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OB > exam 3 last exam! :) > Flashcards

exam 3 last exam! :) Flashcards

1
Q

assess uterus (fundus) for what 3 things

A

firm or boggy (if its squishy its filling with blood) ,

middle or off to the side (if its off to the side then the bladder may be full),

if its higher than belly button

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2
Q

what to do if uterus off to the side

A

have them void

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3
Q

what is role of ptosin after labor

A

decrease bleeding

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4
Q

if everything is normal on assessment and VS are normal then what is priority????

A

mom and baby bonding

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5
Q

what is episiotomy

A

any laceration to get baby out

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6
Q

what is episiostomy

A

laceration

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7
Q

what is homans sign

A

dorsoflexing foot and seeing if there is pain in calf - pain can indiciate DVT THINK hypercoaguable bc theyre more hypercoacuable after labor

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8
Q

avg blood loss for vag delivery

A

300 mL

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9
Q

what is a hemorrage for vag delivery

A

500mL

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10
Q

if pt who has Hg 9 (anemia) , are they more at risk for hemorrage or less

A

more so watch for hemorrage s/s

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11
Q

What are expected physiological changes in the PP period? 6

A

Increase in CO, increase in clotting factors and risk for hypercoagulation, increased urinary output, increased hunger, elevated WBC, after pains with uterine involution

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12
Q

what is uterine involution

A

Process by which the uterus returns to pre-pregnant size, shape, and location; and placental site heals.

Occurs through uterine contractions (release of oxytocin) to decrease the risk of PP hemorrhage.

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13
Q

what is uterine involution

A

Process by which the uterus returns to pre-pregnant size, shape, and location; and placental site heals.

Occurs through uterine contractions (release of oxytocin) to decrease the risk of PP hemorrhage.

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14
Q

G1P1 vs G1P5 who will have more painful contractions

A

5 - bc more pregnancies and more breastfeeding means more painful contractions bc of the inc oxytocin

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15
Q

who has the most afterpains

A

more pregnancies and more breastfeedings

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16
Q

what to do if boggy uterus

A

massage!

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17
Q

position for fundal assessment

A

flat HOB

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18
Q

6 facotrs that dont facilitate uterine involution

A

complications

retained product

no breastfeeding bc no ptsoin

not giving ptosin

no ambulation

full bladder

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19
Q

what is lochia

A

Bloody discharge from uterus that contains necrotic tissue

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20
Q

2 abnormal findings for lochia

A

Saturating a full-size pad in less than an hour or passing large clots.

Foul odor may indicate infection

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21
Q

why is not all pp bleeding lochia

A

lacerations(tear)

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22
Q

what is normal bleeding finding postpartum in weeks

A

4-8 weeks

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23
Q

Assessment acronym for the perineum

A

Redness
Edema
Ecchymosis
Discharge
Approximation

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24
Q

what are expected peritoneal findings 4

A

Mild edema, minor ecchymosis (bruising), approximation (edges together)of any laceration or incision, mild-mod pain

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25
Q

what are 4 abnormal findings for peritoneal and what to do

A

Moderate-severe pain, excessive edema, excessive ecchymosis, and purulent drainage - contact HCP

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26
Q

5 risk factors for perineal lacerations

A

Fetal macrosomia, operative vaginal birth, precipitous birth, episiotomy, primip

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27
Q

priority intervention for perineal laceration

A

look at skin integrity bc could be source of infection

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28
Q

6 interventions for perineal laceration/hematoma

A

Ice packs
Spray bottle
Witch hazel pads
Anesthetic sprays
Sitz baths
Oral pain medication prn
NO HEAT

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29
Q

can people who have a c section lactate

A

yes - it doesnt delay it

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30
Q

when to breastfeed when starting out

A

on DEMAND

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31
Q

education if someone is not breastfeeding 3

A

dont ever ever release - no stimulation, cool showers, supportive bra 24/7

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32
Q

9 education for lactating pt

A

Supportive bra
Warm showers
Correct position
Correct latch-on technique
Nipple inspection: skin integrity
Exposure to air
Frequent nursing, on demand (assess readiness and feeding)
Increase fluid intake
Hydrate!

