Maternity study cards Flashcards
Class
Intimate Partner Violence is the most common form of violence against women worldwide
- Battering occurs in repeated cycles
- Violence and abuse include one or more of the following : Physical, Sexual, Emotional, Economic or Psychological elements.
- Most women abused prior to pregnancy, will be abused during pregnancy and abuse may escalate during pregnancy.
- Pregnant adolescents are abused at higher rates than adult women and should be considered at high risk.
- During Pregnancy, women should be screened for abuse at every prenatal visit and when she presents in the emergency room or Labor and delivery.
- Any reports of abuse or suspected IPV must be documented.
- Any IPV which could constitute a felony must be reported to appropriate authorities.
- Involvement of minors or elders must be reported to CPS.
When abuse is confirmed:
What to do?
What to say?
1.Provide her with resources such as the phone number of the Battered women’s shelter, hotline, safety plan
2.If the patient reveals she is experiencing IPV, make sure she has a safe place to go.
3.Offer to let her use a facility phone if she wants to make these calls.
4.If she is staying with the abusing partner, make sure she has a safety plan:
bag packed with necessities for an overnight stay
cash or check book
identification or legal documents required for identification
Extra set of car keys
Can hide the bag or leave it with a neighbor
5.Let the victim know that nobody deserves to be treated that way but avoid speaking negatively about the abuser (can cause victim to get defensive)
I am afraid for your safety and for the safety of your baby/children
I believe you
Abuse is progressive and will only get worse
You are not alone
I am here for you
You deserve better than this
You deserve to be treated with respect
What are the serious complications which can occur with the use of combined (Estrogen and Progestin) contraceptive Methods?
ACHES= A: Abdominal Pain
C: Chest Pain and/or shortness of Breath
H: Headache Which are sudden, persistent, increased BP or Stroke
E: Eye problems, blurred vision
S: Severe leg pain, Blood clots, Thromboembolic process
What are some factors affecting the effectiveness of Contraceptives?
(Perry, page 105, Box 5.7)
- Frequency of Intercourse (Condoms, withdrawal, barrier methods, natural family planning methods)
- Motivation to prevent Pregnancy
- Clear understanding of Method and use of method.
- Adherence to method
- Liklihood of pregnancy for the individual user
- Consistent use of the method
Can exclusive breastfeeding be a reliable form of birth control?
No, there is no reliable way to tell when ovulation has returned. Many women do not have a menstrual cycle while they are breastfeeding.
What are some ways that the nurse can provide Family centered Care?
- Remember that women and their support people are PARTNERS in their healthcare and not just passive recipients
- Communicate. Keep them in the loop. If you know you will need to weigh the baby between midnight and 2am, tell them ahead of time.
- Acknowledge the support people and family members when you enter the room to provide care.
- Include the primary support person.
- Ask mom “Who is going to be helping the most with the new baby?”
- Identify some ways we can include the support person?
- Include the support person in the teaching.
- Encourage them to provide hands-on care and provide encouragement
How does a nurse provide culturally sensitive care?
- Cultural relativism vs Ethnocentrism
- Culture determines viewpoint. Yours and theirs.
- Affirm the value and uniqueness of every culture
- Recognize that the behavior of others may be based upon different assumptions and logic than those held by the nurse.
Sexually transmitted infections include all of these
Bacterial Chlamydia Gonorrhea Syphilis Group B Strep (Box 4.2) pg.71 Perry
Protozoa
Trichomoniasis
Viruses Human Papilloma Virus HIV Herpes Simplex virus type 1 and 2 Viral Hepatitis A and B Zika Virus
What tool do we use to screen women for depression during and after Pregnancy?
Edinburgh Postpartum Depression Scale
What are the risk factors for Postpartum Depression?
- History of anxiety or depression
- Previous history of Postpartum Depression
- Younger age
- Unintended Pregnancy
- History of Premenstrual Dysphoric Disorder
- Family history of mood disorders
- Unmarried
- Marital Discord
- Substance abuse
- Lack of social support
- Low self-esteem
- Complications of Pregnancy and Birth
- Women who are victims of intimate Partner violence.
