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Nursing school level 2 > MTN child final exam > Flashcards

MTN child final exam Flashcards

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1
Q

postpartum period is how long after birth

A

6 weeks

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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

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3
Q

post partum risks

A

hemorrhage and infection

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4
Q

involution on the uterus

A

continues for 4-6 weeks. uterus returns to prep regnant size

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5
Q

what causes involution

A

contractions and uterine muscle atrophy

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6
Q

what can breast feeding do to uterus

A

cause it to cramp due to oxytocin release and cause afterpains which are normal

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7
Q

uterine atony

A

soft boggy uterus. uterus inadequately contracts, tilts backwards, and can have blood clots form

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8
Q

FFU

A

fundus firm at umbilicus

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9
Q

fundus descends _______ every 24 hours

A

1-2 cm

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10
Q

subinvolution

A

failure of uterus to return to non pregnant state

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11
Q

lochia rubra

A

blood and decidual trophoblastic debris. lasts for 3-4 days. red tinged

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12
Q

lochia serosa

A

old blood, serum, leukocytes, and debris. lasts for 22-27 days after lochia rubra. yellow

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13
Q

lochia alba

A

leukocytes, decidua, epithelial cells, mucus, serum, and bacteria. continues 2-6 weeks after birth. white sometimes yellow

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14
Q

symptoms of shock may not appear until

A

the patient has lost 30-40% of her total blood volume

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15
Q

1 gm = ____ mL

A

1 mL

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16
Q

what should you do with saturated pads

A

weight them

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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

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18
Q

how long does it take for milk to come in

A

3-5 days

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19
Q

BUBBLE postpartum assessment

A 
BREAST
UTERUS
BOWELS
BLADDER
LOCHIA
EPISIOTOMY/LACERATION
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20
Q

positive homan’s sign

A

pain that goes up the back of their legs when pointing and flexing feet - evidence of thrombosis

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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

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22
Q

non breastfeeding teaching

A

wear a well fitting bra, use ice packs for discomfort, do not express milk

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23
Q

vaginal discharge lasts

A

10 days to 4 weeks and color will change from bright red to brownish/tan

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24
Q

period will resume

A

6-8 weeks after birth but you can still ovulate so use condoms

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25
Q

care of episiotomy

A

sitz bath 2-3 times a day, tucks, stitches will dissolve

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26
Q

birth control is advice

A

once you resume sex but should not have sex for 6 weeks

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27
Q

leading cause of maternal death worldwide

A

postpartum hemorrhage

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28
Q

postpartum hemorrhage is defined as

A

loss of more than 500 ml of blood after vaginal birth, 1000 ml after c-section, or 10% reduction in H&H level

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29
Q

primary causes of postpartum hemorrhage

A
  1. uterine atony
  2. soft tissue trauma/internal lacerations
  3. retained placental fragments
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30
Q

management of postpartum hemorrhage

A

massage of fundus, medications, IV fluids, blood transfusion if needed

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31
Q

cytotec will

A

stimulate uterine contractions

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32
Q

uterine tamponade

A

place a catheter with a balloon into the uterus and fill the balloon to place pressure on the uterus in time of hemorrhage

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33
Q

if all interventions fail and bleeding continues the can

A

give a hysterectomy

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34
Q

thromboembolic disease

A

results from blood clot caused by inflammation or partial obstruction of vessel

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35
Q

risk factors for thromboembolic disease

A

c-section, decreased mobility, and obesity

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36
Q

puerperal infection

A

any infection of genital tract within 28 days after miscarriage, abortion, or birth

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37
Q

mastitis

A

red line that leads from the nipple out. is in the shape of a pie slice and is a clogged milk duct

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38
Q

postpartum psychosis

A

syndrome characterized by depression, delusion, and thoughts of harming wither infant or self