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33
Q

what hormones dec after birth

A

Estrogen and progesterone

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34
Q

if someone is not lactating , prolactin drops and what can happen

A

ovulation 2 weeks postpartum meaning someone can get pregnant before they would even have a period

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35
Q

education after postpartum regarding sex

A

not for 6 weeks because of the ability to ovulate 2 weeks postpartum

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36
Q

what is a priority education regarding sex post partum

A

contraception counseling

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37
Q

diastasis recti

A

Separation of rectus muscle

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38
Q

what is GI change after labor 5

A

increase in hunger
Decreased GI motility
Dehydration
Perineal pain
CONSTIPATION

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39
Q

how many calories when someone is lactating

A

500

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40
Q

3 bladder problems after labor

A

urinary distention, incomplete emptying, retention with overflow

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41
Q

interventions for bladder care ppost partum 3

A

early ambulation, remove catheter as soon as possible, void within 12 (6-8 is best) hours after birth

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42
Q

6 ADL education post partum

A

No driving for 2 weeks.
- Wear seat belt and use infant car seat.

No strenuous exercise or heavy lifting until after 6 week exam.

Rest when the baby sleeps.

No sexual intercourse until 6 week check-up.

Can conceive prior to resumption of menses and during breastfeeding.

Mood swings are common.

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43
Q

6 times (emotionaly) when you need to go to ER or contact HCP after discharge

A

Doesn’t want to be with the baby

Inability to cope with baby’s demands

No interest in eating

Inability to sleep,

Becoming more upset, unable to emotionally regulate

Feeling that patient may harm self or baby

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44
Q

5 times to call hcp or go to the ER to educate after discharge

A

saturating pad every hour or more
foul odor
hot raised pain leg or uterus or vagina
100 deg temo
abdominal pain

hemorrage, infection, emotions, hypercoag

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45
Q

major complication of PPH

A

shock related to hypovolemia

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46
Q

main cause of PPH

A

atony or uterine inertia (uterus not contracting or involuting)

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47
Q

blood loss greater than what is PPH

A

500 for vaginal and 1000 for csection

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48
Q

assessments for uterine atony 4

A

Boggy fundus, saturation of peripad w/in 15 minutes, blood clots, s/sx shock

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49
Q

intervention for uterine atony 5

A

fundal massage
assess bladder
give ptosin and methergine, cytotec
h and h
contact HCP

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50
Q

IMPORTANT priority for methergine

A

TAKE BP - dont give if someone has HTN

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51
Q

what person shouldnt get methergine

A

HTN hx

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52
Q

what pt shouldnt get hemabate

A

asthmatics hx

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53
Q

8 risk factors for uterine atony

A

Macrosomia
Birth weight >4000 grams (8.5 lbs)

Overdistended uterus

Polyhydramnios

Operative vaginal delivery

Prolonged first or second stage of labor

Precipitous labor and/or delivery

General anesthesia

Postpartum administration of Magnesium Sulfate

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54
Q

what is endometritis

A

infection of uterine lining

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55
Q

who is most at risk for endometritis 2

A

ROM for >24 hours / internal monitoring

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56
Q

7 ss of infection

A

Elevated Temp (>101),
tachycardia,
redness,
tenderness,
discharge at site of infection,
malaise,
abnormal labs

57
Q

3 risk factors for hypercoag/thrombosis

A

stasis like in a csection, obesity, pariety

58
Q

4 assesments of thrombosis

A

Redness,
tenderness,
and/or swelling in affected leg
+ Homan’s Sign

59
Q

what is diff between PP blues and depression

A

Characterized by emotional lability, irritability and insomnia that typically resolves within 2 weeks. Woman remains able to care for herself and infant.
vs
A major depressive episode which occurs within 6 – 12 months following childbirth

60
Q

7 risk factors for PP depression

A

History of depression before or during pregnancy
Poor quality relationship with partner
Inadequate social support
Poor coping skills
Low self-esteem
Numerous life stressors
Substance abuse

61
Q

mercer theory

A

commitment, attachment, and prep during pregnancy

62
Q

rubin theory intervention

A

sharing birth story

63
Q

bonding v attachment

A

attachment is bidirectional

64
Q

6 risk factors of delayed bonding and attachment

A

Maternal illness or postpartum complications
Neonatal illness or complication
Fatigue for mother and partner
Physical discomfort post-birth
Maternal age or developmental delay
Outside stressors, psychosocial issues, depression

65
Q

Complex emotional responses experienced after the death of a child

A

perinatal bereavement

66
Q

1 priority of nursing care in neonate

A

resp function

67
Q

5 focus of nursing care in the nenonate period

A

Maintaining respiratory function (#1 priority)***
Maintaining body heat
Decreasing risk of infection
Assisting parents in providing appropriate nutrition
Assisting parents in learning to care for their newborn

68
Q

normal temp, HR, resp and BP of newborn

A

Temperature
97.8–99.5 degrees F Axillary
Rectal temp only once to determine patency

Heart rate
100–160 bpm; regular rhythm
FULL minute

Respirations
30-60
Respirations irregular, shallow, unlabored
Symmetrical chest movements

Blood Pressure
Taken once for “normal” newborn

69
Q

if baby VS and everything is normal what is priority

A

baby to mom

70
Q

2 factors that can impede resp transition

A

Decreased surfactant levels (<36wks) (helps w/ oxygen exchange in lungs)

Persistent hypoxemia and acidosis - leads to constriction of the pulmonary arteries.

