FINAL EXAM BROOO Flashcards
What is the teaching for diaphragm method of contraception?
-Round flexible device that covers the cervix
- itted for sized by health care provider
- insert up to 6 hrs before and keep in at least 6 hrs after but no more than 24 hrs (increased risk of UTI)
-Used with spermicidal jelly or cream,
-size refitting if weight fluctuates
- Does not prevent STD, Must be washed after each use with mild soap
-empty bladder before insert
What is the risk for teens and pregnancy?
-Complications common PIH or IUGR
-Denial and late pregnancy care
-Social needs override prenatal care
-Growth and development need as well as support growth of the fetus
UTIs during antepartum period?
High risk for UTIs (symptomatic or asymptomatic. UTI correlated to PREMATURE labor.
§ Symptoms of UTI: frequency with urgency, dysuria, hematuria
§ Teach patients to report all symptoms of UTI, especially the urgency to urinate.
What are the three shunts in utero?
ductus arteriosis, foramen ovale, and ductus venosus
What is ductus arteriosis?
valve that shunts blood around lung
What is foramen ovale?
allows blood flow from right to left atrium
What is ductus venosus?
valve that shunts around the liver
What is education on rh test?
- given to Rh neg mothers at 28 weeks gestation
- and again within 72 hours after birth if Rh+ baby
- usual dose 300mcg IM
- After any invasive procedure (amniocentesis).
What are presumptive signs of pregnancy?
breast changes, amenorrhea, N/V, urinary frequency, fatigue, quickening
What are probable signs of pregnancy?
goodell sign, chadwick sign, hegar sign, positive preg test, braxton hicks contractions, ballotement
what are positive signs of pregnancy?
anything from fetus detected by doctor or movement felt (fetal move palpated, visible)
Veins carry ____ blood in utero?
oxygen
Arteries carry ______ blood in utero?
deoxygenated
In utero, there are ___ arteries and ___ veins?
2 arteries, 1 vein
what is normal weight gain in pregnancy?
2 to 4 lbs in 1st trimester
1 lb/week in 2-3
When does the 1st prenatal visit usually occur?
within first 12 weeks
What are the labs drawn at the 1st prenatal visit?
HCG, CBC w/diff, Blood Type & Rh, RPR, HIV, Hemoglobin Electrophoresis (check anemias), A1C, UA, cervical exam and pap smear,
During weeks 12-28 of pregnancy, how often should prenatal visits be?
once a month
What labs are taken at the monthly visits during weeks 12-28?
UA at every visit
TB skin test, Rubella titer, Hep B test, Triple Screen & MSAFP
Ultrasound
1hr glucola (24-28 weeks)
How often should prenatal visits be during weeks 29-36?
every 2 weeks
What labs are drawn at the biweekly visits?
UA at every visit
Ultrasound if not done before
Type & Rh
How often should prenatal visits be from weeks 36-delivery?
weekly
What labs are taken from 36 weeks-delivery?
GBS, HIV
Possible U/S for presentation
What are expected physiological changes in pregnancy?
-increase in estrogen and progesterone levels
-uterus changes in size, shape, and position
-increase uterine blood flow and stronger muscles for birth process
-vaginal secretions increase
-expansion of vascular volume 45-50%
-cardiac output increase 25-50%
-clotting factors increased
-oxygen consumption increased 15-20%
-breathing changes from thoracic to diaphragmatic
-basal metabolic rate increases 10-20%
-linea nigra
-striae gravidarum
-chloasma
-palmar erythema
Characteristics of GHTN?
-Hypertension WITHOUT proteinuria after 20 weeks gestation
-Recorded at least 2 separate occasions at least 4-6 hours apart but
within 1 week
-bp normal 1-12 weeks after delivery
Characteristics of mild pre-eclampsia?
BP 140/90mm Hg x2 > 4-6hrs apart
MAP > 105
24hr urine protein > 0.3g
Characteristics of severe pre-eclampsia?
BP > 160/110mm Hg on 2 occasions at least 4 hours apart
MAP >105
24hr urine protein >2g
Nursing care for eeclampsia
- Keep the patient safe
- Turn onto side
- Suction
- Oxygen
- IV Magnesium Sulfate
- Monitor fetus
- Uterine & Cervical Assessment
- Document
Cardinal signs of pre-eclampsia?
