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Maternal/Child > Lecture 1 - Introduction > Flashcards

Lecture 1 - Introduction Flashcards

1
Q

What is the antepartum period?

A

From conception to the onset of labour

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2
Q

What is the intrapartum period?

A

From onset of labour to delivery of placenta

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3
Q

How long does the postpartum period last?

A

Usually defined as up to 6 weeks following delivery
–> Up until uterus has returned to pre-pregnancy state

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4
Q

How long does pregnancy typically last?

A

~280 days (40 weeks)

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5
Q

How many weeks is considered term pregnancy?

A

37 weeks
–> A term baby is born after 37 weeks

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6
Q

What is normal maternal temperature in the first 24 hours postpartum?

A

Up to 38°C can be normal d/t dehydration and stress. Should normalize after.

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7
Q

What pulse changes are expected immediately postpartum?

A

Elevated for first hour can be normal, but should begin to normalize to between 60-100.

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8
Q

What BP changes are normal immediately postpartum?

A

Should be normal (baseline). Transience of 5% during first few postpartum days can be normal.
–> Elevation d/t fluids or pain might be seen

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9
Q

What resp rate is normal immediately postpartum?

A

Should be between usual postpartum range (12-24)

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10
Q

What BP changes should be monitored for immediately postpartum?

A

Orthostatic hypotension

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11
Q

What does BUBBLEE stand for?

A

B - Breasts
U - Uterus
B - Bladder
B - Bowel
L - Lochia
L - Legs
E - Episiotomy/laceration or caesarean incision
E - Emotional status

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12
Q

What findings are normal in a breast assessment postpartum through the first 5 days?

A

Days 1-2: Soft
Days 2-3: Full
Days 3-5: Soften with breastfeeding

Colostrum can be expressed

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13
Q

What is colostrum?

A

First breastmilk that is high in antibodies and nutrients that occurs in small quantities.

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14
Q

How can lactation be suppressed in first 72 hours?

A

Goal is to reduce discomfort
–> Well fitted-sports bra, ice packs, cabbage leaves, or mild analgesia

Do not stimulate lactation if goal is to suppress lactation

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15
Q

What is involution? When does it occur completely? What enhances it?

A

The process of the uterus returning to non-pregnant state (6-7 weeks)
–> Enhanced by effective uterine contractions that compress blood vessels (can cause afterpain)
–> Decreased estrogen + progesterone, increased oxytocin

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16
Q

What are postpartum afterpains? In what population are they more common?

A

Strong and vigorous contractions that can last a week postpartum during involution. Occurs during breastfeeding as oxytocin is released.
–> More common with multiparity and with larger NB

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17
Q

When does endometrial regeneration occur during involution of the uterus?

A

Almost complete after 3 weeks, except at placental site which takes 6-7 weeks.

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18
Q

What is a major concern if a uterus is not contracting postpartum?

A

postpartum hemorrhage

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19
Q

Where should the uterus be palpated in the first 24 hours postpartum?
What about 6 days?
When should it no longer be palpable?

A

Following delivery of placenta - 2cm below umbilicus
12 hours - level of umbilicus
24 hours - 1 cm below umbilicus

Should continue to descend 1-2 cm daily.
Should be halfway between umbilicus and symphysis pubis by day 6.
Not palpable by 2 weeks.

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20
Q

What is subinvolution?

A

Failure of the uterus to return to a non-pregnant state.

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21
Q

What are some factors that slow involution of the uterus?

A

Full bladder, prolonged or difficult labour, overdistention, incomplete expulsion of placenta, anesthesia

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22
Q

What is a “boggy” fundus?

A

fundus is soft and spongy, not firm.

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23
Q

What postpartum uterus assessment findings require intervention?

A

Fundus deviated from midline
Fundus higher than expected
Boggy fundus

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24
Q

What interventions can be used to encourage involution?

A

Assist pt to empty bladder
Assess lochia
Gentle fundal massage

If no improvement, report to RM/MD

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25
Q

What is considered an early postpartum hemorrhage? What causes it?

A

First 24 hours
–> Caused by uterine atony (relaxation)
–> May also be caused by lacerations or retained placental tissue

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26
Q

How common are early PPHs?

A

Occur in ~5% of births

27
Q

What is considered a late postpartum hemorrhage? What causes it?

A

24 hours - 6 weeks PP
–> Due to subinvolution
–> May also be retained placental tissue, infection

28
Q

A spontaneous void should occur how soon PP?

A

Within 8 hours

29
Q

Diuresis occurs when PP and lasts for how long?

A

Begins in first 12 hours PP and can be profuse for 3 days.

30
Q

How should patients be taught to prevent urinary incontinence PP?

A

Use of Kegel exercises to strengthen pelvic floor muscles.

31
Q

Bowel sounds should be present immediately following labour. How soon should a bowel movement occur PP?

A

2-3 days

32
Q

What are some factors that can contribute to decreased bowel activity PP?

A

Fear or pain or tearing sutures
NPO status/decreased appetite
Constipation d/t analgesia
Hemorrhoids
Dehydration
Immobility

33
Q

What should lochia be assessed for? What is is a normal lochia volume?

A

~240-400 ml in total
–> Assess for colour/amount/odour/clots or placental fragments which can prevent involution

34
Q

What are the three classification of lochia?

A

Rubra, serosa, alba

35
Q

What is considered heavy bleeding postpartum

A

If a pad is saturated in 1-2 hours

36
Q

What is considered lochial bleeding? What about non-lochial?

A

Lochial
–> Uterine atony
–> Retained placental fragments

Non-lochial
–> Unrepaired cervical or vaginal tears

37
Q

What is lochia rubra? How long does it last PP?

A

Dark/bright red blood containing decidual debris or small clots
–> Lasts 3-4 days

38
Q

What is lochia serosa? How long does it last?

A

Pink/brownish red. Contains older blood, serum, leukocytes, and tissue debris
–> Day 4-14 days (up to 4 weeks)

39
Q

What is lochia alba? How long does it last?

A

Yellowish white, contains leukocytes and decidual debris.
–> Begins after 10-14 days, and may continue until 4-6 weeks after birth.

40
Q

What assessments should be done on the legs PP?

A

Edema: Some ankle edema normal for first few days

Thrombophlebitis: Redness, tenderness, pain

41
Q

How common is DVT PP?

A

Occurs in less than 1% of births, more common in c-section

42
Q

What laceration/episiotomy findings are normal PP?

A

Edema reaches maximum by 24 hours PP and can cause difficulty urinating at this time.
Edges should be well approximated

43
Q

What can be done to encourage healing and decrease pain from a laceration/episiotomy?

A

Ice packs for first 24 hours
Perineal hygiene
Sitz bath

44
Q

What are normal findings of a c-section incision?

A

Dressing should be clean and intact, suture line intact.

45
Q

PP blues appears around day 3, how long does it last typically?

A

Usually only 2 weeks - if not improving we begin to suspect PPD.

46
Q

What are some additional considerations for post-op care following a C-section?

A

Cough & Deep breathing
Gradual ambulation
Pain relief
Rest
Assess for signs of infection

47
Q

How long does full healing take after a c-section?

A

4-6 weeks.

48
Q

When is Anti-D Ig given to Rh- mothers?

A

Prophylactically at 28 weeks and within 72 hours of delivery (or up to 28 days) if fetus is Rh+.

49
Q

What is the role of the newborn admission nurse?

A

Responsible only for the newborn and know antepartum and intrapartum history. Prepared for neonatal resuscitation.
–> Note time of birth, immediate NB assessment & intervention prn, APGAR score, identification.

50
Q

What questions should we ask during NB assessment?

A
  1. Amniotic fluid clear of meconium
  2. Breathing or crying
  3. Muscle tone (flexion)
  4. Is baby full term?
51
Q

What should be done immediately after a NB is born?

A

Place infant prone on birthing parent for skin to skin. Dry & stimulate NB.

Assess airway and auscultate HR (>100)

52
Q

If the answer to any of the main 4 NB assessment questions is no, what should be done?

A
  1. Place NB supine on radiant warmer
  2. Suction using bulb syringe
  3. Dry
  4. Assess resp effort, HR, colour.
53
Q

What things are assessed in APGAR?

A

HR, resp rate, muscle tone, reflect irritability, colour.
(Activity, pulse, grimace, Appearance, Respirations)

54
Q

When is an APGAR score performed?

A

1 minute and 5 minutes of life

55
Q

What is acrocyanosis?

A

cyanotic extremities.

56
Q

What care procedures are performed early in NB’s life?

A

Identification
Physical - weight, measure, gestational age
Medication - erythromycin ophthalmic ointment (2hrs), Vit K (6hrs)

57
Q

What are signs of respiratory distress in the newborn?

A

Nasal Flaring
Intercostal or subcostal retractions
Grunting
Resp rate outside of 30-60 range is concerning

58
Q

What NB HR is normal?

A

110-160 with variations

59
Q

Are murmurs normal in the NB?

A

Murmurs are common and usually temporary

60
Q

What is a normal NB temperature?

A

36.5-37.5°C, axillary

61
Q

Hypothermia of the NB can result in what complications?

A

Cold shock:
Resp distress, hypoglycemia, jaundice (hyperbilirubinemia which crosses BBB)

62
Q

What is physiological jaundice and how common is it in NBs?

A

Physiological jaundice affects 60% of infants by day 2-5 of life.

Considered pathological if it occurs in first 24 hours or persists beyond 7-14 days.

63
Q

How many voids are expected in first week of life?

A

1 void per day of life for first 5 days, then expect 6-7 wet diapers daily.

64
Q

Meconium should occur by what age? How long does it last?

A

Expect first stool by 24-28 hours, lasts up to 3 days.

Maternal/Child (2 decks)

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