71
Q

7 signs of resp distress

A

Cyanosis (Central - mouth, lips)
Apnea, tachypnea (>60)
Retractions
Grunting
Flaring of nostrils
Hypotonia
Rate <30 or >60

72
Q

when to give meds to baby

A

apgar <7

73
Q

if baby has metabolic acidosis then give

A

sodium bicarb

74
Q

APGAR scoring

A

Heart rate
No pulse = 0
Less than 100 = 1
Over 100 = 2

Respiratory effort
No respirations = 0
Slow, irregular = 1
Respiratory normal (good cry) = 2

Muscle tone
Limp = 0
Moving = 2

Reflex irritability
No crying = 0
Grimace = 1
Screaming and crying =2

Color
Pale = 0
Body pink, extremities blue = 1
Pink = 2

75
Q

why is erythromycin ointment given

A

to prevent gonorrhea blindness

76
Q

why is vitamin K given

A

Clotting factors (don’t produce it themselves for about 1 week)

77
Q

what is cold stress

A

excessive heat loss that leads to hypothermia and results in compensatory mechanisms to maintain body temp

78
Q

5 assessment findings for cold stress

A

Axillary temp less than 98
Increased RR and HR
Decreased O2 saturation
Hypoglycemia
Respiratory Distress

79
Q

what happens when baby takes first breath

A

decrease pulmonary resistance → increase pulmonary blood flow → 3 fetal shunts close
Shunts need to close

80
Q

what is brown fat

A

highly dense and vascular adipose tissue that is unique to neonates which produces heat

81
Q

goal of thermmoreg

A

A Neutral Thermal Environment (NTE) is an environment which maintains body temp with minimal metabolic changes and/or O2 consumption

82
Q

what is convection

A

flow of heat from body surface to cooler surrounding air

83
Q

what is evaporation

A

loss of heat when a liquid is converted to a vapor

84
Q

what is conduction

A

transfer of heat from object to object when the two objects are in direct contact

85
Q

what is radiation

A

loss of body heat to cooler, solid surfaces in close proximity, but not in direct contact

86
Q

how to prevent heat loss from convection

A

turn off fans

87
Q

how to prevent heat loss from evaporation

A

dry off baby

88
Q

how to prevent losing heat to conduction

A

skin to skin

89
Q

what to do if baby hypoglycemic and what bg value

A

<40 - cold stress happening so need to rewarm to put naked under radiant warmer

90
Q

4 ways to prevent cold stress

A

Dry neonate, remove wet linen, put on hat
Skin-to-skin or radiant warmer
Swaddle
Maintain NTE

91
Q

4 causes of jaundice

A

immature liver
High RBC (more things to “break down”)
Increased break down
Not peeing or pooping (decreased elimination)

92
Q

physilogical jaundice

A

60% of newborns
Appears after 24 hrs**
Resolves within a week
Breastfed babies = more likely to have jaundice

93
Q

pathological jaundice

A

Appears in the first 24 hrs*
Leads to neurotoxicity
Serum bilirubin = greater than 15mg/dl in preterm**

94
Q

4 signs of hypoglycemia

A

jitteriness (jittery judah), hypotonia, hypothermia, apnea

95
Q

how to prevent hypoglycemia

A

Place infant at breast w/in 1st hour after birth.
early feeding

96
Q

baby weight normal

A

no more than 10% loss

97
Q

when should cord fall

A

7-14 days

98
Q

when should newborn eat normal

A

after 1st 24 hours

99
Q

what is normal elimination pattern 3

A

void and stool in 1st 24 hours
6-8 diapers a day
several stools

100
Q

what is cheesy white coating on skin

A

vernix caseosa

101
Q

what is stork bite

A

nevus simplex

102
Q

what is tiny white bumps

A

milia

103
Q

what is macular blue grey pigmentation on butt

A

dermal melanocytosis

104
Q

what is erythmetaous macules/papules

A

erthma toxicum

105
Q

what is port wine stain

A

nevus flammeus

106
Q

3 normal skin variationa

A

Nevus simplex (“stork bite”)