-elevated bp
-proteinuria (>0.3g in 24 hrs)
-pathological edema
-weight gain of >4.4 lbs in 1 week
Risk factors for pre-eclampsia?
Chronic renal disease, Chronic hypertension, Family history of preeclampsia, Multiple
gestation, Primigravity or new partner, Maternal age, Diabetes, Rh incompatibility, Obesity
Nursing management for mild pre-eclampsia?
Bedrest – Home or Hospital
Monitoring of BP
Daily weights
Fetal surveillance
Monitor urine protein
Educate on signs to report
Healthy diet & adequate hydration
Emotional support
Nursing management for severe pre-eclampsia?
Hospital bed rest
Maternal & fetal surveillance
Possibly in an ICU setting
Quiet, nonstimulating environment & seizure precautions
Pharmacological interventions
Delivery
What are lab values/clinical manifestations to watch for HELLP syndrome?
- (H)-hemolysis—Breakdown of RBC as they pass through the small
vessels with endothelial cell damage and fibrin deposit - (EL)- Elevated liver enzymes- A result of impaired hepatic blood flow
and fibrin deposits - Watch for RUQ pain
- Epigastric pain unresponsive to medication
- (LP)-Low platelets (Thrombocytopenia – platelets less than 100,000)
what is placenta previa?
placenta is
implanted in
lower uterine
segment
CMs of placenta previa?
painless bright red bleeding after 20 weeks
Nursing care for placenta previa?
Observation
and bed rest
NO vaginal
exams,
C/section
delivery
What is placenta abruption?
premature
separation of
the placenta
CMs of placenta abruption?
Painful abdominal pain with or without bleeding, uterine tenderness, confirmed after delivery
Nursing care for placeta abruption?
immediate delivery, palpate uterus for tenderness and tone, monitor fundal height
Why evaluate bladder during labor?
If bladder is full, then it will not give uterus space to contract therefore causing uterine atony
§ Also, a distended bladder causes a dislodged fundus
What are the types of lochia post-partum?
rubra, serosa, alba
Characteristics of lochia rubra?
-day 1-3
-small, clots,
-bloody,
-red to or red-brown
-fleshy, earthy odor
Characteristics of lochia serosa?
-day 4-10
-decreased amount
-sero-sangenous
-pink or brown tinged
Characteristics of lochia alba?
-day 11-21
-white,cream, or light yellow
-decreasing amounts
Characteristics of uterine involution?
-experience pain from uterine contractions, called afterpains
-notice a discharge called lochia in the weeks following delivery.
CMs of uterine subinvolution?
Prolonged lochial discharge
Irregular or excessive bleeding
Larger than normal uterus
Boggy uterus (occasionally)
Nursing management of uterine subinvolution?
-Prevent excessive blood loss, infection, and other complications.
-Massage uterus, facilitate voiding, and report blood loss.
-Monitor blood pressure and pulse rate.
-Administer prescribed medications. (see Drug Chart )
-Be prepared for possible D&C
Nursing interventions if APGAR is 4-6 score?
Vigorous stimulation
* Oxygen
* Narcan
Nursing interventions for 0-3 APGAR score?
CPR
* Drug Tx
* Intubation
Hip dysplasia?
abnormal development=t of the hip and/or the hip joints. Can be related to genetics or environment in utero. 3 degrees 1. preluxation no dislocation – femoral head remains in the acetabulum – will resolve on it’s own 2. Subluxation – incomplete dislocation of the hip – head of femur is partially dislocated 3. dislocation – head of femur is not in the acetabulum.
Glucose findings for newborn?
Normal glucose level is 50-60
§ Below 40 is bad
§ Baby might be lethargic, jittery, high pitched, cry, trimmer when low blood glucose levels
What is caput succedanum?
edematous swelling extending across
suture lines disappearing in 3-4 days.
What is cephalohematoma?
collection of blood between skull and periosteum
that does NOT cross cranial suture lines resolving in 3-6 weeks.
What is the 1st period of activity?
