Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NSPN 7100 > Final > Flashcards

Final Flashcards

1
Q

What does specialty nursing require?

A

commitment to praxis: knowing, being, doing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What processes are required for specialty nursing care?

A

grounded in relationship centered praxis:

professionalism
creative leadership

partnership
communication

systemic inquiry
collaboration

critical thinking

involves integrating nursing ethics!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where does relationship centered praxis come from?

A

from our values/beliefs attained via personal experiences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Can you think of a situation from your own nursing practice where your relationship with your client/patient made a difference in providing care and/or enhanced health promotion?

A

From caring for the same patient over a span of three days straight I was able to build a therapeutic relationship with the patient and gain a better understanding of their hospitalization experience. From building this relationship with my patient, my patient really valued what I taught and took action. E.G. Educated the patient on mobilizing, patient motivated and instantly got up to mobilize.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is perinatal nursing?

4

A

specialty

timeline: pregnant, L&D, up to d/c

family-centered: women, newborn, family as a whole within the context of their lives/environment

*more specifically women-focused care (because at center of each child-bearing relationship is a woman)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do families/communities impact the women that we care for?

A

it is the social context in which women live in

alters attitude/accessibility to HC/relationships with HCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is neonatal nursing?

A

specialty

involves care for: neonate/infant (preterm/ill) up to 1 year, family

timeline: birth, hospitalization, d/c & follow up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hx of maternity nursing

A

Early 20th century: birth transitioning from midwifery to hospital d/t high mortality rates of mom/baby

analgesics & separate rooms for L&D/nursery/decreased BF
were hospitalized up to 14 days
treated women as if they were sick

1960-1970’s: ICEA lobbied for changes
women’s movement also more powerful at this time

Family centered care model evolved & integrated into practice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When was positive pressure mechanical ventilation created

A

1970s

forever changed practice of the NICU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Two important aspect of neonatal nursing

A

1) characteristics of infants are considered (how they interpret/interact with environment)
2) physical/psychological growth & development is appreciated, influences of context on the infants vulnerability is considered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

disadvantages of maternity care in Canada

A

Unequal in accessibility (rural areas, aboriginals)

Shortage of HCPs

Limited provinces offer midwifery care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How to fix these disadvantages?

A

2005: “Multidisciplinary Collaborative Maternity Care Project”
- addresses shortage of HCPs

2006: SOGC initiated “A National Birthing Strategy for Canada”
- goal is to improve maternity care in rural areas

Perinatal Services BC
- to develop regionalization of perinatal care in BC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

4 aspects of nursing care central to relationship centered praxis

A

Communication and collaboration

Education, information and informed consent

Support and advocacy

Nursing ethics: relationships and care

C-ESN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is communication

3

A

written, verbal and non-verbal

meanings exchanged among individuals to come to mutual understanding

basis for forming partnerships

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does collaboration involve

A

respecting choices

informed decision making (capacity/comprehension)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what should informed consent include

A

Explain situation

Description of recommendations (care, test, procedure)

Common risks/benefits

Alternative options

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Support/Advocacy

A

To not just care for a women, but to be there with her in our caring.

Presence

Should provide: physical/emotional/informational support, adovacy (interpret wishes to others)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Can you think of a situation where the focus of care may not be clear and even present a moral dilemma for the caregiver?

A

If parents chose to have the baby terminated after finding out the baby has a disability. It would be difficult to set aside own beliefs/values.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Example of ethical practice

A

Nurse who is working in the intrapartum setting with a woman who has requested no analgesics for her labor. Morally, good nursing care respects this decision and works with the woman using non‑pharmacological methods to help her with her labor, and supports her in trying to realize her wishes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

8 CNA code of ethics

A 
safe, competent, ethical care
health & well being
choice
dignity
confidentiality/privacy
justice
accountability
quality practice environments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why was family/women-centered care created

A

To get away from the medical model (sedative, partner absent for birth, neonates separated from parents)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is family centered care?

A

Process of providing safe, skilled, and individualized care that responds to the psycho social needs of the woman and her family

pregnancy/L&D normal health events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

factors impacting family centered care

A

Environment: e.g. separate birthing units/pp units

Collaboration between HCP e.g. anesthetist, doulas, lactation consultant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What definition of family best fits your family?

A

The family is a group of two + who are joined together by bonds of sharing and emotional closeness and who identify themselves as being part of the family (Friedman, 1992).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Can you think of families who may disagree with this definition?

A

Individuals who believe that anyone who is “blood” is family… no matter how close you are or the bond that you share.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

common themes in family definitions

A

Concern for the well-being of family members is common to all of the definitions. (Use different words)

Beutler et al. (generational ties) and Stewart (future obligation) both refer to a time factor.

Friedman, Hanson et al., and Stewart all suggest that there is an element of family membership which is self-defined.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How does Davies view family?

A

Davies seems to view families as including children and their parents. This is commonly referred to as a “nuclear” family form. We could refer to these families as “childbearing.”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Developmental theories

A

families/individuals go through series of predictable stages of change over time

e.g. Erikson- childs emotional development
Piaget- childs cognitive development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Duvall

A

Focuses on the changes that families go through over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Duvalls 8 stages:

A 
I	Married couples 
II	Childbearing families
III	Families with pre-school children
IV	Families with school children
V	Families with teenagers
VI	Families launching young adults 
VII	Middle-aged parents
VIII	Aging family members

For each stage there is a developmental task that needs to be completed!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Duvalls 2 developmental tasks for childbearing families

A

1) realizing the child really exists
- accepting new/added responsibility
- orienting to parent role
- begin bonding with child

2)adjusting family life to incorporate new baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Duvalls developmental task for preschool/school-aged children

A

pre-school: to socialize/nurture children

School-aged: to promote success in school

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

5 tasks for ALL stages

A

physical maintenance

division of labor

allocation of resources

socialization

reproduction, recruitment, and release of family members.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How might families today relate to Duvalls 8 stages

A

Alot of families will not clearly fit into one of the 8 stages.
(single parent families, blended families, younger/older parents)

Depending on family you could say that they are working on a variety of stages at the moment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How might families today relate to the 5 tasks Duval states is relevant to EACH stage

A

Most families relate to the 5 tasks relevant for each stage

However, they may implement them differently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How might Betty Davies describe families today

A

(believes families are subject to change over time!)

