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N133 > Labour + Delivery + postpartum + newborn > Flashcards

Labour + Delivery + postpartum + newborn Flashcards

1
Q

what are the 5 P’s of labour

A

1) Passenger
2) passageway
3) powers
4) position of mother
5) psychological response

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2
Q

What are the external forces effecting labour?

A
  • place of birth
  • type of provider
  • availability of labour support
  • procedures
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3
Q

what are the internal forces effecting labour?

A

-physiology / sensations

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4
Q

does the placenta usually cause birthing complications?

A

NO it rarely impedes the labour process

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5
Q

What are the factors that effect the passenger

A
  • size of fetal health
  • Fetal presentation
  • fetal lie
  • fetal altitude
  • fetal position
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6
Q

what are the 3 parts of fetal position

A
  • fetal lie
  • fetal attitude
  • fetal position
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7
Q

what are sutures

A

the cranial joints

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8
Q

what are fontanelles

A

where the sutures intersect

the soft spots on babies head

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9
Q

what shape is the front fontanelle

A

diamond (large)

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10
Q

what shape is the back fontanelle

A

triangle (small)

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11
Q

during labour… the sutures & fontanelles are:

A

flexible to accommodate brain growth

can slide over each other (mould) to fit maternal pelvis

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12
Q

when will the brain assume its normal shape after birth?

A

It’ll take shape 3 days after

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13
Q

do the babies shoulders usually cause an issue at birth?

A

No they can be moved so they usually aren’t problems

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14
Q

what is the fetal “presentation”

A

The part the enters the pelvic inlet first

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15
Q

What are the 3 main presentations

A
  • Cephalic
  • Breech (butt or feet)
  • shoulder presentation
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16
Q

what percentage of births are cephalic

A

96%

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17
Q

what percentage of births are breech

A

3%

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18
Q

what percentage of births are shoulder

A

<1%

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19
Q

what would be the region presented for cephalic

A

the occiput (vertex)

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20
Q

what would be the region presented for breech

A

the sacrum

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21
Q

what would be the region presented for shoulder

A

the scalpula

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22
Q

What is the fetal lie

A

The relation of long axis (spine) of fetus to long axis (spine) of mother

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23
Q

What are the types of fetal lies

A
  • Longitudinal/vertical
  • transverse / horizontal
  • oblique
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24
Q

what is a longitudinal lie

A

paralel axis’s with mom

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25
Q

what is a transverse lie

A

long axis @ right angle with mom

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26
Q

what is a oblique lie

A

long axis at an angle (will usually correct itself)

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27
Q

what is fetal attitude

A

the relation of fetal body parts to each other

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28
Q

what is the normal fetal attitude

A
  • General flexion

- rounded back, chin flex, thighs flexed, sarcasm crossed over chest, cord between arms & legs

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29
Q

what are the consequence of an abnormal attitude

A
  • prolonged labour
  • forceps/ vacuum
  • cesarean
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30
Q

what is the largest transverse diameter

A

the biparietal diameter

9.25 cm

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31
Q

what is the fetal position

A

the relationship of a reference pt on the presenting point to the 4 quadrants of the moms pelvis

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32
Q

What does the first letter mean in fetal position

A

Left or Right side of mom

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33
Q

What does the second letter mean in fetal position

A

The part that is presenting

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34
Q

what does the 3rd letter mean in fetal position

A

if it’s posterior, anterior or transverse

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35
Q

what is the “station”

A

Relationship of fetal part to an imaginary line drawn down the maternal ischial spines
***the measure of degree of descent of preceding part through the birth canal

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36
Q

What does it mean if the station is a negative number

A

it is above the ischial spine

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37
Q

what does it mean if the station is a positive number

A

it is below the ischial spine

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38
Q

at what station does birth take place

A

usually +4 or +5

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39
Q

what is engagement

A

the largest transverse diameter of the presenting part has passed through maternal pelvic brim or inlet into the true pelvis

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40
Q

when does engagement occur

A

usually +2 station

  • can often occur weeks before labour in nulliparas
  • in muiltiparas it happens during labour
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41
Q

how can engagement be determined

A

can be determined by abdominal or vag expansion

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42
Q

describe the passageway

A

rigid bony pelvis, soft cervix, pelvis floor, vag & introits

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43
Q

what part plays the biggest role in birth

A

the pelvis size & shape

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44
Q

What is the false pelvis

A

part above the brim, no role in child bearing

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45
Q

what is the true pelvis

A

part involved in birth (brim, mid-pelvis, cavity, outlet)

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46
Q

what is the pelvic inlet/ brim

A

upper boarder of true pelvis

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47
Q

What is the pelvic cavity

A

curved passage w/ short anterior wall

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48
Q

what is the pelvic outlet

A

lower boarder of pelvis (ovoid/ diamond shape)

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49
Q

what are the factors that are important to determine if natural birth is possible

A
  • subpubic angle / pubic arch
  • length of pubic rami
  • subpubic arch
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50
Q

what are the 4 types of pelvis’s

A

1) gynecoid
2) Android
3) Anthropoid
4) Platypelloid

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51
Q

% & shape? (Gynecoid)

A

circle - 50%

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52
Q

% & shape? (android)

A

Resembles a male pelvis (23%) heart

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53
Q

% & shape? (anthropoid)

A

24% and it’s an oval

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54
Q

% & shape? (platypelloid)

A

3% flat pelvis

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55
Q

is the pelvis size tested?

