Midterm Flashcards
What happens during Involution?
Myometrial spiral fibers around uterine blood vessels leading to occlusion of blood supply to the placental site
What is Involution’s effect on fundal position?
Shrinks fundus = weight of the uterus decreases from 1000 grams immediately postpartum to 60 grams 6-8 wks later.
How do you know if there is too much lochia?
Heavy: saturated in 1 hr
PP hemorrhage: within 15 mins or less
What are the different laceration degrees?
1st - small tear
2nd - perineal/bulbocavernosus mucosa torn
3rd - external anal sphincter
4th - internal anal spincter, rectal mucosa torn
What do we give for peri-care?
Treat with ice, tucks, benzocaine spray, hemorrhoid creams, and suppositories
What are postpartum blues?
Mild transient mood disturbance - emotionally labile, restless, fatigue, cries easily, sad
peaks at 5 days, subsides by day 10
experienced by 60-80% of recently pregnant people
What is the BUBBLE-HE Assessment and expected findings?
B - Breasts
- breastfeeding: fuller and heavier as milk comes in, usually 3-4 days, nodular or lumpy milk, teach to prevent engorgement (frequent breastfeeding)
- nonbreastfeeding: bilateral nodularity, tenderness, engorgement, don’t express milk, well fitting bra, ice pack, pain relievers, fresh cabbage leaves
U - Uterine
- post delivery: edema of bladder, urethra, urinary meatus due to delivery trauma. incomplete emptying of bladder and inability to void common problem. diuresis within 12 hrs post delivery to void common problem
B - Bladder
- UO may be 3K ml +/each day
- kidney function returns to normal after 4 wks pp.
- mild proteinuria and increased BUN due to catabolic process of involution
B - Bowels
L - Lochia
- total volume secretion 200-500 ml
- color, odor, amount
E - episiotomy/lacerations
- initially smooth rugae
- returns to near pre-pregnant state after 6-8 wks
H - Homan’s Sign - DVT
- virchow’s triad: hypercoaguability, venous states, and vascular damage = increased incidence of venous thromboembolism
E - Emotions
When do the fetuses/infant’s senses (taste, smell, sight, hearing) become active?
Visual: at birth - not developed the ability to tell the difference between two targets or move their eyes between two images
Auditory: well developed at birth
Olfactory: at birth - mature by the end of first trimester
Taste: 8 weeks after conception. by 14 weeks, baby’s taste buds are mature
Tactile: 4-5 month mark
What is Involution?
Contraction of the interlacing myometrial muscle bundles constricting the intramyometrial vessels and impending blood flow
Results in = return of uterus in a non-pregnant state
Major mechanism preventing postpartum hemorrhage
What is the first thing a nurse does when the nurse palpates a boggy uterus with increased lochia?
Massage the fundus until firm
Soft boggy uterus (atony) = inadequate contraction of the uterus.
Hemorrhage = degree of bleeding that threatens to cause or is associated with hemodynamic instability
Lochia Definition
post birth uterine discharge consisting of necrotic tissue, blood, mucous that reflects healing stages of placenta
What are the stages of lochia?
Rubra: 3-4 days after birth, bright red in color, blood clots normal
Serosa: 4-10 days after birth, thin in density, red to pink to pinkish brown containing mucus. Less than rubra, very few to no clots, but ongoing flow
Alba: 2-4 weeks (10-28 days), discharge yellowish white or whitish liquid, containing little red blood. No odor or real flow.
What is the relationship b/w full bladder vs fundal height vs bleeding?
When the bladder is full, it gets pushed up to the side
bleeding - massage the fundus - uterine atony
full bladder - pushes fundus up and over to the side
higher chance of not involuting if bladder is full
How do you care for laceration/episiotomy?
Comfort measures
Ice packs to perineum first 12-24 hrs
Sitz baths, sprays, “tucks” analgesics
Kegels
What are the hormones of breastfeeding?
