Maternity/Infant Health (Exam Three) Flashcards
1
Q
Regarding the fetus, what substance(s) can be screened for toxins after birth?
A
- Umbilical cord
- Urine
- Meconium
2
Q
Which fetal substance is tested to allow health care providers to view fetal nutrition and toxins for the entire nine month span of pregnancy?
A
Umbilical cord
3
Q
Communities should have health services that are what?
A
- Available
- Accessible
- Acceptable
- Affordable
4
Q
When does prenatal care begin?
A
Prior to conception
5
Q
What should the nurse ensure before a woman becomes pregnant?
A
- Healthy diet
- Folic acid intake
- Iron supplement intake
6
Q
Why is it important for a woman to have a well-balanced diet before conception?
A
To ensure fetal development
7
Q
What questions should be included on the nutrition assessment prior to conception?
A
- Eating disorder
- Specific diet followed
- Overweight/underweight
- Daily folic acid supplementation
8
Q
Give examples of eating disorders the nurse would want to know about?
A
- Anorexia
- Bulimia
9
Q
Give examples of specific diets the nurse would want to know about?
A
- Low carb
- Keto
- Vegetarian
- Vegan
10
Q
How much folic acid should any woman of childbearing capabilities intake?
A
0.4 mg daily
11
Q
What role does folic acid play in fetal development?
A
Prevents neural tube defects
12
Q
List food sources of folic acid.
A
- Green leafy vegetables
- Chicken
- Liver
- Turkey
13
Q
What will aid in decreasing the risk for mother and baby?
A
Gaining a desirable amount of weight
14
Q
What can happen if the mother has an inadequate weight gain?
A
- Risk for pre-term labor
- Intrauterine growth restriction (IUGR)
15
Q
What is intrauterine growth restriction (IUGR)?
A
- Fetus does not have adequate room to develop
- Fetus is not receiving adequate nutrition intake
16
Q
What is the desired weight gain during pregnancy?
A
25 to 35 pounds
17
Q
The desired weight gained by the mother includes what factors?
A
- Weight of fetus
- Weight of amniotic fluid
- Weight of uterus
18
Q
The weight gained by the mother during pregnancy is not strictly _____.
A
Fat or muscle
19
Q
How much should the mother increase her calorie intake during pregnancy?
A
Increase by 300 calories per day
20
Q
What type of foods should the mother intake during pregnancy?
A
-Wide variety of food (i.e. protein, dairy, vegetables, fruits, etc.)
21
Q
What food group is specifically important for fetal development?
A
Complex carbohydrates
22
Q
Besides folic acid, what is also recommended for the pregnant woman to intake daily?
A
Multivitamin or prenatal vitamin
23
Q
What should the nurse recommend if any supplement causes the pregnant woman to become nauseous?
A
Take the vitamin at night
24
Q
How many milligrams of calcium should a prenatal vitamin contain?
A
At least 1300 mg
25
Calcium is important for the development of what fetal structure?
Fetal skeletal development
26
List the fat soluble vitamins.
HINT: BAKED - B
Vitamin A
Vitamin D
Vitamin K
Vitamin E
27
List the water soluble vitamins.
Vitamin C
Vitamin D
Vitamin B
Folic Acid
28
Too much Vitamin A can result in what?
Fetal anomalies
29
Excessive amounts of which vitamin can negatively impact the fetus?
Vitamin A
30
Vitamin B12 is important for the formation of what?
Red blood cells
31
List food sources of Vitamin B12?
- Eggs
| - Dairy
32
How much folic acid should a woman intake during pregnancy?
0.6 mg daily
33
What is pica? What might pica indicate?
- Non-food cravings
| - Nutritional deficiency or sign of anemia
34
Severe nausea and vomiting during pregnancy is known as what?
Hyperemesis gravidarum
35
What would the nurse recommend to a pregnant woman to offset the nauseous feeling?
Sweet or salty food items
36
What medication is prescribed for nausea and vomiting during pregnancy?
Zofran
37
What side effects of Zofran should the nurse educate the patient on?