-heart rate increased at first but gradually falls back to between 100-120 (around 30 minutes)(May be tachycardia for the 1st 30 min)
-Respiratory rate…high at 60-80, May hear fine crackles
-Audible grunting, nasal flaring & chest retraction can be present but should clear with in 1 hour
Infant alert.
-This is the time to initiate breastfeeding and bonding
What is the period of decreased response?
period of decreased responsiveness where the baby will sleep and wake occasionally. IT lasts about 1 hour to 1.5 hour
What is the 2nd period of activity?
Occurs 2-8 hours after birth
* Can last 10 minutes to several hours
* May have brief periods of
Þ Tachycardia
Þ Tachypnea
Þ Increased muscle tone à really jumpy
Þ Increased mucus production à watch for gag and choking (May have to suction)
What are nursing considerations/education after circumcision?
Wash hands before touching newly circumcised penis
* Check for bleeding every hour for first 12 hours
Þ If bleeding occurs apply gentle pressure with a folded sterile 4x4
* Notify physician if bleeding doesn’t stop
* Observe for urination – wet diaper 6 - 10 times in 24 hrs
Þ DO NOT LET BABY GO HOME IF THEY HAVENT URINATED
* Keep the area clean – change diaper at least every 4 hours; wash penis gently with warm water to
remove urine or stool. Fan fold diaper.
Þ CLEAN AREAS EVERY DIAPER CHANGE
* Check for infection – yellow exudate is normal for the first 2-3 days. DO NOT attempt to remove it.
Redness, swelling, discharge indicate infection. Notify the provider.
* Provide comfort – painful procedure. Handle the area gently. Provide extra holding, feeding, nonnutritive sucking for a day or two
What are the 4 types of heat loss?
convection, radiation, evaporation, conduction
What is convection?
Flow of heat from the body surface to
cooler environmental air. (Place the bassinet out of the
direct line of a fan or air conditioning vent, swaddle
the newborn in a blanket, and keep the head covered.
Any procedure done with the newborn uncovered
should be performed under a radiant heat source.
Keep ambient temperature of the nursery or client’s
room at 22 to 26° C (72 to 78° F)
What is radiation?
Loss of heat from the body surface to a
cooler solid surface that is close to, but not in direct
contact.
(Keep the newborn and examining tables
away from windows and air conditioners)
What is evaporation?
- loss of heat when liquid is converted to a vapor (dry infant directly after birth and bathing)
What is conduction?
Loss of body heat resulting from direct
contact with a cooler surface. (Preheat a radiant
warmer, warm a stethoscope and other instruments,
and pad a scale before weighing the newborn. The
newborn should be placed directly on the parent’s
chest and covered with a warm blanket)
What is physiologic jaundice?
occurs in about 60% of newborns. It appears after 24 hours of age and usually resolves
without treatment
What is pathological jaundice?
unconjugated hyperbilirubinemia usually appearing within 24 hours of birth.
-if untreated, condition can lead to kernicterus (may lead to cerebral palsy and hearing loss)
What is breastfeeding jaundice?
Benign and begins at 2-5 days of age (early onset) or 5-10 days of age (late onset),
* Caused by inadequate or poor breastfeeding leading to decreased hepatic clearance. Treatment =
good breastfeeding.
* Usually declines at week 2 but can persist 3-12 weeks.
* No signs of hemolysis or liver dysfunction. Meaning the infant has wet &/or dirty diapers after each
feeding
* If baby still has jaundice, then feed them, Bili light, put them in the window, take outside
What is direct coombs test?
Cord blood obtained to test for presence of antibodies
* Done on fetal cord blood after deliver to determine if there are any maternal antibodies in the fetal
blood
* If titer if high an exchange transfusion an exchange transfusion may be necessary (Not many have to
have this)
What is an indirect coombs test?
Prenatal test used to determine whether a mother has been sensitized
* Done on mother’s first prenatal visit
* To determine if she has built up antibodies to the Rh antigens
* Again at 28 weeks
Why is vitamin k given to newborn?
used to prevent hemorrhagic
disease in the newborn
Vitamin K for clotting, baby doesn’t have any vitamin K because they haven’t eaten yet, the gut is sterile
How is vitamin k given?
