Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

N332 final > maternity- FOCUS: postpartum & neonatal complications > Flashcards

maternity- FOCUS: postpartum & neonatal complications Flashcards

1
Q

high risk, prolonged, or difficult delivery warrants increased…

A

postpartum monitoring!!! increased risk of PPH, infection, postpartum depression

  • astute and attentive nursing care is very important!!!
  • asepsis and hygiene are very important!
  • role modelling!
  • physical care initially, then help with role transition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the BUBBLE assessment???

A 
B= breasts
U=uterus 
B= bladder
B= bowel 
L= legs
E= emotions
** dont forget the baby!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are you looking for during breast assessment?

A

latch of baby onto breast, shape of breast, nipple appearance, mastitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are you looking for during uterus assessment?

A

can recover to prepreg state. lochia is appropriate, it is centered and firm, lacerations or tears, retained parts that could inhibit tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are you looking for during bladder assessment?

A

any incontience? UTI?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are you looking for during bowel assessment?

A

incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are you looking for during legs assessment?

A

thromboembolism!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

common complications for maternal??

A
  • Mastitis, breastfeeding problems
  • PPH-uterine atony, cervical or vaginal lacerations, hematomas (ouch!) or retained POC, endometritis/perineal cellulitis
  • UTIs
  • Constipation/Pain
  • Thrombophlebitis
  • Postpartum Depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

postpartum hemorrhage??

A

typically EXCESSIVE bleeding occurring in first 24 hours, but can occur after!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

early vs. late PPH??

A

early <24 hrs, late >24 hrs to 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how much blood loss?

A

usually >500ml for vaginal birth, 1000ml for c section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

FOUR T’s (RISKS) for pph!!

A

tissue–> retained placenta or clots!
tone–> is uterus firm? how is it sitting?
trauma–> tears in skin, shoulder dystocia
thrombin–> coagulopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

more risks for ppH???

A
  • prolonged labour
  • polyhydramnios
  • macrosomia
  • shoulder dystocia
  • multiple gestation
  • use of forceps
  • retained products of conception (POC)
  • endometritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

uterotonic agent used to help uterus contract to gain tone??

A

OXYTOCIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how do we assess the fundus???

A

moves a finger every day
takes about 6 weeks to get full contractility and be back to pre-pregnancy state
-uterine tone? has pt voided? displaced? any trauma? bleeding amount?
-massage can help uterus firm up
-could need uterus stimulants to help contract!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

assessing the lochia–> how much is scant??

A

2 inch stain (10ml)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

assessing the lochia–>

how much is small?

A

4 inch stain (10-25 ml)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

assessing the lochia–> how much is moderate?

A

6 inch stain (25-50 ml)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

assessing the lochia–> LARGE??

A

> 6 inch stain!! 50-80 ml!!

20
Q

look at the lochia & how …

A

how much is there??
transitions from dark to whitish…
clots???

21
Q

other ppH assessments?

A
  • perineum, are there tears? sutures? bruising? swelling?
  • VS (pulse, resps, blood pressure)
  • pallor and fatigue or SOBOE, cap refil?
  • has the pt voided?
  • does the pt have any risk factors?
  • does the pt have an IV? any medication in the IV? (oxyocin)
22
Q

nursing diagnoses (immediate concerns and afterwards) with PPH??

A
  • 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
23
Q

postpartum hemorrhage PLAN… what do you want to immediate plan to do???

A

-lochia flow will remain within normal limits
-patients physiological need for perfusion and oxygenation will be met
-Mother will receive opportunities to rest, and to receive support and teaching to maximize her ability to feed infant
-Mother will receive nutritional support, supplementation and teaching to restore lost iron stores
-Nurse and parents will partner to identify ways to support the transition to parenting while allowing for rest and recovery from PPH
Mother will not develop PPD

24
Q

what do you do AS IT IS HAPPENING!! (a PPH)

A
  • Fundal massage, support and express clots
  • Call for help, alert physician
  • VS
  • Oxygen administration
  • Lower HOB
  • Blood work
  • IV normal saline or Ringer’s Lactate as ordered
  • Administer medications as ordered (oxytocin, misoprostol, ergometrine, carboprost)
    • ->Starts from oxytocin
  • Catheter or void if able
  • Make sure she has fluid
  • can change quickly so act fast!!
25
Q

PPH evaluation ??

A

• How much blood was lost (EBL)?
• Is the patient well oxygenated, perfused, are they short of breath on exertion? Are VS within normal limits?
• Did your nursing care allow for rest, successful feeding?
• Do the family understand the increased needs for iron rich foods, rest, and support in general?
• Does the family know the signs and symptoms of PPD and who to contact if they are concerned? Has the mother had her need for rest and sleep protected while receiving nursing care?
If not, what needs to be done now and what needs to change?