Believes families are resilient

Believes that when families are given challenges, if they have the appropriate support/resources they will work through it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

6 factors influencing parental behaviour

Merenstein/Gardner

A

personality
personal experience

previous parenting
cultural background

the degree of attachment to the infant
the expectations the parents have of themselves/infant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

7 Factors associated with stress/role strain (Kenner)

A

role ambiguity (i.e. single parents, unsure of who father is)
conflict (i.e. being torn between being a teenager/mom)
incongruity

overload (i.e. returning to work, supportive partner?, birth of twins)
underload

over qualification
under qualification (i.e. young mothers, not enough life experience)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

benefits of support during labour

A

research states it is associated with:

shorter labors
decreased use of oxytocin
fewer operative births/cesarean sections
and a higher rate of satisfaction for the mother

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

5 aspects of supportive care

A

emotional support
advocacy

comfort measures
supporting the husband/partner

offer information/advice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How long should BF be implemented for

A

exlusively for 6m

then continued for 2 years while introducing other foods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

3 fetal periods

A

pre-embryonic (0-2)
embryonic (2-8)
fetal (9-term)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

pre-embryonic period

0-2weeks

A

conception to implantation

fertilized egg differentiates into specialized cells, travels down fallopian tubes & implants in uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

embryonic period

2-8weeks

A 
rapid G&D occurs
organogenesis
heart starts beating
rapid brain G&D
arms/legs develop joints
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

fetal period

9weeks-Term

A

By week 14 placenta formed & functioning
organogenesis continues
major increase in size/weight in last 10-12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

When does the placenta begin to develop

when is it structurally complete?

A

first week after conception

complete after 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

normal amount of amniotic fluid at term

A

800-1200

2000 HIGH- d/t GI/fetal anomalies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

When does the embryos heart start beating?

A

day 17 after conception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the 4 hormones that the placenta produces?

A

Estrogen
Progesterone
Human chorionic gonadotrophin
Human placental lactogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What does Estrogen do?

3

A

increases uterine growth
increases placental blood flow

increases glandular tissue in breast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What does progesterone do?

4

A

maintains endometrium
decreases contractility of the uterus

increases production of breast alveoli
increases maternal metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What does human chorionic gonadotrophin do?

A

aids function of the corpus luteum (making sure continued supply of hormones to maintain pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What does human placental lactogen do?

3

A

stimulates the maternal metabolism to supply nutrients for fetal growth

increases maternal resistance to insulin, and facilitates glucose transport across the placental membrane

stimulates breast development in preparation for lactation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

4 metabolic functions of the placenta

A

excretion
nutrition
storage
respiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

fetal vs. maternal side of placenta

A

Fetal side:
smooth/shiny/bluish­purple, with veins branching out from the umbilical cord (like tree roots).

Maternal side:
rough/gritty/red, looks like a liver, contains 15-20 cotyledons, sometimes has grey/white calcium deposits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

5 key features of fetal circulation

A

fetal oxygen needs are relatively low

the placenta is the organ of gas exchange

the fetal lungs are collapsed and fluid filled

the fetal brain and heart have the highest oxygen needs.

right-to-left shunting occurs through the ductus arteriosus and foramen ovale.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

explain what is meant by the fetus exists in a state of relative hypoxemia

A

the PO2 of the fetus is only 30, which would cause hypoxia in the extra-uterine life.

PO2 of 30 sufficient inutero- zero hypoxia

O2 needs low because maternal system conducts many O2 using functions such as metabolism/digestion/thermoregulation, and zero ventilation is occurring.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

effect of low PO2 on the ductus arteriousus/pulmonary arteries

A

Results in pulmonary vasoconstriction and causes dilation of the ductus arteriousus.

This pulmonary vasoconstriction leads to increased pulmonary vascular resistance, high pulmonary artery pressure, right­to­left shunting, and pulmonary hypoperfusion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Does the R or L ventricle have more pressure?

A

The right ventricle — because it is pumping blood to collapsed, fluid-filled, vasoconstricted lungs — is experiencing higher pressure than the left ventricle which is pumping blood to the low pressure placenta.

*blood always flows in a path of least resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How does an increased PO2 impact adaptation

A

leads to pulmonary vasodilation
ductus arteriousus closes
L to R shunting d/t pressure change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What occurs with perinatal asyphyxia

A

blood shunted to heart/brain

all organs eventually become hypoxic

metabolic acidosis occurs

combo of acidosis/hypoxia results in cardiac/resp depression

low apgar score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

effects of benzodiazepines during pregnany

A

risk of cleft lip/palate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

effects of acutane during pregnancy

A

structural/sensory damage (neck&cranial region)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

effects of aspirin during pregnancy

A

risk of abruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

effects of ibuprofen during pregnancy

A

can cause closure of the ductus arteriosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

effects of cocaine during pregnancy

A

urinary tract defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

effects of alcohol during pregnancy

A

skeletal abnormalities, heart defects, cleft palate, vision/hearing problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

causes of low birth weight

A

preterm

IUGR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

two types of IUGR

A

hypoplastic: early in gestation, decrease in number of cells, small head/body, symmetrical
hypotrophic: later in gestation, decrease in size of cells, big head/small body, asymmetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

SGA maternal causes

A

PIH (decreased blood flow to placenta)
malnutrition
maternal drug use (decreased blood flow to placenta)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

SGA intrauterine causes:

A

placenta previa (decreased perfusion of nutrients d/t improper implantation of placenta)

small placenta (decreased perfusion)

teratogens (inhibit fetal growth)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

SGA fetal causes

A

genetic defects resulting in decreased growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

preterm risk factors

A

maternal medical/past-preg hx
diabetes
HTN
renal disease

abortion
pre-term birth
uterine abnormalities

current preg hx
multiple gestation
placenta previa/abruption
abd. surgery
febrile illness

socioeconomic factors: single, poor, lack of education

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Why are preterm infants more at risk for hypothermia?