§ Use a 5/8 inch needle and administer 0.5 mg for preterm and 1 mg for a term. Within the first 6 hours. They
normally give as soon as baby is born
Why is erythromycin ointment given to newborn?
to prevent ophthalmic neonataorium
caused by exposure to infectious agents. (gonorrhea, chlamydia, e coli)
what is the bulb syringe used for and how?
to clear the infant’s airway. It should be squeezed before being inserted
into the infant mouth before nose for suctioning..
Nursing care for post-op circumcision?
nvolves checking for bleeding every 15 minutes for the first hour and then
every hour for the next 4-6 hours. The nurse also monitors swelling and voiding. When
changing the diaper, inspect every 4 hours (or with every diaper change), wash with water to
remove urine and feces. Apply petroleum jelly or erythromycin to the glans with each diaper
change. Do not wash with soap until exudate gone. Check for infection including redness,
swelling, discharge, or ecchymosis. Handle the area gently.
what is an adequate intake for day 1 to 3 months?
requires 110kcal/kg/day (24 hours)
What is the adequate intake for newborn 3-6 months?
equires 100kcal/kg/day (24 hours)
What is breast milk/formula cal/oz?
20 cal/oz
What are considerations for phototherapy/education for parents?
-treatment for hyperbilirubemia/jaundice
Infants should wear only a diaper and eye
shields. Temperature should be measured. No lotions, oil, or powder should be applied to
infant’s skin during phototherapy.
Care for umbilical chord before discharge?
Clean umbilical cord with water, do not use soap or alcohol preparations for cord care.
The plastic clamp should be removed before discharge or when its dry.
The stump and base of
cord should be assessed for infection, keep dry and above diaper.
Assess for redness, smell,
and purulent drainage. Cord separation occurs 10 to 14 days.
What is cold stress?
Extreme loss of heat that results in increased respirations and nonshivering, oxygen consumption increases, RR increases
Interventions for cold stress?
-skin -to -skin with the mother
-the infant is dried after delivery to keep infant warm and reduce the risk of heat loss via
evaporation.
-The bed is warmed
-room temperature is increased to 75.2
- Cribs are placed away
from windows to prevent heat loss via radiation
Education of mother with HIV?
Give it bath and give vitamin K shot after bath (introduce HIV into babies bloodstream)
§ If mom has HIV/ Hep B does NOT mean baby has these
§ If syphilis does not deliver vaginally
What are Erikson’s development stages?
- Trust vs. Mistrust (Birth to 18 months)
- Autonomy vs. Shame & Doubt (18 months to 3 years)
- Initiative vs. Guilt (3-6 years)
- Industry vs. Inferiority(6-12 years)
- Identity vs. Role Confusion (12-20 years)
- Intimacy vs. Isolation(12-20 years)
- Generativity vs. Stagnation(35-65 years)
- Integrity vs. Despair(65 years-death)
Characteristics of anterior fontanel?
palpable and approximately
5 cm on average and diamond shaped. `
Characteristics of posterior fontanel?
smaller and triangle-shaped.
Normal findings of fontanel?
-soft and flat
-bulge when newborn cries, coughs, or vomits but should be flat when quiet
-bulging at rest=increased IOP, infection, hemorrhage
-depressed fontanel=dehydration
Lab findings of HELLP syndrome?
Elevated liver enzymes (LDH, AST)
● Increased creatinine
● Increased plasma uric acid
● Thrombocytopenia
● Hgb (decreased in HELLP
● Hyperbilirubinemia
Normal HR for newborn?
110-160
Normal RR on newborn?
30-60 bpm
Normal temp for newborn?
36.5-37.4 or 97.7-99.3
CMs of cold stress?
-increased muscle activity
-crying
-restlessness
-cold skin
-acrocyanosis
-hypoglycemia
-skin flushing or pale
-extended posture
How to check for hip dysplasia?
Ortolani and Barlow test
Nursing actions for hip dysplasia?
obtain and maintain a safe congruent position of the hip joints to promote normal hip joint development & ambulation. In the nursery you may see an infant with several THICK diapers on and have a Pavlik harness on. this keeps the hips stabilized. If this does not work they may be in casts with traction or even surgery.
