowish-white
What characteristics should the nurse not when assessing lochia?
color, amount, clots, odor
When should the nurse be worried about the appearance of a woman’s lochia?
when tough fragments in the clot are present
Due to hormonal changes (low estrogen), lactating women may experience?
vaginal dryness
How long do episotomy/lacerations take to heal?
2-4 weeks
How long does it take for sutures to dissolve?
4 weeks
What are dermoplast/tucks?
numbing agents
What is 1st degree perineal laceration?
injury to tissue of perineum and vagina, no injury to muscle
What is 2nd degree perineal laceration?
injury extends to fascia and muscle-anal sphincter intact
What is 3rd degree perineal laceration?
injury extends into anal sphincter
What is 4th degree perineal laceration?
injury extended through anal sphincter and rectal mucosa
What is a hallmark sign of vulvar hematoma?
perineal pain
When do vulvar hematomas need to be surgically drained?
> 10cm
GI changes postpartum?
increases thirst/hunger
bowels sluggish
Urinary changes postpartum?
increased urine output initial 24hrs
What can a full bladder and displaces uterus cause?
uterine atony
Are headaches/vision changes common postpartum?
no may indicate complications
If not lactating when does menstruation begin again?
6-8 weeks
If lactating when does menstruation begin again?
6 months
When should moms void postpartum?
3-4hrs after birth
What is the treatment for spinal headache?
blood patch procedure
What acronym is used for the postpartum assessment?
BUBBLEHED
BUBBLEHED?
Breasts
Uterus
Bowel
Bladder
Lochia
Episiotomy (incision)
tHrombus
Emotions
Discomfort level
REEDA?
Redness
Edema
Ecchymosis
Discharge
Approximation
What happens to temperature in the 1st 24hrs postpartum?
can reach up to 100.4F
What happens to the pulse in the 1st hour after delivery?
increases
If low BP postpartum what is the concern?
hemorrhage
If high BP postpartum what is the concern?
preeclampsia
Why might a postpartum pt experience orthostatic hypotension?
lots of fluid volume changes
What are the step to administering Rhogam?
- verify blood type of mom & baby
- verify provider order
- double check
- administer IVP or IM
- admin ASAP
How long are IV fluids and foleys utilized after C/S?
24hrs
What does a larger-vertical incision for a C/S usually indicate?
emergency/multiple fetuses
Bonding =
attraction
Attachment =
affection
What are factors that affect bonding & attachment?
car practices
visitors
unmet expectations
separation from infant
What are the 3 stages of maternal adaptation?
Taking in
Taking hold
Letting go
How long is the taking-in (dependent) phase?
24-48hrs
What is involved in the taking-in (dependent) phase?
mom is focused on her own person
relives birth experience
dependent on others for immediate needs
decreased ability to make decisions
What is involved in the taking hold (dependent-interdependent) phase?
focus moves from self to infant
increased ability to make decisions
eager to learn
gives up pregnancy role for the maternal role
What is involved in the letting go (independent) phase?
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
What are clinical manifestations of postpartum depression?
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
What is the difference btw baby blues and postpartum depression?
postpartum depression involves more physical symptoms
What is the timeline for postpartum depression?
lingering, present around 2 weeks postpartum
What hormone is elevated when breastfeeding?
oxytocin
What anxiety/depression scales are used with postpartum pts?
Edinburgh Postnatal Depression Scale (EPDS)
PHQ-9
GAD-7
How long should postpartum pts wait to engage in activity/sex again?
6 weeks
What are 3 examples of postpartum complications?
thromboembolic disease
infection
postpartum hemorrhage
What is Virchow’s triad?
indicated risk of DVT
stasis, endothelial injury, hypercoagulability
S/S of DVT?
unilateral swelling, erythema, edema, and induration
Why isn’t Homan’s sign performed anymore to assess for possible DVT?
can create emboli
Why aren’t D-dimer labs drawn to assess for DVT?
it is not reliable because it is usually elevated after birth
Diagnostics for DVT in postpartum pt?
ultrasound (doppler)
What are supportive measures for DVT?
elevate
warm/cold compresses
early ambulation
TED hose
What are S/S of PE?