A 
less brown fat
less subcutaneous tissue
immature CNS-> inadequate temp. regulation
fewer nutrient stores
thinner skin

etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

what does surfactant do?

A

prevents alveoli from collapsing

preterm infants have less surfactant resulting in atelectasis/increased work of breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

F&E imbalances in preterm infants

A

increased total body water (80–85% of body weight).
increased extracellular water.

immature renal function.

++ Water losses d/t:
skin immaturity (evaporation)
increased body SA: body mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

why is absorption of protein/fat/carbs in the GI tract difficult for preterm infants

A

Feeding:
unable to coordinate sucking/ swallowing/ & breathing
impaired gag/cough reflexes

GI tract:
impaired cardiac sphincter-> gastroesophageal reflux

delayed gastric emptying

incompetent ileocecal valve

impaired rectosphincteric reflec.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Why is it difficult for preterm infants to deal with fluid overload/restriction

A

Overload: kidneys immature, so low GFR, unable to filter extra fluid

Restriction: immature kidneys cannot concentrate urine, water not easily reabsorbed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

what are post-term infants at risk for?

A 
asphyxia
meccnium aspiration syndrome
dysmaturity syndrome
hypoglycemia
polycythemia
respiratory distress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q 
pre-mature
late preterm
term
post-term
post mature
A

pre-mature: 42

post mature: >42 with S&S of placental insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

fetal/maternal blood exchange

A

NO mixing of blood unless break in cell membranes

O2/nutrients/toxins go through “sieve” aka cell membranes that line the outside of the chorionic villi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Fetal circulation adaptations

A 
organ of gas exchange lungs
PO2 60-80
CO2 50
Low pulmonary resistance
High systemic resistance
L to R shunting/pressure gradient
Forman ovale closes
Ductus arteriosus closes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Fetal assessment

5

A 
FHR
fetal movement
palpation
fetal growth
gestational age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

When can women offer preconception education to child-bearing women?

A

Public health nurses

Anytime in contact with child-bearing women

Visiting school nurse i.e. sex education

Perinatal nurses i.e. healthy eating, lifestyle choices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

low birth weight

A

1500-2499

very low if <1500 (100x mortality)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

dietary consideration

A

folic acid/folate (0.4) reduces NTD
Iron (16-20) for RBC producion
Fish for omega3 (150g)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

why are pregnant women more at risk for anemia

A

increase in circulating volume when pregnant, specifically plasma. Increase in RBC is not as great as plasma, and d/t low hgb/hct at risk for anemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

optimal weight gain

A

6.8-18.2kg

or 0.4kg/week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

recommendations for vegetarians

A

Increase calories

Take Vit B12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

3 positive signs of pregnancy

A

Visualization of the fetus by ultrasound

auscultation of fetal heart tones

palpation or visualization of fetal movement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

4 signs of pregnancy often noted by women

A

Fatigue
nausea
breast tenderness or tingling
urinary frequency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

When would supine hypotension occur?

A

2nd trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What is the couvade syndrome

A

When men experience S&S of pregnancy such as stress, weight gain, N&V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

what does antenatal care include?

A 
pre-conception counselling
assessing risk factors
assessment of fetus/complications
educate
birth care options
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

How often should parents have Dr. appointments?

A

seen first within 12w of LMP
then q4-6w until 30w
then q2-3w until 36
then qweek

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Benefits of birth plans

A

communication tool for parents

good for when nurses switch during breaks/shift change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Disadvantages of birth plan

A

it is an ideal plan and if things dont go as planned it can cause dissapointment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Difference between breast feeding and breast milk feeding?

A

breast milk feeding does not promote bonding

does not stimulate release of hormones via skin-to-skin/suckling (Critical for maintaining breastfeeding)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

when does lightening occur?

A

between weeks 38-40

fundus drops as fetus descends into the bony pelvis

AKA “the fetus is engaged”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

operculum

A

mucus plug formed in cervix

when plug loosens, tiny blood vessels may become torn aka “bloody show”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

How to confirm PROM

A

either a nitrazine test (for pH)
or ferning test (glass slide shows fern)
VE avoided d/t risk for infection/injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

management criteria for prom

A

afebrile
normal FHR

engaged fetus
<18h labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

True vs. False labour

A

contractions of true:
regular, increase in freq/intensity, continue in despite of comfort measure, more intense with activity

false: decrease with activity, decrease with comfort measures

cervix in true labour: softens/effaces/dialtes, bloody show, anterior position

false: soft, no effacement/dilation, posterior position

fetus in true labour: PP engaged

false labour: not well engaged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Parity

A

number of pregnancies carried to stage of fetal viability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

fetal viability

A

capacity of fetus to live outside of uterus

22-25 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Nullipara
Multipara
Primipara

A

not completed any pregnancies to stage of viablity

carried multiple pregnancies to stage of viability

carried one pregnancy to stage of viability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

gravida

also can be Nul/Primi/Multi

A

of pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What is the presentation of a fetus?

A

part of fetus that enters pelvic inlet first

3 types: cephalic, breech, vertex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What is the position of a fetus?

A

relationship of the PP to the four quadrants of mothers pelvis

can be:
Left/Right
Occiput/Sacrum
Anterior/posterior/tranverse

i.e. LOA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What is the lie of a fetus?

A

relationship of the spine of fetus to spine of mother

can be longitudinal (vertical) /horizontal (transverse)/oblique

111
Q

What is the attitude of the fetus?

A

relationship of fetus body parts to each other

i.e. flexed, extended, deflexed

112
Q

What is the presenting part?

A

Part of fetus felt first during vaginal exam

113
Q

cephalic presentation

A

head first

114
Q

vertex presentation

A

occiput first

115
Q

breech presentation

A

buttocks first

116
Q

5 P’s of L&D

A 
Passenger
Passage
Position
Power
Psychological factors
117
Q

Posterior/Anterior fontanelle closure

A

Posterior: 6-8w, triangle

Anterior: 18m, diamond

118
Q

6 bones of fetal skull

A

two temporal
two parietal
occipital
frontal

119
Q

What suture connects the anterior/posterior fontanelle?

