Maternity NURS242 Flashcards
Lochia Rubra
3-4 days dark red with small clots, no bad odor
Lochia Serosa
4-10 days, pink/brown no foul odor
Lochia Alba
11 days- 6 weeks yellow/light brown to white, stale odor
Cause of postpartum hemorrhage
Uterine atony, retained placenta, tract lacerations, placenta accreta, increta, percreta, uterine inversion, coagulopathy
Symptoms of postpartum hemorrhage
Cumulative blood loss >1000mL or symptoms of hypovolemia
How do you treat postpartum hemorrhage
Pitocin, methergine, hemabate, cytotec
Risk factors for Postpartum hemorrhage
Prolonged labor, uterine over distention, intrapartum infection, previous cesarean section, placenta issues, polyhydramnios, severe pre-eclampsia operative vaginal deliveries, maternal obesity, grand multiparity
Signs of early attachment
Feeding infant, consistency, seeking information, sensitive to newborns needs, cultural factors or barriers
Risk factors for postpartum depression
Prenatal depression, low self esteem, stress of child care, prenatal anxiety, life stress, lack of social support, marital problems, history of depression, single, low socioeconomic status, unplanned pregnancy, young maternal age
Symptoms of postpartum depression
Significant weight loss, insomnia, loss of interest or pleasure in daily activities, decreased energy or fatigue, feelings of worthlessness or guilt, persistent feelings of sadness intense mood swings
Expected physical findings taught at discharge
Involution, after pains, progression of lochia, breast changes, weight loss
Signs of complications after pregnancy
Breast tenderness, warm and reddened, blurry vision or severe headaches, leg pain or chest pain, thoughts of harming self or infant
Risk factors for vaginal hematoma
Vacuum or forceps delivery, prolonged second stage labor, episiotomy
Risk factors for metritis
C-section, prolonged rupture of membranes, prolonged labor, internal monitoring, meconium stained fluid, obesity, multiple cervical exams
Symptoms of metritis
Elevated temp, lower abdominal pain, uterine tenderness, tachycardia, subinvolution, lochia heavy and foul smelling
Nursing actions for infection
Up fluid intake, early ambulation, proper hand hygiene and peri care, antibiotics, pain management, remind to void, warm compresses
Risk factors for cystitis
Epidural anesthesia, overdistended bladder, Foley, operative vaginal deliveries, macrosomnia
Risk factors for wound infection
Obesity, diabetes, malnutrition, premature rupture of membranes, preexisting infection
Risk factors for thrombosis
C-section, metritis, decreased mobility, obesity
Nursing action for newborn with low temperature
Skin to skin, warm blankets, feed, increase room temp, preheated warmer with skin probe
SIDS recommendations
Lay on back to sleep, firm safe sleep surface, do not sleep with your baby, keep objects and blankets out of crib, prenatal care, avoid smoking and smoke exposure, avoid alcohol and drugs, breastfeed, offer pacifier at nap time and bed time, avoid over heating
How to breast feed
Pillow to support, newborn should completely face breast, ear shoulder and hip and aligned, woman should support breast, baby’s lips flang out and mouth around areola is wide open
Bottle feeding
1/2-1 oz per feeding during first few days of life feed every 3-4 hours. 2.5-3 oz per feeding by day 4 and gradually to 32 oz per day. Hold newborn during each feeding, burp half way through feeding
Three unbilical vessels that close after pregnancy
Ductus venosus, foramen ovale, ductus arteriosis
Presumptive signs of pregnancy
Amenorrhea, fatigue, breast tenderness, nausea, vomiting, urinary frequency, hyperpigmentation of the skin, fetal movements, uterine enlargement, breast enlargement
Probable signs of pregnancy
Softening of the lower uterine segment, softening of the cervix, bluish purple coloration of vaginal mucosa and cervix, changes in shape and size of uterus, abdominal enlargement, Braxton hicks, ballottment
Probable signs of pregnancy
Uterine shape and size consistency can be changed by uterine tumors, polyps, infection, pelvic congestion, positive pregnancy tests
Positive signs of pregnancy
Ultrasound verification, auscultation of fetal heart tones, fetal movements felt by clinician
Maternal risks for gestational diabetes
Hydramnios, hyper/hypoglycemia, ketoacidosis, dystocia, retinopathy, pre-eclampsia, induction, cesarean, spontaneous abortion, preterm labor
Fetal risks for gestational diabetes
Macrosonmia, hypoglycemia, iugr, respiratory distress, cardiac, CNS, skeletal defects, hyperbilirubinemia
Risk factors for preeclampsia
Teens, over 35, existing hypertension, multiple gestation, obesity, gravida 1
How do you care for a newborn with withdrawal?
Do not over stimulate, provide quiet environment, swaddle, assess NAS, frequent small feedings, pacifier, meds as needed.
What are diagnostic tests for hyperbilirubinemia?
Total serum bilirubin, direct, coombs test, hemoglobin and hematocrit, blood incompatibility, electrolytes.
Symptoms of pre-eclampsia
BP over 140/90, proteinuria more than 300mg in 24hr urine, edema, headache, hyper-reflexia, clonus, blurred vision.
