Maternity/Infant Health (Exam One) Flashcards
What laboratory panel is standard in labor and delivery?
Complete Blood Count (CBC)
What specific laboratory values are assessed in labor and delivery?
- Hemoglobin
- Hematocrit
What is the leading cause of maternal morbidity and mortality?
Postpartum hemorrhage
Why does postpartum hemorrhage often go unnoticed?
Patients believe it is a normal finding following delivery
How has postpartum hemorrhage traditionally been classified?
- Early
- Late
Nurses and physicians tend to ______ guess the amount of postpartum blood loss.
Under-guess
Is postpartum bleeding a subjective or objective finding?
Subjective
Dark red blood is usually indicative of what?
Deep cervical lacerations
When does early postpartum hemorrhage occur?
Within 24 hours of the birth
When does late postpartum hemorrhage occur?
More than 24 hours but less than 6 weeks after the birth
Postpartum hemorrhage is defined by how much blood loss following a vaginal birth?
500 mL
Postpartum hemorrhage is defined by how much blood loss following a cesarean birth?
1000 mL
Why would hydramnios or a macrosomic fetus cause a boggy uterus?
Makes the uterus bigger
What is the leading cause of postpartum hemorrhage within the first hour following birth?
Uterine atony
What is the priority nursing intervention for a patient experiencing hemorrhage due to uterine atony?
Perform fundal massage
What is the first sign of uterine atony?
Profuse bleeding
How is the risk of hemorrhage reduced?
- Contraction of uterus
- Firming of uterus
What length of time is allotted to deliver the placenta following birth?
30 minutes
If the placenta has not been delivered within 30 minutes following the birth, what is this considered?
Retained placenta
List the risk factors associated with manual removal and separation of the placenta.
- Infection
- Bleeding
- Retained placental fragments
What type of surgical intervention is utilized to remove retained placental fragments that are unable to be manually removed?
Dilation and curettage (D&C)
List the three different levels of adherent retained placenta.
- Accreta
- Increta
- Percreta
What is placenta accreta?
Slight penetration of the myometrium
What is placenta increta?
Deep penetration of the myometrium
What is placenta percreta?
- Deep penetration of the myometrium
- May invade nearby organs
List the risk factors associated with adherent retained placenta.
- Bleeding
- Infection
- Hysterectomy
Describe placenta abruptio.
Premature separation of the placenta
_________ _________ is NOT considered an abnormal placental adherence pattern.
Placenta abruptio
A patient with a firm uterus is experiencing bright red bleeding from the vagina. The nurse knows the most likely cause for the bleeding is what?
Lacerations of genital tract
List the most common causes of lacerations of the lower genital tract.
- Operative births
- Precipitate births
- Abnormal presentation of fetus
- Congenital abnormalities of maternal soft tissue
- Previous scarring from infection
Describe the bleeding characteristics associated with lacerations of the genital tract.
- Slowly
- Continuous
What is the most common type of hematoma?
Vulvar hematoma
Describe a vulvar hematoma.
Visible and painful
What type of patient is most at risk for developing a vaginal hematoma?
- Primiparous women
- Use of forceps
Patients who have had a episiotomy are at an increased risk for what?
Vaginal hematomas
What type of hematoma is the least common and most life threatening?
Retroparateneal
List nursing interventions for a patient with a hematoma.
- Apply ice
- Pain medication
- Cushion (donut) to sit on
What is the purpose of marking a hematoma?
Manage size and growth
What condition is potentially life threatening, a medical emergency, and requires immediate attention?
Inversion of the uterus
Inversion of the uterus occurs in ___ in _______ births.
1 in 2,500 births
What type of medication is given to a patient with an inversion of the uterus? Why?
- Tocolytics
- Relaxes the uterus
Describe incomplete inversion of the uterus.
- Smooth muscle can be palpated through the cervix
- Uterus has not come through the cervix
Describe complete inversion of the uterus.
- The uterus is inside-out
- Uterus is coming out through the cervix
Describe prolapsed inversion of the uterus.
Large mass of uterus is protruding outside of the vagina
What is the most common reason for late postpartum hemorrhage?
Subinvolution of the uterus
List the signs and symptoms of subinvolution of the uterus.
- Uterus does not shrink
- Increased bleeding
- Prolonged lochial discharged
List medications used to manage postpartum hemorrhage.
- Oxytocin
- Methergine
- Hemabate
What medication increases the risk of postpartum hemorrhage?
Magnesium sulfate
Why does magnesium sulfate increase the risk for postpartum hemorrhage?