Dyspnea
Tachypnea
Tachycardia
Chest pain
Cough
Orthopnea
Wheezing
Hemoptysis
What is the normal WBC for postpartum pt?
elevated up to 30,000
What amount of blood loss indicates hemorrhage post vaginal delivery?
> 500mL
What amount of blood loss indicates hemorrhage post C/S?
> 1,000mL
When does primary postpartum hemorrhage become secondary?
after 24hrs following delivery
What is a common risk factor for postpartum hemorrhage?
stress on the uterus
What are the 4 T’s of postpartum hemorrhage?
Tone
Tissue
Trauma
Thrombin
What is the treatment for uterine atony?
bimanual uterine massage or oxytocin
What is the treatment for retained products of conception?
uterine evacuation or antibiotics if endometritis is present
What is the treatment for DIC?
replace coagulation factors
90% of the time ____ is the cause of hemorrhage
soft, boggy uterus
When would be considered late postpartum hemorrhage?
1-2 weeks post-delivery
What can be the result of retained placental fragments?
may lead to infection & bleeding may need D&C and antibiotics
What are the nursing implications for postpartum hemorrhage?
control bleeding
continuous fundal massage
empty bladder to straight cath
S/S of hypovolemic shock
AMS
Tachycardia
Dyspnea
Cool, clammy skin
Decreased urine output
Hypotension
Moderate shock?
20-40% loss in blood volume
Mild shock?
20% loss in blood volume
1,300mL
S/S of moderate shock?
decreased perfusion to vital organs
oliguria or anuria
Severe shock?
> 40% loss in blood volume
2,600mL
S/S of severe shock?
decreased perfusion to heart & brain
restlessness, coma, cardiac arrest
What meds are used in the treatment of uterine atony?
oxytocin (pitocin)
misoprostol (cytotec)
Methylergonivine (Methergine)
Prostagladin (Hemabate)
Why can’t TXA be a secondary line?
interacts with many things
What is a bimanual exam/massage?
provider inserts fist into cervix and manually massages uterus
What is JADA?
suctioning mechanism to remove blood
What is the priority intervention with postpartum hemorrhage?
fundal massage
MOA of misoprostol?
binds to myometrial cells to cause contractions
MOA of oxytocin?
increases amplitude and frequency of uterine contractions causing dilation and effacement of the cervix
MOA of methergine?
increases the intensity, frequency, amplitude of contractions by stimulating smooth muscles
MOA of hemabate?
stimulates smooth muscle contraction
What is another name for precision medicine?
personalized medicine
What is genotype?
genetic makeup of individual
What is phenotype?
physical traits of an individual
Autosomal Dominant?
1 parent affected: 50% chance for offspring
Autosomal Recessive?
Both parents affected: 25% chance for offspring
What are examples of autosomal recessive diseases?
cystic fibrosis
sickle cell disease
X-linked?
Mother carries: 50% chance for offspring
male offspring will have disorder
Mitochondrial?
mother: all children will inherit
What are females represented as on pedigrees?
circles
What are males represented as on pedigrees?
squares
What is pharmacogenetics?
how variation in single gene can influence response to single drug
What is pharmacogenomics?
how variation in genome can influence reactions to drugs
What is the GINA act?
Genetic information and non-discrimination act: doesn’t inform employment or insurance agencies of results
A pt presents to ED and is not perfusing well… what are the priorities?
EKG
Oxygentation/Airway
IV access
Hook up to defib
Meds
Versed if use defib
VS
Cardioversion?
elective procedure
pt awake & frequently sedated
synchronized
How many Joules are used with cardioversions?
50-200 J
Debrillation?
Emergency
V-Fib/V-Tach
No CO
Pt unconscious
How many Joules used with defibrillation?
200-360 Joules
How do you admin Adenosine?
Lift arm above head and slam med
Flat line before return to normal sinus rhythm
dizzy, drowsy, feel like crap
What do they use for sedation for cardioversions?
versed, fentanyl
What are the 5 T’s of ACLS?
Tamponade
Toxins
Tension Pneumothorax
Thrombosis (pulm)
Thrombosis (coronary)
What are the 5 H’s of ACLS?
Hypovolemia
Hypoxia
Hydrogen Ion Excess (Acidosis)
Hypo/Hyperkalemia
Hypothermia
What is the primary nurse’s role during a code?
check pulse and start CPR
tell code team pt’s story
What are 2 examples of antiarrhythmics?
amiodarone
lidocaine
What is one small square on ECG paper??