A

sagittal suture

120
Q

What is the diameter of the head when it is flexed?

What happens to diameters when not flexed?

A

there are two diameters:

1) biparietal (transverse)= 9.25 cm
2) suboccipitobregmatic (anteroposterior)=narrowest part of head

when not well flexed suboccipitobregmatic diameter widens

121
Q

What are the 4 bones in the pelvis?

A

ischium
ilium
pubic bone
sacrum

*all fused together

122
Q

what are the 4 joints in the pelvis?

A

symphysis pubis
R/L sacroiliac joints
sacrococcygeal joint

123
Q

3 cavities of the pelvis

A

inlet
mid pelvis
outlet

124
Q

Where are the ischial tuberosities found?

A

on the outlet of the pelvis

125
Q

most common type of pelvis

A

gynecoid

126
Q

gynecoid vs. android pelvis

A

gynecoid brim is round, android heart shaped

gynecoid cavity wider, android narrower diameter

gynecoid sacrum is deep/curved, android is straight and beak-like

gynecoid favorable for birth, android results in delayed L&D/assisted birth

127
Q

what tissues are found in the soft pelvis?

A

lower uterine segment, the pelvic floor muscles, the vagina, and the introitus.

128
Q

what is the Ferguson reflex?

A

the urge to push

129
Q

what will decrease contractions in early labour?

A

1) narcotics
2) water therapy
3) epidural analgesia

130
Q

advantages of changing positions in labour?

A

increase comfort
increase circulation
relieve fatigue
gravity

131
Q

Most common birthing positions

A

semirecumbant
side lying
squatting
lithotomy

132
Q

7 cardinal movements in L&D

A 
(Occurs in first stage of labour)
Engagement
Flexion
Descent
Internal rotation

(Occurs in second stage of labour)
Extension
Resituation and external rotation
Explusion

133
Q

4 stages of labour

A

First stage (latent/active/transition)

Second stage (passive/active)

Third stage stage

Fourth

134
Q

Times included on partogram

A 
onset of labour (contractions Q5m)
rupture of membranes
10 cm dilation
pushing commenced
birth of baby
apgar scores (1min/5min/10min)
birth of placenta
135
Q

when to start partogram

A

recommended during active phase of labour (4-7cm)

136
Q

when does SROM occur?

A

usually in transition stage of labour (7-10cm)

137
Q

When does ARM usually have to be done?

A

second stage of labour

passive/active pushing

138
Q

what can occur if membranes not ruptured?

A

caul birth

born with amniotic sac

139
Q

When should 1:1 nursing be commenced?

A

in active phase (4-7cm)

140
Q

Peri-natal nurse assessment for pt. who just arrived at hospital

A 
assess contractions
cervical changes
fetal descent (VE)
leopolds maneuvers
fetal well-being
141
Q

how to assess contractions

A

palpate (preferred)
EFM (not good for strength)
IUPC (last resort d/t ++ invasive

strength/duration/freq

142
Q

How to assess cervical changes

A

VE in dorsal position

assessing: effacement/dilation/membrane status
fetal position/station/PP/caput&molding

  • be careful not to rupture membranes! to nitrazine/ferning test before to see if ruptured
143
Q

How often should FHR be assessed?

A

every 15-30mins in first (active) stage

every 5 mins in second stage

144
Q

benefits of entonox

A

self-administered
rapidly excreted- minimal side effects
portable

145
Q

choices of narcotics

A

Morphine IM for first time moms
Demerol if ALRG to morphine
Fentanyl for multiparous women d/t short acting

146
Q

disadvantages of narcotics

A

half life longer in fetal system d/t immature system so can cause side effects (it crosses the placental-blood barriers)

should set up rescuitation equipment if administered close to birth (Narcan)

147
Q

Demerol vs. Morphine

A

no detectable morphine in umbilical cord after 3h d/t no active metabolites

demeral active metabolites remains in system for longer

148
Q

when can an epidural be used?

A

> 3cm

149
Q

disadvantages of epidural

A 
slower progression
higher risk of c-section
decreased mobility
at risk for nerve injury
requires IV fluids
risk for infection

etc.

150
Q

narcotic scenarios

A

review in module 5A!

151
Q

What to do if couple in second stage of labour, actively pushing, first baby, attached to EFM, coping well.

Dr. wants to do vacuum assisted birth, mom tired but still pushing well. What would you do?

A
  • detach women from EFM, and change positions? (i.e. gravity enhancing positions)
  • educate re: ferguson reflex and tell mom to only push when she has an urge

-tell Dr. to wait if mom is still coping

152
Q

What to do if cord wrapped around neck?

A

coach mom to pant until cord cut

153
Q

Risk for mom in stage 3 of labour.

How to prevent?

A

PPH
(hemostasis/involution do not occur)

Administer uterotonic agents (Oxytocin IV/IM)

154
Q

S&S of detached placenta

A

firm fundus
gush of blood
lengthening umbilical cord
vaginal fullness on VE

155
Q

2 approaches to 3rd stage of labour

A

expectant care: don’t cut cord until stops pulsing, no oxytocin, placenta separated/delivered spontaneously

active care: cut/clamp cord, oxytocin, apply traction to cord until placenta delivered

156
Q

Two approaches for PROM

A

expectant management (wait for labour-> induce after 12-18h)

or

induce labour right away

157
Q

How to determine if cervix is ripe or not?

A

Bishop score! >8 for primigravida, >6 for multigravidas

  • effacement
  • dilation
  • station (head in relation to pelvis)
  • position of cervix (more anterior)
  • cervix softer to touch
158
Q

how is labour induced?