26
Q

postpartum infection…

A
  • most often caused by streptocci and anaerobic organisms

- ex. endometritis, UTI, resp infections

27
Q

risk factors for postpartum infection???

A
  • > 24 ROM
  • Retained POC
  • PPH
    -Pre-existing anemia
    -Prolonged labour
  • Use of instruments
  • Internal fetal monitoring
    -repeated vaginal exams
  • ++ manual exploration of uterus after delivery
    -Unsterilized equipment and gloves
  • Improper or no pericare after delivery
    § Use squirt bottle and change pad frequently
  • Poor handwashing
  • Shared supplies between patients
    -Cleaning between patients limited or poorly done
    -Bedding soiled (think PV losses, moisture, feet in the bed, guests on the bed)
28
Q

postpartum infection nursing care

A
  • signs vary as per infection
  • assessments: uterine pain, malaise, foul smelling lochia, fever, increased PV losses, discolored lochia, usually starting 3-4 days after delivery, WBC count, erythema, edema, swelling at site of C section or tear in perineal area
29
Q

interventions for postpartum infection

A

o 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
o Education is important aspect
Know postpartum triggers that could causes psych disorders

30
Q

thrombolytic disorders–> 3 types of clots?

A
  • superficial venous thrombus
  • deep venous thrombus
  • pulmonary embolism
31
Q

causes of thrombolytic disorders?

A

-venous stasis, extra volume and weight, caesarian, trauma, varicose veins, history of VT, diabetes, multiparidy, increased maternal age, obesity, cigarette smoke

32
Q

signs of thrombolytic disorders?

A
  • warmness, red enlarged veins calf tenderness and swelling with pain
  • dyspnea, chest pain, tachycardia, apprehension for PE
33
Q

interventions for thrombolytic disorders?

A

encourage early movement
fluids
compression stockings, elevated legs
blood work

34
Q

nursing care of a family with a high-risk newborn?

A
  • New normal
  • ADPIE for high risk newborns with a focus on prematurity and macrosomia
  • Common infection and health promotion strategies
    Foci of Nursing Care
    • Respirations and Extrauterine Circulation
    o How does fetus transition to external world
    • Temperature
    • Fluids and Electrolytes
    • Nutrition and Waste
    • Preventing Infection
    • Bonding and Attachment
    • Assessments are extremely important
35
Q

nursing diagnosis for high-risk infants

A
  • Ineffective airway clearance r/t the presence of mucous or amniotic fluid in the airway
  • Ineffective tissue oxygenation r/t breathing difficulty
  • Ineffective thermoregulation r/t immature status
  • Risk for deficient fluid volume r/t insensible water loss
  • Risk for imbalanced nutrition, less than body requirements r/t the lack of strength for effective sucking
  • Risk for infection r/t lowered immune response due prematurity
  • Risk for impaired parenting r/t illness in newborn at birth
  • Deficient diversional activity (lack of stimulation) r/t to illness at birth
  • Readiness for developmental care to decrease overstimulation easily caused by necessary lifesaving procedures
36
Q

assessment of the newborn?

A

• Review the pregnancy, labor, and birth history and consider what effects these might have on the infant.
o Review maternal history for illnesses, bloodwork, risk factors (GBS, TORCH infections, smoking, substance use, HIV, Hepatitis B, gestational diabetes).
o Review the APGAR. What can it tell you?
§ Done at 1, 5 and 10 min
§ Heart rate, tone, reflex and resp effort
• Know the norms for VS and fetal development/gestational age.
• Perform a physical assessment.
• Include a review of the feeding and elimination patterns.
Assessing The Birth History
· C/S vs. Vaginal
· Long vs. Rapid
· Use of forceps or vacuum
· Fetal size and maturity
· Environment
· Need for resuscitation
VS normal
• Respirations 30-60
• Temperature 36.5-37.2 C axilla
• Pulse 110-160
Sugars
• Done on babies who are too large or too small
• 3.2-6
Respirations
• Normal rate going
• We should not see ‘see-saw’ respirations, intercostal indrawing, xiphoid retractions, flared nares, or grunting!
Gestational Age
• Resting Posture
• Recoil of Extremities
• Extremities
• Sole (Plantar) Creases
• Breast Tissue