- Headaches
| - Constipation
38
What medication is considered safer, when compared to Zofran, to use during pregnancy?
Diclegis
39
Diclegis is made up of what? What form of tablet is Diclegis?
- Vitamin B6
- Unisalm
- Extended relief tablet
40
List non-pharmacological interventions for nausea and vomiting during pregnancy.
- Ginger
| - Pressure bands
41
What is anemia?
Iron deficiency
42
What will be prescribed if the pregnant patient is anemic?
Iron supplement
43
What should the patient monitor while taking an iron supplement?
- Constipation
- Monitor stools for color
- Monitor stools for consistency
44
What vitamin aids in iron absorption?
Vitamin C (i.e. supplement tablet or orange juice)
45
What nursing management should be provided to a pregnant patient suffering from constipation?
- Increased fluid intake
| - High fiber diet
46
What is pyrosis?
Heartburn
47
What nursing management should be provided to a pregnant patient with pyrosis?
- Encourage small frequent meals
| - Remain in upright position for 30 minutes after meal consumption
48
What are nutritional concerns regarding adolescent pregnancy?
- Well balanced diet
| - Gaining appropriate amount of weight
49
What is the recommended amount of water consumption during pregnancy?
3L daily
50
What is the recommended amount of protein consumption during pregnancy?
70 grams daily
51
Are more calories needed during lactation or during pregnancy?
Lactation
52
How much should the mother increase her calorie intake during lactation?
Increase by 500 more calories per day
53
Calories make ______.
Breastmilk
54
What is postpartum?
Interval from childbirth to the return of the uterus to a non-pregnant state
55
After childbirth, the uterus should do what?
- Shrink in size
| - Move down to non-palpable state inside of pelvic area (below the umbilicus)
56
What is involution?
Shrinking of the uterus
57
Does the uterus ever return to its original size before pregnancy? What do we call this state?
- No
| - Non-pregnant state
58
List factors that promote involution?
- Early and frequent ambulation
- Uterine contractions (i.e. fundal rubbing)
- Breastfeeding
59
How long will the mother experience contractions after delivery?
2 to 3 days postpartum
60
Explain how breastfeeding promotes involution.
1) Any time the newborn is put to breast or the nipple is stimulated, the body will release oxytocin
2) Oxytocin causes the uterus to contract
3) Uterine contraction will compress blood vessels and minimize blood loss
61
What is the synthetic form of oxytocin?
Pitocin
62
Exposed blood vessels in the uterus are a result of what?
The placenta detaching from the uterus
63
How is the uterus location measured? What landmarks are used?
- Measured by abdomen
| - Above or below the umbilicus
64
After delivery, how many centimeters should the uterus move below the umbilicus?
1 to 2 cm per day
65
How many hours after delivery will the uterus remain above the umbilicus?
12 hours
66
How long does it take after delivery before the uterus is unable to be externally palpated?
2 weeks
67
What is subinvolution?
Failure of the uterus to return to a non-pregnant state
68
Subinvolution may also be referred to as what?
Uterine atony (no tone)
69
How will the nurse describe a contracted uterus?
Firm uterus
70
How will the nurse describe a uterus that is not contracted or soft?
Boggy uterus
71
What causes postpartum hemorrhage?
Failure of the uterus to contract
72
What is the normal estimated blood loss (EBL) during a vaginal delivery?
500 mL
73
What is the normal estimated blood loss (EBL) during a cesarean delivery?
1000 mL
74
List factors of subinvolution or factors that slow involution.
- Full bladder
- Previous births
- Prolonged labor (18+ hours)
- Anesthesia
- Infection
- Retained placental fragments
75
What is a nursing intervention that aids in uterine contraction and prevents postpartum hemorrhage?
Fundal rubbing
76
If the bladder is full, the uterus will be deviated to which side of the body?
Left
77
What should be assessed before a fundal rub is performed?
- Whether or not the patients bladder is full
| - Last time the patient voided
78
Colostrum is sufficient to nourish the newborn for how many hours?