A

for unripe cervix, PE2 intra-vaginally OR amniotomy

for ripe cervix, oxytocin

159
Q
  1. You are working in the labor and birthing unit and receive a call from Lori. This is her first baby and she is 40 weeks pregnant. Lori tells you that her membranes have ruptured and wonders what she should do. What would you advise her?
A

Tell her to come to hospital for assessment, and bring underwear soaked in drainage so it can be assessed.

160
Q

assessments for rupture of membranes history

A
  • confirm rupture: assess discharge (amount, colour, smell, nitrazine/ferning test)
  • record time of rupture
  • Leopolds maneuver: to determine fetal lie, position, engagement of PP
  • FHR
  • presence of contractions: strength/duration/freq
  • Avoid VE unless maternal/fetal distress
161
Q

recommendations for caring for women who are in labour and membranes ruptured

A

assess for S&S of infection
prevent ascending ninfection (pericare, change pads)

assess drainage

Maternal temp/pulse Qhour
FHR Q15m

Limit VE

162
Q

Loris membranes ruptured 24 hours ago, she is now 8 cm, her temperature is 38°C, and the FHR 160. Have you concerns regarding the present clinical picture? Why?

A

Yes I would be concerned of chorioamnionitis (infection)

Look back at partogram to compare changes

Since Loris membranes have been ruptured for over 24 hours now, and there are indications of infection I would contact the Dr. to suggest inducing labour? (Oxytocin)

163
Q

List 3 concerns of ‘the passenger’ during L&D

A

macrosomia
deflexed head
malpresentation *any position that is not vertex (breech, brow, face, shoulder)
malposition

164
Q

Common malposition

S&S

A

occiput posterior

needs to be rotated into anterior position before birth

S&S: backache, prolonged labour, exhausted, uncoordination contrtaction

165
Q

Interventions for OP

A

positions for rotation: hands-knees, squat
oxytocin
epidural
assisted birth

166
Q

form of fetal head deflexion

A

asynclitism (head tilted to side, suture no midline)

results in wider skull diameter-> prolonged birth

167
Q

positions to facilitate rotation of fetus in second stage of labour

A

Squatting

The use of a birthing stool

The lateral lying position, upper leg held by labor supporter.

pushing on toilet (early second stage)

Water birth

168
Q

S&S of breech

A

Leopolds maneuver: head at top of abdomen, softer pp

Meconium drainage

VE: bulge of membranes, fetal toes/feet felt

169
Q

S&S of shoulder dystocia

Interventions

A

slow progress of L&D
caput formation
turtle sign
no external rotation

Interventions: BE CALM

170
Q

What is the mcRoberts maneuver

A

maneuver used for shoulder dystocia to enlarge to pelvic diameter

171
Q

after brachial plexus injury when should the infant be referred to neurologist

A

6-12 months

172
Q

BE CALM

A

for shoulder dystocia

Breathe/pant, do not push
Elevate legs into McRoberts position
Call for help
Apply suprapubic pressure (NOT fundal pressure)
Largen the vaginal opening via episiotomy
Maneuvers (Rubins)

173
Q

3 pelvic variations in labour

A

full bladder/bowel
small diameter
hx of cervical surgery

174
Q

Most common reason for C-section after onset of labour

A

Cephalopelvic disproportion (CPD) is the term used to describe fetal and pelvic alterations

e.g. head too big to fit through pelvis

175
Q

small pelvic diameter results in…

A

pelvic dystocia

zero engagement/descent, prolonged labour

176
Q

what is a rigid/edematous cervix

A

often result of cervical lip
often associated with OP

strong urge to push prior to 10cm due to PP forced onto lip leading to edema and increased resistance to dilation

177
Q

interventions for rigid cervix

A

manually place lip over PP, decrease pushing until lip absent, gravity enhancing position, epidural

178
Q

uterine actictivity

A

can be hypotonic (decrease in freq/strength/duration)

or hypertonic (uncoordinated- more than 5 contractions in 10 minutes or contractions lasting longer than 120 seconds)

179
Q

what can hypertonic uterus lead to

Interventions:

A

freq but inefficient contractions -> prolonged labour -> placental insufficiency-> fetal distress/placenta abruption

intervetions: decrease or stop Oxytocin

180
Q

what would you want to know if labour was not progressing?

A

changes in contractions?
changes in dilation/fetal descent?

what is hampering labour? (maternal/fetal factors)
maternal/fetal responses

Have the parents been updated on their progress?

181
Q

amniotomy

A

only performed if head engaged and when c-section can be performed

aka artifical rupture of membranes

first choice usually

182
Q

what is oxytocin

A

natural hormone secreted from. post pituitary

causes smooth muscles to contract

183
Q

3 vacuum assisted birth risks

A

maternal laceration
fetal scalp laceration
facial nerve palsies

184
Q

3 forceps assisted birth risks

A

bruising/lacerations at blade sites
fetal skull fracture
intracranial hemorrhage

185
Q

04.00 Vali, accompanied by her partner Doug, arrives at a very busy hospital birthing suite. Vali is 39 weeks pregnant with her first baby. She has had a healthy pregnancy and started having contractions six hours ago. She has not been able to sleep.

The admitting nurse does a full assessment of Vali and her fetus. The nurse finds the fetus in an LOA position and engaged. Contractions are every 8 minutes, lasting 40 seconds. VE reveals a cervix that is 2 cm dilated, 1.5cm long, and the presenting part at spines with the membranes intact. The FHR is normal. Also noted is that Vali is very tired and tearful and not handling her contractions well.

What care would you recommend for Vali at this time?

A

The assessment findings indicate that Vali is still in early labor. Although she is tired and finding contractions difficult to deal with the best recommendation for her at this time is discharge home until contractions are more frequent. Vali and Doug should be reassured that labor has commenced but is still early and offered suggestions for comfort techniques that will help in dealing with contractions. Suggestions may include various breathing techniques, bathing, or showers. The couple should also be given the telephone number of the birthing suite so they can call if they have any concerns or to verify that they should return to the hospital.

186
Q

The physician looking after Vali recommends a therapeutic sleep and orders 10 mg IM of Morphine. Vali is admitted to the birthing unit and given the prescribed Morphine. The EFM is attached to monitor the fetus.