A

no it’s approximate b/c radiographic exam is bad for baby

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56
Q

What are the soft tissues

A

lower uterine segment, cervix, pelvic floor muscles, vagina & introitus

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57
Q

the uterus becomes… ( once birth begins)

A

very muscular so that it can push against the cervix

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58
Q

To allow the first fetal position to descend into vagina….

A

the cervix (effaces) thins & dilates opens)

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59
Q

what is efface

A

thin (happens first)

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60
Q

what is dilate

A

opens (happens after)

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61
Q

what is the pelvic floor

A

muscular layer that separates pelvic cavity from perineal space below & helps rotate fetus

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62
Q

the soft tissues …

A

develope throughout pregnancy until the vagina can dilate to accommodate fetus

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63
Q

what are the 2 types of powers

A

involuntary & voluntary

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64
Q

What are the primary powers?

A

involuntary contractions that originate from certain pace maker points in upper uterine muscles
they move downward in waves, separated by short rests

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65
Q

How are primary powers described?

A

1) Freq. (from beginning of one to the beginning of next one)
2) Duration ( length of contraction
3) Intensity (strength of contraction @ peak)

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66
Q

What are the primary powers responsible for?

A

Effacement- shortening/ thinning of cervix

this usually happens before dilation

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67
Q

facts about dilation

A
  • goes from <1 cm to 10cm.
  • can’t be palpated when fully dilated
  • marks end of 1st labour stage
  • due to pressure AND hormones
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68
Q

Are uterine contractions independent or dependent of external forces

A

uterine contractions are independent of external forces

-may reduce if given narcotics which can cause prolonged labour

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69
Q

When do the secondary powers begin

A

As soon as the presenting part reaches the pelvic floor

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70
Q

What are the secondary powers contractions like?

A

explosive- involuntary urge to push

-bearing down efforts: contracts diaphragm & abs

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71
Q

What is the result of secondary powers?

A

intra-abdominal pressure

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72
Q

do secondary powers have an effect on dilation?

A

No

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73
Q

Are frequent positions changes good or bad

A

good

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74
Q

what are the benefits of position change

A

reduce fatigue
increase comfort
increase circulation

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75
Q

What are the benefits of upright birth

A
  • gravity promotes descent
  • contractions are stronger & more effective in dilating cervix
  • labour is shorter
  • improves blood flow
  • pressure on vena cava reduce
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76
Q

If the woman wants to lie down…

A

lateral ( on side) is best

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77
Q

benefits of all 4’s birth

A
  • relieve back ache
  • decreases length
  • decreases need for assistance
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78
Q

how is a birthing position determined

A
  • woman preference
  • condition
  • environment
  • HC provider confidence
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79
Q

What is lightening

A

dropping of the baby into the pelvis

  • happens 2-4w before term in first time pregnancy
  • in multipara’s lightening won’t happen till the uterus contracts
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80
Q

signs of labour coming

A
  • lightening
  • strong frequent irregular contraction
  • low back pain
  • bloody show: mucus
  • cervix soften
  • membranes rupture
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81
Q

signs of days proceeding labour

A

1) loss of 0.5-1.5kg (water weights)
2) surge of energy (nesting)
or diarrhea, nausea, vomit & indigestion
3) return of frequent urination

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82
Q

is there a single cause of labour?

A

no there is no single cause

  • hormones
  • distention of uterus & pressure
  • result in strong, regular rhythmic contractions
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83
Q

What are the stages of labour

A

1) regular progression of uterine contractions
2) Effacement & progressive dilation of cervix
3) progress in descent of presenting part

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84
Q

Describe stage one of labour

A
  • last onset of regular uterine contractions to full dilation of the cervix
  • longest stage
  • can take 1-18hr
  • 2 phases: -latent (early)
    - active labour - quicker dilation & descent
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85
Q

Describe stage two of labour

A
  • fully dilated to brith
  • latent (passive)
  • active (urge to push stretch receptors)
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86
Q

describe stage three of labour

A

birth of fetus - birth of placenta

3-5 mins or an hour

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87
Q

Describe stage four of labour

A

2hr after placenta

recovery, bonding & breastfeed

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88
Q

What are the mechanisms of labour

A
  • engagement
  • descent
  • flexion
  • internal rotation
  • extensions
  • restitution & external rotation
  • expulsion
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89
Q

What is meant by engagement

A
  • when the biparietal diameter of head passes pelvic inlet

- in nulliparas - this occurs b4 active labour

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90
Q

what is asyclitsm

A
  • head is deflected in pelvis
  • head is positioned so that it cannot descend
  • this is an error in engagement
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91
Q

what is meant by the descent

A
  • progression through the pelvis by 4 forces
  • slow & steady in first baby
  • Rapid in second baby
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92
Q

What are the 4 forces that determines descent

A

1) pressure via amniotic fluid
2) direct pressure exerted by contracting fundus on fetus
3) force of contraction of diaphragm & abs
4) extension & straighten fetal body

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93
Q

why does the head flex into the chest

A

to produce a smaller diameter

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94
Q

what is internal rotation

A

head must rotate in order to exit

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95
Q

what is extension

A

the head emerges vis extension

the occiput, then face, then chin

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96
Q

what is restitution & external rotation

A

after the head is born , baby rotates to position it was in, in inlet (restitution)
the anterior shoulder will descend first

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97
Q

what is expulsion

A

trunk is born by flexing laterally

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98
Q

fetal heart rate?