Milia

Dermal Melanocytosis - almost appears like a bruise - common in certain skin tones - previously called “Mongolian Spot”

107
Q

Caput succedaneum vs cephalohematoma

A

Caput Succedaneum: crosses suture lines, above periosteum (more symmetric) - fits like a “cap” (ie: over sutures)

Cephalohematoma: Under periosteum, does NOT cross suture lines (more asymmetric) collection of blood from trauma ** at greater risk for jaundice **

108
Q

when do newborn relfexs dissapear normally

A

6 months

109
Q

if mom is GBS pos. what to do

A

baby can get sick but mom isnt so give mom abx during labor - CAN STILL HAVE VAGINAL

110
Q

2 categories of gestational aging

A

NM
physical maturity

111
Q

5 risk factors for LGA

A

Maternal diabetes mellitus or glucose intolerance
Prior history of a macrosomic infant
Postdates gestation
Maternal obesity
Genetics

112
Q

risk factors for SGA 5

A

​​Pre-eclampsia
Smoking
Drug Use
Decreased Maternal Nutrition
Multiple Gestation Prior

113
Q

what constitutes AGA

A

80% of newborns

114
Q

what qualifies sga

A

Birth weight is below the 10th percentile
Birth weight is less than 2500 grams

115
Q

what is LGA

A

Birth weight is above the 90th percentile;
Birth weight is more than 4000 grams

116
Q

4 common problems with LGA

A

Birth trauma due to cephalopelvic disproportion (CPD) = Depressed skull fracture, cephalohematoma, fracture of the clavicle or humerus, brachial plexus injuries, or facial palsy

Hypoglycemia:
Blood glucose level below 40 mg/dL

Polycythemia:
A venous hematocrit over 65%

Jaundice secondary to hyperbilirubinemia:
Usually due to the breakdown of increased numbers of RBCs in circulation

117
Q

4 common problems with SGA

A

Perinatal asphyxia

Hypothermia (due to no “brown fat”)

Hypoglycemia

Meconium aspiration

118
Q

preterm is what and term is what

A

<37 and then 37-42

119
Q

7 characteristics of postterm newborn

A

Dry, cracked, wrinkled skin
Creases cover entire soles of feet
Abundant hair on scalp
Thin umbilical cord
Limited vernix and lanugo
Meconium-stained skin
Long nails

120
Q

5 characteristics of preterm baby

A

Minimal creases in foot
Pinna folded
Translucent skin with floppy extremities (less flexion)
Foreskin may not cover tip of penis
Labia majora may not fully cover minora

121
Q

Transient Tachypnea of the Newborn (TTNB)

A

> 60 rr

122
Q

education about breastfeeding and csection vs vaginal

A

There is no difference in who is most successful with breastfeeding in regards to vaginal or cesarean delivery!!!***

123
Q

What does a “boggy” uterus mean and what should the nurse do?

A

not contracted, nurse should massage

124
Q

4 abnormal perineal findings

A

Moderate - severe pain
Excessive edema
Excessive ecchymosis
Purulent drainage

125
Q

sign of subinvolution

A

Prolonged or heavier lochia

126
Q

Why is Pitocin given postpartum?

A

To encourage uterine involution and contraction

127
Q

What condition is Hemabate contraindicated in?

A

asthma

128
Q

Name the nursing intervention during the taking in phase

A

talking about birth experience

129
Q

what is normal for newborn resp

A

irregular breathing but not labored or cooing

130
Q

cyanosis in the newborn

A

generalized is not normal but hands and feet is called acrocyanosis

131
Q

if APGAR is abnormal what to do

A

repeat 10 minutes

132
Q

what does less surfectant mean

A

less ability to breathe

133
Q

4 ways baby respond to the cold

A
  • increase metabolic
  • increase muscle activity
  • vascular constriction
    -brown fat metabolism
134
Q

if bilirubin is > then what , then its pathologic

A

15

135
Q

if someone is breastfeeding hwo to know if baby is getting enough

A

output and weight - pee and poop

136
Q

when is baby most at risk for jaundice

A

cephalohematoma and it is when crosses suture line

137
Q

if mom is GBS pos

A

mom gets abx, can still have vaginal BABY DOESNT GET ABX

138
Q

study APGAR

A

!!!!

OB (5 decks)

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