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39
Q

most important step in neonatal transition

A

initiation of respirations, fetal breathing movements, and surfactant

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40
Q

chemical factors to initiate respirations

A

hypoxia causes CO2 to rise activating brain stem respiratory center to initiate breathing

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41
Q

factors leading to breathing

A

chemical, sensory, thermal, and mechanical

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42
Q

thermal factors initiating breathing

A

the air is cold which decreases skin sensor stimulus to brain which signals breathing

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43
Q

mechanical factors initiating breathing

A

fluid in alveoli gets pushed out by air and this makes the baby want to breath more

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44
Q

once the umbilical cord is clamped the umbilical arteries and umbilical vein

A

constrict which causes increased aortic pressure, decreased venous pressure, increased systemic pressure, and decreased pulmonary pressure

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45
Q

brown adipose tissue begins around

A

26-30 weeks

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46
Q

deposits of brown fat increase until

A

2-5 weeks after brith

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47
Q

brown fat does what for the baby

A

used for heat, energy, and transportation of oxygen

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48
Q

if baby gets cold we worry about

A

hypoglycemia and low oxygen

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49
Q

which babies are at most risk for using up all their brown fat

A

babies from diabetic moms

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50
Q

acrocyanosis

A

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

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51
Q

APGAR test

A 
quick test performed on a baby 1-5 minutes after birth
A - appearance 
P- pulse
G- Grimace 
A- activity
R- respirations
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52
Q

1 mintes APGAR score

A

determines how well the baby tolerated birth

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53
Q

5 minute APGAR score

A

tells doctor how well the baby is transitioning to extrauterine life

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54
Q

name of gestational age assessment

A

BALLARD

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55
Q

medication given to baby when they are born

A

erythromycin 1 bead in each eye and vitamin k IM

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56
Q

if fontanelles are sunken

A

dehydration

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57
Q

grunting or nasal flaring is a sign of

A

respiratory distress

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58
Q

loud heart murmur

A

foramen ovale is closing

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59
Q

soft heart murmur

A

foramen ovale is wide open

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60
Q

if you hear a murmur what do you need to do

A

four point blood pressure

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61
Q

liver should be _____ spleen should _________

A

liver should be palpable but spleen should not be

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62
Q

umbilical cord should have

A

two arteries and one vein

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63
Q

what reflexes do we test

A

moro - lift baby and let go to see if they get scared, babinski- toes will spread out, suck, and grasp reflex

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64
Q

less than ____ equals hypoglycemia for baby

A

40

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65
Q

labs for baby

A

universal newborn screening, hypoglycemia, hearing, CBC and blood type, urinalysis/drug screen if needed

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66
Q

bilirubin is

A

breakdown of red blood cell

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67
Q

jaundice results from

A

the accumulation of bile pigments associated with an excessive amount of unconjugated bilirubin in the blood

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68
Q

why do babies get jaundice

A

liver isn’t fully functioning until 3-5 days after birth

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69
Q

risk factors for getting jaundice

A

ethnicity, diabetes, prematurity, feeding delay, hemolytic disease, brith trauma

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70
Q

surgical removal of foreskin is called

A

Gomco or mogen clamp

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71
Q

Gomco or mogen clamp treatment

A

petroleum jelly gauze placed over head of penis for 1 week

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72
Q

plastibell

A

type of circumcision. plastic bell placed over glans and tied to cut off blood supply. falls off within one week

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73
Q

brachial plexus injury

A

nerve pinch or break

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74
Q

cephalohematoma

A

collection of blood from hemorrhage that does not cross the suture lines

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75
Q

when do you get RhoGam

A

if mom is negative blood type, then get at 28 weeks and 72 hours after birth

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76
Q

ABO incompatibility

A

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

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77
Q

treatment for ABO incompatibility

A

IV immunoglobulins, phototherapy, and exchange transfusion

78
Q

respiratory distress signs

A

nasal flaring, grunting, tachypnea, central cyanosis, substernal retractions, crackles, apnea

79
Q

most significant cause of neonatal mortality

A

infection and sepsis

80
Q

sign and symptom of sepsis

A

poor feeding, irritability, apnea, mottling, tachycardia, hypotension, hypoglycemia, hypothermia

81
Q

mottlign

A

skin gets blotchy

82
Q

most common infection in newborn 24-48 hours after birth

A

E. coli and GBS

83
Q

test used to indicate infection and sepsis in newborn

A

I/T ration - immature to total neutrophils

84
Q

I/T ratio when infection is suspected

A

20-25% neutrophils are immature or there are bands

85
Q

if there is a shift of _____ newborn will be treated for sepsis

A

0.3 or greater and if more than 0.8 there is severe sepsis and probable mortality

86
Q

gastroschisis

A

congenital anomaly where the stomach and intestines herniate through the abdominal wall

87
Q

omphalocele

A

congenital condition where the intestines protrude into the umbilical card region and are covered by a membrane. associated with trisomy

88
Q

nursing care for gastrchisis and omphalocele

A

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
Q

KUB

A

abdominal x-ray

90
Q

necrotizing enterocolitis

A

caused by inflammation of the intestines and ischemic episodes of the bowel as blood is shunted away from intestines

91
Q

signs and symptoms of necrotizing enterocolitis

A

emesis, lack of bowel movements, abdominal distention, increase in abdominal circumference, irritability

92
Q

4 phases of endometrial cycle

A

menstrual phase, proliferative phase, secretory phase, and ischemic phase

93
Q

menstrual phase

A

vasoconstriction and sloughing of endometrial tissue- bleeding

94
Q

proliferative phase

A

ends with ovulation. rapid growth of the endometrium and is restored in 4 days

95
Q

secretory phase

A

day after ovulation. increasing amounts of progesterone thicken and vascularize the endometrium

96
Q

ischemic phase

A

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
Q

what phase is it when the endometrium reaches full thickness

A

secretory phase where it is 10-12 mm thick

98
Q

phase of ovarian cycle

A

follicular phase, ovulatory phase, and luteal phase

99
Q

follicular phase

A

before ovulation 1-30 follicles begin to mature. LH affects a single follicle

100
Q

ovulatory phase

A

estrogen peaks and ends with the release of the egg from the Graafian follicle

101
Q

luteal phase

A

cells of the follicle form the corpus luteum.

102
Q

if pregnancy occurs the corpus luteum

A

continues to release progesterone and estrogen until placenta matures

103
Q

4 major hormones of the menstrual cycle

A

follicle stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone

104
Q

conception occurs when

A

a sperm nucleus enters the nucleus of the egg

105
Q

3 days after fertilization the zygote has how many cells

A

16 cells

106
Q

implantation should occur ______ days after ovulation

A

6-10 days

107
Q

screening and management of group B streptococcus

A

retrovaginal culture screening at 35-37 weeks and treatment is antibiotic prophylactically for the baby

108
Q

nagele’s rule

A

LMP subtract 3 months, add 7 days and 1 year

109
Q

how long is each trimester

A

1st - week 1-13
2nd - week 14-26
3rd - week 27-40

110
Q

fetal heart rate is

A

110-160 beats per minute

111
Q

when is sex identifiable

A

12 weeks but usually not on ultrasound until 18 weeks

112
Q

gravidity

A

of pregnancies a woman has had

113
Q

parity

A

number of pregnancies in which fetus has reached 20 weeks

114
Q

term

A

of pregnancies that have reached 38-42 weeks (to term)

115
Q

preterm

A

pregnancy that has reached 20 weeks of gestation but before completion of 37 weeks of gestation

116
Q

biochemical marker of pregnancy

A

HCG - human chorionic gonadotropin

117
Q

presumptive symptoms

A

changes felt by the woman

118
Q

probable symptoms

A

changes observed by health care provider

119
Q

positive symptoms

A

signs only by the presence of a fetus such as ultrasound, movement felt by practitioner, doppler of heart beat

