Mat p3 Flashcards
what is the focus of postpartum nursing care? (acronym)
BUBBLE B-breasts U- uterus B-bladder B-bowel L-legs E-emotions
what focus do you have in regards to breasts (BUBBLE) in postpartum nursing care?
breast feeding problem, mastitis tends to occur when you’ve gone home r/t poor latch
what focus do you have in regards to the uterus (BUBBLE) in postpartum nursing care?
PPH-uterine atony, cervical or vaginal alcerations, hematomas or retained POC, endometritis/perineal cellulitis
what focus do you have in regards to the bladder (BUBBLE) in postpartum care?
UTIs (from trauma to the urethra and sweeps up bacteria and repeated exams and catheterizations)
what focus do you have in regards to the legs in postpartum nursing care?
thrombophlebitis, DVTs
what is considered early postpartum hemorrhage? late?
majority are?
<24 hours is early
>24 hours- 6 weeks is late
early
what are the risks of hemorrhage (4 T’s)
Tissue (things left inside the uterus), Tone (uterine atony), trauma (tears to cervix or vagina, rectum), thrombin (clotting issue)
what other risks are there for postpartum hemorrhage?
Prolonged labour Polyhydramnios Macrosomia Shoulder dystocia Multiple gestation Use of forceps Retained products of conception (POC) Endometritis
what assessments do you do for determining postpartum hemorrhage?
-fundus- palcement, timing
-lochia- amount, timing, colour, clotting
-perineum- are there tears, sutures, bruising, swelling
VS
-pallor and fatigue or SOBOE, cap refill
-has the pt voided?
-risk factors?
-IV? meds (oxytocin)
if your patients fundus is not one finger below after the following day and pushed to one side, what might be your first action?
is her bladder full? instruct her to empty her bladder and full bladder is preventing it from involuting (contracting down)
what is living ligature?
tightening motion of vessels around the uterus causing it not to bleed
what is one action you might do to stop a hemorrhage?
fundal massage, lower bed to promote oxygenation to brain
if blood is tricking out, can this be a hemorrhage?
might be a tear in the perineum
what is the drug you want to give for hemorrhage?
Mesd are oxytocin, misoprostil, ergometrine (IM injection causes uterus to contract), carboprost/hemabate (smooth muscles contract) causes bowels and uterus to cramp, will have uncontrolled diarrhea from hemabate!!
how much blood loss during vaginal delivery is considered hemorrhage? C/s?
vaginal >500ml
C/s ~1000ml
how much blood is a fully saturated pad?
around 100ml
what are some nursing diagnosis for postpartum hemorrhage?
Deficient fluid volume r/t increased lochia flow
Ineffective peripheral tissue perfusion r/t circulating volume losses
Situational low self-esteem r/t postpartum fatigue and inability to feed infant
Risk for impaired role transition r/t fatigue d/t PPH
Ineffective breastfeeding r/t fatigue d/t PPH
Interventions during PPH
Fundal massage, support and express clots
Call for help, alert physician
VS
Lower HOB
IV normal saline or Ringer’s Lactate as ordered
Administer medications as ordered (oxytocin, misoprostil, ergometrine, carboprost)
Catheter or void if able
risks for postpartum infection?
> 24 hours ROM, retained POC, pre-existing anemia, prolonged labor, internal fetal monitoring, repeating exams, inc manual explooration of uterus after delivery, unsterilized equipment, improper or no peri care after delivery, poor HH, shared supplies between pt, cleaning between pt limited or poorly done, PPH, use of instruments
Postpartum infection- assessments?
uterine pain, malaise, foul smelling lochia , fever, PV losses, discoloured lochia(green, frothy), usually starting 3-4 days after delivery, WBC count elevation
if a uterus is infected, how will this affect it contracting?
it can’t contract bc it is inflamed and the muscle is inflamed (can’t involute)
if a women is diaphoretic and says she feels hot/has the flue. how will you differentiate lactogenesis from infection. milk comes in around day 3-4 same with infection?
check her discharge, look at loch and ask about it, palpate uterus that it is 2-3 finger bowl umbilicus
interventions for PP infection?
Teach signs and symptoms of infection prior to discharge, abx, analgesia, oxytocic agent may be needed to support involution, strict asepsis and infection control measures to prevent spread of microorganisms to others
if mom has GBS (group B streptococcus) and baby gets it through delivery, what is the baby at risk for?
meningitis
when do they screen for GBS?
around 35-37 weeks
what do you do if mom goes into labour early and has not been tested for GBS?
goes on penicillin and clundomicin and baby only if its symptomatic after its born
can herpes be contracted to fetus?
yes, it can cross the placenta if mom has a primary infection during pregnancy/ more often contracted from vaginal secretions at birth
what is the therapy for baby that contracts herpes?
antretroiviral drug such as acyclovir (zoviraz) a drug that inhibits DNA synthesis that is effective in combating overwhelming infection
can babies contract hep B?
can be transited thru contact with infected vaginal blood when
what do you do if mom is Hep B pos?
ask if they infant would like vaccination t birth
should be bathed ASAP to get secretions off
gentle suctioning to avoid trauma to mucous membrane
infant administered serum immunglobulin (HBIG)
can Hep B get into breast milk?
yes but if it has immune globulin baby is safe
when is apgar done?
1,5, 10 minutes
what does apgar look at?