37
Q

ABCs: respirations & extrauterine circulation

A

• Healthy infants will simply need to be rubbed dry and kept warm. They sometimes need suctioning, but we try to keep a “hands off” approach.
• High risk infants struggle with this first critical step in life.
• APGAR scores – lower the number the more support baby needs
Fetal to neonatal circulation
- Changes occur when baby exits mother
- Watch video relating on D2L
Factors leading to respiratory distress in preterm infants
• One or more signs of increased effort and breathing
o Tachypnea, nasal flaring, chest retraction, grunting
• Decreased 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

38
Q

assessment of newborn? continued

A
  • Assess for signs of rep distress
  • Ongoing assessment every 30 min for first 2 hours of life
  • Suction if necessary
  • Resp rate counted for full minute
  • Temp checks
  • Fluid status
  • Oxygen and 02 sat
    Nutritional support, glucose testing
39
Q

temperature and newborn?

A

• Prevent Heat Loss
o Convection, Radiation, Conduction, Evaporation
• Remove wet linens, and place Skin to Skin if healthy
• Incubators, dry linen, plastic wrap, warmed stethoscopes, warmed beds
Fluids and Electrolytes
• Assess anterior fontanel, urine and feces, feeding, acidosis at birth
• Query blood loss from placenta previa or abruptio?
• Insensible losses from increased respiratory efforts (RR)
• Consider the impact of radiant warmers, incubators, skin to skin and over bundling
• Remember that neonates have decreased circulatory blood volumes and that dehydration or FVD can happen very easily, even 15 mL blood loss is significant
• Frail or sickly infants are not able to restore fluid losses through eating, kidneys are very immature and have difficulty concentrating urine
Conversely, FVE can happen very quickly with an IV, and result in a return to fetal circulation (opening of ductus arteri

40
Q

nutrition and waste and baby?

A

-healthy–> baby needs to be able to eat and suck
-high risk: premature–> need more calories, suck might take more to get going
-macrosomia–> blood sugars, get enough food
-infection
BREAST MILK= high protein and rich in fat

41
Q

gestational diabetes and neonatal blood sugars?

A

• Babies born to GD mothers are used to a high level of glucose coming to them
• The baby produces high levels of insulin to cope with the high sugars
• After birth the sugar “supply” is cut off, but insulin persists in the body for several hours, causing neonatal blood sugars to drop to low levels
• Nursing care of these babies centers on frequent BS checks and ensuring adequate intake. Supplementation with formula is usually necessary until breastmilk supply is established
o Milk usually comes in day 3 or 4
Babies need to suck at breast for milk to come in

42
Q

where are gestational diabetes neonate babies usually cared for

A

in the SCN due to their unstable status (tendency to low blood sugars and respiratory distress)
Macrosomia and Respiratory Distress
· The workload of supplying a large body mass with oxygenated blood is can prove too much for baby’s lungs and heart.
· Additionally, a newborn may not feed well in the first hours of life, worsening the risk for low sugars. Low BS contribute to acidosis and impede his respiratory function.
· Macrosomic babies in distress need 1:1 nursing care for their unstable status in the SCN
· Macrosomic babies are supported with frequent BS monitoring, supplemental feeds, possible IV, and oxygen
Preventing Infection
· Compromised or immature immune systems
· Moms with group B streptococci can infect neonates in utero-meningitis
· Breastmilk has immunologic properties
· Strict infection control and visiting policies

43
Q

bonding and attachment???

A
  • Nursing care supports bonding and attachment no matter what the circumstances.
  • Parents are enabled to be partners in care, no matter how complex the infant’s condition.
  • Babies are encouraged to be skin to skin and spend time with parents.
  • Babies in the nursery do suffer, but when we allow for attachment, bonding, and contact with the mother (parents), they do better.
44
Q

neonatal abstinence syndrome??

A 
- Various symptoms 
· Irritability
· Disturbed sleep pattern
· Constant movement, tremors
· Frequent sneezing
· Shrill, high-pitched cry
· Possible hyperreflexia and clonus
· Convulsions
· Tachypnea
Vomiting and diarrhea
45
Q

discharge processes for mom and babe…

A

• Consider teamwork, collaboration, and informatics when preparing a family for discharge after they have experienced a maternal or neonatal complication.
Top “Take Homes” and Summary
• ABC problems always take priority in moms and babies
• Thermoregulation and blood sugars influence ABC status
• All babies (healthy and high-risk) are cared for with a focus on respirations and circulation, temperature, fluids etc. but high risk babies often develop problems in these areas
• Preterm, postterm, macrosomia(LGA), SGA, or neonatal infections place babies in a high-risk category: unstable
• Know hyperbilirubinemia, meconium aspiration syndrome, transient tachypnea of the newborn, definitions of preterm, macrosomia (LGA)

N332 final (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions