Families Exam 2 Flashcards
1
Q
How often should you assess the mom’s BP and HR for the first 2 hours after birth?
A
q 15 mins
2
Q
How often should you assess the mom’s temp for the first 8 hours after birth?
A
q 4 hrs
3
Q
What temperature increase is normal in the mom for the first 24 hours after birth?
A
100.4
4
Q
What can a decreased BP and increased HR in the mom indicate after birth?
A
shock, bleeding
5
Q
How long after delivery does milk production begin?
A
3-5 days
6
Q
What should be assessed during the uterine assessment?
A
- fundal height
- uterine placement
- consistency
7
Q
What should the uterus feel like?
A
FIRM
8
Q
What should be done if a boggy uterus is assessed?
A
- fundal massage
- admin of oxytocin or methylergonovine
- breastfeeding (releases oxytocin)
9
Q
What can cause urinary retention in the mom after birth?
A
- loss of bladder elasticity
- meds/anesthesia
10
Q
What amount of urine output is normal for the mom for 2-3 days after birth?
A
> 3,000 mL
11
Q
How often should you assess the mom’s ability to void after birth?
A
q 2-3 hrs
12
Q
When is lochia rubra normal?
A
days 1-3
13
Q
When is lochia serosa normal?
A
days 4-10
14
Q
When is lochia alba normal?
A
days 10-28
15
Q
When should hemorrhage be suspected after birth?
A
if lochia is heavy with clots
16
Q
What does a first degree laceration tear through?
A
skin
17
Q
What does a second degree laceration tear through?
A
skin and mucles
18
Q
What does a third degree laceration tear through?
A
skin, muscles, and the external anal sphincter muscle
19
Q
What does a fourth degree laceration tear through?
A
skin, muscles, the external anal sphincter muscle, and the anterior rectal wall
20
Q
What is rooming in?
A
the baby’s crib is by the mother’s bed
21
Q
What can be used to help with lacerations?
A
- ice packs
- dermoplast spray
- sitz bath
- stool softener
22
Q
What should you assess for post-epidural?
A
- maternal hypotension
- fetal bradycardia
- return of sensation and motor control
23
Q
What can be used to help with hemorrhoids?
A
- sitz bath
- topical creams
- rectal suppositories
- witch hazel pads
24
Q
What happens to HCT after birth?
A
it decreases for 3-4 days and is back to normal by 8 weeks
25
What happens to WBC's after birth?
can be 20-25,000 within the first 4-7 days
26
How long does the taking-in phase last?
24-48 hours
27
Should you teach during the taking-in phase?
NO
28
How long does the taking-hold phase last?
day 2-3 and lasting 10 weeks
29
Should you teach during the taking-hold phase?
YES
30
What medication is given for PIH?
mag sulfate
31
After a vaginal birth, what amount of blood loss indicates post partum hemorrhage?
> 500 mL
32
After a c-section, what amount of blood indicates post partum hemorrhage?
> 1000 mL
33
What should be assessed when post partum hemorrhage is suspected?
- fundus
- bleeding
- bladder distention
34
What medications are given for post partum hemorrhage?
oxytocin or methylergonovine
35
What patient should methylergonovine not be given to?
a patient with HTN
36
What should be assessed when there are lacerations/hematomas?
- lochia
- pain
- source of bleeding
- VS
- vulva/perineum/rectum
- hemodynamic status
37
What problems can occur from a hematoma?
urge to defecate and difficulty voiding
38
How long should a mom breastfeed for to prevent engorgement?
until breast is soft and completely empty
39
How many times a day should a mom nurse?
8-12
40
When should you warm the breasts?
before breastfeeding
41
When should you cool the breasts?
after breastfeeding
42
What does the lochia look like with endometritis?
dark and profuse
43
Does endometritis affect the baby?
NO
44
What happens to the uterus with endometritis?
tender and enlarged
45
What happens to the breast with mastitis?
it is painful/tender with a localized hard mass and reddened area
46
Should you stop breastfeeding if experiencing mastitis?
NO
47
What side should you start feeding on with mastitis?
the unaffected side
48
What characteristics of the urine indicate UTI?