A

110-160bmp

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99
Q

fetal circulation is affected by…

A
  • Maternal position
  • uterine contractions (contractions decrease circulation)
  • bp
  • umbilical cord flow
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100
Q

fetal respiration

A

decreases during labour

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101
Q

maternal cardiac changes during labour

A
  • increase cardiac output will return to baseline after both
  • increased bp during contractions
  • increased HR
  • increased WBC
  • flushed or hot or cold cheeks & hemmorhoids
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102
Q

maternal respiratory changes during labour

A
  • increased respiratory rate

- o2 consumption doubles

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103
Q

maternal renal changes during labour

A

spontaneous voiding becomes hard

proteinuria is common

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104
Q

integumentary system changes during labour

A

skin will stretch and tear

increased temperature

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105
Q

musculoskeletal maternal changes during labour

A
  • diaphoresis, fatigue

- joint pain

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106
Q

neurological changes maternal during labour

A

euphoric, serious, elated or fatigued

-decreased perception of pain

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107
Q

GI tract maternal changes during labour

A
  • motility & ability to absorb food decrease

- nausea & vomiting is common

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108
Q

endocrine maternal changes during labour

A

decreased progesterone, increased estrogen. Increased metabolism

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109
Q

moms with a history of sexual abuse may be triggered by

A
  • memories during invasive procedures
  • loss of control or feeling of being restrained
  • being watched by students or intense sensations
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110
Q

women with a history of sexual abuse may…

A

fight labour process
be controlling
be submissive or dependent
mentally retreat or dissociation

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111
Q

the nurse can help women in labour with history of sexual abuse by

A
  • help associate feelings with present
  • maintain sense of control by informing her
  • validate needs
  • fulfil requests
  • permission before touch
  • be conscious about words
  • limit invasive procedures
  • help her come an advocate
  • *** care for all women like this you don’t know who is a victim
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112
Q

What is assessed during a psychosocial assessment of labouring woman

A
  • verbal interaction
  • body language
  • perceptual ability
  • discomfort level
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113
Q

women reactions to labour reflect their life experiences with:

A

childbirth, physical, social, cultural & religion aspects

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114
Q

some society expectations of birthing women:

A
  • pain is inevitable and must be endured by birthing moms
  • pain can be avoided in childbirth
  • pain in childbirth indicates sin
  • pain can be managed by a women
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115
Q

muiltiparas base their expectations on…

A

their last birth & may only voice their concerns when asked

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116
Q

how will stress effect labour

A

it will cause a slower labour

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117
Q

how can the nurse help with stress during labour

A
  • provide trust & support
  • explain things in detail
  • let woman know that there aren’t any expectations
  • explain the role of the nurse
  • encourage the woman to trust her ability to give birth
  • acknowledge that the support person may also feel stressed
  • be sensitive to needs
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118
Q

how to better accommodate LGBTQ+ labour

A
  • transmen can give birth (biologically female)
  • ask how they describe their gender identity
  • document their gender identity & pronoun
  • best if met before birth to plan
  • ask permission to touch
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119
Q

indigenous birth is a….

A

family event & community - the hospital vistitor limit may effect this

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120
Q

what questions should you ask to provide culturally safe care during labour

A
  • value/ meaning of childbirth
  • view of wellness or sickness of childbirth
  • private vs social
  • diet, med, activity, emotional & physical support
  • appropriate maternal/ paternal behaviour
  • birth companions
  • views of immediate newborn care
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121
Q

a birth companion is a source of…

A
  • support
  • encouragement
  • comfort
  • *not always the partner!!!
  • *some woman prefer another women
  • *woman will determine their role
  • *some women modesty is very important
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122
Q

how a non-english speaking women in labour feels:

A
  • increased anxiety
  • loss of control
  • panic
  • withdrawn
  • agression
  • *some only want a female interpreter
  • *over the phone is better than nothing
  • *speak slow w/ no jargon
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123
Q

How long is postpartum / puerperium / 4th trimester

A

6 weeks

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124
Q

what is the postpartum involution process of the uterus

A

it means to return to non-pregnant state

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125
Q

when does involution begin

A

immediately after explosion of placenta with contraction of uterus

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126
Q

where is the uterus at the end of the 3rd stage of labour

A
  • uterus midline
  • 2cm above from umbilicus
  • fundus rest on sacral promontory
  • weights about 1000g
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127
Q

within 12hr uterus is

A

1cm below umbilicus

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128
Q

within 24hr the uterus is

A

the same size as @ 20 w

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129
Q

the fundus descends…. (rate)

A

1-2cm /24hr

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130
Q

by day 6 the uterus is

A

half way between symphysis pubis & umbilicus

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131
Q

when should the uterus no longer be palpable

A

by 2 weeks

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132
Q

how much more does the term uterus weight than prepregnancy

A

11X the pre-pregnant weight

133
Q

after 1 week the uterus weighs:

A

500 g

134
Q

after 2 weeks the uterus weighs

A

350g

135
Q

after 6 weeks the uterus weighs

A

60-80g

136
Q

why does the uterus grow?

