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Nursing - Bloomberg > NUR 360: Maternity > Flashcards

NUR 360: Maternity Flashcards

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1
Q

Word that means pregnancy

A

Gravidity

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2
Q

A woman who has had 2 or more pregnancies

A

Multigravida

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3
Q

A woman who has completed 2 or more pregnancies to 20 weeks or more

A

Multipara

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4
Q

A woman who has never been pregnant and is not currently pregnant

A

Nulligravida

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5
Q

A woman who has not completed a pregnancy beyond 20 weeks

A

Nullipara

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6
Q

Number of pregnancies that have reached 20 weeks

A

Parity

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7
Q

A woman who is pregnant for the first time

A

Primigravida

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8
Q

A woman who has completed one pregnancy that has reached 20 weeks

A

Primipara

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9
Q

Capacity to live outside the uterus, between 22 and 25 weeks

A

Viability

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10
Q

A pregnancy from the beginning of week 37 to end of week 40 plus 6 days of gestation

A

Term

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11
Q

A pregnancy that has reached 20 weeks of gestation but prior to completing week 36

A

Preterm

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12
Q

A pregnancy between 37 snd 38 weeks 6 days

A

Early Term

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13
Q

A pregnancy between 39 and 40 weeks 6 days

A

Full Term

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14
Q

A pregnancy in the 41st week

A

Late Term

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15
Q

A pregnancy after 42 weeks

A

Post Term

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16
Q

1st Trimester

A

1 to 13 weeks

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17
Q

2nd Trimester

A

14 to 26 weeks

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18
Q

3rd Trimester

A

27 to 40 weeks (or until birth)

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19
Q

Puerperium

A

Birth to the return of the reproductive system to the pre-pregnant state

(Approx 6 weeks postpartum)

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20
Q

Enhancing self-efficacy

A

A person’s belief in their ability to complete a task, and whether or not they can behaviourally do something

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21
Q

Factors affecting postpartum psychosocial adaptation

A
  1. Pregnancy/birth experience
  2. Physical recovery
  3. Role attainment
  4. Binding and attachment
  5. Infant characteristics
  6. Fatigue
  7. Ability to meet needs
  8. Emotional responses
  9. Socioeconomics
  10. Social supports
  11. Family dynamics
  12. Cultural considerations
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22
Q

Facilitating infant behaviours

A
  1. Easily consolable
  2. Enjoys cuddling
  3. Crying only when hungry/wet
  4. Smiles
  5. Lifts arms to parent greeting
  6. Clings to parent
  7. Eye contact
  8. Visually alert
  9. Tracking parents face
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23
Q

Inhibiting infant behaviour for attachment

A
  1. Ignores parents
  2. Indifference to parents from others
  3. Unpredictable sleep and feeding schedule
  4. Cries for hours
  5. Inconsolable
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24
Q

Facilitating parental behaviours

A
  1. Naming baby
  2. Holding baby
  3. Wanting to sooth baby
  4. Showing off baby
  5. Showing similarities of baby to parents
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25
Q

Inhibiting parental behaviours for attachment

A
  1. Unwilling to talk about their labour/birth experience
  2. Doesn’t want to find infant
  3. Identifies infant with someone parent dislikes
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26
Q

What are the 3 phases of Postpartum Psychosocial Adaptation?

A
  1. Taking in (dependent)
  2. Taking Hold (dependent-independent)
  3. Letting Go (independent)
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27
Q

Taking In Phase

A
  • first 24hrs
  • women more focused on their own self and meeting basic needs
  • recovering, exhausted, turned inward
  • more indecisive
  • wonderment and exciting, talkative about birth
  • May not feel entirely maternal yet
  • Not receptive to teaching
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28
Q

Taking Hold Phase

A

Day 2-3, often lasts 10 days

  • focus on learning
  • recovered, feeling more competent
  • taking charge, involved and eager
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29
Q

Letting Go

A

Accepting new role, letting go of old self and finding new meaning in life.

  • focus on forward movement of family, planning for future
  • re-establish relationship with partner
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30
Q

Mercer Theory of becoming a mother

A
  1. Commitment, Attachment
  2. Acquaintance/Attachment, Learning Infant Care
  3. New Normal
  4. Achievement of Maternal Identity
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31
Q

Becoming a Father

A
  1. New Expectations
  2. Set new priorities
  3. Balance work
  4. Redefine their role
  5. Reaping rewards
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32
Q

Return to menstrual cycle in nonlactating mother’s

A

Usually 6-8 weeks, 100% by 6 months

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33
Q

Return to menstrual cycle in lactating mothers

A

12 weeks to 18 months

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34
Q

GTPAL

A

Gravidity (# pregnancies)

Term Births (>37weeks)

Preterm Births (20-37)

Abortions/Miscarriages

Living children

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35
Q

GP #

A

Gravidity (# pregnancies)

Parity (# pregnancies >20 weeks)
- not number of fetuses (ie twins)

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36
Q

SVD

A

Spontaneous vaginal delivery

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37
Q

SROM

A

Spontaneous Rupture of Membranes

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38
Q

A&W

A

Alive and well

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39
Q

WNL

A

Within Normal Limits

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40
Q

SA or TA

A

Spontaneous or Therapeutic Abortion

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41
Q

BUBBLLEE

A 
Breasts (and nipples) 
Uterus
Bladder
Bowels
Lochia 
Legs 
Episiotomy/Laceratuon/Incision 
Emotional status
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42
Q

Uterine involution

A

After birth the uterus shrinks back down to normal size.
@u for first 12 hrs
At 24hrs should be at 20 weeks pregnancy
Then 1-2 cm every 24hrs.
Day 2: u/2
Day 3: u/3
Day 6: halfway between umbilicus and pubis
Day 9-14: completely involuted, unable to palpate

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43
Q

Subinvolution

A

Failure of uterus to return to nonpregnant state. Most commonly due to retains placental fragments and infection.