0.04sec
What is one large square on ECG paper?
0.20sec
How to calculate HR?
count R-R intervals in 6 second and multiply by 10
What is a normal QT interval?
0.34-0.43sec
What is stable angina?
chest pain goes away at rest
What is unstable angina?
Chest pain is constant
What is the common response of older females having MI?
might not have symptoms, may feel like acid reflux
What is silent ischemia?
no symptoms
usually DM pts
What is Prinzmetal’s (Variant) angina?
occurs when pt is at rest (smokers, alcohol abuse)
What is Microvascular angina?
no history of CAD, related to atherosclerosis, more common in women (provoked by exercise)
At what rate are smokers more predisposed to developing CAD?
2-6x higher
What cholesterol level is a risk factor for CAD?
> 200
What fasting triglyceride level is a risk factor for CAD?
> 150
What BMI is a risk factor for CAD?
> 30
At what rate are DM pt more predisposed to developing CAD?
2-4x higher
Which population is most at risk for CAD?
white, middle-aged men
At which age are genders at the same risk for developing CAD?
65
Which race is more predisposed to CAD?
African Americans
What does PQRST stand for?
precipitating events
quality of pain
region
severity of pain
timing
When is a EKG supposed to completed when angina emergency?
within 10min
What is the golden standard marker for cardiac damage?
troponin
What does CK-MB lab value indicate?
heart muscle damage
What does myoglobin lab value indicate?
muscle damage anywhere in body
What is included in BMP?
electrolytes
kidney function
glucose
What does Homocysteine lab value indicate?
risk for HF
When is a stress test positive?
if ST segment changes
What does an echocardiogram tell?
ejection fraction
What is the normal ejection fraction?
60-70%
What ejection fraction is concerning?
40%
What is electrophysiology studies?
Catheter through femoral artery to look at heart rhythm
Which arteries are insertion sites during angiograms?
femoral/radial
What does the EKG demonstrate with chronic stable angina?
ST depression or T wave inversion
What is chronic stable angina provoked by?
physical activity
emotional distress
How often do you check trop levels?
q6hr
When are calcium channel blockers given during angina treatment?
when beta-blockers aren’t tolerated
What is the etiology of acute coronary syndrome?
plaque rupture
What is STEMI?
completely blocked vessel = medical emergency
Treatment for STEMI?
PCI (percutaneous coronary intervention) within 90 minutes
What are the options for percutaneous coronary intervention?
cardiac catheterization within 90min
OR
thrombolytic therapy within 30min
What is NSTEMI?
partially blocked vessel
may or may not have ST depression and/or T wave inversion
When should cardiac catheterization be implemented when NSTEMI is present?
within 12-72hrs
What are EKG changes with unstable angina?
may be normal or ST depression and/or T wave inversion
Manifestations of MI?
Severe pain 20min or longer that is not relieved with rest
SNS stimulation
Clammy, cool
Decreased urine output
Crackles
Edema
N/V
Fever
Emergency care of ACS?
12-lead EKG
sit upright
O2 application
IV access (2 18G in AC)
Nitro
Morphine’s MOA with ACS?
decreases cardiac workload/contractility (specific to heart)
Decrease BP, HR
Decrease anxiety
What is a CABG?
bypass blockage by taking vein out somewhere else in body (saphenous)
What is the gold standard procedure to identify and localize CAD?
cardiac catheterization
What is the nurse assessing after cardiac catheterization?
insertion site for bleeding
have to remain flat for hours after
What is the emergency first-line treatment for STEMI?
PCI
Reperfusion dysrhythmias?
PVCs= good thing
How often do you want to monitor BP when administering nitro IV?
q3-5min
How often do you draw labs with ACS?
q3-6hr
How long is activity limited post ACS?
12-24hr
S/S of papillary rupture?
systolic murmur
SOB, pulmonary edema
EMERGENCY
Which wall of heart is more predisposed to aneurysm or rupture?
Left ventricular
When does pericarditis present itself after an MI?