120
Q

Chadwicks sign

A

deepening color of the vulva by 6-8 weeks

121
Q

Goodell sign

A

increased vascularity and hypertrophy of the cervix

122
Q

what occurs with the renal system during pregnancy

A

GFR increases and bladder tone decreases so there may be frequency, urgency, and needing to pee multiple times at night

123
Q

breathing during pregnancy

A

there is a shift from abdominal to thoracic breathing and may be more shallow/short/fast breaths

124
Q

what happens to cardiac output during pregnancy

A

increases by 30-40%

125
Q

chloasma

A

mask of pregnancy - brownish pigmentation of skin over cheeks and forehead

126
Q

PICA

A

cravings for non-food substances. usually a sign of iron or magnesium deficiency

127
Q

what does progesterone do to the GI system

A

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
Q

lab tests during prenatal visit

A

HIV testing, blood type, H&H, HCG levels, rubella, Hep B, urinalysis, alpha Fetoprotein

129
Q

alpha Fetoprotein (AFP)

A

15-20 weeks
if elevated -NTD, anencephaly, omphalocele, gastroschisis
if decreased - trisomy 21

130
Q

amniocentesis

A

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
Q

tests for fetal well being

A

umbilical artery doppler flow, amniocentesis, chorionic villus sampling, non-stress test, amniotic fluid index, and biophysical profile

132
Q

amniotic fluid index

A

Measures the volume of amniotic fluid via ultrasound in four quadrants of the uterus. Used to detect fetal hypoxia and kidney function

133
Q

amniotic fluid index levels

A

normal 8-24 cm
oligohydramnios- less than 5 cm
polyhydramnios- greater than 24

134
Q

Biophysical profile (BPP)

A

Assessment of fetal breathing movements, gross body movements, fetal tone, amniotic fluid volume, and heart rate activity via ultrasound (2 points each)

135
Q

Biophysical profile (BPP) levels

A

reassuring - 8-10
score of 6 = delivery depending on gestational age
non-measuring = 4 or less and warrants delivery

136
Q

nutrient needs during pregnancy

A

folate or folic acid and iron supplements

137
Q

normal weight gains during pregnancy

A

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
Q

adolescent pregnancy needs

A

increased need for calcium, possibly more weight gain, and they may have a smaller pelvis size

139
Q

when risk factors are identified the patient is referred to

A

a perinatologist

140
Q

risk factors for high risk pregnancies

A

high or low age, multiple gestation pregnancies, genetic or nutritional considerations, medical disorders, psychosocial factors, socioeconomical factors

141
Q

gestational hypertension

A

onset of hypertension without proteinuria after 20 weeks

142
Q

chronic hypertension

A

hypertension that is present before pregnancy, develops before 20 weeks, or persists longer than 12 weeks postpartum

143
Q

preeclampsia

A

pregnancy specific syndrome in which hypertension and proteinuria develop after 20 weeks of gestation in previously normotensive women

144
Q

signs and symptoms of preeclampsia

A

elevated BP, epigastric pain that is worse at night, sudden weight gain, peripheral edema, hyperactive DTRs, proteinuria, headaches, heartburn

145
Q

HELLP syndrome

A

severe preeclampsia. H= hemolysis, EL= elevated liver enzymes, LP= low platelet

146
Q

signs and symptoms of HELLP syndrome

A

flu-like symptoms, malaise, N/V, HA, shoulder pain, bruising, and hematuria

147
Q

eclampsia

A

onset of a seizures or coma in a women with preeclampsia with no history of seizure disorder

148
Q

placenta previa

A

the placenta is implanted in the lower uterine segment - can be complete, marginal, partial, or low lying

149
Q

abruptio placentae

A

the prematures separation of a normally implanted placenta. can be graded 1 (mild), 2 (moderate), 3 (severe)

