Families Exam 2 Flashcards
How often should you assess the mom’s BP and HR for the first 2 hours after birth?
q 15 mins
How often should you assess the mom’s temp for the first 8 hours after birth?
q 4 hrs
What temperature increase is normal in the mom for the first 24 hours after birth?
100.4
What can a decreased BP and increased HR in the mom indicate after birth?
shock, bleeding
How long after delivery does milk production begin?
3-5 days
What should be assessed during the uterine assessment?
- fundal height
- uterine placement
- consistency
What should the uterus feel like?
FIRM
What should be done if a boggy uterus is assessed?
- fundal massage
- admin of oxytocin or methylergonovine
- breastfeeding (releases oxytocin)
What can cause urinary retention in the mom after birth?
- loss of bladder elasticity
- meds/anesthesia
What amount of urine output is normal for the mom for 2-3 days after birth?
> 3,000 mL
How often should you assess the mom’s ability to void after birth?
q 2-3 hrs
When is lochia rubra normal?
days 1-3
When is lochia serosa normal?
days 4-10
When is lochia alba normal?
days 10-28
When should hemorrhage be suspected after birth?
if lochia is heavy with clots
What does a first degree laceration tear through?
skin
What does a second degree laceration tear through?
skin and mucles
What does a third degree laceration tear through?
skin, muscles, and the external anal sphincter muscle
What does a fourth degree laceration tear through?
skin, muscles, the external anal sphincter muscle, and the anterior rectal wall
What is rooming in?
the baby’s crib is by the mother’s bed
What can be used to help with lacerations?
- ice packs
- dermoplast spray
- sitz bath
- stool softener
What should you assess for post-epidural?
- maternal hypotension
- fetal bradycardia
- return of sensation and motor control
What can be used to help with hemorrhoids?
- sitz bath
- topical creams
- rectal suppositories
- witch hazel pads
What happens to HCT after birth?
it decreases for 3-4 days and is back to normal by 8 weeks
What happens to WBC’s after birth?
can be 20-25,000 within the first 4-7 days
How long does the taking-in phase last?
24-48 hours
Should you teach during the taking-in phase?
NO
How long does the taking-hold phase last?
day 2-3 and lasting 10 weeks
Should you teach during the taking-hold phase?
YES
What medication is given for PIH?
mag sulfate
After a vaginal birth, what amount of blood loss indicates post partum hemorrhage?
> 500 mL
After a c-section, what amount of blood indicates post partum hemorrhage?
> 1000 mL
What should be assessed when post partum hemorrhage is suspected?
- fundus
- bleeding
- bladder distention
What medications are given for post partum hemorrhage?
oxytocin or methylergonovine
What patient should methylergonovine not be given to?
a patient with HTN
What should be assessed when there are lacerations/hematomas?
- lochia
- pain
- source of bleeding
- VS
- vulva/perineum/rectum
- hemodynamic status
What problems can occur from a hematoma?
urge to defecate and difficulty voiding
How long should a mom breastfeed for to prevent engorgement?
until breast is soft and completely empty
How many times a day should a mom nurse?
8-12
When should you warm the breasts?
before breastfeeding
When should you cool the breasts?
after breastfeeding
What does the lochia look like with endometritis?
dark and profuse
Does endometritis affect the baby?
NO
What happens to the uterus with endometritis?
tender and enlarged
What happens to the breast with mastitis?
it is painful/tender with a localized hard mass and reddened area
Should you stop breastfeeding if experiencing mastitis?
NO
What side should you start feeding on with mastitis?
the unaffected side
What characteristics of the urine indicate UTI?
- cloudy
- blood-tinged
- malodorous
- sediment visible
- retention
What urine specimen is done when testing for UTI?
clean catch
What medication is given for vulvovaginitis?
metronidazole
What can happen to the neonate if the mom has vulvovaginitis?
- preterm birth
- LBW
- infection
- miscarriage
What characteristics does discharge have with vulvovaginitis?
thick and white
What characteristics does discharge have with gonorrhea?
yellow- green
What risks does gonorrhea have to the neonate?