- cloudy
- blood-tinged
- malodorous
- sediment visible
- retention
49
What urine specimen is done when testing for UTI?
clean catch
50
What medication is given for vulvovaginitis?
metronidazole
51
What can happen to the neonate if the mom has vulvovaginitis?
- preterm birth
- LBW
- infection
- miscarriage
52
What characteristics does discharge have with vulvovaginitis?
thick and white
53
What characteristics does discharge have with gonorrhea?
yellow- green
54
What risks does gonorrhea have to the neonate?
- blindness
- transmission
55
How long is postpartum blues normal?
up to 10 days
56
When is it considered post partum depression?
if symptoms increase after 10 days of post partum blues
57
What is the biggest risk for those with postpartum depression?
rejection/harm to the infant
58
What medication is given to the mom and baby for HIV?
retrovir
59
What should be encouraged to a pregnant mom with HIV?
Hep B, pneumonia, and flu vaccines
60
What should be done at birth to an infant born to a mom with HIV?
BATH
61
What is normal when first starting to breastfeed?
cramping
62
Hand to mouth/hand, rooting, and sucking are infant cues for what?
hunger
63
Slow sucking, soft breasts, and a sleeping baby are infant cues for what?
satisfaction
64
When should you burp the baby?
when alternating breasts
65
What position should you place the baby in after feeding?
on their back
66
How should you help flat/inverted nipples?
- roll them in your fingers prior to feeding
- wear a breast shield in between feedings
67
How should you help sore/irritated/cracked nipples?
- breast milk, air dry
- breast creams
68
What type of bra should a breastfeeding mom wear?
well-fitting, supportive
69
What type of bra should a non-breastfeeding mom wear?
tight-fitting
70
If a non-breastfeeding mom experiences engorgement, what can be done?
cold compress = fresh cold cabbage leaves in bra
71
Why is the basal body temp contraception method not reliable?
other variables can change temperture
72
When should you take your temperature if using the basal body temp contraception method?
before getting out of bed in the morning
73
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
74
What should you do before inserting the diaphragm?
empty bladder
75
What should the diaphragm be washed with?
mild soap and warm water
76
What type of barrier method requires a prescription and a visit to a provider?
diaphragm
77
What are the main side effects of combined and progestin-only birth controls?
- HA
- N/V
- breast tenderness
- breakthrough bleeding
78
What hormonal contraceptive is safe when breastfeeding?
progestin-only (minipill)
79
What does the emergency oral contraceptive do?
prevents fertilization
80
How often are injectable progestins given?
4x/year, q 11-13 weeks
81
What hormonal contraceptive does not impair lactation?
injectable progestins
82
How long is fertility delayed after discontinuing injectable progestins?
up to 18 months
83
How is the vaginal ring beneficial?
vaginal delivery of hormones means lower doses and less adverse effects
84
What method of contraception can cause discomfort during intercourse?
vaginal ring
85
How long are implantable progestins effective for?
3 years
86
What contraceptive methods can be used/inserted immediately after an abortion, miscarriage, birth, and while breastfeeding?
IUD and implantable progestins
87
How long is an IUD effective for?
1-10 years
88
What surgery can be done within 24-48 hours after childbirth?
female sterilization
89
Do female and male sterilization affect sexual function?
NO
90
What does a hysterosalpingography assess?
patency of the fallopian tubes
91
What are the contraindications of hysterosalpingography?
seafood and iodine allergy
92
What order should suction or the baby be done in?
mouth and then nose
93
What is considered bradypnea in a newborn?
< 30/min
94
What is considered tachypnea in a newborn?
> 60/min
95
When does the foramen ovale go away?
within a few minutes
96
When does the ductus arteriosus go away?
within a few hours
97
When do the umbilical vein and ductus venosus go away?
within a few days
98
Where is normal PMI in a newborn?
5th intercostal space
99
What does a normal umbilical cord have?
1 vein and 2 arteries
100
What should be assessed when looking at the fontanels?
- size
- presence
- fullness
- bulge
101
How big should a newborn's head be?