2-3days
S/S of pericarditis?
chest pain with inspiration
cough
relieves pain when sitting forward
hypotension
fever
friction rub
What is Dressler syndrome?
pericarditis 1-8weeks after MI
autoimmune reaction
S/S of Dressler syndrome?
joint pain
fatigue
fever
friction rub
What is the treatment for Dressler syndrome?
high dose of aspirin
When does sudden cardiac death occur?
within 1hr of chest pain onset
After sudden cardiac death when is pt referred for ICD?
40days of medical therapy
When is ICD implanted (defibrillator)?
when ejection fraction <30%
What is placed on baby to prevent heat loss and help stabilize body temp?
hat
An injection of _________ is given to the newborn to prevent bleeding
vitamin K
APGAR score stands for?
Appearance
Pulse
Grimace
Activity
Respiration
Apgar score of 0-4 would be considered?
poor condition
Apgar score of 5-7 would be considered?
fair condition
Apgar score of 8-10 would be considered?
good condition
The baby is scored on the APGAR two different times ____ and ______ minutes after birth
1, 5
Term for blue extremities
acrocyanosis
What is bilirubin?
a by-product made by hemoglobin in the liver
Why do newborns often have jaundice?
immature liver
What 4 general measurements are taken at birth?
wt, length, temp, BS
What is the Babinski Reflex?
big toes flex backward and toes fan out
What is another name for the Moro Reflex?
startle response
How do the benefits of breastfeeding relate to primary care?
initiates prophylaxis for baby later on in life
Infant cold stress causes?
increased O2 consumption, which can lead to increased respiratory rate, which can lead to metabolic acidosis
When thinking about a newly delivered infant, what are your priority concepts?
gas exchange
thermoregulation
perfusion
Priority nursing actions with newborn?
keep baby warm
ensure patent airway
provide stimulation
What potential problems may occur when caring for a newborn infant?
hyperbilirubinemia
hypothermia
respiratory distress
infection
What stimulates the production of milk?
prolactin
What stimulates the release of milk?
oxytocin
_____ in the receptor sites produces colostrum
progesterone
Why does progesterone decrease after birth?
delivery of placenta
If not breastfeeding, when can mothers expect to lose their supply?
within a week
Lactose is a ______
carbohydrate
Human milk contents
high in water, low in protein and fat
Colostrum for ______ days
1-3
Transitional milk for _______ days
2-4
Mature milk after _____ days
7
How many breastfeedings should their be per day?
12
How often do you bottle fed?
q3-4hrs
How often do you breastfed?
q1-3hrs
Wet diapers?
1 wet for everyday old until 7 days.
Then 6-7 a day
Dirty diapers?
1 q24hrs
When should the nurse assist the mother in breastfeeding her newborn after delivery?
within 1hr of life
Breastmilk can be stored at room temp for
6hrs
Breastmilk can be stored in an insulated cooler for
1 day
Breastmilk can be stored in a refrigerator for
5 days
Breastmilk can be stored in a freezer for
3-6 months
Breastmilk can be stored in a deep freezer for
6-12 months
When is the newborn most reactive?
first 1-2 hrs after birth
How long do they delay cord clamping?
until the onset of respirations
PPHN
Persistent pulmonary HTN
lungs and vessels have low pressure
TTN
Transient Tachypnea
self limiting, fluid retention in lungs, common in C/S babes
What should BG be during the first 24hrs?
40
What should BG be after 24hrs?
50
What is the name of the condition brought on by bilirubin encephalopathy?
kernicterus
Physiologic jaundice appears
after 24hrs
Pathologic jaundice appears
before 24hrs
Risk factors for hyperbilirubinemia?
+ Coombs test
hemolytic disease
cephalohematoma
extensive bruising
asian
What is the worry for newborns with hyperglycemic mom?
hypoglycemia
What is the most common sign of hypoglycemia?
jitteriness
At 1min of life, a newborn will have O2 sat of
60-65%
After birth, a newborn’s O2 sat will increase __% per min of life?
5
At 10min of life, a newborn will have O2 sat of
85-95%
A cephaohematoma _____ cross the sagital suture
doesn’t
Newborns can lose _____% of wt in the first few days of life
8-10% will gain back in a week or so
Umbilical cord falls off at ____ days
7-10
What is the term used for parental feeding?
gavage
What Finnegan score is very severe?
> 12