- blindness
- transmission
How long is postpartum blues normal?
up to 10 days
When is it considered post partum depression?
if symptoms increase after 10 days of post partum blues
What is the biggest risk for those with postpartum depression?
rejection/harm to the infant
What medication is given to the mom and baby for HIV?
retrovir
What should be encouraged to a pregnant mom with HIV?
Hep B, pneumonia, and flu vaccines
What should be done at birth to an infant born to a mom with HIV?
BATH
What is normal when first starting to breastfeed?
cramping
Hand to mouth/hand, rooting, and sucking are infant cues for what?
hunger
Slow sucking, soft breasts, and a sleeping baby are infant cues for what?
satisfaction
When should you burp the baby?
when alternating breasts
What position should you place the baby in after feeding?
on their back
How should you help flat/inverted nipples?
- roll them in your fingers prior to feeding
- wear a breast shield in between feedings
How should you help sore/irritated/cracked nipples?
- breast milk, air dry
- breast creams
What type of bra should a breastfeeding mom wear?
well-fitting, supportive
What type of bra should a non-breastfeeding mom wear?
tight-fitting
If a non-breastfeeding mom experiences engorgement, what can be done?
cold compress = fresh cold cabbage leaves in bra
Why is the basal body temp contraception method not reliable?
other variables can change temperture
When should you take your temperature if using the basal body temp contraception method?
before getting out of bed in the morning
How long before sex do you have to insert the diaphragm? How long do you have to leave it in after?
6 hours before, 6-24 hours after
What should you do before inserting the diaphragm?
empty bladder
What should the diaphragm be washed with?
mild soap and warm water
What type of barrier method requires a prescription and a visit to a provider?
diaphragm
What are the main side effects of combined and progestin-only birth controls?
- HA
- N/V
- breast tenderness
- breakthrough bleeding
What hormonal contraceptive is safe when breastfeeding?
progestin-only (minipill)
What does the emergency oral contraceptive do?
prevents fertilization
How often are injectable progestins given?
4x/year, q 11-13 weeks
What hormonal contraceptive does not impair lactation?
injectable progestins
How long is fertility delayed after discontinuing injectable progestins?
up to 18 months
How is the vaginal ring beneficial?
vaginal delivery of hormones means lower doses and less adverse effects
What method of contraception can cause discomfort during intercourse?
vaginal ring
How long are implantable progestins effective for?
3 years
What contraceptive methods can be used/inserted immediately after an abortion, miscarriage, birth, and while breastfeeding?
IUD and implantable progestins
How long is an IUD effective for?
1-10 years
What surgery can be done within 24-48 hours after childbirth?
female sterilization
Do female and male sterilization affect sexual function?
NO
What does a hysterosalpingography assess?
patency of the fallopian tubes
What are the contraindications of hysterosalpingography?
seafood and iodine allergy
What order should suction or the baby be done in?
mouth and then nose
What is considered bradypnea in a newborn?
< 30/min
What is considered tachypnea in a newborn?
> 60/min
When does the foramen ovale go away?
within a few minutes
When does the ductus arteriosus go away?
within a few hours
When do the umbilical vein and ductus venosus go away?
within a few days
Where is normal PMI in a newborn?
5th intercostal space
What does a normal umbilical cord have?
1 vein and 2 arteries
What should be assessed when looking at the fontanels?
- size
- presence
- fullness
- bulge
How big should a newborn’s head be?
2-3 cm longer than the chest
What should fontanels feel/look like?
soft and flat
What shape is the anterior fontanel, and when does it close?
diamond-shaped, closes in 12-18 months
What shape is the posterior fontanel, and when does is close?
triangle-shaped, closes in 6-8 weeks
What characteristic of fontanels can indicate increased ICP, infection, and hemorrhage?
bulging
What characteristic of fontanels can indicate dehydration?
depressed
What is caput succedaneum?
swelling of the soft tissue of the scalp due to pressure on the head during labor
How long does it take for caput succedaneum to heal?