2-3 cm longer than the chest
102
What should fontanels feel/look like?
soft and flat
103
What shape is the anterior fontanel, and when does it close?
diamond-shaped, closes in 12-18 months
104
What shape is the posterior fontanel, and when does is close?
triangle-shaped, closes in 6-8 weeks
105
What characteristic of fontanels can indicate increased ICP, infection, and hemorrhage?
bulging
106
What characteristic of fontanels can indicate dehydration?
depressed
107
What is caput succedaneum?
swelling of the soft tissue of the scalp due to pressure on the head during labor
108
How long does it take for caput succedaneum to heal?
3-4 days
109
What is cephalohematoma?
collection of blood in the head
110
When can cephalohematoma appear, and how long does it take to resolve?
appears 1-2 days after birth, resolves in 2-3 weeks
111
What can low-set ears indicate?
a chromosomal abnormality or kidney disorder
112
What can excessive saliva indicate?
tracheoesophageal fistula
113
What are epstein's pearls?
expected small, white cysts
114
What can a protruding tongue indicate?
down syndrome
115
What can the absence of head control indicate?
prematurity or down syndrome
116
When should meconium and urine be passed in a newborn?
within 24 hours
117
What should RR be in a newborn?
30-60/min with short (<15 sec) periods of apnea during sleep
118
What should HR be in a newborn?
110-160
119
What should BP be in a newborn and where should it be taken?
60-80/40-50 on the lower leg
120
How should BP be taken before discharge?
on all 4 extremities
121
What is a normal temp for a newborn?
97.7-99.5
122
What is a normal weight for a newborn?
5.5-8.8 lbs
123
What is normal length for a newborn?
18-22 inches
124
What is a normal head circumference for a newborn?
12.6-14.5 inches
125
What is a normal chest circumference for a newborn?
12-13 inches
126
What are milia?
small, raised, white spots (chin, nose, forehead)
127
What are mongolian spots?
bluish-purple spots
128
What are telangiectatic nevi?
flat pink/red marks that blanch and fade
129
What are nevus flammeus?
capillary angiomas that do not blanch or fade
130
What is erythema toxicum?
pink rash that appears during the first 3 weeks
131
What is vernis caseosa?
thick, cheese-like protective covering
132
What is lanugo?
fine, downy hair (pinnas, forehead, shoulders)
133
What is the sucking and rooting reflex?
the infant turns its head to the side that is touched and starts sucking
134
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
135
What reflex causes the baby to extend and abduct its arms at the elbows and fingers to form a "c"?
the moro reflex
136
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
137
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
138
What happens to the toes with the babinski reflex?
they fan up and out when the sole of the foot is stroked
139
What is the stepping reflex?
holding the baby upright and touching their feet to a flat surface should make them step
140
When does the sucking and rooting reflex occur?
from 3/4 months to a year
141
When does the palmar grasp reflex occur?
3-4 months
142
When does the plantar grasp reflex occur?
from birth to 8 months
143
When does the moro reflex occur?
from birth to 6 months
144
When does the tonic neck reflex occur?
from birth to 3/4 months
145
When does the babinski reflex occur?
from birth to 1 year
146
When does the stepping reflex occur?
from birth to 4 weeks
147
What do you want the Apgar score to be?
7-10
148
What does the Apgar score consist of?
- HR
- RR
- muscle tone
- reflex irritability
- color
149
What blood should you collect at delivery?
cord blood
150
Where should a heel stick be done?
outer aspect
151
What should you do to the heel before sticking it?
warm it
152
How deep can you go for a heel stick?
no deeper than 2.4mm
153
How can a baby's discomfort be decreased during a heel stick?
breastfeeding or skin-to-skin contact
154
What has to be done before a heel stick and PKU testing?
formula or breast milk for 24 hours
155
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
156
What part of the mouth should you avoid when bulb suctioning?
the center (gag)
157
What med prevents bleeding in newborns before it is naturally made in their body?
vitamin K
158
How long does it take for vitamin K to be produced by the body?
1 week
159
What procedure should not be done if vitamin K is denied at birth?
circumcision
160
When are Hep B immunizations given to a baby born to a mom WITHOUT Hep B?
