Exam #4 Flashcards
Hemorrhage
Blood loss >500mL after vaginal birth or 1000mL after cesarean birth.
Early Postpartum Hemorrhage
Occurs within 24 hours of birth
Late Postpartum Hemorrhage
Occurs after 24 hours and within 6 wks after birth. Usually results from retention of placental fragments or subinvolution of the uterus.
Hypovolemic Shock
The major risk with hemorrhage, interrupts blood flow to body cells.
S/S of Hypovolemic Shock
Tachycardia, Narrow Pulse Pressure and BP continues falling and eventually cannot be detected. Pale, cold, clammy skin and mucous membranes, anxiety, confusion, restlessness, lethargy. Decreased urine output.
Managing Hypovolemic Shock resulting from Hemorrhage
Stop the blood loss. Give IV fluids. Give blood transfusions. Give oxygen. Place foley cath.
Methylergonovine
Increases BP and should not be given to a woman with hypertension
Lacerations
Bleeding can be profuse, and is usually brighter red than lochia and flows in a continuous trickle. Fundus is firm.
Hematomas of the Reproductive Tract
Usually on the vulva or inside the vagina. Seen as a bulging bluish/purplish mass. Usually severe, unrelenting pain that analgesics do not relieve. Pressure in the vulva, pelvis, or rectum. May be unable to urinate. PULSE AND RR RISE & BP FALLS.
Why does a poorly contracted uterus lead to hemorrhage?
Because there is no pressure where the placenta was
Bleeding associated with Uterine Atony
Heavy with clots
PP Infection
Characterized by T 100.4 after the first 24hrs after birth, occurring on at least 2 days during the first 10 days after birth.
Puerperal Sepsis
Infection or septicemia after childbirth
Mastitis
Infection of the breast, usually occuring 2-3 wks after giving birth. Breast engorgement and inadequate emptying of milk are associated with mastitis.
S/S of Mastitis
redness or heat in the breast, tenderness, edema and a heaviness in the breast, purulent drainage (may or may not be present). The woman usually has fever, chills, and other systemic S/S
Tx of Subinvolution
Methylergonovine to maintain firmness, antibiotics for infection, dilation of the cervix and currettage to remove fragments of the placenta from the uterine wall
Cardiovascular System
Develops between the 3rd and 8th week of gestation. First system to function in intrauterine life. When development is incomplete, heart defects occur.
S/S common to congenital cardiac problems
Failure to thrive/poor weight gain, cyanosis or pallor, visually observed pulsations in neck veins, tachypnea/dyspnea, irregular pulse rate, clubbing of fingers, fatigue during feeding/activity, excessive perspiration especially over the forehead
Acquired Heart Disease
Occurs AFTER birth
Defects that Increase Pulmonary Blood Flow
Atrial Septal Defect, Ventricular Septal Defect, Patent Ductus Arteriosus
Atrial Septal Defect
An abnormal opening between the R and L atria. Blood already containing oxygen is forced back to the R atrium. Most pts do not have symptoms. Usually a murmur is heard. Darcon patch or nonsurgical closure during a cath
Ventricular Septal Defect
Most common. Opening between the R and L ventricles. Increased pressure within the L ventricles forces blood back into the R ventricle. Loud, harsh murmur and systolic thrill.
Patent Ductus Arteriosus
Blood continues to pass from the aorta into the pulmonary artery. Causes oxygenated blood to recycle through the lungs. Makes heart pump harder. Dyspnea, bounding radial pulse, wide pulse pressure. Machinery type murmur. More common in girls. NSAIDs and indomethacin drug therapy results in closure of the PDA.
Coarctation of the Aorta
Restricts ventricular blood flow. Constriction of the aortic arch. Increased pressure proximal and decreased pressure ditally. S/S are a marked difference in the BP and pulses of the upper and lower extremities. Hypertension, CHF, and infective endocarditis may develop.
Tetralogy of Fallot
Stenosis or narrowing of pulmonary artery. Hypertrophy of the R ventricle. Dextroposition of the aorta (displaced to R), VSD. Cyanosis, clubbing, squating to breath easier, feeding problems, respiratory infections, dyspnea on exertion. Polycythemia to compensate for lack of oxygen. Tet spells.
Manifestations of CHF
Cold and/or blue hands and feet, tachycardia, tachypnea, fatigue, weak cry, excessive perspiration, edema, failure to gain weight, frequent respiratory infections.