3-4 days
What is cephalohematoma?
collection of blood in the head
When can cephalohematoma appear, and how long does it take to resolve?
appears 1-2 days after birth, resolves in 2-3 weeks
What can low-set ears indicate?
a chromosomal abnormality or kidney disorder
What can excessive saliva indicate?
tracheoesophageal fistula
What are epstein’s pearls?
expected small, white cysts
What can a protruding tongue indicate?
down syndrome
What can the absence of head control indicate?
prematurity or down syndrome
When should meconium and urine be passed in a newborn?
within 24 hours
What should RR be in a newborn?
30-60/min with short (<15 sec) periods of apnea during sleep
What should HR be in a newborn?
110-160
What should BP be in a newborn and where should it be taken?
60-80/40-50 on the lower leg
How should BP be taken before discharge?
on all 4 extremities
What is a normal temp for a newborn?
97.7-99.5
What is a normal weight for a newborn?
5.5-8.8 lbs
What is normal length for a newborn?
18-22 inches
What is a normal head circumference for a newborn?
12.6-14.5 inches
What is a normal chest circumference for a newborn?
12-13 inches
What are milia?
small, raised, white spots (chin, nose, forehead)
What are mongolian spots?
bluish-purple spots
What are telangiectatic nevi?
flat pink/red marks that blanch and fade
What are nevus flammeus?
capillary angiomas that do not blanch or fade
What is erythema toxicum?
pink rash that appears during the first 3 weeks
What is vernis caseosa?
thick, cheese-like protective covering
What is lanugo?
fine, downy hair (pinnas, forehead, shoulders)
What is the sucking and rooting reflex?
the infant turns its head to the side that is touched and starts sucking
What is it called when the baby wraps its fingers around your fingers? When the baby wraps its toes around your fingers?
palmar grasp and plantar grasp
What reflex causes the baby to extend and abduct its arms at the elbows and fingers to form a “c”?
the moro reflex
What arm and leg extend with the tonic neck reflex?
the arm and leg on the side that the baby’s head is turned to
What arm and leg flex with the tonic neck reflex?
the arm and leg on the opposite side that the baby’s head is turned to
What happens to the toes with the babinski reflex?
they fan up and out when the sole of the foot is stroked
What is the stepping reflex?
holding the baby upright and touching their feet to a flat surface should make them step
When does the sucking and rooting reflex occur?
from 3/4 months to a year
When does the palmar grasp reflex occur?
3-4 months
When does the plantar grasp reflex occur?
from birth to 8 months
When does the moro reflex occur?
from birth to 6 months
When does the tonic neck reflex occur?
from birth to 3/4 months
When does the babinski reflex occur?
from birth to 1 year
When does the stepping reflex occur?
from birth to 4 weeks
What do you want the Apgar score to be?
7-10
What does the Apgar score consist of?
- HR
- RR
- muscle tone
- reflex irritability
- color
What blood should you collect at delivery?
cord blood
Where should a heel stick be done?
outer aspect
What should you do to the heel before sticking it?
warm it
How deep can you go for a heel stick?
no deeper than 2.4mm
How can a baby’s discomfort be decreased during a heel stick?
breastfeeding or skin-to-skin contact
What has to be done before a heel stick and PKU testing?
formula or breast milk for 24 hours
What is PKU and what can it lead to?
a protein metabolism defect (accumulation of phenylalanine) that can lead to mental retardation if not treated within 2 months
What part of the mouth should you avoid when bulb suctioning?
the center (gag)
What med prevents bleeding in newborns before it is naturally made in their body?
vitamin K
How long does it take for vitamin K to be produced by the body?
1 week
What procedure should not be done if vitamin K is denied at birth?
circumcision
When are Hep B immunizations given to a baby born to a mom WITHOUT Hep B?
- birth
- 1 month
- 6 months
When are Hep B immunizations given to a baby born to a mom WITH Hep B? What else is given?