- birth
- 1 month
- 6 months
161
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
162
What 2 things should not be given in the same leg?
Hep B vaccine and Vitamin K
163
Why is erythromycin ointment given?
prophylactic to prevent blindness
164
How long is the umbilical cord clamped for?
24-48 hours
165
What should you assess the stump and base of the umbilical cord for?
- drainage
- edema
- erythema
166
What cannot be done until the umbilical cord falls off?
tub bath
167
What does temperature have to be stabilized to for bathing to start?
97.7
168
When should a sponge bath be done after birth?
- 1-2 hours after
- until cord falls off and circumcision heals
169
What should the bath water be at?
100.4
170
Is tap water okay when bottle feeding?
yes
171
How long can formula be refrigerated?
48 hours
172
What angle should the baby be held at when bottle feeding?
45 degrees
173
How long can breast milk be stored at room temp?
8 hours
174
How long can breast milk be stored in the fridge?
8 days
175
How long can breast milk be stored in the freezer?
6 months
176
How long can breast milk be stored in the deep freezer?
12 months
177
How long should breast milk be thawed in the fridge?
24 hours
178
Can you refreeze or microwave breastmilk?
NO
179
How much weight is lost after birth?
5-10%
180
When is weight regained?
in 10-14 days
181
How much weight do babies gain per week for the first 3 months?
110-200g
182
What newborn temperatures should be reported to the provider?
- > 100.4
- < 97.9
183
What should you use to clean after a circumcision?
warm water
184
What cannot be used to clean after a circumcision?
alcohol wipes
185
What should you watch for after a circumcision?
- bleeding
- cold stress
- hemorrhage
- infection
- unable to void
186
How long should a baby be in a rear facing carseat?
2 years
187
What should the chest clip of a carseat be level with?
axilla
188
If the baby is having poor feeding from withdrawal, what can be done to help?
you can switch nipples (nipple confusion = okay)
189
How should the baby be swaddled if they have NAS?
with their legs flexed
190
If the baby is withdrawing from cocaine, what should you avoid?
eye contact
191
What might the head of a baby with NAS look like?
large with a soft skull
192
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
193
What babies are at a high risk for hypoglycemia?
- LGA
- SGA
- mom with gestational diabetes
- <37 weeks or >42 weeks
194
What blood glucose indicates hypoglycemia in a newborn?
< 40
195
How is hypoglycemia in a newborn treated?
- formula/breastfeed
- D5W or D10W (oral or IV)
196
What weight is considered LGA?
> 8 lbs 12 oz
197
What puts the baby at risk for shoulder dystocia, clavicle fracture, Erb-Duchenne paralysis, asphyxia, hypoglycemia, polycythemia, and c-section?
being LGA
198
What happens to the muscle tone of a baby with hypoglycemia?
flaccid, jittery, twitching
199
What happens to the muscles of a baby with LGA?
hypotonic, tremors
200
What causes acute bilirubin encephalopathy?
bilirubin in the brain
201
What does kernicterus result from?
chronic bilirubin toxicity
202
What can hyperbilirubinemia cause?
- hypoxia
- hypothermia
- hypoglycemia
- metabolic acidosis
203
What can happen if kernicterus is left untreated?
- hypertonic with backward arching of the neck and trunk
- high pitched cry
- fever
204
What should the baby wear for phototherapy?
- eye mask
- diaper or undressed
205
How often should you reposition and remove the baby during phototherapy?
reposition q 2 h, remove q 4 h
206
Can babies receiving phototherapy have water?
no, this can cause dehydration
207
Can babies receiving phototherapy use lotion/ointment?
NO
208
What is a non-serious complication of phototherapy?
bronze coloring or rash
209
What is it called when the bladder is outside the body?
exstrophy
210
What is it called when the pee hole is under the penis?
hypospadias
211
What is it called when the pee hole is on top of the penis?
epispadias
212
What is important to manage with GU tract abnormalities?
- respiratory status
- extrauterine circulation
- thermoregulation
213
What is important to assess with GU tract abnormalities?
the ability to take in and eliminate
214
How are GU tract abnormalities treated?
surgery
