Mat P3 WORKBOOK

Question 1

what factors predispose women to DVTs?

Answer 1

inactive during labor and during early puerperium bc this inc risk of blood clot formation
prolonged time in birthing room w legs in stirrups
preexisting obesity and pre weight gain >recommended
preexiseting varicose veins
develop a postpartum infection
hx of previous thrombophlebitis
older than 35 or inc parity
high incidence in family
smoke cigarettes bc nicotine causes vasoconstriction

Question 2

strategies to prevent DVT development?

Answer 2

ambulation, limiting time in stirrups or make sure well padded, support stockings for first 2 weeks after birth, instruct to remove them twice daily to look at skin for inflm, might be prescribed aspirin q4h

Question 3

why is it dangerous to massage the area over a clotted area?

Answer 3

bc can loosen the clot causing a PE

Question 4

measures to prevent development of mastitis?

Answer 4

-making certain baby is positioned correctly and grasps nipple properly
helping a baby release a grasp on the nipple before removing the baby from the breast
-washing hands between handling perineal pads and touching breasts
-expose nipples to air once a day
-vit K ointment daily to soften nipples
-encouraging women to begin breastfeeding on an unaffected nipple

Question 5

what organism are associated with nosocomial mastitis?

Answer 5

infant usually acquired staphylococcus aureus, a MRSA infect or candidiasis

Question 6

assessment findings associated with mastitis

Answer 6

usually unilateral, although epidemic mastitis bc originates from infant may be bilateral. Feels painful and appears swollen and red. Fever comes within first hours and breast milk becomes scant. Sonogram may be done

Question 7

medical and nursing intervention to treat mastitis

Answer 7

abx effective against penicillin resistant staph such as diclozacillin or cephalosporin

Question 8

should you continue breast feeding with mastitis?

Answer 8

yes if possible bc keeping breast empty prevents frowth of more bacteria. sometimes hurts from sucking so want to express milk until abs works (3 days or so)

cold or ice compress and supportive bra for pain

warm, wet compress dec inflm and edema

Question 9

why are women prone to UTIs after delivery?

Answer 9

Because often woman are catheterized at the time of childbirth or during postpartal period and bacteria are introduced there.

Question 10

Describe the assessment findings and therapeutic management of a UTI after delivery.

Answer 10

burning on urination, possibly hematuria, frequency, sharp pain on voiding, may have low grade fever and low andm pain,

urin spec but use a sterile cotton swab to tuck into vagina to avoid local discharge

mgmt: broadspectrum abs such as amoxicillin or ampicillin (make sure it is safe for breastfeeding)

lots of fluids

Question 11

what does oxytocin do?

Answer 11

it is a hormone that stimulates smooth muscle contraction (uterus) similar to contractions. has vasopressor and antidiuretic effects

Question 12

what does misoprostil do?

Answer 12

This medication may also be used in the hospital to assist with childbirth only at the time of delivery (e.g., cervical ripening, induction of labor) and for the treatment of severe bleeding after delivery.

inserted vaginally

Question 13

what does ergometrine do?

Answer 13

type of medication called an ergot alkaloid and used to help prevent and control bleeding after childbirth.
acts on 3 different types of receptors walls of vessels and uterus. cause blood vessels to constrict and uterus to contract. contractions help deliver placenta. reduces blood flow to uterus which reduces blood loss

Question 14

what does hemabate do?

Answer 14

IM injection to stop bleeding following pregnancy

also used to induce abortions.

Question 15

what is ophthalmia neonatorum?

when does it occur?

how do you treat?

Answer 15

eye infection that occurs at birth during first month of life. generally bilateral conjuctivae become fiery red with thick pus and eyelids are edematous

occurs 1-4 days of life

treat with IV ceftriaxone and penicillin
sterile saline in eyes using dropper or bulb syringe

Question 16

when do neonatal absintince symptoms appear and fade? (Drug-dependent mother)

Answer 16

24-48 hours and lasts about 2 weeks

Question 17

if drug dependent mom was on methadone maintenance, will baby still show symp?