A
  • increased estrogen & progesterone
  • hypertrophy & hyperplasia
  • pressure from baby inside
137
Q

what is autolysis

A

self destruction of hypertrophied tissue (AKA happens to uterus)

138
Q

will the uterus ever be the same size again?

A

no due to extra cells it’ll be a tiny bit bigger

139
Q

what is sub-involution

A

failure for uterus to return to size

140
Q

what are common causes of sub-involution

A

placental fragments

infection

141
Q

how is postpartum hemostasis achieved

A

mostly be compression of intramometrial blood vessels as uterine muscles contract & not as much clot formation
***oxytocin coordinates these contractions

142
Q

why are woman often give oxytocin after birth of placenta

A

to make sure that uterus contracts so that they won’t lose blood

143
Q

what does breastfeeding do to oxytocin

A

increased it & decreases likely hood to hemorrhage

144
Q

what are afterpains & who are they experienced by

A
  • Uterus firm in 1st mothers (only mild cramps)

- vigorous contractions in subsequent pregnancies (more pain) (breastfeeding & oxytocin will make these pains worse)

145
Q

what is placental sight

A

post-partum vascular constriction & thromboses

an upward growth of endometrium that causes sloughing of dead tissues

146
Q

what does placental sight do

A

prevents scaring of womb so it can function again

147
Q

when is endometrial regeneration completed by

A

day 16 (except placenta site) (w6)

148
Q

what is lochia

A

post-birth vaginal discharge

149
Q

what is lochia rubra

A

bright red with clots (first 2hr)

  • like a heavy period but it’s a steady decreased
  • its blood a trophoblastic waste
150
Q

what is lochia serosa

A
  • pink/brown (starts 3-4 days after) (22-27 days long)

- old blood, rum, WBC, & debris

151
Q

what is lochia alba

A
  • starts 10 days after
  • yellowish white
  • WBC, decidua, epithelial, serum, mucus, bacteria
  • can go on for 4-8 weeks
152
Q

common facts about lochia

A
  • less in cesarean
  • blood gushes when walk
  • persistent bleeding can mean a fragmented placenta
  • 10-15% of ppl will have serosa at week 6
  • endometriosis can be the cause if there is still serosa at week 4-5 with pain & fever
  • an offensive odour means infection
153
Q

what would indicate non local bleeding

A
  • if it spurts out

- could be cervical or vaginal tear

154
Q

characteristics of the cervix after birth

A
  • soft
  • the ectocervix is bruised
  • gradually closes but id edamtous, thin & fragile several days after birth
155
Q

how dilated is the cervix after day 2 post partum

A

2-3cm

a week = 1 cm

156
Q

does the cervix go back to the way it was?

A

no it never regains its pre pregnant appearance

157
Q

postpartum estrogen deprivation causes

A

1) thinness of mucosa
2) absence of rugae
3) vagina is drier

158
Q

Does the vagina go back to the way it was?

A

no it never completely regains it’s prepregnat tone

the reggae reappear after 3 weeks but aren’t as prominent

159
Q

what is a scared hymen called

A

a myrtiform carnuckles

160
Q

postpartum the introitus is

A

erythematous & edematous but after 2 weeks i looks just like a nullipara if lacerations are carefully prepared, good hygiene & hematoma treated

161
Q

what to know about healing an episteotomy

A
  • signs of infection
  • any loss of approximation
  • 2-3 w to 4-6 months for complete heal
162
Q

when will hemorrhoids decrease size by

A

6 weeks

163
Q

how long will it take for pelvic floor muscles to regain strength

A
  • may take 6 months

- kegels are encouraged

164
Q

how long for abdominal wall to relax after birth

A 
2 weeks (still has pregnant appearance) 
within 6 weeks it'll look almost preprgnant
165
Q

what are the factors that determine if you regain ur muscle tone

A
  • previous tone
  • proper exercise
  • adipose
166
Q

what happens to hormones when the placenta leaves

A

decreased hormones

  • diuresis of extra cellular fluid due to decreased estrogen
  • woman who don’t breast-fed regain estrogen quicker
  • HCG will disappear 3-4 weeks after
167
Q

what happens to prolactin

A

rises throughout pregnancy
even more @ birth (highest first month after)
remains high if breast feeding continues
determined by: - freq. duration & degree of supplementary feeding
-in non-breast feeding woman prolactin will go back to normal within a week

168
Q

when will ovulation occur?