72 to 96 hours
79
What is engorgement?
Distended, firm, tender, and fullness of the breasts due to an influx of breastmilk
80
Colostrum is high in what? Colostrum is low in what?
- High in antibodies and protein
| - Low in fat
81
When will the vagina return to a non-pregnant size following childbirth?
6 to 10 weeks postpartum
82
Describe the cervix following childbirth.
- Edematous
| - Thin
83
Lactation will delay the production of what? This is in direct relation to what?
- Cervical mucosa
| - Directly related to hormones because cervical mucus is dependent on hormones
84
How long does the postpartum period last?
6 weeks
85
What is lochia? What is it the result of?
- Vaginal discharge
| - Result of involution and the regeneration of the endometrium
86
What makes up lochia?
- Blood from the site of placental attachment
| - Dead cells from the placenta
87
What is lochia rubra?
- First lochia present after childbirth
- Occurs 3 to 4 days
- Bright, red discharge
88
What is lochia serosa?
- Pinkish brown discharge
| - Lasts 22 to 27 days
89
What is lochia alba?
- Whitish discharge
| - May last up to 6 weeks postpartum
90
Regarding lochia, what three characteristics should the nurse assess?
- Color
- Amount
- Odor
91
Regarding lochia, what is the distinct sign of infection?
Smell
92
List the three different amounts of lochia.
- Heavy
- Moderate
- Scant
93
What is a heavy amount of lochia?
- Saturation of a peri-pad within one hour
| - Requires intervention!
94
During childbirth, what can happen to the perineum?
Laceration or tear
95
What are the two types of perineal lacerations?
- Natural
| - Episiotomy
96
What is an episiotomy?
- Surgical incision into the perineum
| - Widens the birth canal to allow the fetus to pass through
97
How long should it take an episiotomy heal?
2 to 3 weeks postpartum
98
What is a fourth degree laceration?
Tear of the perineum that extends to the anus
99
What are the nursing priorities regarding perineal lacerations?
- Infection
| - Comfort
100
What are the nursing management options for a patient with a perineal laceration?
- Ice
- Encourage high fiber diet
- Encourage stool softeners
- Sitz bath
101
What are the indications for a cesarean section?
- Large fetus
| - Fetal distress in utero
102
List nursing management for a patient who has had a cesarean section?
- Bedrest for 12 hours
- Ambulate after 12 hours
- Monitor for blood clots
- Apply SCD bilaterally
- Monitor incision site for signs and symptoms of infection
103
Patients who have a cesarean section delivery still require what?
Fundal rubbing
104
How long will a cesarean section patient stay in the hospital following delivery?
Approximately 3 days
105
How long will a natural childbirth patient stay in the hospital following delivery?
A little over 24 hours
106
The respiratory system will return to its pre-pregnancy state in how many weeks postpartum?
6 weeks postpartum
107
The cardiovascular system will return to its pre-pregnancy state in how many weeks postpartum?
2 to 6 weeks postpartum
108
Is an elevated WBC count normal or abnormal postpartum?
Completely normal!
109
The mother will receive rhogam during pregnancy if she has what?
If she has a negative blood type
110
If the mother has a negative blood type and the fetus has a negative blood type, will the mother need rhogam? How long after delivery will she need this?
-No, she will not receive rhogam at all
111
If the mother has a negative blood type and the fetus has a positive blood type, will the mother need rhogam? How long after delivery will she need this?
- Yes
| - Within 72 hours after delivery
112
Why might a woman retain urine following delivery?
- Fear of voiding
| - Decreased sensation to void
113
When will the menstrual cycle with ovulation return after childbirth?
As early as 28 days postpartum
114
What is the consistency of the first three to four menstrual flows following childbirth?
Heavier than normal
115
Abdominal distention may remain for how many weeks postpartum?
6 weeks postpartum
116
A woman who has had an epidural may complain of what following childbirth?
Headache
117
What is a spinal headache?
- Result of an epidural
| - Leaking of cerebrospinal fluid from the epidural space
118
How is a spinal headache diagnosed?