150
Q

signs and symptoms of abruptio placentae

A

dark vaginal non-clotting bleeding, severe abdominal pain, uterine tenderness, hypovolemia, abnormal FHR

151
Q

treatment for abruptio placentae

A

emergency C-section, replace blood loss, O2

152
Q

normal magnesium levels

A

1.7-2.2

153
Q

first stage of labor

A

begins with uterine contractions and ends with complete effacement and cervical dilation

154
Q

phases of first stage of labor

A

latent phase, active phase, and transition phase

155
Q

latent phase of first stage of labor

A

0-3 cm will be walking around, usually still at home, drinking a lot of water.

156
Q

active phase of first stage of labor

A

rapid dilation of the cervix. 4-7 cm come to hospital when contractions are 5 minutes apart

157
Q

transition phase of first stage of labor

A

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
Q

second stage of labor

A

begins when cervical dilation complete until birth of the baby. women may have burst of energy

159
Q

latent phase of second stage of labor

A

fetus continues to descend passively through the birth canal and rotates to an anterior position

160
Q

active phase of second stage of labor

A

strong urge to push as baby pushes on stretch receptors

161
Q

en caul birth

A

infant born inside the amniotic sac

162
Q

1st degree lacerations

A

perineal skin and vaginal mucosa membrane

163
Q

2nd degree lacerations

A

skin, mucosa, and fascia of the perineum

164
Q

3rd degree laceration

A

skin, mucosa, fascia, and muscle of the peritoneal body and extends to rectal sphincter

165
Q

4th degree laceration

A

extends into the rectum and exposes the lumen of the rectum

166
Q

third stage of labor

A

separation and expulsion of the placenta and membranes usually occurs 5-30 min after birth

167
Q

fourth stage of labor

A

recovery and homeostasis beginning to be re-established

168
Q

early decelerations indicate

A

head compression and nurse doesn’t need to do anything

169
Q

what happens during late deceleration

A

deceleration starts after contraction and HR doesn’t recover within 30 sec after contraction

170
Q

late deceleration indicates

A

utter-placental insufficiency - not enough oxygen

171
Q

late deceleration care

A

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
Q

variable decelerations indicate

A

cord is being squeezed/compressed

173
Q

what to do during variable decelerations

A

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
Q

prolonged decelerations

A

HR drops more than 15 beats and lasts 2-10 minutes

175
Q

prolonged decelerations indicates

A

fetal distress - baby telling us its not okay

176
Q

what do you do for prolonged decelerations

A

emergency c section

177
Q

5 Ps

A

powers (contractions), passage (pelvis), passenger (baby), position, psyche

178
Q

longitudinal fetal lie

A

baby’s spine is parallel with mom’s spine

179
Q

transverse lie

A

baby’s spine is at a 90 degree angle to moms spine

180
Q

can get an epidural up until

A

7 cm

181
Q

what can opioids do to labor

A

it can prolong it

182
Q

epidurals are contraindicated in

A

hypotension, infection, thrombocytopenia, and cardiac condition

183
Q

spinal anesthesia (block)

A

anesthetic injected into the 3rd, 4th, and 5th interspace into the subarachnoid space

184
Q

nerve block analgesia

A

injecting lidocaine into the skin - local

185
Q

nitrous oxide

A

self administered and helps with pain

186
Q

general anesthesia is used for

A

emergency c section

187
Q

low dose oxytocin administration

A

begin at 2 mu/min and increase by 2 mu/min every 30 minutes until 5 contractions in 10 minutes

188
Q

high dose Pitocin

A

begin at 4 mu/min and increase by 4 mu/min until 5 contractions in 10 minutes

189
Q

max dose of pitocin

A

20 mu/min

190
Q

preterm labor

A

uterine contraction occurring between 20-37 weeks but can still make it to full term

191
Q

care for preterm labor

A

administer tocolytic and antenatal coticsoteriods

Nursing school level 2 (15 decks)

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