Rheumatic Fever
Systemic disease involving the joints, heart, CNS, skin, and subcutaneous tissues. Common feature is destruction of the connective tissue. Causes scaring of mitral valves. Peak between 5-15 yrs old. More prevalent during winter and spring. Autoimmune disease that occurs as a complication of untreated strep throat.
Manifestations of Rheumatic Fever
May not occur for 1-6 wks after a strep infection. Migratory polyarthritis, skin eruptions, chorea, inflammation of the heart, subcutaneous nodules, abdominal pain, fever, pallor, fatigue, anorexia, unexplained nosebleeds. Recurrences more frequent during the first 5 years after initial attack.
Tx of Rheumatic Fever
Penicillin is the drug of choice followed by long term chemoprophylaxis; benzathine penicillin injections are given monthly for a minimum of 5 years or until age 18.
Good sources of iron
Boiled egg yolk, liver, leafy green vegetables, cream of wheat, dried fruits, dry beans, crushed nuts, whole grain breads
Manifestations of Iron Deficiency Anemia
Pallor, irritability, anorexia, decrease in activity. Screening is suggested at 9 and 24 months.
Sickle Cell Disease
An inherited defect in the formation of hemoglobin. Occurs mainly in Africans. Sickling caused by decreased blood oxygen may be triggered by dehydration, infection, stress, or exposure to cold. Inheritated from BOTH parents.
S/S of Sickle Cell Disease
Hgb level from 6-9g/dL or lower, pale, tires easily, little appetite.
Manifestations of Leukemia
Low fever, pallor, bruising, leg and joint pain, listelessness, abdominal pain, enlargement of lymph nodes. Lemon yellow skin, petechiae and purpura, anorexia, vomiting, weight loss, dyspnea, enlarged kidneys/testicles.
Chemortherapy
Includes the following components: 1. induction period 2. CNS prophylaxis for high-risk pts 3. Maintanance 3. Reinduction therapy 4. Extramedullary disease therapy
Hodgkin’s Disease
A malignancy of the lymph system that may metastasize to the spleen, liver, bone marrow, lungs, or other parts of the body. Presence of giant multinucleated cells called Reed-Sternberg cells is diagnostic of the disease. Rarely seen before 5 yrs of age and twice as common in boys as in girls.
Esophageal Atresia
“Tracheoesophageal Fistula” - Caused by a failure of the tissues of the GI tract to separate properly from the respiratory tract early in prenatal life.
Types of TEF
- Upper esophagus and the lower esophagus end in a blind pouch 2. Upper esophagus ends in a blind pouch; the lower esophagus connects to the trachea 3. Upper esophagus is attached to the trachea; the lower esophagus is also attached to the trachea 4. Upper esophagus connects to the trachea; the lower esophagus ends in a blind pouch
Manifestations of TEF
Earliest sign occurs prenatally when the mother develops polyhydramnios. At birth, infant will vomit and choke when first feeding is introduced. Newborn cannot swallow and will appear to be drooling.
Polyhydramnios
The fetus cannot swallow the amniotic fluid, resulting in an accumulation of fluid in the amniotic sac.
Tx of TEF
Prevent pneumonia, choking and apnea. If symptoms noted, infant placed on NPO status. Suction to clear airway, positioned to drain mucus from the nose and throat. Surgical repair is essential for survival.
Imperforate Anus
The lower end of the GI tract and the anus end in a blind pouch.
Manifestations of Imperforate Anus
Failure to pass meconium in the first 24 hours.
Pyloric Stenosis
An obstruction at the lower end of the stomach caused by an overgrowth of the circular muscles of the pylorus or by spasms of the sphincter. Symptoms do not appear until 2-3 weeks.
Manifestations of Pyloric Stenosis
Projectile vomiting. vomitus contains mucus and ingested milk. Infant is constantly hungry and will eat again immediately after vomiting. Olive shaped mass may be felt in the RUQ.
Celiac Disease
AKA gluten enteropathy and sprue. Leading malabsorption problem in children.
Manifestations of Celiac Disease
Evident at 6months - 2 yrs. Stools are large, bulky, and frothy because of undigested contents.
Hirschsprung’s Disease
Occurs when there is an absence of ganglionic innervation to the muscle of a segment of the bowel. Usually happens in the lower portion of the sigmoid colon. There is a lack of normal peristalsis. Results in chronic constipation.
Manifestations of Hirschsprung’s Disease
Failure to pass meconium stool within 24-48hrs. Constipation, ribbon like stools, abdominal distention, anorexia, vomiting, failure to thrive.
Intussusception
A slipping of one part of the intestine into another part just below it