A
  • in lactating women it’ll occur within 6 months b/c prolactin suppresses ovulation
  • in non lactating women: 27 days (7-9 weeks ) (70% by week 12)
  • 1st flow after birth quite heavy (3-4 cycles & it’ll be back to normal)
169
Q

what happens to the urinary system postpartum urinary system

A

-diminished steroid levels after birth (reduced renal function)
back to normal within a month
-dilation of ureters & hypotonia (6w to normal)
-can persist for 3 months ( increased risk for UTI)

170
Q

what are the important facts about urine components

A

glycosuria is gone by 1 week
lactosuria may occur in lactating women
blood urea nitrogen b/c autolysis of involuting uterus
protein uria will resolve in 6 weeks
ketonuria happens with women of prolonged labour & dehydration

171
Q

what happens to do with partpartum fluid loss

A

-within 12 hr, begin to lose excess tissue fluid
-profuse diaphoresis occurs for 2-3 days b/c of low estrogen, removal of increased venous pressure & loss of pregnancy induced fluid volume
Will lose about 2.25kg of “water weight”

172
Q

What happens to the urethra & bladder post partum

A

-experiance decreased urge to void due to birth induced trauma, increased bladder capacity & effects of anaesthesia, and pelvic floor soreness

173
Q

what causes pelvic floor soreness

A
  • forces of labour
  • vagina lacerations
  • episteotomy
174
Q

if bladder is distended it causes the uterus to have…

A

excessive bleeding, cannot contract as well, higher risk of UTI

175
Q

when does a postpartum women regain bladder tone?

A

5/7 days

176
Q

are postpartum woman hungry or full?

A

HUNGRRY

177
Q

why may bowel evacuation not occur for 2/3 days

A
  • drecreased muscle tone of intestines
  • prelabour diarrhoea
  • lack of food
  • dehydration
  • may resist urge to defecate
  • *should increase fluid & fiber
  • operative births have increased risk of anal incontinence (shouldn’t last more than 6mo)
  • cesarean birth also may have a build up of gas
178
Q

when does the breast milk come in

A

within 72-96hr

breasts will feel warm, from & tender

179
Q

when will engorgement go away

A

24-48hr

180
Q

what happens when moms decide to not breast feed

A

prolactin levels will drop very quickly
engorged but will resolve within 24-36hr
milk present but shouldn’t be expressed
-comfort measures: binder, bra, ice packs, pain meds
-avoid stimulating nipples
-lactation will cease in days to 1 week

181
Q

how much blood is lost in vaginal birth

A

300-500ml (10%)

182
Q

how much blood is lost during cesarean

A

500-100ml (15-30% )

183
Q

when will blood plasma volume be replenished by

A

3rd day

184
Q

what are the 3 major blood volume changes

A

1) elimination of uteroplacental circulation
2) loss of placental endocrine function removes the stimulus for vasodilation
3) mobilization of extra vascular water stored during pregnancy

185
Q

what will happen to cardiac output postpartum

A

it will increase for 48hr

then it will remain increased for 12 weeks after birth & may not stabilize until 24 weeks

186
Q

what will happen to vital signs post partum

A

hr & bp will return to normal within a few days
RR will rapidly return to normal
temperature will rise b/c dehydration will resolve in a day
orthostatic hypotension for 48hr

187
Q

what will happen to the postpartum circulation

A

increased WBC, increase plasmofibrinogen

immune system is mildly suppressed but will go back to normal

188
Q

what will happen to the postpartum respiratory system

A

decreased pressure
increased chest compliance
rib cage elasticity can take months to regain
stretched intercostals may never return to normal
normal metabolism by 1-2 weeks

189
Q

in the neurological & musculoskeletal system

A

all changes will be revered

190
Q

what will happen to the postpartum immune system

A
  • melasma mask will sometimes stay
  • hyper pigmentation of areolae & lineament nigra may not go away
  • stretch marks will fade
  • hair growth slows
  • spider angiomas, palmar erethema, & elupis go away
191
Q

how is attachment maintained

A

through proximity & interaction with infants as the parent becomes acquainted with the infant
identifies infant as an individual
claims infant as a family member
**THIS IS A MUTUALLY SATISFYING PROCESS

192
Q

attachment includes mutuality

A

an infants behaviour elicit a corresponding set of parental behaviours

193
Q

attachment occurs most easily when

A

the temperament, social characteristics, appearance & sex match characteristics
*** DISSAPOINTMENT can cause delays in attachment

194
Q

how do parents become aquainted

A

by touch, eye contact, talk, & exploring

195
Q

what is the claiming process

A

ID baby - terms of likeness, difference, uniqueness incorporated into fam
**CAN BE NEGATIVE OR POSITIVE

196
Q

how do labour processes effect attachment

A

-long labour, drugs, breast-feed probs, premature birth, separation can all delay initial positive feelings

197
Q

What should be known about close contact

A

-it facilitates attachment, affection, breastfeeding less crying, increased thermoregulation, increased cardiorespiratory stability
but isn’t an essential

198
Q

extended contact is especially good for:

A

those @ risk for parenting difficulties

  • adolescents
  • low social/ financial support
199
Q

best ways to facilitate eye contact

A

enface position: 20cm apart
dim light
right after birth

200
Q

what is etrainment

A

when newborn moves in time with structure of adult speech

201
Q

what is biorhythmicity

A

fetus in toon with mothers natural rhythms such a heartbeat

infant musst establish own through routine and consistent learning & care

202
Q

what is reciprocity

A

behaviour that provides the observer with clues to respond to cues

203
Q

what is synchrony

A

the fit between the infants cues & parents response

204
Q

describe transition to parenthood

A 
time of disorder &amp; satisfiaction 
normal coping may not work
may become unsupportive 
the transition is harder on the father 
limited knowledge
205
Q

what are the phases to becoming a mother

A

1) dependent ( taking in phase)
2) dependent- independent phase (taking hold)
3) Interdependent (letting go phase)

206
Q

what happens in the mothers dependent phase of motherhood

A

first 1-2 days
-focus on self& basic needs
excited

207
Q

what happens in the motherhood dependent - independent stage

A

2-3 days lasts 10day-2 week
-focus is the care of baby
this is optimal teaching time

208
Q

what happens in the motherhood interdependent phase

A

Focus is forward as a family

reassertion of relationship with partner

209
Q

4 stages of becoming a mother

A

1) commitment, attachment to unborn baby & prep
2) Acquaintance/ attachment for infant, learning care (2-6 weeks)
3) moving ward new normal
4) achievement of maternal identity through redefining self (4m)

210
Q

Maternal sensitivity to needs deremines the relationship

A

awareness, affect, timing, perception, flexibility, acceptance, responsivensss to cutes

211
Q

mothers may feel overwhelmed for

A

3-6 mo

212
Q

plan additional supportive consoling for

A
  • 1st time mom
    -in experienced with child care
    carreer provided stimulation
    lack friends or fam
    adolescent
213
Q

What are the phases to become a father

A
  • Expectations + intentions (desire for emotional involvement)
  • confronting reality (deal w/ expectations - frustration, disappointment, guilt, helpless)
  • creating role of father (alter expectations, refine role, learn to care & struggle for recognition)
  • Reaping rewards (smile, meaning 6w-2 mo)
214
Q

what happens to fathers first 4-10 weeks

A
  • uncertin
  • increased responsibility
  • bad sleep
  • re-establish relationship with partner
215
Q

common adjustment issue for couples

A
  • changes in relationship
  • division of household & infant duties
  • finance
  • balance
  • social activities
216
Q

was to cope for couples

A
  • share expectations & assess relationships
  • date nights
  • appreciation
  • be flexible
217
Q

what are the factors of changes in woman sexuality

A
  • hormone shift
  • increased breast size
  • body not pre-preg yet
  • fatigue
  • exhaustion
218
Q

what is a contingent response

A

occurs within a specific time & are similar to a stimulus behaviour
(smile, cooing, eye contact)

219
Q

how long does postpartum blues last for

A

3-5 days

220
Q

behaviour characteristics influencing behaviour adjustment

A

1) modulation of rhythm
2) modification of behavioural repertoire
3) mutual responsivity

221
Q

birth -2 hour period focus?

A

assess & stabilizing

-signs of distress & interventions

222
Q

immediate after birth care

A

primary goal = effective respiration’s

223
Q

routine care can begin if…

A
  • term
  • cry/breath
  • good muscle tone
224
Q

assessment

A

airway, dried, hr, color, resuscitation, stimulation

225
Q

when to wear gloves

A
  • physcial assessment
  • breast milk contact
  • diaper change
226
Q

apgar score

A 
low = bad 
rapid exam 
1) hr via palpate umbilical cord or auscultate
2) resp rate movement or auscultation
3) muscle tone (flexion) 
4) reflex irritability 
5) skin color 
occurs 1 &amp; 5 minutes after birth 
0-3 = sever distress
4-6 = moderate difficulty 
7-10 = little to no difficulty 
**reassessed @ 10 &amp; 20 min if less than 7 
**doesn't predict future neurooutcome, just transition to extrauterine life
227
Q

if resuscitation is required it happens

A

-after drying

b4 one minute apgar

228
Q

infant hr

A

110-160

229
Q

infant resprate

A

30-60

230
Q

if baby is having trouble breathing

A

side laying until they clear their throat

231
Q

are crackles normal after birth?

A

yes fine crackles

232
Q

what are the 4 conditions for adequate O2 supply

A

1) clear airway
2) adequate establishment of respiration’s
3) adequate circulation, perfusion, function
4) adequate thermoregulation

233
Q

Abnormal resp

A

tacky = over 60
brady = under 30
O2 sat = less than 95

234
Q

how hot to keep nursery

A

22-26degrees

235
Q

what is babies usual temp

A

37 (36.5-37.5)
will stabillize around 8hr use auxiliary
post pone bath until stable

236
Q

what does eye prophylaxis do

A

prevent ophthalmia neonatorum

237
Q

what does vitamin K prophylaxis do

A

prevent hemorrhagic disease

238
Q

infant assessment: proceed head to toe except

A

-procedures that need quite first

then more distracting

239
Q

ave newborn bp

A

60-80 / 40-50

240
Q

average birth weight

A

2500-4000g F: 3400 M: 3500

241
Q

average head circumference

A

32-36.8cm

242
Q

average length

A

45-55 cm

243
Q

head makes up

A

1/4 of body length

244
Q

assess umbilical cord for

A

2 arteries 1 vein, dry & odourless

245
Q

should bowel sounds be heard right after birth in infant?