06.00 The nurse doing assessments notes that Vali has managed to get some sleep. The EFM shows that contractions are now every 10 minutes, lasting 40 seconds and that the fetal heart is 130 with decreased variability. The nurse calls Dr. Jones to inform him of the decreased variability and the spacing of contractions. Dr. Jones says to continue monitoring and he will be in around 7 am.

What is your opinion of the care that has been given to this point?

A

Morphine should not have been ordered this early in labour, should have been offered other pain management options (entonox/non-pharmacological)

narcotics this early in labour (First stage-latent) will inhibit contractions, slow labour/FHR.

Does not require EFM monitoring… In this stage should only be monitored Q15m

187
Q

12.00 Dr. Jones returns to the unit to see how Vali is doing. Contractions are now 5–6 minutes apart, lasting 50 seconds, and palpate as moderate. VE finds the cervix to be 3 cm, 1cm long, and the presenting part at spines. The amniotic fluid draining is clear. Dr. Jones tells Vali and Doug that labor progress is slow and thinks that an oxytocin augment would be a good idea to speed up the labor progress. Since Vali is tired and finding it difficult to handle her labor, Dr. Jones recommends that Vali has an epidural prior to the oxytocin augmentation. Vali and Doug agree with their doctor’s recommendations.

Give your opinion on the above recommendations.

A

You may think that Dr. Jones is being a little hasty in his decision to offer more medical interventions. This is a time when the nurse should advocate for more time for Vali to labor without further interventions. Vali and Doug do not seem to be well involved with the decisions that are been made. Have they been informed of the risks and benefits involved for the interventions that have been suggested so far?

188
Q

Suggest some other approaches to care that may have facilitated a more normal birthing process

A

sending Vali home until labor is better established

not administering narcotics in early labor

not using the EFM for assessments after narcotic administration.

buying more time for Vali’s labor to become established before an ARM is performed.

using ambulation, labor enhancing positions, and lots of support and encouragement to help labor progress.

buying more time before an augmentation and epidural are considered.

189
Q

What interventions may impact c-section rates?

A

inducement
pain management
dystocia management
EFM

190
Q

What are some predictors of a positive birth experience for women?

A

awareness

being with baby within 1h

support

degree of control

191
Q

How long will it take to recover from c-section?

A

wait 8-10 weeks following cesarean section before resuming vigorous activity.

Generally woman should be advised that recovery from cesarean section takes longer than from vaginal birth, and that heavy lifting or physical exertion should be avoided for 6 weeks post partum.

192
Q

If mother says she doesnt know if she can do this again… what to say

A

provide resources for support/debriefing
educate re: VBAC (increasing success rate)
how multigravidas L&D often tens to be shorter than first time

193
Q

care for c-section after 24h

A

Joanne is 24 hours post-op which means her dressing, urinary catheter and IV can all be removed.

assess fundus
vaginal flow
incision
mobility

support skin to skin/BF
shower
reg diet

194
Q

if mom hesistant to BF after taking anaglesics (post-op c section)

A

educate re: benefits of taking medications (better able to care for infant when pain managed)

educate re: colostrum is in small quantity, so only small amount of medication will be passed to baby

educate re: research has shown no evidence of post-op pain meds having an impact on baby

195
Q

concern for VBAC

A 
uterine rupture: 
constant pain
no contractions
vag bleeding
blood in urine
maternal shock
abnormal FHR
196
Q

resp rate of newborn

A

30-60

shallow/irrreg/apnea may be present

197
Q

3 cardinal signs of resp distress

A

nasal flare
grunt
chest retractions

198
Q

APGAR

A 
Appearance
Pulse
Grimacing
Activity
Respirations
199
Q

factors stimulating newborn to take first breath

A

no placenta blood flow, cutting off PE2 which inhibits breathing

Chemical factors (low O2, high CO2, low pH) stimulating resp centre in brain

release of pressure off babies head stimulating resp center

release of pressure off of chest, allowing chest expansion

external stimuli stimulating resp center

200
Q

Sheena weighs 3.3 kg and is 39 weeks gestation. She was given positive pressure ventilation in the delivery room with 21% oxygen for several minutes before she began breathing on her own. Her one minute Apgar was 3. Her five minute Apgar was 9 and she has done well since she was admitted into your care. You have read her chart and the only remarkable information is that the amniotic membranes were ruptured for two weeks prior to delivery. Otherwise the pregnancy was normal.

What, if anything, are you concerned about? Think about Sheena’s gestational age, Apgar score, and antenatal history.

A

Sheena is a full-term AGA infant so there are no risks related to gestational age or her weight.

She had a low one-minute Apgar and for this reason she should be monitored for several hours to ensure that she does not develop problems associated with perinatal asphyxia.

The amniotic membranes were ruptured for two weeks prior to delivery, placing Sheena at risk for sepsis. Microorganisms may have ascended the birth canal and entered the amniotic fluid.

201
Q

how to assess gest. age

A

looking at 6 physical, 6 neurological features and rating degree of maturity for each one

should be done in conjunction with newborn assessment

202
Q

5 subsytems that newborns use to continuously interact with environment **

A

1) autonomic (resps/color/organs)
2) motor (tone/posture/movement)
3) state (alertness/consciousness)
4) interactive state (response to stimuli)
5) self-regulatory system (maintain homeostasis)

203
Q

6 basic states of infant

A

drowsy
light sleep
deep sleep

active alert
quiet alert
crying

204
Q

what is habituation

A

tuning out stimuli d/t overload & boredom

205
Q

when does baby start hearing us

characteristics of hearing

A

24w gestation

prefers familiar/high-pitched voices
sudden noise=startle
prolonged noise=habituation
gradual noise=alert state

206
Q

when is growth hormone secreted

A

in active sleep states

207
Q

newborn sight

A

The ability to fix, follow, and alert is present at birth and indicates a normal CNS. Infants can see best 810 inches away and at birth can see mother, as this is the cradle-in-arms distance. Infants prefer human faces, black and white, and patterned objects. They are sensitive to bright light. Color discrimination develops at around three months of age.