HR, tone, reflex irritability, colour, resp effort
what effect does mom smoking have on baby?
tiny placenta and tiny baby and baby will have unusual od our
how does the baby look (size)in a women with diabetes mellitus? how does their face look?
macrosomia (bigger) from overstimulation of growth hormone and extra fat deposits created by high levels of insulin during preg. baby is often immature so size doesn’t say much
face is cushingoid (fat and puffy)
why does a baby that goes through C/S have poor gut health?
because the vaginal flora helps with gut
VS for baby? sugars?
resp 30-40
temp: 36.5-37.4
pulse 110-160
sugars: 3.2-6
do premature babies have more or less flexion?
lesss flexion in upper extremities and partial flexion on lower extremities.
what do the sole creases on a newborn look like?
premature have very few or no creases
genitalia of premature babies?
male- tests are v high and inguinal canal and there are few rug on scrotum. full term are lower in the scrotum and rugae developed
female- when on back with hips abducted, clitoris is prominent and labia major are small and widely separated. full term labia minora and clitoris are covered by majora
what does the foramen ovale do?
connects between right and left atrium
what does ductus venosus do?
these ducts allow blood to go from placenta to heart and bypasses from lungs
what does ductus artercosus do?
allows blood back into main circulation and to lungs to service as organs
what can cause us to go back to extrauterine circulation?
lack of surfactant, inc acidosis and being cold.
if we are in an acidotic state or cold, the ducts stay open and flutter open.
what factors lead to resp distress in preterm infants?
-dec surfactant and lung maturity
-susceptibility to cold stress and metabolic disturbances
-immature organ development
-immature CNS
-decreased fat deposits and no brown fat
decreased ability to eat and absorb nutrition
what are the 4 methods babies use to lose height?
convection, radiation, conduction, evaporation
how can we prevent heat loss?
Remove wet linens, and place Skin to Skin if healthy
Incubators, dry linen, plastic wrap, warmed stethoscopes, warmed beds
if baby is too hot and forced to dec metb, to spare o2 for essential body, what will the body do to cause it to go back to intrauterine circulation?
vasoconstriction of the peripheral vessels pushing into torso and continues for so long, pull vessels become lax and pulm perfusion dec and pO2 drops and fetal shunts will remain open. surfactant also dec. and anerobic resp causes acidosis, inc risk of acute bilirubin encephalopathy or kenricterus
when you’re assessing for fluid and electrolyte balance, where do you look?
assess anterior fontanel (if sunken and soft-dehydrated), urine and fees, feeding, acidosis at birth.
fluid volume excess can result in what?
returning to fetal circulation
why is it so difficult to restore sick infants fluid losses?
unable to restore through eating, kidneys are very immature and have difficulty concentrating urine
how does breastfeeding help with nutrition and waste?
stabilizes resp, temp, and blood sugar
colostrum loosens up mucus and clears airway
why is sucking difficult for preterm?
because neuro not fiully developed ? not able to co-ordinate suck, shallow breath
why might a pre-term infant require a TF
because they have difficulty breathing with the suck, swallow, breath pattern- energy calories and inc effort
bowels in re: nutrition and waste for newborn?
may not be mature enough to absorb (NEC)
what is necrotizing enterocolitis?
intestinal dysfunction. bowel deelops necrotic patches, interfering with digestion and possibly leading to paralytic ileus, perforation and peritonitis.
occurs d/t anoxia to bowel- may result as complication of exchange of transfusion or episode of breathing didiculty
how does colostrum help with the cells in the bowel?
do you give more or less colostrum to a preterm?
cells in bowel are loosely aligned and proteins slip through these gaps and get into the blood stream. when you give bb colostrum it helps to tighten these cells
more– may give a weeks worth of colostrum to a preterm
does the moms milk production differ depending on when baby is born?
yes. has lots of protein in it and essential fatty acids and mom will produce more immune preserving properties in her milk if she delivers prematurely. only lasts about 2 weeks.
when else does a baby present preterm, even if baby is not preterm?
when macrocosmic
if mom is diabetic, what happens to baby in terms of sugars and insulin in utero and then when delivered?
high level of glucose coming to them in utero and therefore produces high levels of insulin so once baby supply is cut off and baby is delivered, insulin persists in the body for several hours and sugars drop to low levels
what BG do we intervene for baby?
2.8
how can we intervene to help hypoglycaemic babies?
Nursing care of these babies centres on frequent BS checks and ensuring adequate intake. Supplementation with formula is usually necessary until breastmilk supply is established
low BS contribute to alkalosis or acidosis ? why?
what does this impede?
acidosis which then impedes respiratory function
how closely do you need to care for macrocosmic babies?
what types of interventions/monitoring?
1:! care for their unstable status
frequent BS, supplemental feeds, possible IV, o2, skin t skin
why are premature babies at higher risk of infection?
compromised or immature immune systems
how can we prevent infection for babies?
breastmilk has immunologic properties
strict infection control and visiting policies
what are symptoms of neonatal abstinence syndrome?
Irritability Disturbed sleep pattern Constant movement, tremors Frequent sneezing Shrill, high-pitched cry Possible hyperreflexia and clonus Convulsions Tachypnea Vomiting and diarrhea
what is hyperbilirubinemia?
hemolytic disease of the newborn
excess RBC breakdown
caused by ABO or Rh incompatibility
mom builds Ab against fetal RNC- lead to hemolysis, severe anemia and hyperbilirubinemia