Prolactin: milk making hormone
Expression inhibited by progesterone
When pregnancy ends, progesterone level drops and prolactin expresses itself and milk is made
Prolactin suppresses ovulation but suppression is affect by individual breastfeeding patterns.
Non breastfeeding: prolactin returns to prepregnancy levels after 3 weeks
What would you expect a breast assessment to be like on day 1?
Little change, colostrum usually present
When do we give a RhoGam shot?
Within 72 hrs of delivery to prevent isoimmunization
When a mom is blood type negative (Rh-) and gives birth to a Rh+ infant.
Mom makes antibodies against Rh factor which will then attack RBC of the next Rh+ baby the mother has)
Rhogam prevents mother from developing the antibodies
What is the newborn assessment process?
APGAR
A - appearance (skin color)
P - pulse (HR)
G - grimace (reflex irrability)
A - activity (muscle tone)
R - respiration
What is are the expected findings for respiratory newborn assessment? What are signs of respiratory distress?
Nose breathers
Shallow and irregular respirations
Chest and abdomen rise simultaneously
Short periods of apnea (<15 seconds)
Expected RR 30-60/min
Airway noises may be present
Respiratory distress
persistent nasal flaring
retractions
expiratory grunting
increased use of intercostal muscles
tachypnea > 60 breathes per minute
cyanosis
apnea lasting longer than 15 seconds
What is the expected findings for cardiac patterns for newborns?
Cardiac Patterns
HR 110-160 BPM, fluctuating depending on infant activity
auscultate apical pulse for 1 minute
murmurs may be present 90% transient, but needs to be monitored
Average BP: 80-60/50-40 at birth
Color: perfused
Average blood vol: 300 ml, varies by 100 ml depending on timing of cord clamping
delay cord clamping = neonatal benefits
What is the expected findings for newborn thermoregulation?
Axillary temp: 97.7-99.5 F (varies depending on hospital)
Balance achieved b/w heat loss and heat generation
What are the most important things for the nurse to do at delivery to assure a successful newborn transition to extrauterine life?
Establish respirations and circulation, heat regulation
Golden hour = first 60 mins after childbirth
delayed cord clamping until umbilical cord has stopped pulsating (between 1-5 mins)
maternal-neonatal skin to skin contact, including performing all assessments while infant is on abdomen
early breastfeeding
Routine interventions not time sensitive should be delayed
What are the newborn medications that are given prior to the infant leaving the hospital?
Erythromycin Ointment: prevention of gonococcal opthalmia, neonatorum and chlamydial conjuctivitis
mandated in most states
Vitamin K (Aquamephyton): prevent vitamin k dependent hemorrhagic disease. newborns risk first week of life due to immature liver and sterile GI tract. stimulates liver to synthesize factors
Hepatitis B Vaccine: safety net reducing risk of getting the disease from moms or family members who may not know they’re infected with hep B. people can spread virus even when they don’t have sx
What is the importance of maintaining an infant’s temperature and range of appropriate newborn temp?
Tolerate a narrow range of environmental temps and vulnerable to under/overheating.
Will attempt to regulate via flexed position, peripheral vasoconstriction, increased metabolic rate, and metabolism of brown fat.
Cold stress: depletes brown stores, increases O2 needs, increases glucose consumption - hypoglycemia, metabolic acidosis, jaundice, hypoxia, and decreased surfactant production
How can you teach a parent how to recognize whether their infant is getting enough breastmilk? What should the urine look like?
1-2 wet diapers for every day the baby is old
at 4 days, 6-8 wet diapers a day = adequate intake
Urine = pale, straw colored. may be initially blood tingued or have mucous (cloudy)
What are the vessels inside the umbilical cord?
Umbilical Vein: Oxygenated blood and nutrients are carried from placenta to fetus
2 Umbilical Arteries: Waste products and deoxygenated blood are carried back from fetus.
Then transferred back into maternal ciruclation.
Surrounded by Wharton’s Jelly to cushion and protect it