Pre-eclampsia to eclampsia
Thrombocytopenia, pulmonary edema, epigastric pain, confusion, seizures
How do you manage pre-eclampsia
Early identification, monitor BP, weight, urine protein, NST’s, CBC, LFT, kidney function, urine protein, magnesium sulfate, CNS depressant, antihypertensive, emergency delivery
Antidote for magnesium sulfate
Calcium gluconate
HELLP syndrome
Hemolysis, elevated liver enzymes, low platelets, RUQ pain, malaise, flu symptoms, hemolytic anemia, liver necrosis, bleeding, stabilize, protect infant, blood products
What is the difference between placenta previa and abruptio placentae
Placenta previa is painless bleeding and can resolve on its own
Infertility risks for men
Toxic substance exposure, smoking, alcoholic, genitals exposed to high Temps, hernia repair, obesity, cycling, running, STI, undescended testicle, mumps after puberty
Infertility risks factors for women
Over or underweight, hormone imbalance, uterine fibroid, tubal blockage, cervical stenosis, chromosomal abnormalities, immune system disorders, chronic illness, STI, endometriosis, PID, smoking, alcohol, chemo, miscarriages, psychological stress
Male infertility management
Hormone therapy, lifestyle changes, antibiotics, surgical repair
Female treatment for infertility
Lifestyle changes like stress reduction, better nutrition, no smoking or alcohol, meds to stimulate egg production, surgery, antibiotics
Artifical insemination
Insertion of sperm directly into uterus best outcome when used with clomiphene
Gamete intrafallopian transfer
Removing egg outside body combine with sperm then place in fallopian tube and fertilization happens naturally
In vitro fertilization
Eggs fertilized in lab and transferred to uterus indicated for tubal obstruction, endometriosis, pelvic adhesions, and low sperm counts
Intracytoplasmic sperm injections
One sperm injected into cytoplasm in egg to fertilize it indicated for male infertility
Preimplantation genetic diagnosis
Identify genetic defects in embryos created through IVF
Gestational carrier
Lab fertilization with embryos transferred to a woman who will carry the pregnancy, legal issues
Psychological aspects of infertility
Crisis, stress, anxiety, depression, relationship strain, stress with extended family, social isolation, self esteem issues
Types of contraception
Subdermal implant, intrauterine device, injectable, combined hormonal contraceptives, barrier methods, standard days method, emergency contraception, female sterilization, male sterilization, abstinence
Pros to implant contraceptive
Long duration, low hormone dose, reversible, estrogen free
Cons of implant contraceptive
Irregular bleeding, weight gain, breast tenderness, difficult removal
IUD pros and Cons
Pros: immediately effective, can use during lactation
Cons: menstrual irregularities, unknowingly expelled, increased risk of pelvic infection, check string placement
Injectable pros and cons
Pros: can be used by smokers and lactating women
Cons: menstrual irregularities, office visit Q3 months, weight gain, depression
Male and female condom failure rate
Male 18%
Female 21%
Maternal and fetal risk for premature rupture of membranes
Maternal- infection
Fetal- low AFI, infection, cord issues
Treatment for premature rupture of membranes
Watch vitals, fetal monitoring, maternal lab values, bedrest with BRP, antibiotics if indicated
Preterm labor signs and symptoms
Abdominal, back, and pelvic pain, menstrual like cramps, pelvic pressure, urinary frequency, diarrhea
How to manage preterm labor
Tocolytic drugs, modified bedrest, IV hydration, antibiotics, corticosteroids
Betamethasone for fetal lung maturity
12mg IM q 24 hr x 2 stimulates the production of more mature surfactant in fetal lungs
It’s Not My Time (tocolytics)
Indomethacin, Nidefipine, Magnesium, Terbutaune
Risks of a vaginal birth after cesarean and nursing actions
Uterine rupture baby dies,
Assess fetal HR, ensure IV access, ensure blood products available, assess scar for separation, ensure OR team readily available
Risk of forceps assisted delivery
Cephalohematoma, nerve injuries, skin lacerations or bruising, skull fractures, intracranial hemorrhage
Risks for vacuum assisted delivery
Lacerations, hemorrhage, bladder trauma, extension of episiotomy
Why would someone need a C-section
Previous C-Section, placental abnormalities, dystocia, previous uterine surgeries, unsuccessful vacuum or forceps delivery, malpresentation, FHR difficulties, underlying medical condition
VEAL CHOP
Variable. Cord compression
Early. Head compression
Accelerated. Okay
Late. Placenta insufficient
Latent first stage of labor
0-6cm contractions 30-45 seconds and 5-30 minutes apart
First active stage of labor
6-8 cm contractions 2-5minutes apart lasting 45-60 seconds
First transition stage of labor
8-10 cm contractions last 60-90 seconds and are 1-3 min apart
Why would someone get induced
Chorionamnionitis, gestational diabetes, pre-eclampsia, eclampsia, premature rupture of membranes, post term pregnancy, fetal compromise, maternal medical conditions, fetal demise
Risks of pharmacological cervical ripening
Uterine hyperstimulation, nonreassuring fetal heart rate
Risks of amniotomy
Umbilical cord prolapse, cesarean birth, variable deceleration, infection, fetal injury, bleeding
Transcervicle balloon catheter risk
Infection, cervical trauma
Risks for osmotic dilators
Chorioamnionitis, cervical trauma
Primary infertility
Not able to conceive after one year of frequent attempts in women under 35 and 6 months in women older than 35
Secondary infertility
Women who have been pregnant in the past but cannot conceive or carry a baby presently
Six infant reflexes
Sucking, rooting, Moro, Palmar grasp, plantar grasp, babinski