- Acts as smooth muscle relaxant
- Causes uterine relaxation
- Causes uterine atony
What type of surgical intervention is utilized for late postpartum hemorrhage if it is unable to be corrected otherwise?
Dilation and curettage (D&C)
A _________ ________ is a nonsurgical intervention that is inserted into the uterus to apply internal pressure in order to manage postpartum hemorrhage.
Bakri balloon
If a Bakri balloon is inserted, the nurse knows not to perform what?
Fundal massage
Inversion of the uterus will most likely lead to __________ _______.
Hemorrhagic (hypovolemic) shock
List the signs and symptoms of hemorrhagic (hypovolemic) shock.
- Hypotension
- Tachycardia
- Urine output less than or equal to 30 mL per hour
What is the primary nursing intervention for a patient experiencing hemorrhagic (hypovolemic) shock?
Fluid replacement
An autoimmune disorder in which anti-platelet antibodies decrease the lifespan of platelets is known as what?
Idiopathic thrombocytopenic purpura (ITP)
Describe von Willebrand disease (vWD).
Defect in blood clotting protein
What is considered the primary treatment of choice for von Willebrand disease (vWD) as it can be administered orally, nasally, and IV?
Desmopressin
___________ __________ results from formation of blood clots inside of a blood vessel, caused by inflammation or partial obstruction of the vessel.
Venous thromboembolism (VTE)
Where does deep venous thrombosis (DVT) most commonly occur?
Lower extremities
Involvement varies, but deep venous thrombosis (DVT) can extend from the ______ to the _________ _________.
From the foot tot he iliofemoral region
What medical manifestation is considered a complication of deep venous thrombosis and occurs when part of a blood clot dislodges?
Pulmonary embolism
Pain and tenderness in the extremities, accompanied by warmth, redness, and harness is indicative of what condition?
Thrombophlebitis
What is considered the first sign or symptom of postpartum infection?
Increased temperature for two successive days, beginning 24 hours after birth
What is considered the most important and least expensive measure to prevent postpartum infection?
- Aseptic technique
- Handwashing
Infants whose birth weight is below the _____ percentile are considered to have a low birth weight.
10th
Infants whose birth weight is above the _____ percentile are considered to have a high birth weight.
90th
An infant whose birth weight falls between the 10th and 90th percentiles on intrauterine growth curves is considered what?
Appropriate for gestational age (AGA) infant
Describe a preterm infant in relation to gestational age.
An infant born before 37 weeks gestation
Describe a postterm infant in relation to gestational age.
An infant born at or after 42 weeks gestation
The majority of high risk infants are those born in less than ____ ________.
37 weeks
A premature infants growth and developmental milestones are corrected for gestation until they reach what age?
2 1/2
Because premature infants will not hit normal growth and development milestones, their age is often __________.
Corrected
Describe corrected age for the premature infant.
Add gestational age and postnatal age
What anatomical structure on the premature infant is the first to experience catch-up growth?
Head
Describe the purpose of administering artificial surfactant in a neonate.
Improves ability of lungs to exchange oxygen and carbon dioxide
Apnea occurs when an infants breathing ceases for what amount of time?
Longer than 20 seconds
What type of breathing pattern is common in premature infants?
Periodic breathing
Describe periodic breathing.
5 to 10 seconds of respiratory pauses followed by 10 to 15 seconds of rapid respirations
List the signs and symptoms of an infant experiencing cold stress.
- Mottled skin
- Acrocyanosis
- Cyanosis
- Irritability
- Increased respiratory rate
- Periods of apnea
Rapid changes in body temperature may cause what in the neonate?
Apnea
What is the normal range for PaO2 in the neonate?
60 to 80 mm Hg
If a neonate is on mechanical ventilation, what are the priority nursing interventions?
- Auscultate breath sounds
- Ensure patency of endotracheal tube
- Assess oxygen saturation
- Notify x-ray to verify placement
A neonate on mechanical ventilation is continuing to experience respiratory distress after multiple intervention attempts. As the nurse you know this is indicative of what condition?
- Shock
- Hypovolemia
Hyperoxygenation, or a high arterial blood oxygen level, can result in what condition for the neonate?
Retinopathy of prematurity (ROP)
Describe bronchopulmonary dysplasia.
Caused by use of positive pressure ventilation against immature lung tissue
Is patent ductus arteriosus (PDA) associated with hyper-oxygenation or hypo-oxygenation?
Hypo-oxygenation
Why are endotracheal tubes usually accompanied by a nasogastric or oral tube in a neonate?