208
Q

Brazeltons assessment tool

A

contains 6 newborns abilities to assess newborn behaviors

1) habituation
2) orientation to sight/sound stimuli
3) motor control/coord
4) responsiveness
5) state regulation
6) self-consoling

209
Q

Why is it difficult for critically ill infants to express needs?

A

don’t have energy to show behaviors that express different things

210
Q

what state of sleep is characterized by facial twitching

A

light(active) sleep

211
Q

what could cause periods of apnea

A

resp issues: blocked airway, hypoventilation hypoxia

stress

sepsis

prematurity: lacks autonomic control of respirations that full-term infants have d/t neurobehavioural immaturity

212
Q

what could cause seizure like behaviour in a pre-mature infant

A

Active sleep state

neurobehavioural immaturity

213
Q

What is being communicated:
baby is drowsy, returns to sleep when not stimulated
crying, arching back

A

Virginia is communicating that she wants to sleep. It is important not to wake an infant from deep sleep because it is during this state that brain growth occurs. Infants who are woken from a deep sleep feed poorly and can actually demonstrate a disorganized sucking pattern. They are drowsy, disinterested in feeding, and fall asleep at the breast. Parents’ persistence at trying to get their infant to feed is usually in vain.

When Virginia is not able to return to sleep she begins to show stress cues. It is likely that Virginia was demonstrating several more subtle stress signals as Lorraine was trying to wake her. Crying and arching are potent stress signals. Virginia is saying stop what you are doing. I need a change or timeout. In this case timeout is returning to sleep.

214
Q

Alerting behaviours.

What states does this occur in?

A

eyes wide/bright

focused attention on stimuli

states: active alert, quiet alert, drowsy

215
Q

what state is optimal for visual responses in newborn

A

quiet alert

216
Q

self consoling behaviours

A

thumb sucking
sucking on hand/fingers/fist

paying attention to voices/faces around them

changes in position

217
Q

how long should caregivers wait before offering consoling ?

A

15 secs of crying

218
Q

What is sensory threshold

A

level of tolerance of stimuli that an infant can respond to appropriately

if threshold reach, stress response

219
Q

stress response

A 
Irritable
Disorganized sleep-wake states
Gaze aversion*
Frowning
Sneezing
Yawning*
Hiccupping
Irregular respirations
Apnea*
Increased oxygen requirements
Heart rate changes
Finger splaying*
Arching/stiffening*
220
Q

stability cues

A 
regular vitals
consoled easily
sucking
focused gaze
smooth movements
self consolling behaviours
221
Q

What can you do to help infants get enough sleep and maintain circadian rhythms?

A

not waking an infant from deep sleep
gently waking infants from active sleep

assess infant/provide care right before feeds so infant has good resting time in between
cluster care

afternoon nap-time during which the lights are dimmed, noise levels reduced, and handling minimized

222
Q

What are the implications for caregiving when touching is either a postive and/or a negative experience for infants?

A

Be gentle but firm
Maternal touch

what can cause negative associations:
excessive handling
repeated painful procedures

223
Q

3 benefits of BF for mom/baby

A

mom:
increases confidence
increases successful BF
increases bonding

baby:
increases sleep
physiological stability (temp, RR, HR)
decreases stress

224
Q

How to educate parents re: concern of molding

A

explain modling

focus on positive aspect (how amazing it is that this happens)

reassure that it will return to normal in a few days

225
Q

father concerned about babies head after vacuum assisted birth. Baby cries after father touches it. What would you do.

A

I would assure Ross that his baby is okay, but that he had a hard time making his way through Paula’s pelvis. I would point out both the areas of molding and the swelling on the baby’s head (without touching them). I would explain to him the difference between caput and hematoma, and reassure him that both a caput and a hematoma would resolve over the next days and weeks. In the meantime, I would suggest that he handle the baby’s head with care and avoid touching the swollen or bruised areas.

226
Q

common newborn challenges

5

A

Pink: TTN, meconium in amniotic fluid

Warm: Hypothermia

Sweet: Hypoglycemia (<2.6mmol/L)

Organized: sleepy/floppy from narcotics/hypoxia

Attached

227
Q

High risk newborn challenges

A

Pink: resp. distress syndrome (lack of surfactant)

Warm: Hypothermia (cold stress)

Sweet: Hypoglycemia

Organized: Intraventricular hemorrhage d/t fragile blood vessels , increased pressure/hypoxia damages these

Attached

228
Q

Why is a newborn at risk for hypoglycemia

A 
1. Decreased availability of glucose:
•Intra-uterine growth retardation
Glycogen storage disease
Inborn errors (e.g., fructose intolerance)
Prematurity
Prolonged fasting without IV glucose
  1. Hyperinsulinemia:
    Diabetic moms
  2. Other endocrine abnormalities:
    •Pan-hypopituitarism •Hypothyroidism
    •Adrenal insufficiency
  3. Increased glucose utilization:
    cold stress
    sepsis
229
Q

common concerns about breastfeeding

A

if mother returns back to work

bad previous experience

concern about no success

breast surgery: implantation usually not as difficult as breast reduction d/t interference with milk ducts- causes nerve damage & removes glandular tissue.

230
Q

composition of breast milk

A

0-3 days colostrum
3-10 days transitional milk
mature milk

231
Q

composition of colostrum

0-3

A

high protein/fat-soluable vits/minerals/antibodies

thick & yellow
small volume

232
Q

composition of transitional milk

3-10

A

high fat/calories/lactose/vitamins

creamy
breasts are bigger/firmer
milk gradually changing to mature milk

233
Q

composition of mature milk

~ 2 weeks

A

high fat/lactose/h20, lower protein compared to colostrum

high volume
thinner

contains foremilk & hindmilk

234
Q

foremilk

A

initial milk

high in proteins, vitamins, h20

235
Q

hindmilk

A

end of breast feeding

++ fat

236
Q

AM milk

A

high in volume, low in fat

237
Q

4 common contraindications to BF

A

Breast ca tx
HIV/AIDS

recreational drug use
prescription drugs

238
Q

Process of BF

A

baby suckles

mechanoreceptors send signal to hypothalamus

hypothalamus:
1) stimulates release of oxytocin from the post. pituitary: myoepithelial cells contract

2) stimulates prolactin release from ant. pituitary: increased milk production (lactogenesis)

239
Q

how does lactogenesis occur right after birth?

