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247 > Module 3A > Flashcards

Module 3A Flashcards

1
Q

Puerperium

A

Begins after delivery of placenta and last approx 6 weeks.
“4th trimester”

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2
Q

Involution

A

Retrogressive changes that return uterus (organ) to nonpregnant size and condition

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3
Q

What are the 3 retrogressive processes for uterine involution?

A
  1. Contraction of muscle fibers to reduce those previously stretched during pregnancy
  2. Catabolism, which shrinks enlarged individual myometrial cells
  3. Regeneration of uterine epithelium from the lower layer of decidua after upper layers have been sloughed off and shed during lochial discharge
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4
Q

Approx 1 week after birth how much does the uterus shrink, end of 6 weeks??
During first 12 hours postpartum the fundus is at the level of?
The uterus typically descends from the level of umbilicus at rate of ______per day?

A

end of 1st week - 50% &1lb, end of 6 weeks 2oz
Umbilicus
1cm/day

*by end of 10 days cannot be palpated bc descended into true pelvis

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5
Q

What are factors that inhibit involution?

A

Prolonged labor, difficult birth, incomplete expulsion of amniotic membranes and placenta, uterine infection, overdistension of uterine muscles (multiples, hydramnios, large fetus), a full bladder, anesthesia, close childbirth spacing

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6
Q

Lochia
Define
Results from
Immediatley after childbirth -
Alkaline/acidic
Each day lochia should be

A

1.Vaginal discharge that occurs after birth and usually continues approx 4-8 weeks.
2. Results from involution during which a superficial layer of decidua basalis becomes necrotic and is sloughed off
3. bright red, consists mainly of blood, fibrinous products, decidual cells and red and white blood cells
4. Lochia from uterus is alkaline, becomes acidic from vagina
5. Each day should be less and color lighter

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7
Q

What is the primary mechanism preventing hemorrhage from placental site

A

Uterus begins to contract, constricting intramymetrial vessels and impeding blood flow
“afterpains”
*usually respond to oral analgesics

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8
Q

What will inadequate myometrial contractions result in

A

atony which will result in early postpartum hemorrhage

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9
Q

Why are afterpains stronger during breastfeeding?

A

Because oxytocin is released increasing the contractions

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10
Q

Immediately after vag birth what does cervix look like?

A

Extends into vagina, partly dilated, bruised and edematous
*returns to prepregnant state at 6 weeks.
*internal cervical os closes and returns by 2wkes
**External cervical os no longer a circle but a slit opening

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11
Q

How is vagina after birth?

A

Edematous, relaxed, thin with few rugae
As ovarian function returns and estrogen returns mucosa thickens and rugae return approx 3 weeks

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12
Q

What are comfort measures for swollen hemorrhoids

A

Ice pack
Pour warm water over area
which hazel pads
anesthetic spray
sitz bath

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13
Q

Cardiovascular system adaptations after birth

How is
Cardiac output
Blood volume
Hematocrit?

A

-C/o remains high few days then declines w/in 3 months
-Blood volume -Prepregnant w/in 4 weeks
-Hematocrit - relatively stable might even increase, reflecting loss of plasma

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14
Q

Why would a woman have a elevated temp up to 100.4 in the first 24hrs postpartum?

A

Due to dehyrdation.
Might also have a slight decrease in BP

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15
Q

The decrease in C/o is reflected in—– for how many weeks?

A

Bradycardia
first 2 weeks

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16
Q

What would tachycardia in post partum indicate?

A

hypovolemia
dehydration
hemmorhage

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17
Q

What changes affect BP after birth

A

Falls in first 2 days
increases 3-7 days
Returns to normal by 6 weeks

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18
Q

What could decreased bp postpartum indicate?

A

infection
hemorrhage

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19
Q

What places post partum women at increased risk for blood clots?

A

Hemostatsis that favor coagulation, reduced fibrinolysis, pooling and stais of blood

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20
Q

What can increase the risk of coagulation disorders?

A

SMoking, obesity, immobility, infection, bleeding, emergency surgery (c-section)

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21
Q

What happens to hemoglobin and hemotacrit in first 24 hrs post partum

A

decrease slightly
Over next 2 weeks rise slowly

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22
Q

When does urinary system return to normal post partum?

A

6 weeks

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23
Q

What is a major cause of uterine atony?

A

Urinary retention

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24
Q

What does urinary retention and bladder extension cause?

A

Displacement of uterus to the right and can inhibit contractions which increases risk of postpartum hemmorhage

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25
Q

What does freq amounts of less than 150ml of urine suggest?

A

Urinary retention with overflow
Catherterization may be necessary

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26
Q

What factors contribute to rapid filling of bladder wtihin 12hours after birth?

A

large amounts of IV fluids
decreasing antidiurtiec effect of oxytocin
build up of extra fluids during preg
decrease production of aldosterone (decreases sodium retention and increases urine production)

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27
Q

GI system adaptations

Why do women expierence decreased bowel tone and sluggish bowels post partum?

A

decreased peristalsis in response to analgesics, surgery, diminished intraabdominal pressure
low fiber
insufficient fluid intake
diminished muscle tone

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28
Q

Integumentary system adaptations

What is the purpose of postpartum diaphoresis

A

reduce amount of fluids retained during preg and restore pre preg levels

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29
Q

Respiratory system adaptations

When does respiratory volumes return to normal

A

1-3 weeks

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30
Q

Endocrine system adaptations

When is there a rapid clearnace of placenta hormones?
Decreased estrogen levels are assoc with?
When is estrogen the lowest?

A

Delivery of placents
-Breast engorgement, diuresis
- estrogen lowest 1wk after , non breast feeding - increase by weeks 2 / breastfeedign estrogen remains low

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31
Q

When is Progesterone levels undectable?
When is Hcg undectable?
When does prolactin decline?

A

Progesterone - 3 day
Hcg - 1 day
Prolactin - decline w/in 2 weeks

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32
Q

Lactation

A

Secretion of milk by breasts
Brought on by interaction of progesterone, estrogen, prolactin and oxytocin
Appears 4-5 days post

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33
Q

What are APP Recommendations for breast feeding

A

exclusive for 6 months
Intro foods w/ breastfeeding to 1 year+

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34
Q

What are the roles of the following in breastfeeding?
Estrogen
Progesterone
Prolactin
Oxytocin

A

Estrogen - stims growth of milk collection system
Progesterone- stims growth of milk collection system
Prolactin- triggers synthesis and secretion of milke after birth
Oxytocin - milk can be ejected from alveoli to nipple

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35
Q

The newborn sucking on breast stimulated what?

A

Pituitary gland to release PROLACTIN and OXYTOCIN

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36
Q

Engorgement

A

Postnatal physiologic painful condition in which distention and swelling of breast tissue occurs as result of increase in blood and lymph sypply as a precursor to lactation

Peaks 3-5days postpartum
Subsides 24-36hrs

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37
Q

What helps minimize discomfort for full breasts for a woman who is breast feeding?

A

Freq emptying
warm shower or compress
heat/cold
cabbage leaf
massage
antiinflam agent

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38
Q

What helps minimize discomfort for full breasts for a woman who is not breast feeding?

A

Wear tight supportive bra 24hrs
Apply ice 15-20 mins every other hour
Avoid sexual stimulation
not squeeze or express milk
*avoid warmth
Usually sibsides wtihin 2-3 days

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39
Q

What is taking-in phase

A

Time immediately after birth when pt needs sleep, depends on other to meet needs, relives events of birth
Characterized by dependant behavior / passive role
Allowing nurse to make decisons
Lasts 1-2days

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40
Q

Taking-hold phase

A

2nd phase of maternal adaptation, characterized by dependent and independent maternal behavior
*starts on 2nd or 3rd day and may last several weeks
_Preoccupied with present, concerns about her health, infants condition, and ability to care for baby. Begins to take charge

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41
Q

Letting go phase

A

3rd phase
Women reestablishes relationships with other people
Assumes parental role and separates herself from symbiotic relationship that she and newborn had during pregnancy
Establishes lifestyle with infant

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42
Q

To foster maternal role attainment what are 3 specific nursing interventions

A
  1. instructions about infant care and infants capabilities
  2. Mothers perfer live classes rather than videos
  3. Id barriers that reduce skin to skin contact
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43
Q

What does a postpartum assessment include?

BUBBLE-EE

A

Vital signs
Pain level
Epidural site inspection for infection
Systematic head to toe
Psychosocial assessment
Assessing parents and other family members

Use BUBBLE_EE
Breasts
Uterus
Bladder
Bowels
Lochia
Episiotomy.perineum/epidural site
Extremeties
Emotional status

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44
Q

Postpartum assessments typically are as follows
During first hour?
2nd hour?
First 24hrs after 2nd hour?
After 24 hours?

A

During first hour- q 15min
2nd hour - q 30 min
First 24hrs after 2nd hour- q 4hrs
After 24 hours - q 8hrs

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45
Q

What happens to moms temp postpartum?

Temp above 100.4?

A

Remains in normal range or low grade elevation up to 100.4 bc of dehyrdation

above 100.4 first 24hrs = infection, maternal sepsis

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46
Q

What happens to moms pulse postpartum?

A

60-80bpm for first week - called puerperal bradycardia
Elevated stroke volume after baby is out leads to lower HR

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47
Q

Puerperal bradycardia

A

pulse rate after birth 60-80bpm

48
Q

What does tachycardia in post partum women indicate?

A

anxiety, excitment, fatique, pain, excessive blood loss, delayed hemorrhage, infection, underlying cardiac problems

bpm higher than 100 warrants further investigation

49
Q

What happens to respirations to mom postpartum?
What does change in respiratory indicate?

A

Shoud be normal 12-20bpm

Change in respiratory indicates: pulmonary edema, atelectasis, pulmonary embolism

50
Q

What happens to moms blood pressure postpartum?
Increase could indicate?
Decrease?

A

After birth BP should remain same as during labor

Increase in BP: gestational HTN
Decreae in BP: shock, orthostatic hypotension, dehydration

Should not be higher than 140/90
or lower than 85/60

51
Q

How should nurses ease moms pain postpartum?

Aim for pain level?

A

5th vital sign

Ease pain: perineal care, clean gown, mouth care, warm blanket, adequate fluid, repositioning, rest, premedicate

Maintain pain at 0-2 at all times

52
Q

What could it mean if a mom has severe pain in [erineal region despite use of comfort measures?

A

hematoma

53
Q

Bonding

A

close emotional attraction to a newborn by parents that develops during first 30-60mins after birth

54
Q

Attachment

A

Development of strong affection between infant and significant other (mother, father, sibiling, caregiver)

*influences view of world and future relationships

55
Q

En face position

A

face to face while holding or feeding

56
Q

Proximity

A

refers to physical and psychological experience of parents being close to their infant

57
Q

What are the 3 dimensions of proximity?

A

Contact: sensory experiences of touch, holding, gazing
Emotional state: Affective expierences of new parents toward newborn
Individualization: Parents are aware of need to differentiate the infants needs from their own

58
Q

Reciprocity

A

Process by which infants abilities and behaviors elicit parental response

59
Q

What is complementary reciprocity
What is Sensitivity

A

Complementary - involves taking turns and stopping when other is not interested or tired

Sensitivity: parents who are sensitive to infants communication

60
Q

What are recommended excersices for first few weeks postpartum

A

Abdominal breathing
Head lifts
Modified sit ups
double knee roll
pelvic tilit

61
Q

When women are on what medication should they not breast feed?

A

Antithyroid
antineoplastic drugs
alcohol
active herpes infection on breasts
street drugs
HIV positive

62
Q

What are other contraindications to breasfeeding a newborn

A

Galactosemia, PKU, active untreated TB, mother with serious mental health

63
Q

How to alleviate breast engorgment when not breast feeding

A

Ice packs
Snug supportive bra for 24hrs a day
mild analgesics
avoid stimulation

64
Q

uterine atony

A

loss of muscle tone

65
Q

What could uterine atony place mom at risk for

A

hemorrhage

66
Q

Neonatal period

A

first 28 days of life

67
Q

What are the 4 interdependent areas the newborns most dramatic transitions occur

A

Circulatory
Respiratory
Thermoregulation
Ability to stabalize blood sugar

68
Q

During first few mins of birth newborns HR is
and decreases to an avg of

A

110-160
120-130bpm

69
Q

What newborns actions corresponds to increase in HR and BP

A

Increase in activity, wakefulness, movement, crying

70
Q

What is newborn tachycardia found with
Bradycardia?

A

tachycardia - volume depletion, cardiorespiratory disease, drug withdrawl, hyperthyroidism

Bradycardia - apnea and hypoxia

71
Q

What is the typical blood volume of a newborn and what does it depend on

A

approx 80-100ml/kg of body weight

depends on amount of blood transfered from placenta at birth

72
Q

What do recent studies show as benefits of delayed cord clamping

A

improving newborns cardiopulmonary adaptation, preventing iron deficiency anemia, increaseing bp, improving oxygen transport, increasing RBC

73
Q

What is the lifespan of RBC for a newborn

A

80-100 days compared to adutls 120 days

74
Q

Surfactant

A

surface tension-reducing lipoprotein found in newborns lungs that prevent alveolar collapse at end of expiration and loss of lung volume

75
Q

The first breath of life is a gasp that generates an increase in

A

transpulmonary pressure and results in diaphragmatic desent

76
Q

What becomes stimuli for initiating respirations

A

hypercapnia, hypoxia and acidosis from normal labor

77
Q

What must occur before newborns lungs can maintain respiratory function

A

Initiation of respiratory movement
Expansion of lungs
Esta of functional residual capacity (ability to retain air in lungs on expiration)
Increased pulmonary blood flow
Redistribution of cardiac output

78
Q

After respirations are established, how are they in newborn?
RR?

A

30-60bpm w/ short periods of apnea and shallow and irregular

79
Q

What are signs of respiratory distress in newborn

A

Cyanosis, tachycardia, expiratory grunting, sternal retractions, nasal flaring

80
Q

Thermoregulation

A

Process of maintaining the balance between heat loss and heat production in order to maintain the bodys core internal temperature

81
Q

What are several things that predispose newborns to heat loss

A

1Thin skin with blood vessels close to surface
2Increased skin permeability to water
3Lack of shivering ability until 3mo
4Limited stores of metabolic substrates (glucose, glycogen, fat)
5Large surface of area-to-body mass ratio
6Lack of subq fat
7Little ability to conserve heat by changing posture
8No abiltiy to adjust their own clothing or blankets
9Inability to communicate

82
Q

Conduction

A

Transfer of heat from one object to another when two objects are in direct contact with each other

83
Q

Convection

A

Flow of heat from body surface to cooler surrounding air or to air circulating over body surface

84
Q

Evaporation

A

Loss of heat when a liquid is converted to a vapor

Sensible - objective and can be noticed
Insensible - individual not aware

85
Q

Radiation

A

loss of body heat to cooler, solid surfaces that are in proximity but not direct contact

86
Q

Where is the primary heat regulator located

A

hypothalamus and CNS

87
Q

What does overheating do to fluid, respiratory rate and metabolic rate

A

Increases fluid loss, respiratory rate and metabolic rate

88
Q

Thermoregulation is related to newborns rate of

A

Metabolism and oxygen consumption

89
Q

Neutral thermal environment

A

Environment in which body temp is maintained without an increase in metabolic rate or oxygen use

Promotes growth and stability, conserves energy, minimizes heat and water loss

90
Q

The newborns primary method of heat production is through

A

nonshivering thermogenesis
Process in which brown fat is oxidized in response to cold exposure

91
Q

What does brown adipose tissue do

A

Convert chemical energy directly into heat when activiated by sympathetic nervous system
Produced during 3rd trimester

92
Q

Where is brown adipose tissue found

A

Scapulae, axillae, nape of neck, mediastinum, areas surrounding kidneys, adrenal glands

93
Q

When a newborn is exposed to cold what does the body do

A

NE is released
which stims brown fat metabolism by breaking down triglycerides
C/O increases = increasing blood flow through brown fat tissue
Blood becomes warmed as a results of increased metabolic activity of brown fat

94
Q

Cold stress

A

excessive heat loss that required newborn to use compensatory mechanism to maintain core temp

-less active, lethargic, hypotonic, weaker

–at risk mostly 1st 12 hours

95
Q

What problems can cold stress lead to in newborn

A

depelted brown fat, increased O2 and gluocse consumption, respiratory distress, depletion of glycogen = hypoglycemia, pulmonary vasoconstriction, metabolic acidiosis, jaundice, hypoxia and decreased surfactant production

96
Q

What determins the iron status of a newborn at birth

A

Maturity, birth weight, hemoglobin level

97
Q

Bilirubin

A

yellow-orange bile pigment produced by breakdown of RBC

Normally circulates in plasma, taken up by liver cells and changed to water soluable pogment that is excreted in bile

98
Q

Newborns produce bilirubin at what rate per day

A

8-10mg/kg/day

twice the rate of adults, declines to adult level in 10-14days post birth

99
Q

What causes jaundice

A

failure of liver cells to break down and excrete bilirubin causes an increased amount in bloodstream. Deposited in skin and mucous membranes as a result of the build up

yellowing of skin, eyes and sclera and mucous membranes

100
Q

Bilirubin encephalopathy

A

permenent and devastating brain damage

101
Q

What are common risk factors for developing jaundice

A

fetal-maternal blood group incomatibility
Prematurity
asphyxia at birth
insufficient intake of milk during breast feeding
drugs (diazepam, oxytoci, sulfisoxazole. chloramphenicol)
Maternal gestational diabetes\
infreq feeding
male gender
trauma at birth
intrauterine infection
asian or native american ethnicity

102
Q

Meconium

A

composed of amniotic fluid, shed mucosal cells, intestinal secretions, and blood

greenish black, tarry consistency, usually passed within 12-24 hours after birth

103
Q

After meconium is passed and feedings are initiated how are stools?

A

greenish-brown to yellow brown, thinner and seedy in appearance

Breastfeed - light mustard w/ seed like particles

Formula fed - tan/yellow firmer

104
Q

When does renal cortex reach maturity in a newborn

A

12-18 months

105
Q

What immunoglobin is able to cross placenta

A

IgG
Begining at 20-22wks

Produces antibodies against bacteria, toxins and viral agents

106
Q

What is a major source of IgA

A

Breast milk

107
Q

First period of reactivity

A

birth may last from 30 mins to 2 hours

Alert, moving and hungry’

Characterized by myoclonic movements of eyes, spontaneous moro reflexes, sucking, chewing, rooting, fine tremors/ Muscle tone and motor activity are increased

108
Q

Period of decreased responsiveness
2nd stage

A

at 30 mins to 120mins of age,
period of decreased responsiveness, movements less jerky and less freq
HR and RR declines and newborn sleeps
Difficult to arouse

109
Q

2nd period of reactivity

A

Awakens and shows interest in environmental stimuli

lasts 2-8hrs
Hr and Rr increases
Peristalis also increases
Meconium or void during this period

110
Q

Neurobehavioral responses

A

how newborns interact with world around them

Orientation, habituation, motor maturity, self-quieting ability, social behaviors

111
Q

How does orientation reflect in newborns

A

Response to auditory and visual stimuli demonstrated by their movements of head and eyes to focus on stimulus

112
Q

Habituation

A

newborns ability to process and respond to visual and auditory stimuli

How well infant responds to environment
ability to block out external stimuli after becoming accustomed to activity

useful indicator of neurobehavioral intactness

113
Q

Motor maturity

A

involves evaluation of posutre, tone, coordination and movements

*bringing hand up to mouth

114
Q

Why are we checking for protein in urine at prenatal visits?

A

When BP is out of control kidneys will throw out protein

115
Q

How long during breastfeeding does mom take prenatals and folic acid

A

1 month after breastfeedings

116
Q

what increase in cal does a breast feeding mom need

A

330 cal +

117
Q

What are the 7 cardinal movements of labor and delivery?

A

a. Engagement.
b. Descent.
c. Flexion.
d. Internal rotation.
e. Extension.
f. Restitution and external rotation.
g. Expulsion.
[Mnemonic for memory is: Every day fine infants enter eager and excited

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