Answer 17

yes

Question 18

how can you test if mom was using during birth? hint: test on infant

Answer 18

test in mec or urine sample of first hour of birth- narc metbaolites

Question 19

what might present in preschool age if cocaine using mom?

Answer 19

maladaptive coping behaviours

Question 20

cocaine infants have problem with?

Answer 20

sucking.
quiet dark room

woman advised not to BF

Question 21

what are some common drugs used to counteract absintince symp?

Answer 21

morphine and phenobarbital. Others are methadone, chlorpromazine and diazepam,

Question 22

which babies are at risk for RDS?

Answer 22

preterm infants, infant of diabetic mothers, infants born by c/s or those who have dec blood perfusion of the lungs. surfactant

Question 23

when does surfactant usually form?

Answer 23

usually forms in the 34th week of gestation

Question 24

what are the S&S of RDS and when do they first appear?

Answer 24

(long) difficult resps at birth. After resuscitation they have hours or days of no symptoms bc initial release of surfactant but will have subtle symp such as: low boy temp, nasal flaring, sternal and subcostal retractions, tachypnea (more than 60RR), cyanotic mucous membranes. Within hours, expiratoy grunting occurs caused by the closure of the glottis,aas it tries to inc the p in alveoli on expiration in order to keep them from collapsing. Infants become cyanotic and their po2 and o2 sat level fall on RA

Question 25

as distress cont infant may exhibit?

Answer 25

Auscultation- fine rales and diminished breath sounds bc of poor air entry. As distress inc an infant may exhibit:

• seesaw resps (inspiration- ant chest wall retracts and abdomen protrudes and expiration the sternum rises)
• Heart failure, evidenced by dec output and edema of the extremities
• Pale gray skin
• Periods of apnea
• Bradycardia
• Pneumo

Question 26

Describe the action of surfactant and CPAP or PEEP oxygen administration.

Answer 26

CPAP or PEEP (positive end-expiratory pressure) exerts pressure on the alveoli at the end of expiration and help keep alveoli from collapsing and also supply o2.

Question 27

what is the risk of too much o2 on immature infant?

Answer 27

ROP (retinopathy of prematurity) or bronchopulmonary dysplasia

Question 28

what is transient tachypnea of the newborn? (TTN)

Answer 28

at birth, rapid reps d/t retained lung fluid normal (up to 80bpm)

Question 29

what is the cause of TTN?

Answer 29

slight dec in the production of of phosphatidylglcerol or mature surfactant, it is a direct result of retained lung fluid which limits the amount of alveolar surface that is available for oxygen exchange

Question 30

normal newborn RR and TTN rate?

Answer 30

normally rapid rate of 80 then goes to 30-60

TTN stays 80-120

Question 31

why is feeding difficult with TTN?

Answer 31

child cannot suck and breath rapidly at the same time

Question 32

which babies are more at risk for TTN?

Answer 32

born by C/s, infants whose mothers received lots of fluid during labor, preterm infants

Question 33

what nursing actions are required if an infant has TTN?

Answer 33

Close observation is priority. Watch carefully to be certain the inc effort is not tiring and other signs of resp distress such as nasal flaring or retractions are not occurring bc rapid resp rate is often first sign of resp obstruction. O2 may be necessary. Mild glucosteroid to reduce resp tract inflm

Question 34

when should TTN resolve?

Answer 34

eOnset is about 6 r and peaks in 36 hrs and then begins to fade around 72 hours as lung fluid is absorbed and resp activity is effective

Question 35

how soon does fetus have mec?

Answer 35

as early as 10 weeks gestation

Question 36

what causes mec aspiration syndrome?

Answer 36

if hypoxia occurs, stimulates the vagus nerve which relaxes the rectal sphincter and mec is released into the amniotic fluid

Question 37

why is MAS a concern?

Answer 37

Cau cause serious resp distress in 3 ways: inflm of bronchioles bc foreign substance, bloc small bronchioles b y mechanical plugging, and it can dec surfactant prod through lung trauma. Hypoxemia, co2 retention and inrapulmonar and extrapulmonary shunting can occur. Secondary infection of injured lung tissue can lead to pneumonia

Question 38

What signs and symptoms (assessment findings) will the nurse note with MAS?