Findings of spina bifida?
little hairs, whole pouch on the back
Findings of hypospadias?
boy, urethral opening in different spot, no circumcision right off bat
Findings of cleft lip/palate?
touch top of hard palate when finger In mouth to find cleft palate
LGA baby grams?
4000+
SGA baby grams?
2500 or less
Characteristics of normal amniotic fluid?
- Pale and straw colored with white flecks of vernix caseosa
- Lacks strong odor. If thick, cloudy, or foul smelling, suspect infection
- Normal amount is 700-1000mL
- Intact membranes are acidic and have a negative nitrazine result
- Ruptured membranes are alkaline and have a positive nitrazine result
Abnormal amniotic fluid findings?
Greenish brown- meconium stained due to recent hypoxic episode that caused relaxation of the anal sphincter
- Yellow- Fetal hypoxia > 36 hours prior, fetal hemolytic disease (bilirubin); infection
- Port wine- bleeding associated with premature separation of placenta (abruption)
What is polyhydramnios?
> 2000mL; associated with congenital abnormalities of the GI system (fetus can’t drink fluid) GDM
What is oligohydramnios?
<300mL; associated with absence of kidneys or obstruction of urethra. (fetus can’t excrete urine)
What is VEAL CHOP MINE?
V = Variable decelerations
E = Early decelerations
A = Acceleration
L = Late decelerations
C = Cord Compression
H = Head Compression
O = OK!
P = Placenta Insufficiency
M = Move position
I = Initiate secondary measures
N = Nothing!
E = Emergency Delivery
Nursing care for cervical ripening agents (tocolytic)?
- Misoprostol (cytotec)
- Ask pt. To void
- Maternal and fetal HR assessed prior to administration and continuously throughout treatment
- Maintain supine position with lateral tilt or side lying position for 30-60 mins
- Administer terbutaline 0.25mg in cases of adverse reaction
Characteristics of true labor?
- Contractions are at regular intervals
- Contractions increase in frequency, duration, and intensity
- Pains usually begin in the lower back, radiating to the abdomen
- Dilation and effacement of the cervix are progressive
- Activity such as walking usually increases labor pains
How to know when there is an adequate latch?
When the infant is properly latched, the tip of their nose, cheeks, and chin should all be touching the breasts.
Steps for late decels?
- Turn the patient to side laying position (This allows for better perfusion to the placenta)
- Open Iv fluids or at least give a 500mL bolus & Elevate patient’s legs (This will allow the IV fluids that have oxygenated blood to flow to the placenta better)
- Discontinue Oxytocin (As contractions continue it also continues to stress the fetus making it lose any oxygen reserves it has.)
- Administer O2 by tight face mask at 8-10 L/min (This brings more oxygen into the blood stream going to the infant to help it build up oxygen reserves)
- Notify the provider
- Continue to assess labor process
- Prepare for an assisted vaginal birth or caesarean birth.
Nursing actions to prevent subinvolution?
- Encourage early ambulation
- Administer meds as ordered such as oxytocin to stimulate uterine contractions
- Assess uterine tone. If uterus is not contracting the way it should, massage or medications may be needed
- Manage pain
- Promote good hygiene to prevent infection which can lead to subinvolution
Education on burping?
- Usually performed midway at the end of the feeding to remove excess air from the infant’s stomach
- Parents are taught to either hold the baby over their shoulder or on their lap with the baby’s head supported
- The baby’s back is gently rubbed until air is expelled
- Advise parents that baby’s usually spit up during burping and that it is a normal occurrence.
- Some studies show that not releasing the air can lead to GERD in later life
Adequate newborn intake and output?
- Should be fed at least 8-12 times in a 24 hour period
- Should be fed for at least 10-15 minutes on each breast
- Should have at least 6-8 wet diapers a day
- Output is 1-3mL/kg/hr
Examination of newborn umbilical chord?
- 2cm in diameter
- 30-90cm in length
- 2 arteries
- 1 vein
- Wharton’s jelly (connective tissue)- cushions vessels from compression