A

yes melconium 24-48hr

246
Q

voiding schedule of newborn

A

1 void a day till day 5

then 6-8 wet diapers

247
Q

how soon should ballard score be done? (test for gestational age)

A

less than 26w- within 12 hr

over 26w - 96 hr ok

248
Q

Neuromuscular maturity is based on

A
  • posture
  • square window (angle between base of thumb & forearm)
  • arm recoil (hold em out they should flex back in)
  • popluteal angle (flex legs in & & put down)
  • scarf sign (elbow shouldn’t reach midline)
  • heel to ear (measure distance of food to ear & degree of knew flex)
249
Q

what is considered an early term infant

A

37-38 and 6 days.

-breast feed difficult, resp distress, transient achy, learning difficulty, mortality

250
Q

late term pre term infant risks

A

34-36 & 6 days.

resp distress, temp instability , hypoglycaemia, apnea, feeding difficulty, hyperbulirubinea

251
Q

soft tissue injuries of infant

A
  • subconjunctive hemorage will clear within 5 days

- all other rashes will clear by 2-3 days

252
Q

What are the infant tasks of physiological adjustment

A

1) establish & maintain respiration
2) adjust circulatory changes
3) regulate temperature
4) ingesting & retaining nutrients
5) eliminating waste
6) regulating weight

253
Q

behaviour adjustments of infant

A

1) establishing a regulated behavioural tempo independent of mom
- arousal, change in state, sleeping pattern)
2) process, storing organizing multiple stimuli
3) establishing a relationship with caregivers & environment
* *usually not much difficulty

254
Q

what happens during the transition to extrauterine life

A

6-8hr

  • monitored by sympathetic nervous system
  • change hr, rrr, temp, GI function
    1) period of reactivity
    2) period of decreased responsiveness
    3) 2nd period of reactivity
255
Q

what happens in the period of reactivity

A

(30min)
- hr rapidly falls to 110-160
- rr is 60-80bmp
- fine rachel’s
- tremors, crying, bowel sounds

256
Q

what happens in the period of decreased responsiveness

A

60-100 min

  • pink
  • increased shallow respoations
257
Q

what happens in the 2nd period of reactivity

A 
2-8 hr can last 10 min to hours
-tahycardia &amp; tachypnea
-increased muscle tone 
skin color change
-increased mucus 
meconium
258
Q

factors that cause initiation of breath

A
  • clamping cord causes increased bp, cirulation
  • chem factors (hypoxia in labour)
  • mech factors (changed intrathoracic pressure)
  • thermal factor ( cold stress)
  • sensory factors (being handed, dried, pain, light, sound, smells)
259
Q

what are the signs of respiratory distress

A

nasal flare, retraction, grunting, stridor / gasping, seesaw, apnea (increased temp, hypo or hyperglycaemia, sepsis)
tachypnea (fluids not cleaned, sepsis, pneumonia, surfactant deficiency)

260
Q

how long is acrocyanosis normal for

A

first 7-10 days

261
Q

how low can HR be while asleep

A

90 when asleep, 180 when cry

262
Q

is a drop in bp within first hour normal?

A

yes 15 is normal

263
Q

what is an infants blood volume

A

80-100ml/kg of body weight
increases by 300mL immediately after birth
preterm have more blood b/c more plasma
late clamp expands blood volume

264
Q

what are the advantages to late clamp

A

increase birth weight, increase hct. increased iron & decreased anemia can last up to 6 months. increased fine motor control by 4yr increased risk of jaundice

265
Q

what could persistent tachycardia mean

A

anemia, hypervolemia, hyperthema, sepsis

266
Q

what could persistent bradycardia mean

A

heart block, hypoxemia, hypothermia

267
Q

what could infant pallor mean

A

anemia, peri-vasoconstriction, difficult delivery or sepsis

268
Q

what causes increased risk of cardiac defects

A
  • rubella
  • diabetes
  • drugs
269
Q

do platelets change after labour for infant

A

no they’re same as adults

270
Q

what happens to RBC’s after baby is born

A
  • RBC’s are high & slowly fall
  • polycythemia (delayed clamp, maternal hypertension & diabetes, intrauterine growth & restriction)
  • @ birth 70% fetal hemoglobin, week 5 55%, 5% by week 20
271
Q

why might a baby have neutrophilia

A
  • crying
  • high altitude
  • hemolytic disease
  • maternal fever
  • melonconium aspiration
  • lactation
  • surgery
  • difficult labour
272
Q

what are the factors for heat loss

A
  • temp/humidity
  • flow & velocity
  • surface in contact w/ infant
273
Q

what does a neutral thermal environment do

A

allow infant to maintain normal temp & minimize O2 & glucose consumption

274
Q

how does heat loss occur

A

1) convection - head loss body surface to air
2) radiation - head form body surface to cooler surface not in direct contact (keep baby away from)
3) evaporation - liquid to labour
4) conduction- cooler surface (direct contact)