Headache completely disappears when patient is laid flat
119
How is a spinal headache treated?
Anesthesia will fill the hole in the epidural space of the spinal cord with blood known as a blood patch
120
What nursing education is priority for the mother and family following childbirth?
- Safety of the newborn
- Abduction of the newborn
- Social media awareness
121
How is attachment to the newborn established?
By maintaining proximity
122
How do parents bond to their newborn?
Skin-to-skin contact
123
Skin-to-skin contact helps the newborn maintain what?
- Temperature
| - Respirations
124
How is proximity maintained?
- "Rooming-in" method
| - Keeping baby close to the parents
125
What is mutuality?
Newborn displays behavior and it elicits a reaction from the mother
126
How is acquaintance developed?
- Eye contact
- Touching
- Talking to newborn
127
Define claiming as it relates to the newborn. Give an example of claiming.
- Process of identifying with the newborn
| - Parent stating "Baby has my eyes" or "Baby's nose looks like mine"
128
What is involved in the process of transition to parenthood?
- Attachement
- Bonding
- Proximity
- Mutuality
- Acquaintance
- Claiming
129
What might a younger sibling display in response or adaptation the newborn?
Regression
130
What might an older sibling display in response or adaptation the newborn?
- Resentment
| - Feeling that more responsibility will be placed on them
131
What is early parent-infant contact?
- Skin-to-skin
| - Facilitates the attachment process
132
What is extended parent-infant contact?
- Couplet care
| - "Rooming-in"
133
What is biorhythmicity? What does it promote?
- Newborn is in tune with mothers natural rhythm
| - Promotes bonding
134
What is entrainment?
-Responding to adult speech (i.e. turning head in response to voice)
135
Describe the taking-in phase?
- Lasts 24 hours
- Mother is focused on herself
- Mother wants to discuss childbirth experience
136
Describe the taking-hold phase?
- Lasts 2 to 3 days
| - Mother is focused on care of the baby
137
Describe the letting-go phase?
- Mother learns to move on as a unit
| - Mother balances the needs of herself, newborn, other family members
138
Is grunting and nasal flaring normal or abnormal following birth?
Normal
139
What would the nurse want the baby to do as a signal of reactivity during the first 30 minutes of life?
- Spontaneously cry
| - Display startle reflex
140
When is meconium usually passed?
Second period of reactivity
141
The neonatal period is a time of _____ and _____ changes.
Physiological and behavioral changes
142
List the six adaptations of the newborn during the neonatal period?
- Establishing and maintaining respirations
- Experiencing circulatory changes
- Ingesting and digesting nutrients
- Eliminating and regulating weight
- Regulating temperature
- Establishing relationships
143
Most of the circulating antibodies in the newborn are what?
IgG
144
How are IgG antibodies transferred to the newborn?
Across the placenta from maternal circulation
145
How long is IgG sufficient for the newborn?
The first three months
146
Newborn intestines are _____ at birth.
Sterile
147
Newborn GERD or vomiting is the result of what?
An immature gastrointestinal system
148
How much of the newborns weight is lost at birth?
10%
149
The newborns weight loss is generally attributed to what?
Extracellular fluid loss
150
The newborns first void should occur within what time frame?
24 hours
151
List normal reproductive system signs of the newborn female?
- Vaginal discharge
- Bloody spotting due to hormone changes
- Edematous labia
- Vernix may be present in external genitalia
152
What will the nurse assess regarding the reproductive system of the newborn male?
- Both testis are palpable
| - Assess penis for hydrocele, hypospadias, epispadias
153
Define hydrocele?
- Fluid accumulation in the scrotum
| - Does resolve without treatment
154
Define hypospadias.
Urethra is found on the ventral side of the penis
155
Define epispadias.
Urethra is found on the dorsal side of the penis
156
Leg length should be _____ in the newborn.
Symmetrical
157
The nurse should assess for what abnormal regarding the newborns skeletal system?
