Midterm Exam (Ch.17, 18, 19, 21, 22, 25, 31, 32, 33, 34, 35, 36, 37, 40) Flashcards
Lochia Rubra
bright red & consists of blood; lasts 3-4 days
Lochia Serosa
pink/brown; lasts 10-14 days
Lochia Alba
yellow to white; continues 4-8 weeks after birth
When should you report to the healthcare provider if sloughing of eschar over placental site does not subside?
1-2 hours
What is one indication of lochia serosa?
con’t flow of lochia serosa after 3-4 weeks
In nonlactating women, when do estrogen levels increase?
within 2 weeks
After birth when is hCG detectable?
3-4 weeks after birth
Fluid loss PP
postpartal diuresis is caused by decreased estrogen
- profuse diaphoresis occurs
- w/in 12 hours women begin to diurese
Blood Volume PP
- blood loss is tolerated due to pregnancy-induced hypervolemia
- by 3rd PP day, plasma volume replenished
Cardiac Output
increased in PP by 60-80%
Vital Signs
- increased BP >140/90 when measured at least twice indicates preeclampsia
- temp. increase to 100.4 in 1st 10 days indicates infection
What kind of bradycardia is common PP?
Puerperal
Cardiac Output affects the blood components
- Hct & Hbg return to normal
- coagulation factors return to normal
- varicosities regress rapidly/totally
PP period
interval between birth & return of reproductive organs to normal
Uterus Involution
The process is return of uterus to nonpregnant state
- timeframe of 6 weeks
- fundus descends 1-2 cm/24 hrs
Subinvolution
Failure of the uterus to return to normal
Lochia
Postbirth uterine discharge
Placental hormones- metabolic changes
decrease in chorionic somatomammotropin, estrogens, placental enzyme insulinase
When does ovulation return in nonlactating women?
As early as 27 days after birth; pituitary hormones are responsible for this
3 Crucial Points for OB nurses
- understand normal birth
- prevent & detect deviations
- Implement nursing measures
What are the main interventions for labor & birth?
- suppression of uterine activity
- promotion of fetal lung maturity
- fetal & early natal loss
How are spontaneous labors predicted?
Risk factors; Cervical Length; Fetal Fibronectin test
PROM
Premature Rupture of Membranes
-rupture of the amniotic sac
Labor will be AUGMENTED
PPROM
Preterm premature rupture of membranes -pathologic weakening of membranes -membranes rupture before 37 weeks Managed conservatively Usually hospitalized
What is a MAJOR risk factor for PPROM/PROM?
INFECTION
Chorioaminonitis
bacterial infection of the uterine cavity
-cause of complications
Maternal fever and fetal tachycardia are two key findings; foul odor of fluid
How many weeks are considered to be post-term?
> 42 weeks
What is the purpose of Oxytocin?
a cervical ripening method that is used to induce or augment labor
-hormone that is normally produced
Stimulates uterine contractions
High alert med
Risk Factors for Spontaneous Preterm Labor
- african-american race
- hx of a previous spontaneous preterm birth
- underweight or obese
What is the priority intervention after assessing heart rate?
Monitor Fetal Heart Rate
Couplet
Mother/baby model of care
Diuresis
Begins about 12 hours after birth
Blood loss after birth is assessed, what is considered normal?
- 500 mL of blood for vaginal delivery
- 1000mL of blood for c-section
What is the proper way to palpate the uterus?
Upper hand cupped over fundus
Hypovolemic Shock
this is considered to be an emergency treatment situation S&S -persistent bleeding occurs -woman feels weak -woman appears anxious
Interventions for Hypovolemic Shock
- give oxygen by nonrebreather face mask
- tilt woman onto her side
- provide additional/maintain IV
After birth, when must hospital personnel be present?
the first time woman get up
When is the risk for hemorrhage PP minimal?
By 2 weeks postpartum
In regards to post-anesthesia recovery when is the woman discharged?
When she has recovered from the anesthetic
What are some priorities of discharge for the mother?
- How is she bonding with baby?
- recovery from c-section
- encourage bonding with baby
- address financial concerns
What is the correct process or description of pelvic floor exercises?
“I pretend that I am trying to stop the flow of urine midstream.”
Newborns’ and Mothers’ Health Protection Act of 1996
Allows for a minimum of 48 hours stay after a vaginal birth and 96 hours after c-section
What is the leading cause of morbidity in postpartum?
postpartum hemorrhage
uterine atony
marked hypotonia of uterus
inversion of uterus
turning inside out
hemorrhagic shock
this is a hypovelmic emergency
- restore circulating blood volume
- recognize early S&S, summon for help, continuous monitoring of status
Idiopathic/immune thrombocytopenic purpura
autoimmune disorder of antiplatelet antibodies
Von Willebrand Disease
type of hemophilia
Postpartum infection
occurs within the genital tract after miscarriage
Endometritis
infection of uterus lining
postpartum depression
the prevalence varies based on definitions
-likely to occur with PPD
postpartum psychosis
pp depression with psychotic features
When monitoring for postpartum depression…
Watch for agitation, overreactions, complaints/suspcious; suicidal/homicidal ideations are symptoms of PPD
Tx for PP Depression
-screening for PP depression
-use of psychotropic meds & lactation
in bipolar disorder, severe anxiety is common, what medications are used to treat this?
-olanzapine
-quetiapine
used as mood stabilizers
preterm labor
diagnosed as regular contractions
preterm birth
b/w 20 weeks and 36 weeks 6/7 days
intrauterine growth restriction
inadequate fetal growth
Fetal Fibronectin
diagnostic test for preterm labor
tocolytics
given to arrest labor
antenatal glucocorticoids
accelerates fetal lung maturity
dystocia
lack of progress in labor
dysfunctional labor
long, difficult/abnormal
precipitous labor
lasts <3 hours
cephalopelvic disproportion
AKA fetopelvic disproportion
After Birth Hemorrhage
Risk Factors
- 2 biggest are uterine atony & retained placenta/fragments
- lacerations of the genital tract
- inversion of uterus
Assessment of Hemorrhage
- uterine massage, uterotonics: oxytocin, methergine, expression of clots
- frequently assess & monitor, brief explanations of interventions, comfort measures
- uterine tamponade, uterine artery ligation, hysterectomy
Integumentary System- physiologic adjustments
the skin is red for a few hours after birth; edema or bruising may be present; single palmar crease in some babies
Extrusion Glabellar
newborn forces tongue outward
tonic or neck “fencing”
If the infant faces one side the opposite arm and leg flex
Stepping or Walking
When held vertically, infant will stimulate walking
Babinski
All toes hyperextend
Pull-to-sit
head lags until infant is in upright position
Truncal incurvation
trunk is flexed
Additional NB reflexes
yawning, stretches, burps
caput succedaneum
edema of the scalp
cephalhematoma
collection of blood between skull bone and its periosteum
subgaleal hemorrhage
bleeding into subgaleal compartment
Infant expected weight gain
- 5-7 ounces weekly for first 6 months
- 3-5 ounces for next 6 months
- birth weight triples at 12 months
Stranger fear develops
6 to 8 months
Age infant rolls over
happens accidentally as a newborn and purposefully at 6 months
Age infant grasps objects
2 to 3 months
Age infant stands
by 1 year
Age to sit
about 4 months
Colic
*crying and fussing Risk Factors -infant's diet -smoking in the house -imbalance of microflora Tx -sometimes sedatives, antiflatulents, antispasmodic are used -detailed hx of mother's diet, characteristics of cry, infant's diet -milk-free diet for mom
Sudden Infant Death Syndrome
the sudden death of an infant risk factors -co-sleeping -maternal smoking during pregnancy -smoke in environment
Preoperational phase of toddler
Piaget
involves sensorimotor skills starting with reflexes, cognition develops rapidly b/w 1 and 2 years of age and ends at age 4 years
Tertiary Circular Reactions
active experimentation, applying knowledge to new situations, learning spatial relationships
What is the final stage of sensorimotor development?
*Invention of new means
Ages 19-24 months
Poor Concept of Time
Imitation for behaviors
Preoperational Phase
Piaget
- begins about age 2 years
- lasts until age 4
- Does not yet think in operational patterns
Language in Toddlers
at 1 year, one-word sentences are used with 25% vocalizations; by age 2 child uses multi-word sentences with 65% of language intelligible
When is a toddler ready to toilet train?
Age 18-24 months the child will T- two or more hours with dry diaper O-On and off I-Interested in potty L-likes sitting on the toilet E-Experiencing regular BM T- Tells you they have to go
A characteristic of a toddler’s language development at 18 months is
Increasing level of comprehension
What is the preschool period?
Ages 3-5 years
- prepares child for school
- increased attention span
- Cooperative interaction with other children
Initiative vs Guilt
Preschool age
- development of super ego
- feelings of guilt, anxiety, fear
- learning right from wrong
Trust vs. Mistrust
Infants trust comfort needs will be met
Autonomy vs. Shame and Doubt
Id, Ego, superego
Industry vs. Inferiority
Peer approval is a strong motivator
- eagerness to develop skills
- growing sense of independence
Identity vs. Confusion
Teens work at the sense of self
Intimacy vs. Isolation
Young adults struggle to form close relationships
Generativity vs. Stagnation
Middle-aged feel a sense of contributing to the world to give back