275
Q

what is thermogenesis

A

generation of heat via music. avtity

metabolize brown fat

276
Q

what happens during cold stress

A

-increased RR
decreased perfusion
hypoglycaemia

277
Q

what happens to the renal system

A

-@ birth 40 ml of urine (usually during birth )
then they will pee 15-60 a day gradual increase
-they must void at least once
-not very concentrated urine
can be cloudy, crystals is normal
water = 75% of weight
decreased ability to remove wast

278
Q

what are epstein pearls

A

normal white cysts on gums

279
Q

when is an infant coordinated enough to swallow

A

32/33 weeks

  • neuromusc maturity
  • maternal needs
  • initial feeding
280
Q

when does amylase appear in saliva

A

by 3m

281
Q

what could no meconium be

A

-malrotation
atresia
inborn error of metabolism
congenital defect

282
Q

what would ab distension mean

A

very serious

283
Q

what is meconium made of

A

amniotic fluid, intestine secretions, shed cells & blood

284
Q

what is transition stool made of

A

3rd day after feed (yellow or green)

285
Q

what is milk stool made of

A

(4th day)

yellow, pasty, sour milk

286
Q

how much room does the liver occupy

A

40%
-iron storage, carb metabolism, conjugations of billiruibn
coagulation

287
Q

what is jaundice

A

increased serum levels of unconjugated billirubin

288
Q

what are bilirubin levels effected by

A
  • gestational age
  • weight
  • race
  • blood type nutrition
  • mode of feed
289
Q

asian & indigenous have…

A

higher bilirubin

-most risk if breast fed

290
Q

what is physiological jaundice

A

60% term, 80% preterm
2 phases: 1) bilirubin increases for 60-72
2) decreases to plateau by day 5
3) slowly decrease for 2-4w

291
Q

pathological jaundice

A

if exceeds 256 mol

292
Q

symptoms of pathological jaundice

A
  • lethargy
  • hypotonia
  • delayed motor skills
  • hearing loss
  • cerebral palsy
  • gaze abnormalities
293
Q

when will baby reach adult levels of coagulation

A

9 months

294
Q

how long are maternal IGG antibodies effective for

A

3 months

-adult concentration by 4-6 yr

295
Q

when is acidic stomach

A

3/4 weeks

296
Q

are newborns @ risk for infection?

A

yes all newborns especially premies are at high risk

leading causes

297
Q

Dysperunia

A

dryness

298
Q

signs of newborn infection

A

-fever, lethargy, irritability, poor feed, vomit, diarrhea, decrease reflexes, pale skin

299
Q

signs of pneumonia

A

apnea, tachypnea, grunting, retracting

300
Q

what are some risk factors of infection

A
  • rupture of membranes
  • choriamnionitis
  • maternal fever
  • asphxia
  • invasive procedures & stres
  • congenital abnormalities
301
Q

babies over 35 weeks will have

A

vernix caseosa

decrease ph, decrease erythema, increase hydration

302
Q

when is acrocyanosis normal for

A

first 7-10 days

303
Q

what is milia

A

distended white sebaceous glands on face

304
Q

when will babies start to sweat

A

day 3

305
Q

desquamation

A

peeling

306
Q

what are nevi

A

will go away in a few years

307
Q

what is erythema toxic

A

transient rash (24-74 hr) last up to 3 weeks

308
Q

signs of integumentary problems

A

pallor, plethora (purple), petechiae, central cyanosis, jaundice

309
Q

why is hypospadias

A

urethra not @ tip

310
Q

skeletal system characteristics

A
  • arms longer than legs
  • legs 1/3 of length 15% weight
  • disapears within 3-4 days
311
Q

what is caput succedaneum

A

generalized deem of scalp (gone by 3-4 days)

312
Q

what is cephalic hematoma

A
  • blood between skull & peropsteum

- goes away by 3-6 week

313
Q

subgaleal hemorrhage

A

associated w/ vacuum

314
Q

what is oligodactyly

A

missing digit

315
Q

what is polydactyly

A

extra digit

316
Q

what is syndactyly

A

fused digit

317
Q

what tests for dysplasia of hip

A
  • easily siloactate
  • asymetrical gluteal fold
  • ortolani test
  • barlow test
318
Q

what babies are at high risk for hypoglycaemia

A
  • diabetic mom
  • macrosomic or stimuli
  • prolonged birth
  • hypoxia
  • preterm
319
Q

what are transient tremors

A

normal until a month

320
Q

what is myerson/ glabellar reflex

A

tap on face& will blink for first 4-5 times

321
Q

truncal incurvation (gallant) reflex

A

trunk flexes & pelvis swings to stimulated side

322
Q

what is magnet reflex

A

pressure against feed will flex back

323
Q

infant vision

A

can see 50 cm away but clearest 17-20 cm

by 5 days they’re attracted to black &white

324
Q

hearing, taste, small and touch

A

highly developed

325
Q

what is habituation

A

ability to respond & inhibit responding to descrete stimulus

  • protective mechanism
  • helps avoid overload
  • especially responsive to human void, soft light, soft sound
326
Q

what is orientation

A

quality of alert states & ability to attend to stimuli

327
Q

what is autonomic stability

A

signs of stress

328
Q

what does crying signal

A

hunger, discomfort, pain, want attention, fussy, cold, overstim, held by to many people

N133 (10 decks)

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