- immunoglobulin and immunization within 12 hours of birth
- immunization only at 1 month, 2 months, and 12 months
What 2 things should not be given in the same leg?
Hep B vaccine and Vitamin K
Why is erythromycin ointment given?
prophylactic to prevent blindness
How long is the umbilical cord clamped for?
24-48 hours
What should you assess the stump and base of the umbilical cord for?
- drainage
- edema
- erythema
What cannot be done until the umbilical cord falls off?
tub bath
What does temperature have to be stabilized to for bathing to start?
97.7
When should a sponge bath be done after birth?
- 1-2 hours after
- until cord falls off and circumcision heals
What should the bath water be at?
100.4
Is tap water okay when bottle feeding?
yes
How long can formula be refrigerated?
48 hours
What angle should the baby be held at when bottle feeding?
45 degrees
How long can breast milk be stored at room temp?
8 hours
How long can breast milk be stored in the fridge?
8 days
How long can breast milk be stored in the freezer?
6 months
How long can breast milk be stored in the deep freezer?
12 months
How long should breast milk be thawed in the fridge?
24 hours
Can you refreeze or microwave breastmilk?
NO
How much weight is lost after birth?
5-10%
When is weight regained?
in 10-14 days
How much weight do babies gain per week for the first 3 months?
110-200g
What newborn temperatures should be reported to the provider?
- > 100.4
- < 97.9
What should you use to clean after a circumcision?
warm water
What cannot be used to clean after a circumcision?
alcohol wipes
What should you watch for after a circumcision?
- bleeding
- cold stress
- hemorrhage
- infection
- unable to void
How long should a baby be in a rear facing carseat?
2 years
What should the chest clip of a carseat be level with?
axilla
If the baby is having poor feeding from withdrawal, what can be done to help?
you can switch nipples (nipple confusion = okay)
How should the baby be swaddled if they have NAS?
with their legs flexed
If the baby is withdrawing from cocaine, what should you avoid?
eye contact
What might the head of a baby with NAS look like?
large with a soft skull
What is important to assess in a baby with NAS and what interventions should be done?
RESPIRATORY (distress, apnea, periodic breathing)
- suction
- O2
- pulse ox
What babies are at a high risk for hypoglycemia?
- LGA
- SGA
- mom with gestational diabetes
- <37 weeks or >42 weeks
What blood glucose indicates hypoglycemia in a newborn?
< 40
How is hypoglycemia in a newborn treated?
- formula/breastfeed
- D5W or D10W (oral or IV)
What weight is considered LGA?
> 8 lbs 12 oz
What puts the baby at risk for shoulder dystocia, clavicle fracture, Erb-Duchenne paralysis, asphyxia, hypoglycemia, polycythemia, and c-section?
being LGA
What happens to the muscle tone of a baby with hypoglycemia?
flaccid, jittery, twitching
What happens to the muscles of a baby with LGA?
hypotonic, tremors
What causes acute bilirubin encephalopathy?
bilirubin in the brain
What does kernicterus result from?
chronic bilirubin toxicity
What can hyperbilirubinemia cause?
- hypoxia
- hypothermia
- hypoglycemia
- metabolic acidosis
What can happen if kernicterus is left untreated?
- hypertonic with backward arching of the neck and trunk
- high pitched cry
- fever
What should the baby wear for phototherapy?
- eye mask
- diaper or undressed
How often should you reposition and remove the baby during phototherapy?
reposition q 2 h, remove q 4 h
Can babies receiving phototherapy have water?
no, this can cause dehydration
Can babies receiving phototherapy use lotion/ointment?
NO
What is a non-serious complication of phototherapy?
bronze coloring or rash
What is it called when the bladder is outside the body?
exstrophy
What is it called when the pee hole is under the penis?
hypospadias
What is it called when the pee hole is on top of the penis?
epispadias
What is important to manage with GU tract abnormalities?
- respiratory status
- extrauterine circulation
- thermoregulation
What is important to assess with GU tract abnormalities?
the ability to take in and eliminate
How are GU tract abnormalities treated?
surgery