- Mechanical ventilation causes distention
- Tubes are used to decompress the stomach if filled with air
A premature infant is scheduled to receive a gavage feeding. The nurse should encourage the parents of the infant to do what during this feeding?
Hold the infant
List nursing interventions to prevent bloating, reflux, and vomiting in a neonate receiving gavage feedings.
- Administered slowly over 20 to 30 minutes
- Small amounts
- Warm temperature
What should the nurse document after each gavage feeding administration?
Response to the feeding
Describe necrotizing enterocolitis.
Inflammatory disease of gastrointestinal mucousa
List the signs and symptoms of necrotizing enterocolitis.
- Abdominal distention
- Temperature instability
- Grossly, bloody stools
List the risk factors for developing necrotizing enterocolitis.
- Polycythemia
- Anemia
- Congenital heart disease
Describe the purpose of kangaroo care.
- Infant directly interacts with parents
- Enhances infant temperature regulation
How should a nurse interact with the parents of an infant who is being cared for in the NICU?
- Educate parents
- Frequent communication
- Explain procedures/equipment
- Encourage questions
T/F: Preterm infants have greater surface area in proportion to their weight.
True
Small for gestational age (SGA) and intrauterine growth restriction (IUGR) infants are at an increased risk for which complications?
- Perinatal asphyxia
- Hypoglycemia
- Hyperglycemia
- Polycythemia
- Heat loss
List the conditions that late preterm infants are at an increased risk for.
- Respiratory distress
- Thermoregulation
- Hypoglycemia
- Hyperbilirubinemia
- Infection
List complications commonly associated with a post mature infant.
- Meconium aspiration
- Hypoglycemia
- Dry, cracked skin
- Persistent pulmonary hypertension
Describe asymmetric intrauterine growth restriction (IUGR).
- Weight is less than 10th percentile
- Head circumference is greater than 10th percentile
T/F: Infants with asymmetric intrauterine growth restriction (IUGR) have the potential for normal growth and development.
True
A newborn acquires petechiae during childbirth. The nurse will determine this finding benign if what?
Disappears within 48 hours and does not come back
Because bruising of the newborn sustained during childbirth may be mistaken as cyanosis or respiratory distress, it is critical for the nurse to do what?
- Document the bruising
- Report the bruising to co-workers
A retinal hemorrhage may cause what?
- Vision issues
- Complete vision loss
Describe caput succedaneum.
- Crosses suture line
- Presents as pitting edema
- Resolves within 48 to 72 hours
Describe cephalhematoma.
-Occurs over parietal bone
-Does not cross suture line
-Initially firm and softens over time
-Resolves in 2 to 3 weeks
-
How are cephalhematoma’s diagnosed in a full-term infant?
Laboratory testing
What type of hemorrhage due to childbirth causes more long-term damage to the neonate and is hard to recognize?
Subgaleal hemorrhage
T/F: Unless a blood vessel is involved, linear skull fractures heal without special treatment.
True
What bone of the newborn is most often fractured during childbirth?
Clavicle
What type of therapy or treatment is implemented for a newborn suffering from a clavicle fracture?
- No special treatment necessary
- Swaddle the newborn
Birth trauma that results the in paralysis of the arm caused by nerve injury to C5 or C6 is known as what?
Erb-Duchenne palsy
Which type of palsy is classified as an upper plexus injury?
Erb-Duchenne palsy
What type of nerve injury results in respiratory distress of the newborn due to the inability of the diaphragm to expand properly?
Phrenic nerve injury
Describe Klumpke’s palsy.
- Rare injury of shoulder
- Affects movement of affected lower arm and hand
Which type of palsy is classified as a lower plexus injury?
Klumpke’s palsy
A subarachnoid hemorrhage occurs in preterm infants as a result of what?
Hypoxia
A subarachnoid hemorrhage occurs in term infants as a result of what?
Trauma
List the signs and symptoms of a subdural hemorrhage.
- Apnea
- Unequal pupils
- Tense fontanel seizures
- Coma
Describe distinguishable features of infants of diabetic mothers.
- Macrosomia
- Squinty eyes
- Big, round cheeks
What conditions are infants of diabetic mothers at a higher risk for developing?
- Respiratory distress syndrome
- Perinatal hypoxia
- Birth trauma
Hypoglycemia is indicated in the term infant of a diabetic mother if their blood glucose level is less than what?
40 mg/dL
List the signs and symptoms of hypoglycemia in a term infant.
- Jitteriness
- Apnea
- Tachypnea
- Cyanosis
A diabetic mother gives birth to a macrocosmic infant. What is the priority nursing intervention?