What is the difference between Postpartum depression, Postpartum Blues and Postpartum Psychosis?
Signs of Postpartum Blues (Should go away in a few days to a week)
Sad, anxious or feeling overwhelmed
Crying spells
Loss of appetite
Difficulty Sleeping
Signs of Postpartum Depression (Can begin any time in the first year)
Same signs as Postpartum Blues but last longer and are more severe
Thoughts of harming baby or self
Not having any interest in the baby
Not being able to care for baby or self
Anxiety
Loss of enjoyment
Signs of Postpartum Psychosis
Seeing or hearing things that are not there
Feelings of confusion
Rapid Mood swings
Trying to harm yourself or your baby.
What is Universal newborn screening?
Blood spot screening: Ideal time of collection is 24 - 48 hours of age. Some screening tests are not valid if the specimen is collected before 24 hours of age, so another screen will be needed in order to complete the blood spot screening process. Early discharge guidance: • Blood spot screening should be performed prior to discharge, regardless of age. • Arrange to collect a subsequent blood spot screen between the optimal time of 24 and 48 hours of life. This additional screen should be collected no later than 48 hours given the severity of the disorders.
Hearing screening: Ideal timing is after 12 hours of age and before discharge. Hearing screening is valid at any age, so standard recommendations for follow-up and documentation/communication of results should be followed.
Pulse oximetry screening: Ideal timing is 24 - 48 hours of age. Early screening may not accurately measure a newborn’s circulation as ductal closure may not have occurred yet, which increases the likelihood of both false positive and false negative results. Early discharge guidance: • Pulse oximetry screening should be performed prior to discharge, regardless of age. • Alert newborn’s primary care provider that the newborn was discharged early and oxygen saturation levels should be assessed at the first well-child check.
PG 539 Perry
What is NAS and how do we screen for it?
Evidence-based standardized protocols are needed to provide the best treatment for the mother-infant dyad and improve outcomes for infants neonatal abstinence syndrome (NAS) and mothers with substance use disorders.
Nurses must increase their awareness, establish trust, and support mothers who frequently feel judged and stigmatized because of drug use.
An infant’s recovery from NAS depends on positive attachment to a mother who is able to respond effectively to her infant’s needs.
To improve outcomes for infants with NAS and the mothers of these infants, a broader healthcare perspective is needed that recognizes that NAS isn’t an acute medical condition but requires a multidisciplinary team care approach.
Diagnosis
Diagnosing an infant with NAS requires an accurate history of the mother’s drug use (including the last drug used and the time of consumption) and evidence of withdrawal. A scoring system can be used to aid diagnosis. Points are assigned based on the severity of each sign, and the total score helps determine the treatment plan. No strong evidence exists that one scoring tool is superior to another; however, research shows that a standard approach to diagnosis and treatment using a scoring tool improves outcomes and is recommended by the American Academy of Pediatrics.
Finnegan NAS scoring system
The Finnegan NAS scoring system, developed in 1975, is the seminal and most common tool used to guide pharmacologic NAS treatment. Nurses evaluate infants every 1 to 4 hours, based on their age, and score them on the presence and severity of common withdrawal signs, including central nervous system, metabolic vasomotor, respiratory, and GI disturbances. Pharmacologic treatment is recommended for any infant who receives a score ≥ 8 on three consecutive evaluations.
The Finnegan tool is long and complex, but a simplified short form recently was developed as a more efficient option. The short form allows for rapid assessment with limited items for scoring; however, although simpler to use, limited evidence exists to validate its use.
Other assessment tools to guide pharmacologic NAS treatment include the 11-item Lipsitz Neonatal Drug-Withdrawal Scoring System, the seven-item Neonatal Narcotic Withdrawal Index, the seven-item Neonatal Withdrawal Inventory, and the 19-item MOTHER NAS Scale. These tools haven’t been as widely adopted as the Finnegan tool.