A

delivery of placenta
decreased estrogen/progesterone/human placental lactogen
increase prolactin

resulting in lactogenesis

240
Q

what is galactopoiesis

A

ongoing milk production

impacted by sensory stimulation (pituitary gland), breast emptying, supply & demand, let down reflex

241
Q

how does breast emptying stimulate galactopoiesis

A

via pressure and feedback inhibitor of lactation

the more milk, the more pressure & feedback inhibitor of lactation (small protein), stopping cells from secreting more milk

242
Q

What is the let-down relfex

A

stimulated by oxytocin release

(contraction of myoepithelial cells to expel milk)

enhanced when mom relaxed so focus on decreasing stress!

243
Q

What is milk transfer dependent on

A

Compression: far back in mouth where palates meet

Suction: negative pressure forms teat

Tongue action: wave like action

244
Q

How often should baby feed

A

8-12 feeds Q24H

usually Q2-3h in day, Q3-4h at night

245
Q

2 principles of BF

A

positioning & latching technique

Knowledge of freq & duration of feeds

246
Q

what to do if mom notices signs of rooting

A 
C-hold
wait until mouth wide open
lead with chin
draw baby firmly to breast
nipple in between tongue & upper lip
lower-jaw as far back as possible
hold baby close
247
Q

S&S of good latch

A

tugging sensation- no pinching
mouth wide open
nose & chin touching breast
cheeks round

248
Q

S&S of good suck

A

no clicking, clacking, smacking

starts with quick sucks then when let down, deep and rhythical

comfortable

ends feed on own

249
Q

How to help mother with first feed

A

assess learning needs of mom, and ASK if she would like help and if so with what

give positive reassurance to reinforce

ask mom to focus on what the latch feels like (tugging)

limit distractions & promote relaxation

250
Q

How do narcotics impact BF

A

delay (decreased suck, coord, rooting, swallowing)

depends on drug, dose, route, peak, timing, newborns metabolizing abilities

can administer narcan if depressed

251
Q

Psychosocial & BF behaviours

Day 1 PP

A

Psychosocial: Quiet alert state, long sleep

BF: may or may not feed immediately, sleepy, just learning to BF

252
Q

Psychosocial & BF behaviours

1 month

A

Psychosocial: follows objects with eyes, reacts to noise by stopping behaviour or by crying

BF: efficient at suckling, feeds last 17mins, feeds 8-16 times per day

253
Q

Psychosocial & BF behaviours

2 months

A

psychosocial: smiles, vocalizes

BF: easily calmed by BF

254
Q

Psychosocial & BF behaviours

3 months

A

pyschosocial: grasps objects, increase in interest of surroundings, vocalizes when spoken to, turns head & eyes in response to moving objects

BF: will interrupt feed to focus on moving object, growth spurt

255
Q

Psychosocial & BF behaviours

4-5 months

A

Psychosocial: shows interst in strange settings, smiles at mirror images

BF: enjoys freq feedings, may be distracted

256
Q

Psychosocial & BF behaviours

6 months

A

Psychosocial: laughs, increase awareness of stangers vs. parents, distress if caregiver leaves

BF: solids offered, fewer feeds, may wake to BF more at night, growth spurt

257
Q

Psychosocial & BF behaviours

7-8 months

A

Psychosocial: imitates actions & noises, responds to name and no, enjoys peek a boo

BF: will breast feed anytime, attempts to BF

258
Q

Psychosocial & BF behaviours

9-10

A

Psychosocial: distressed by new situations or people, waves bye, reaches for toys out of reach

BF: easily distracted, may hold breast while feeding

259
Q

Psychosocial & BF behaviours

11-12

A

Psychosocial: drops objects purposely, speaks few words, interested in picture books

BF: acrobatic BF

260
Q

Psychosocial & BF behaviours

12-15

A

Psychosocial: fears unfamiliar situations, but will explore. Shows emotions, speaks several words

BF: uses top hand to play while feeding, playes with hair, pinches nipple. Will pat chest when wants to BF, may have code word forBF

261
Q

Psychosocial & BF behaviours

16-20

A

Psychosocial: temper, imitates parents, speaks 6-10 words

BF: verbalizes delight with BF, will lead mom to nursing chair

262
Q

Psychosocial & BF behaviours

20-24

A

Psychosocial: fewer temper tantrums, engages in play, small sentences, uses 15-20 words

BF: stands up while nursing at times, nursing for comfort, feeds before bed, weaning.

263
Q

Elimination patterns

A

day 3= 3-4 wet diapers
day 4= 6-8 wet diapers

meconium within 24h
day 3-4= 3-6 stools per day

264
Q

How much weight loss is a red flag

A

8-10% within first few days

265
Q

normal term weight

A

2500-4000

266
Q

when should birth weight be attained by

A

2 weeks

weight loss usually stabilizes at 3-4 days, starts gaining weight at 5 days (20-30g per day)

267
Q
  1. Walker states that breast milk is higher in antioxidant capacity than formula. Why is this important to a late preterm infant?
A

Breast milk will neutralize oxidative stress (i.e. intraventricular hemorrhage, chronic lung disease)

268
Q

3 barriers to BF late pre-term infant

A

insufficient sucking patterns

reduced alertness and stamina

inability to self-regulate

269
Q

Common BF challenges

A

See chart!! Module 7

270
Q

3 concepts to overcome BF**

A

Nurse early and often

Nipple and areola in babies mouth

BF on demand

271
Q

5 indications for supplementation

A

hypoglycemia
dehydration

ill mothers
prescriptive meds
metabolism issues

272
Q

if not BF when will start ovulating again

A

4-9 w

273
Q

BF scenario

A

look at module 7

NSPN 7100 (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions