MTN child final exam Flashcards
1
Q
postpartum period is how long after birth
A
6 weeks
2
Q
insurance give mothers who do a vaginal birth ______ in the hospital vs a c section birth mother _________
A
vaginal birth - 48 hours
c-section - 96 hours
3
Q
post partum risks
A
hemorrhage and infection
4
Q
involution on the uterus
A
continues for 4-6 weeks. uterus returns to prep regnant size
5
Q
what causes involution
A
contractions and uterine muscle atrophy
6
Q
what can breast feeding do to uterus
A
cause it to cramp due to oxytocin release and cause afterpains which are normal
7
Q
uterine atony
A
soft boggy uterus. uterus inadequately contracts, tilts backwards, and can have blood clots form
8
Q
FFU
A
fundus firm at umbilicus
9
Q
fundus descends _______ every 24 hours
A
1-2 cm
10
Q
subinvolution
A
failure of uterus to return to non pregnant state
11
Q
lochia rubra
A
blood and decidual trophoblastic debris. lasts for 3-4 days. red tinged
12
Q
lochia serosa
A
old blood, serum, leukocytes, and debris. lasts for 22-27 days after lochia rubra. yellow
13
Q
lochia alba
A
leukocytes, decidua, epithelial cells, mucus, serum, and bacteria. continues 2-6 weeks after birth. white sometimes yellow
14
Q
symptoms of shock may not appear until
A
the patient has lost 30-40% of her total blood volume
15
Q
1 gm = ____ mL
A
1 mL
16
Q
what should you do with saturated pads
A
weight them
17
Q
how often do you assess fundus
A
every 15 min for 1 hr, then every 30 minutes for 1 hr, then per police. more frequently if there is excessive bleeding
18
Q
how long does it take for milk to come in
A
3-5 days
19
Q
BUBBLE postpartum assessment
A
BREAST UTERUS BOWELS BLADDER LOCHIA EPISIOTOMY/LACERATION
20
Q
positive homan’s sign
A
pain that goes up the back of their legs when pointing and flexing feet - evidence of thrombosis
21
Q
breastfeeding teaching
A
wash breast with water daily, air dry nipples after feeding, if nipples are sore apply drops of breast milk, apply warm packs if breast are engorged
22
Q
non breastfeeding teaching
A
wear a well fitting bra, use ice packs for discomfort, do not express milk
23
Q
vaginal discharge lasts
A
10 days to 4 weeks and color will change from bright red to brownish/tan
24
Q
period will resume
A
6-8 weeks after birth but you can still ovulate so use condoms
25
care of episiotomy
sitz bath 2-3 times a day, tucks, stitches will dissolve
26
birth control is advice
once you resume sex but should not have sex for 6 weeks
27
leading cause of maternal death worldwide
postpartum hemorrhage
28
postpartum hemorrhage is defined as
loss of more than 500 ml of blood after vaginal birth, 1000 ml after c-section, or 10% reduction in H&H level
29
primary causes of postpartum hemorrhage
1. uterine atony
2. soft tissue trauma/internal lacerations
3. retained placental fragments
30
management of postpartum hemorrhage
massage of fundus, medications, IV fluids, blood transfusion if needed
31
cytotec will
stimulate uterine contractions
32
uterine tamponade
place a catheter with a balloon into the uterus and fill the balloon to place pressure on the uterus in time of hemorrhage
33
if all interventions fail and bleeding continues the can
give a hysterectomy
34
thromboembolic disease
results from blood clot caused by inflammation or partial obstruction of vessel
35
risk factors for thromboembolic disease
c-section, decreased mobility, and obesity
36
puerperal infection
any infection of genital tract within 28 days after miscarriage, abortion, or birth
37
mastitis
red line that leads from the nipple out. is in the shape of a pie slice and is a clogged milk duct
38
postpartum psychosis
syndrome characterized by depression, delusion, and thoughts of harming wither infant or self
39
most important step in neonatal transition
initiation of respirations, fetal breathing movements, and surfactant
40
chemical factors to initiate respirations
hypoxia causes CO2 to rise activating brain stem respiratory center to initiate breathing
41
factors leading to breathing
chemical, sensory, thermal, and mechanical
42
thermal factors initiating breathing
the air is cold which decreases skin sensor stimulus to brain which signals breathing
43
mechanical factors initiating breathing
fluid in alveoli gets pushed out by air and this makes the baby want to breath more
44
once the umbilical cord is clamped the umbilical arteries and umbilical vein
constrict which causes increased aortic pressure, decreased venous pressure, increased systemic pressure, and decreased pulmonary pressure
45
brown adipose tissue begins around
26-30 weeks
46
deposits of brown fat increase until
2-5 weeks after brith
47
brown fat does what for the baby
used for heat, energy, and transportation of oxygen
48
if baby gets cold we worry about
hypoglycemia and low oxygen
49
which babies are at most risk for using up all their brown fat
babies from diabetic moms
50
acrocyanosis
hands and feet still a little blue because body is shunting blood to heart and brain – normal for a couple days as long as the mouth and trunk are pink
51
APGAR test
```
quick test performed on a baby 1-5 minutes after birth
A - appearance
P- pulse
G- Grimace
A- activity
R- respirations
```
52
1 mintes APGAR score
determines how well the baby tolerated birth
53
5 minute APGAR score
tells doctor how well the baby is transitioning to extrauterine life
54
name of gestational age assessment
BALLARD
55
medication given to baby when they are born
erythromycin 1 bead in each eye and vitamin k IM
56
if fontanelles are sunken
dehydration
57
grunting or nasal flaring is a sign of
respiratory distress
58
loud heart murmur
foramen ovale is closing
59
soft heart murmur
foramen ovale is wide open
60
if you hear a murmur what do you need to do
four point blood pressure
61
liver should be _____ spleen should _________
liver should be palpable but spleen should not be
62
umbilical cord should have
two arteries and one vein
63
what reflexes do we test
moro - lift baby and let go to see if they get scared, babinski- toes will spread out, suck, and grasp reflex
64
less than ____ equals hypoglycemia for baby
40
65
labs for baby
universal newborn screening, hypoglycemia, hearing, CBC and blood type, urinalysis/drug screen if needed
66
bilirubin is
breakdown of red blood cell
67
jaundice results from
the accumulation of bile pigments associated with an excessive amount of unconjugated bilirubin in the blood
68
why do babies get jaundice
liver isn't fully functioning until 3-5 days after birth
69
risk factors for getting jaundice
ethnicity, diabetes, prematurity, feeding delay, hemolytic disease, brith trauma
70
surgical removal of foreskin is called
Gomco or mogen clamp
71
Gomco or mogen clamp treatment
petroleum jelly gauze placed over head of penis for 1 week
72
plastibell
type of circumcision. plastic bell placed over glans and tied to cut off blood supply. falls off within one week
73
brachial plexus injury
nerve pinch or break
74
cephalohematoma
collection of blood from hemorrhage that does not cross the suture lines
75
when do you get RhoGam
if mom is negative blood type, then get at 28 weeks and 72 hours after birth
76
ABO incompatibility
occurs if fetal blood type is A,B, or AB and maternal type is O. naturally occurring anti -A and anti-B antibodies transfer across the placenta to fetus which causes severe jaundice in baby and brain damage
77
treatment for ABO incompatibility
IV immunoglobulins, phototherapy, and exchange transfusion
78
respiratory distress signs
nasal flaring, grunting, tachypnea, central cyanosis, substernal retractions, crackles, apnea
79
most significant cause of neonatal mortality
infection and sepsis
80
sign and symptom of sepsis
poor feeding, irritability, apnea, mottling, tachycardia, hypotension, hypoglycemia, hypothermia
81
mottlign
skin gets blotchy
82
most common infection in newborn 24-48 hours after birth
E. coli and GBS
83
test used to indicate infection and sepsis in newborn
I/T ration - immature to total neutrophils
84
I/T ratio when infection is suspected
20-25% neutrophils are immature or there are bands
85
if there is a shift of _____ newborn will be treated for sepsis
0.3 or greater and if more than 0.8 there is severe sepsis and probable mortality
86
gastroschisis
congenital anomaly where the stomach and intestines herniate through the abdominal wall
87
omphalocele
congenital condition where the intestines protrude into the umbilical card region and are covered by a membrane. associated with trisomy
88
nursing care for gastrchisis and omphalocele
keep abdominal contents sterile and covered with warm saline or wrapped in plastic, bowel will be places in a silo and reduced back into the cavity by gravity, baby is NPO until after surgical repair
89
KUB
abdominal x-ray
90
necrotizing enterocolitis
caused by inflammation of the intestines and ischemic episodes of the bowel as blood is shunted away from intestines
91
signs and symptoms of necrotizing enterocolitis
emesis, lack of bowel movements, abdominal distention, increase in abdominal circumference, irritability
92
4 phases of endometrial cycle
menstrual phase, proliferative phase, secretory phase, and ischemic phase
93
menstrual phase
vasoconstriction and sloughing of endometrial tissue- bleeding
94
proliferative phase
ends with ovulation. rapid growth of the endometrium and is restored in 4 days
95
secretory phase
day after ovulation. increasing amounts of progesterone thicken and vascularize the endometrium
96
ischemic phase
does not occur if you get pregnant. day 27-28. estrogen and progesterone are very low. spiral arteries vasoconstriction and bleeding begins marking day 1 of cycle.
97
what phase is it when the endometrium reaches full thickness
secretory phase where it is 10-12 mm thick
98
phase of ovarian cycle
follicular phase, ovulatory phase, and luteal phase
99
follicular phase
before ovulation 1-30 follicles begin to mature. LH affects a single follicle
100
ovulatory phase
estrogen peaks and ends with the release of the egg from the Graafian follicle
101
luteal phase
cells of the follicle form the corpus luteum.
102
if pregnancy occurs the corpus luteum
continues to release progesterone and estrogen until placenta matures
103
4 major hormones of the menstrual cycle
follicle stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone
104
conception occurs when
a sperm nucleus enters the nucleus of the egg
105
3 days after fertilization the zygote has how many cells
16 cells
106
implantation should occur ______ days after ovulation
6-10 days
107
screening and management of group B streptococcus
retrovaginal culture screening at 35-37 weeks and treatment is antibiotic prophylactically for the baby
108
nagele's rule
LMP subtract 3 months, add 7 days and 1 year
109
how long is each trimester
1st - week 1-13
2nd - week 14-26
3rd - week 27-40
110
fetal heart rate is
110-160 beats per minute
111
when is sex identifiable
12 weeks but usually not on ultrasound until 18 weeks
112
gravidity
of pregnancies a woman has had
113
parity
number of pregnancies in which fetus has reached 20 weeks
114
term
of pregnancies that have reached 38-42 weeks (to term)
115
preterm
pregnancy that has reached 20 weeks of gestation but before completion of 37 weeks of gestation
116
biochemical marker of pregnancy
HCG - human chorionic gonadotropin
117
presumptive symptoms
changes felt by the woman
118
probable symptoms
changes observed by health care provider
119
positive symptoms
signs only by the presence of a fetus such as ultrasound, movement felt by practitioner, doppler of heart beat
120
Chadwicks sign
deepening color of the vulva by 6-8 weeks
121
Goodell sign
increased vascularity and hypertrophy of the cervix
122
what occurs with the renal system during pregnancy
GFR increases and bladder tone decreases so there may be frequency, urgency, and needing to pee multiple times at night
123
breathing during pregnancy
there is a shift from abdominal to thoracic breathing and may be more shallow/short/fast breaths
124
what happens to cardiac output during pregnancy
increases by 30-40%
125
chloasma
mask of pregnancy - brownish pigmentation of skin over cheeks and forehead
126
PICA
cravings for non-food substances. usually a sign of iron or magnesium deficiency
127
what does progesterone do to the GI system
it slows food that is going through the stomach so that more nutrients can be taken in for the baby but this can cause bloating and constipation
128
lab tests during prenatal visit
HIV testing, blood type, H&H, HCG levels, rubella, Hep B, urinalysis, alpha Fetoprotein
129
alpha Fetoprotein (AFP)
15-20 weeks
if elevated -NTD, anencephaly, omphalocele, gastroschisis
if decreased - trisomy 21
130
amniocentesis
Needle inserted through abdominal wall into the uterine cavity to obtain amniotic fluid sample
indicated for women over 35, history of genetic or hemolytic disorders, or + alpha fetoprotein
131
tests for fetal well being
umbilical artery doppler flow, amniocentesis, chorionic villus sampling, non-stress test, amniotic fluid index, and biophysical profile
132
amniotic fluid index
Measures the volume of amniotic fluid via ultrasound in four quadrants of the uterus. Used to detect fetal hypoxia and kidney function
133
amniotic fluid index levels
normal 8-24 cm
oligohydramnios- less than 5 cm
polyhydramnios- greater than 24
134
Biophysical profile (BPP)
Assessment of fetal breathing movements, gross body movements, fetal tone, amniotic fluid volume, and heart rate activity via ultrasound (2 points each)
135
Biophysical profile (BPP) levels
reassuring - 8-10
score of 6 = delivery depending on gestational age
non-measuring = 4 or less and warrants delivery
136
nutrient needs during pregnancy
folate or folic acid and iron supplements
137
normal weight gains during pregnancy
if you are underweight - 28-40 lbs
if you are average weight - 25-35 lbs
if you are overweight - 15-25 lbs
if you are obese - 11-20 lbs
138
adolescent pregnancy needs
increased need for calcium, possibly more weight gain, and they may have a smaller pelvis size
139
when risk factors are identified the patient is referred to
a perinatologist
140
risk factors for high risk pregnancies
high or low age, multiple gestation pregnancies, genetic or nutritional considerations, medical disorders, psychosocial factors, socioeconomical factors
141
gestational hypertension
onset of hypertension without proteinuria after 20 weeks
142
chronic hypertension
hypertension that is present before pregnancy, develops before 20 weeks, or persists longer than 12 weeks postpartum
143
preeclampsia
pregnancy specific syndrome in which hypertension and proteinuria develop after 20 weeks of gestation in previously normotensive women
144
signs and symptoms of preeclampsia
elevated BP, epigastric pain that is worse at night, sudden weight gain, peripheral edema, hyperactive DTRs, proteinuria, headaches, heartburn
145
HELLP syndrome
severe preeclampsia. H= hemolysis, EL= elevated liver enzymes, LP= low platelet
146
signs and symptoms of HELLP syndrome
flu-like symptoms, malaise, N/V, HA, shoulder pain, bruising, and hematuria
147
eclampsia
onset of a seizures or coma in a women with preeclampsia with no history of seizure disorder
148
placenta previa
the placenta is implanted in the lower uterine segment - can be complete, marginal, partial, or low lying
149
abruptio placentae
the prematures separation of a normally implanted placenta. can be graded 1 (mild), 2 (moderate), 3 (severe)
150
signs and symptoms of abruptio placentae
dark vaginal non-clotting bleeding, severe abdominal pain, uterine tenderness, hypovolemia, abnormal FHR
151
treatment for abruptio placentae
emergency C-section, replace blood loss, O2
152
normal magnesium levels
1.7-2.2
153
first stage of labor
begins with uterine contractions and ends with complete effacement and cervical dilation
154
phases of first stage of labor
latent phase, active phase, and transition phase
155
latent phase of first stage of labor
0-3 cm will be walking around, usually still at home, drinking a lot of water.
156
active phase of first stage of labor
rapid dilation of the cervix. 4-7 cm come to hospital when contractions are 5 minutes apart
157
transition phase of first stage of labor
increased rate of decent of the presenting part. 8 - 10 cm super painful. can't get an epidural anymore. contractions usually 1-2 minutes apart
158
second stage of labor
begins when cervical dilation complete until birth of the baby. women may have burst of energy
159
latent phase of second stage of labor
fetus continues to descend passively through the birth canal and rotates to an anterior position
160
active phase of second stage of labor
strong urge to push as baby pushes on stretch receptors
161
en caul birth
infant born inside the amniotic sac
162
1st degree lacerations
perineal skin and vaginal mucosa membrane
163
2nd degree lacerations
skin, mucosa, and fascia of the perineum
164
3rd degree laceration
skin, mucosa, fascia, and muscle of the peritoneal body and extends to rectal sphincter
165
4th degree laceration
extends into the rectum and exposes the lumen of the rectum
166
third stage of labor
separation and expulsion of the placenta and membranes usually occurs 5-30 min after birth
167
fourth stage of labor
recovery and homeostasis beginning to be re-established
168
early decelerations indicate
head compression and nurse doesn't need to do anything
169
what happens during late deceleration
deceleration starts after contraction and HR doesn't recover within 30 sec after contraction
170
late deceleration indicates
utter-placental insufficiency - not enough oxygen
171
late deceleration care
don't need to call doctor right away. turn pt, hydrate and oxygenate. if that doesn't work turn down Pitocin. if that doesn't work call doctor
172
variable decelerations indicate
cord is being squeezed/compressed
173
what to do during variable decelerations
turn pt, if that doesn't work then amnioinfusion which might cause buoyancy so the cord can float, and if that doesn't work call the doctor
174
prolonged decelerations
HR drops more than 15 beats and lasts 2-10 minutes
175
prolonged decelerations indicates
fetal distress - baby telling us its not okay
176
what do you do for prolonged decelerations
emergency c section
177
5 Ps
powers (contractions), passage (pelvis), passenger (baby), position, psyche
178
longitudinal fetal lie
baby's spine is parallel with mom's spine
179
transverse lie
baby's spine is at a 90 degree angle to moms spine
180
can get an epidural up until
7 cm
181
what can opioids do to labor
it can prolong it
182
epidurals are contraindicated in
hypotension, infection, thrombocytopenia, and cardiac condition
183
spinal anesthesia (block)
anesthetic injected into the 3rd, 4th, and 5th interspace into the subarachnoid space
184
nerve block analgesia
injecting lidocaine into the skin - local
185
nitrous oxide
self administered and helps with pain
186
general anesthesia is used for
emergency c section
187
low dose oxytocin administration
begin at 2 mu/min and increase by 2 mu/min every 30 minutes until 5 contractions in 10 minutes
188
high dose Pitocin
begin at 4 mu/min and increase by 4 mu/min until 5 contractions in 10 minutes
189
max dose of pitocin
20 mu/min
190
preterm labor
uterine contraction occurring between 20-37 weeks but can still make it to full term
191
care for preterm labor
administer tocolytic and antenatal coticsoteriods