Eat, Sleep, Console scoring tool
The new Eat, Sleep, Console (ESC) NAS assessment scoring method uses regular assessments of the infant’s ability to eat, sleep, and be consoled to determine the need for pharmacologic treatment. (See Eat, Sleep, Console.) Several studies of the ESC approach report decreased lengths of stay, less unnecessary exposure to pharmacologic treatments, and lowered care costs.
What are the symptoms of NAS?
Irritability Seizures Hyperactivity High-pitched cry Tremors Exaggerated Moro reflex Hypertonicity of muscles Poor feeding Diarrhea Dehydration Vomiting Uncoordinated sucking Gastric residuals Diaphoresis Fever Mottled skin Tachypnea Nasal flaring Nasal stuffiness Disrupted sleep patterns Excoriations Temperature instability
What is Meconium Aspiration Syndrome?
What are the risk factors for Meconium Aspiration syndrome?
Meconium Aspiration Syndrome is a condition in a newborn that causes respiratory distress when meconium is aspirated into the lungs. Risk Factors: Thick/moderate fresh MEC stained fluid Late preterm and term babies increased risk after 38 weeks, SGA/IUGR babies, Post-term babies, Post-dates, SGA, Placental insufficiency, Cord compression, Fetal distress Mother is obese Breech presentation.
What is Meconium aspiration syndrome?
What are the risks involved in MAS?
It is a common cause of neonatal respiratory pathology characterized by in utero or perinatal aspiration of meconium-stained amniotic fluid that causes respiratory distress. It is a respiratory difficulty found in term and preterm infants with clinical features include tachypnea, nasal flaring, and grunting and chest retractions.
Can cause the following:
Respiratory distress, cold stress, weight loss, jaundice, and infection.
Airway obstruction, interference with surfactant, chemical pneumonitis (bile acids, etc.), pulmonary HTN.
What is shoulder dystocia?
What are the risk Factors?
What are nursing responsibilities?
Defined as a delivery in which additional maneuvers are required to deliver the fetus after normal gentle downward traction has failed
Shoulder dystocia occurs when the fetal anterior shoulder impacts against the maternal symphysis
Shoulder dystocia occurs with equal frequency in primigravid and multigravid women
More common in infants born to women with diabetes
The single most common risk factor for shoulder dystocia is the use of a vacuum extractor or forceps during delivery
However, most cases occur in fetuses of normal birth weight and are unanticipated, limiting the clinical usefulness of risk-factor identification
Maternal
Abnormal pelvic anatomy
Gestational diabetes
Post-dates pregnancy
Previous shoulder dystocia
Short stature
Fetal
Suspected macrosomia
Labor related
Assisted vaginal delivery (forceps or vacuum)
Prolonged active phase of first-stage labor
Prolonged second-stage labor
Nursing responsibilities H- Call for additional HELP/assistance E – Evaluate for episotomy L – Legs (McRobert’s Maneuver) P – Pressure (suprapubic) E – Enter the vagina R – Remove the posterior arm R – Roll the patient To hands and knees
Laura is a 25 year old currently pregnant. Her history indicates that she has three living children. Her first child was born at 38 weeks gestation. Second pregnancy was a boy born at 34 weeks gestation. She has a three year old child who was born at 35 weeks gestation. She had an abortion at 6 weeks gestation and a 24 week stillborn.
What is her gravidity and parity using the GTPAL system?
G6 T1 P3 A1 L3
Six pregnancies total including current pregnancy.
One term infant
Three preterm including the 24 week stillborn
One Abortion at 6 weeks
three living children.
Elizabeth is pregnant at 8 weeks per her LMP. Her history includes a delivery at 25 weeks, a delivery at 40 weeks, a delivery at 37 weeks and a stillborn at 18 weeks.
What is her Gravida and Para?
G5 P3
Currently pregnant
Three pregnancies that delivered after 20 weeks
One pregnancy that ended prior to 20 weeks. (Does not count in the Para but counts in the Gravida)
What does the Postpartum nurse teach parents about safe sleep for baby?
Always place baby on his or her back to sleep, for naps and at night.
Share your room with baby.