Answer 38

difficulty establishing resps at birth. Apgar is low. Almonst immediately, tachypnea, retractions and cyanosis begin. After initiation of resps, an infants resp rate may remain rapid (tachypnea) and coarse bronchial sounds may be heard on auscultation. May continue to have retractions bc the inflm of the bronchi tends to trap air in the alveoli, limiting the entrance of oxygen. Air trapping may also cause englargement of anteroposteriod diameter of the chest. Poor gas exchange wth po2 and blood gases. CXR will show bilateral coarse infiltrates in the lungs with spaces of hyperaeration (peculiar honey comb effect) diaphragm will also be pushed downward by over-expanded lungs

Question 39

in MAS- why might the infants chest (anteroposteroid diameter) be enlarged?

Answer 39

air trapping

Question 40

what causes hemolytic disease of the newborn (hyperbilirubinemia)

Answer 40

Results from destruction of red blood cells by a normal physiologic process as the newborn breaks down excess red blood cells formed in utero. Can be from Rh incompatability or ABO incompatability

Question 41

What does the term hydrops fetalis mean?

Answer 41

severe form of Rh incept at birth. hydrops refers t the edema and fetalis to the lethal state.
total body swelling

Question 42

when does mom start to form Ab if baby is pos (rh)

Answer 42

within 72 hours after birth

Question 43

why are high bilirubin levels dangerous?

Answer 43

they are dangerous because the liver cannot convert all the indirect bilirubin produced too direct bilirubin so jaundice is extreme. High levels above 20mg/dl in a term infant causes brain damage from bilirubin-induced neurlogic dysfunction, a wide spectrum of disorders can occur from mild dysfunction to ABE (invasion of bilirubin into brain cells)

Question 44

explain the effect of early feeding (hyperbilirubenmia)

Answer 44

Initation fo early feeiding (urge mom to BF 8-10 times a day for first 2 days)- bilirubin is removed from the body by being incorporated into feces- sooner the elimination the sooner it is removed.

Question 45

effect of phototherapy for hyperbilirubinemia

Answer 45

Phototherapy- exposure to light triggers liver to assume function. Infant is exposed to liht such as quartz halogen, cool white daylight, or special blue fluorescent light. Placed 12-30 in above newborns bassinet or incubator. Generally scheduled for phototherapy when the total serum bilirub level rises to 10-12 mg/dl at 24 hours of age preterm is lower than this. Might admin iV immunoglobulin with phototherapy. Infants eyes are covered cause exposure to retina is damaging. Cover with dressing or cotton balls over a mask. Stools will be bright green and loose urine may be dark fro urobilinogen formation.

Question 46

what are the normal total serum bilirubin (TsB) levels? What TsB level becomes dangerous?

Answer 46

Normal I think? Is 0-3mg/100ml in cord blod? It is dangerous if it rises above 20mg/dl or as low as 12mg/dl in term infants

Question 47

Why does hemorrhagic disease of the newborn happen?

Answer 47

def of vit k- essential for formation of prothrombin by the liver. Lack of causes impaired blood coagulation. Formed by action of bacteria in the intestine but babys intestine is sterile at birth w minimal amonts of vit k until normal flora is established. Admin vit k to mom often protexts newborn.

Question 48

what med is given to babies with hemorrhagic disease of the newborn

Answer 48

1mg vit K IM

Question 49

what is necrotizing enterocolitis?

Answer 49

Intestinal dysfunction that develops in 5% of infants in ICY nurseries.
he bowel develops nectroic patches interfering with digestion and possibly leading paralytic ileus, perforation and peritonitis. Occurs bc of anoxia to the bowel and may result as a complication of exchange transfusion or an episode of dyspnea.

Question 50

what causes ROP (retinopathy of prematurity?

Answer 50

Caused by vasoconstriction of immature retinal blood vessels. Happens bc of high conc of oxygen exposure and vessels constrict, endothelial cells in the periphery of the retina proliferate causing retinal detachment and possible blindness