- Frequent blood glucose level monitoring
- Observe for s/sx of hypoglycemia
The newborn infant is susceptible to infection because of what?
Immature immune system
List the causes of sepsis in a newborn.
- Lacerations (trauma)
- Meconium aspiration
- Prolonged rupture of membranes
- Transplacental infections
What sign(s) or symptom(s) is indicative of sepsis in an infant, both before and after birth?
- Tachypnea
- Tachycardia
What is the purpose of erythromycin (antibiotic) instillation into the eyes of the newborn shortly after birth?
- Prophylactic treatment
- Prevents gonorrheal infection
- Prevents ophthalmia neonatorum
What transplacental infection is caused by contact with cat-litter boxes, or undercooked or contaminated meats?
Toxoplasmosis
A newborn infant has a rash on their palms and around their anus. This is indicative of what infection?
Syphilis
How is HIV transmitted to a newborn from the mother postnatally?
- Breastfeeding
- Breast milk
Which neonatal infection is the leading cause of neonatal morbidity and mortality in the United States?
Group B streptococci (GBS)
The incidence of group B streptococci is decreasing in the neonate because of what?
Effective drug treatment
Tachycardia in utero may be present if the mother uses which substances? (SATA) A. Tobacco B. Meth C. Cocaine D. Heroine E. Alcohol F. Marijuana G. Ecstasy
A, B, C, F, G
Describe the characteristics of an infant with fetal alcohol syndrome.
- Small for gestational age
- Thin eyes
- Thin upper lip
- Microcephaly
- Lowset ears
__________ is the number one cause of cognitive impairment and dysfunction in the neonate.
Alcohol
There is an increase for placental abruption if the mother abuses which substances? (SATA) A. Meth B. Heroine C. Alcohol D. Tobacco E. Cocaine
A, E
What scoring system is used for an infant experiencing withdrawals?
Neonatal abstinence syndrome (NAS) scoring
What medication is commonly prescribed for infants experiencing withdrawal from substances?
Morphine
What nursing intervention should be implemented for an infant experiencing withdrawal from substances?
- Swaddling the infant
- Holding the infant
- Frequent, increased feedings
According to the American College of Obstetricians and Gynecologists, pregnant women should not exceed _______ of caffeine per day.
200 mg
A person who is Rh negative means he/she _______ have the Rh antigen.
Does not
Rhogam is given during what week of pregnancy as a standard precaution.
29 weeks
The mother will receive another Rhogam injection within 72 hours after birth if the infant has what Rh factor?
Rh positive (Rh+)
Describe the maternal and paternal characteristics of an infant who is most likely to express Rh incompatibility.
- Rh negative mother
- Rh positive father
- Father is dominant (homozygous) for Rh factor
Only Rh-_______ offspring of an Rh-_________ mother are at risk for Rh incompatibility.
Only Rh-positive offspring of an Rh-negative mother are at risk for Rh incompatibility.
What is the most common cause of pathological hyperbilirubinemia?
Hemolytic disorders
When is a direct Coombs’ test performed? Who/what is the direct Coombs’ test performed on?
On the cord blood after birth
When is an indirect Coombs’ test performed? Who/what is the indirect Coombs’ test performed on?
On the mother before birth
What medication has the most effect on preventing neural tube defects?
Folic acid
The CDC urges all women of reproductive age to consume ______ of folic acid each day.
400 mcg
List foods high in folic acid.
- Broccoli
- Bananas
- Lentils
- Avocado
- Asparagus
What is the priority nursing intervention for a patient with myelomeningocele?
- Protect the sac
- Infection prevention
List the signs and symptoms of acute distress related to parental grieving?
- Crying
- Denial
- Shock
- Hyperventilation
- Want someone with them
What should the nurse not expect to see in a family that is grieving?
- Numbness
- Lack of response
Describe the reorganizational phase of grief.
- Able to function at home/work
- Experience a return of self-esteem and confidence
- Able to cope with new challenges
- Placed loss in perspective
Describe complicated grief.
- Intense
- Lasts longer than the expected amount of time
Why is the term recovery not appropriate to describe the grief related to perinatal loss?
Grief can continue for life
Within a family, who is most likely to experience survivors guilt related to perinatal loss?
Grandparents
A mother is anticipated to give birth to a stillborn infant. What should the nurse ask the mother prior to delivery?
Would you like to see or hold your baby after giving birth?
What must the nurse be cognizant of in regard to autopsies and perinatal loss?
- Personal views
- Cultural views
- Religious views