Keep baby close to your bed, on a separate surface designed for infants.
Use a firm and flat sleep surface, such as a mattress in a safety-approved crib* , covered by a fitted sheet with no other bedding or soft items in the sleep area.
Breastfeeding reduces the risk of SIDS Babies who are breastfed or are fed expressed breastmilk are at lower risk for SIDS compared with babies who were never fed breastmilk. According to research, the longer you exclusively breastfeed your baby (meaning not supplementing with formula), the lower his or her risk of SIDS. If you bring baby into your bed for feeding, remove all soft items and bedding from the area. When finished, put baby back in a separate sleep area made for infants.* If you fall asleep while feeding baby in your bed, place him or her back in the separate sleep area as soon as you wake up.*A crib, bassinet, portable crib, or play yard that follows the safety standards of the Consumer Product Safety Commission (CPSC) is recommended. For information on crib safety, contact the CPSC at 1-800-638-2772 or http://www.cpsc.gov.
Why is Vitamin K given to babies after birth?
How is Vitamin K administered and when is it given?
Vitamin K actually comes from the German word “koagulation,” the process by which blood clots that we know of as coagulation.
According to the CDC, all babies are born with a deficiency in vitamin K, and they cannot easily make more. Vitamin K does not cross the placenta and only small amounts are in breastmilk or formula; about 90% of the vitamin K adults consume comes from leafy green vegetables. There is no dietary option that offers sufficient vitamin K for newborns.
Your newborn is at risk of internal bleeding because of vitamin K deficiency, which can cause motor skill delays and even death. Giving the vitamin K shot at birth ensures that all babies are protected. The CDC reports that “newborns who do not get a vitamin K shot are 81 times more likely to develop severe bleeding than those who get the shot.”
Vitamin K is given 1-2 hours after birth by IM injection.
Under what circumstances would a Pregnant woman receive Rhogam?
The problem comes if the mom is Rh- and the baby is Rh+. And it most likely won’t be a problem in a first pregnancy. But it can become a problem in later pregnancies.
If mom’s Rh- blood comes into contact with the baby’s Rh+, the mom’s body automatically makes antibodies against the Rh positive factor. The Mom’s body senses something foreign and is trying to protect itself by making these antibodies. When our bodies make antibodies, their purpose is to attack and destroy. Usually this is helpful when our bodies do this for things like colds and flu’s but in this case it can have adverse effects on further pregnancies.
The mom and baby don’t share a blood system during pregnancy, but sometimes the mom’s blood and baby’s blood could mix. This could happen during certain invasive medical tests, during delivery, during a miscarriage or an abortion.
If a mom’s Rh- blood mixes with a baby’s Rh+ blood during any of those situations, the mom’s body will create Rh antibodies. Then in future pregnancies, if Mom has another Rh+ baby, the antibodies in the mom’s body will cross the placenta and attack the new baby’s Rh+ blood. The baby’s blood won’t have enough oxygen, and the developing baby will suffer serious illness or even death.
So how does the RhIg (Rhogam) shot solve the problem?
First, your doctor will do a blood test to see if you are Rh positive or negative and if you have developed Rh antibodies. Then, if you are Rh- and have not developed antibodies, your doctor will give you a shot of RhIg (Rhogam). This Rhogam shot prevents the mom from making antibodies against the Rh factor, so the mom’s body won’t attack the blood of any future babies.
If you have a miscarriage or abortion, make sure to ask your medical provider whether you are Rh positive or negative and if you need the Rhogam shot.
If you are Rh- and your body has already made antibodies against the Rh factor, a Rhogam shot will not work. In that case, your doctor will closely monitor any future pregnancies and keep a close eye on your baby’s development.
What are the major risk factors for Postpartum Hemorrhage?
Prolonged labor Augmented Labor Rapid, Precipitous labor History of a Postpartum Hemorrhage in a previous delivery Episiotomy or perineal tear Preeclampsia Placenta Previa Placental abruption Uterine over distention Multiple pregnancy Polyhydramnios Grand Multiparity >5 pregnancies