Hip dysplasia
158
What are signs and symptoms of hip dysplasia in the newborn?
- Uneven gluteal folds
- Uneven thigh folds
- Uneven knee levels
159
What maneuver is used to test for hip dysplasia?
Ortolani maneuver
160
Meconium must occur within what time frame?
Within 24 hours
161
What are the two types of jaundice?
- Physiologic
| - Pathologic
162
Hemoglobin is further broken down and converted into what?
Bilirubin
163
What are the two types of bilirubin?
- Unconjugated or indirect
| - Conjugated or direct
164
Describe unconjugated (indirect) bilirubin.
- Able to cross the blood brain barrier
- Able cause neurotoxicity
- Fat soluble
165
What is kernicterus?
Neurotoxicity from bilirubin
166
Describe conjugated (direct) bilirubin.
- Water soluble
| - Excreted in waste
167
When does physiological jaundice appear? When does it peak?
- Appears after 24 hours of life
- Peak time is 2 to 4 days
- Most common
168
When does pathological jaundice appear? What causes this?
- Occurs within 24 hours of life
| - Result of maternal-newborn blood type incompatibility
169
Babies can lose fluid through which mechanisms?
Perspiration
170
What is the normal heart rate for a newborn?
- 120 to 160 beats per minute
| - A little irregularity is not uncommon
171
It is common to see what involving the chest with the newborn?
- PMI is visible on chest wall
| - Can visually see the newborns heart beating via the chest
172
What is persistent tachycardia?
Heart rate >160 beats per minute
173
Persistent tachycardia may be indicative of what?
- Anemia
- Hypovolemia
- Hyperthermia
- Sepsis
174
What is persistent bradycardia?
Heart rate <100 beats per minute
175
Persistent bradycardia may be indicative of what?
- Heart block
| - Hypovolemia
176
Why are the newborns red blood cells elevated at birth?
Fetal circulation is less effective at oxygen exchange
177
Why are newborns given IM Vitamin K at birth?
Newborns are unable to synthesize Vitamin K to do their immature gastrointestinal system
178
Describe cold stress on the newborn?
1) Newborn gets cold
2) Oxygen consumption increases
3) Respiratory rate increases
4) Pulmonary vasoconstriction occurs
179
What is the normal respiration rate of the newborn?
30 to 60 breaths per minute
180
What are signs of respiratory distress?
- Retractions
- Stridor
- Episodes of apnea
- Acrocyanosis
- Central cyanosis
181
What is acrocyanosis? Is this normal or abnormal?
- Bluish-purple discoloration of the hands and feet
- Normal following the first 24 hours of life
- Beyond 24 hours of life, it is a sign of respiratory distress
182
Describe caput succedaneum?
- Edematous area on the newborns head from pressure against the cervix
- May cross suture line
- Resolves in 3 to 4 days
- Very common
183
What is a cephalohematoma? How does it differ from caput succedaneum?
- Bleeding between the skull and its covering
- Does not cross the suture line
- Resolves in 2 to 8 weeks
184
Newborns who present with cephalohematomas are at an increased risk for what?
Jaundice
185
What are mongolian spots?
- Bruise like pattern that develops on the coccyx and up the spine
- Most common in dark complexed newborns
- Disappear by the time the child is two
186
What is the nursing priority regarding mongolian spots?
Documentation!
187
What is erythema toxicum?
- Normal newborn rash
| - Will resolve on its own
188
What is the rooting and sucking reflex?
- When a newborns mouth or cheek is touched, the head will turn towards that stimuli
- The newborn will begin sucking whatever is placed near the mouth
- Disappears between 3 months and 12 months
189
What is Babinski's sign? When does this disappear?
- Lateral aspect of the heel is stroked
- Assessed bilaterally
- The big toe will dorsiflex and the remaining toes will fan out
- Disappears between one and two years
190
If Babinski's sign is present for longer than two years this is indicative of what?
Neurological damage
191
What is the Palmer Grasp? When does it disappear?
- Newborn will grasp any object placed in the palm
| - Disappears by 4 months of age
192
What is the Plantar Grasp? When does it disappear?
- Newborn will curl toes at the placement of an object on the foot
- Disappears by 4 months of age
193
What is Moro's reflex?
- Indicates the sensation of falling (startle reflex)
- Adduction of extremities followed by abduction of the extremities
- Disappears by 4 months of age
194
If Moro's reflex is present for longer than six months of age this is indicative of what?
Neurological damage
195
Factors that influence behavior are based on what?
Gestational age
196
List factors that influence behavior?
- Vision
| - Smell
197
The newborn can see how far in front of them?
6 to 12 inches
198
Preterm infants require what?
- More sleep
| - Less stimuli
199
What is the main source of thermoregulation for the newborn?
Flexed state
200
How can newborns produce heat?
Non-shivering thermogenesis
201
Non-shivering thermogenesis is the metabolism of what?
Brown fat
202
Why are babies unable to maintain thermoregulation?
- Very thin layer of fat
| - Blood cells located closer to the surface of the body
203
What are the three nursing concerns during the first two hours following birth?
- APGAR Score
- Stabilization
- Medications
204
What does the APGAR score indicate?
- How the newborn is transitioning to extrauterine life
| - How they are responding to respiration
205
When is the APGAR performed?
- At 1 minute of life
| - Again at 5 minutes of life
206
How is the newborns heart rate scored according to APGAR?
>100 bpm = 2 points
<100 bpm = 1 point
Absent = 0 points
207
How is the newborns respiratory rate scored according to APGAR?
Strong cry = 2 points
Weak cry = 1 point
Absent = 0 points
208
How is the newborns muscle tone scored according to APGAR?
Well flexed = 2 points
Some flexion = 1 point
No tone = 0 points
209
How is the newborns irritability scored according to APGAR?
Crying/Whaling = 2 points
Grimace = 1 point
No response = 0 points
210
How is the newborns color scored according to APGAR?
Completely pink = 2 points
Pink in core = 1 point
Blue and pale = 0 points
211
The APGAR score is continuously repeated if it is less than a what?
7
212
What is suctioned first, the newborns mouth or nose?
Mouth
213
After 10 minutes of life, what will the newborns respiratory rate be?
85% to 95%
214
What does the term preductal mean?
Right hand or right wrist
215
When does the anterior fontanel typically close?
At approximately 18 months of age
216
What are the three standard medications given to the newborn following birth?
- Erythromycin eye ointment
- Vitamin K
- Hepatitis B Vaccine
217
A Pavlik harness is used for what type of newborn injury?
Hip dysplasia
218
List indicators of pain in the newborn.
- Change in blood pressure
- Change in heart rate
- Change in 02 saturation
- Change in respiratory rate
- Crying
- Sweating
- Grimacing
- Not sleeping/eating
219
What happens if the heel of the newborn is penetrated too deeply during a heel stick?
-Damage the bone
220
What is measure during a Critical Congenital Heart Defect (CCHD) test of the newborn?
- Measuring oxygen saturation
- Must be greater than 95%
- Performed preductal and postductal (must be within 3% of eachother)
221
Describe lactogenesis.
- Progesterone is decreased
- The release of prolactin is triggered
- Prolactin prepares the breast to secrete milk
222
Breastfeeding is a _____ and _____.
Supply and demain
223
What is essential for breastfeeding?
Oxytocin
224
What is oxytocin responsible for?
Milk ejection reflex or letdown
225
Breastmilk is composed of this essential component.
Immunoglobulins
226
Breastfeeding is contraindicated in what conditions?
- Galactosemia of newborn
- Maternal active TB
- Maternal HIV
227
What is the top priority when initiating breastfeeding?
Skin-to-skin
228
What is the correct latch position?
- Lips flanged out
| - Consuming entire areola
229
It is recommended that infants be exclusively breastfed for how many months?
6 months
230
If formula feeding, babies should be what?
Burped every 15 mL or if excessive spit up is present
231
When should complementary feeding begin?
6 months for breastfed and formula fed babies