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44
Q

After pains

A

Contractions after birth facilitate uterine involution.

Maintains homeostasis by clampingnoff blood vessels to control bleeding in uterus, and less clotting.

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45
Q

Oxytocin

A

Released from the pituitary to stimulate and coordinate uterine contractions.

Stimulated by cervical stretching and breast feeding.

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46
Q

Primip vs Multip

A

Second time moms may experience more severe cramping than first time moms

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47
Q

Rubra Lochia

A

Red.
Blood
Small clots
Tissue debris

3-4 days postpartum

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48
Q

Serosa Lochia

A

Pink-brown

Old blood
Serum
Leukocytes
Tissue debris

22-27 days postpartum

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49
Q

Alba Lochia

A

Yellow-white

Serum
Leukocytes
Mucus
Epithelial cells

4-8 weeks postpartum

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50
Q

Scant lochia

A

<5cm

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51
Q

Small/light Lochia

A

10cm

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52
Q

Moderate lochia

A

15cm (half of peripad)

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53
Q

Large/heavy lochia

A

> 15cm (soaking pad in one hour)

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54
Q

Lochia blood flow

A

Trickles, stops when uterus contracts.
Expressed on palparían but then will stop with contraction.
Usually not as bright red as hemorrhagic blood and more mucousy.

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55
Q

1st Degree Laceration

A

Through superficial skin

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56
Q

2nd Degree Laceration

A

Through perineal muscular body

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57
Q

3rd Degree Laceration

A

Perineal and anal sphincter torn (but not completely)

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58
Q

4th Degree Laceration

A

Involves entire rectal wall

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59
Q

Episiotomy

A

Incision into perineal wall to prevent 3rd or 4th Degree Lac.

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60
Q

Perineum Assessment (REEDA)

A 
Redness
Ecchymosis
Edema 
Discharge/Discomfort
Approximation
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61
Q

Vital signs postpartum

A

Opioid medications can cause respiratory depression, drop in BP

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62
Q

Legs Postpartum Assessment

A

Slight increase risk of DVT due to laying down for longer after operation or

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63
Q

Lochia post C-section

A

Slightly less

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64
Q

C/S Assessment

A
  1. Breath sounds (resp depression from anesthesia)
  2. Bowel sounds
  3. Bloodwork (CBC in 2 hours)
  4. Signs of infections
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65
Q

Postpartum Hemorrhage (PPH)

A

Hemodynamics instability, life threatening

Vaginal Birth: >500mL blood
C/S: >1000mL blood loss

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66
Q

Early PPH

A

After 24 hrs due to poorly contracted uterus (uterine atony)

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67
Q

Uterine atony

A

Poorly contracted uterus

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68
Q

Late PPH

A

After 24hrs but less than 6 weeks postpartum. Usually due to subinvolutions, infection, placental remnants.

69
Q

PPH Management

A
  1. Call for help
  2. Fundal massage
  3. O2 mask and BP cuff on
  4. Meds to contract uterus
70
Q

Risk Factors for PPH

A
  1. Uterine Atony
    a) high parity
    b) big baby or twins
    c) trauma, forceps assisted birth
    d) prolonged labour/oxytocin
  2. Infection (chorioamnionitis)
  3. Retained placental products
  4. Uterine subinvolution
71
Q

PPH Etiologist - 4 Ts

A

Tone - poor tone or atony

Tissue - retained or abnormal placental implantation

Trauma - Laceration in genital tract, sgx, instrumental delivery

CloTting - hemophilia or Willebrand disease

72
Q

What are the 3 categories of Venous Thromboembolic Disorders?

A
  1. Superficial Venous Thrombosis
  2. DVT
  3. Pulmonary Embolism

Formation of blood clot in BV. Leading cause of death in Canada.

73
Q

Venous stasis

A

Pregnant women 4-5x more likely to develop clot due to hypercoagulation

74
Q

Risk Factors for Venous Theomboembolic Disorders

A
  1. C/s or forceps delivery
  2. History of VTE, PE, varicositiws, blood clots
  3. Obesity
  4. Maternal age over 35
  5. Multiparity, multiple gestation, twins.
  6. Smoking (causes hypercoagulability)
  7. Bed rest or immobility
75
Q

Endometritis

A

Infection of endometrial lining of uterus (most common postpartum infection).

Higher risk with C/S.

S/S: fever, increased HR, chills, anorexia. Nausea, fatigue, lethargy

76
Q

UTI

A

Not uncommon

Fever, elevated WBCs, dysuria, increased frequency of urination, pain, foul smelling urine I

77
Q

Mastitis

A

Breast infection, usually unilateral

78
Q

What are the 3 types of postpartum mood disorders?

A
  1. Postpartum blues
  2. Postpartum Depression (non-psychotic)
  3. Postpartum Depression (psychotic)

Effects almost half of women

79
Q

Postpartum Blues

A

Heightened sense of joy followed by blue period, peaking around day 5-10 then subsiding.

Transient, with NO FUNCTIONAL IMPAIRMENT

80
Q

Postpartum Depression (PPD)

A

Insomnia/Hypersomnia, fatigue, appetite changes, feelings of worthlessness, guilt, hopelessness, irritability, decreased concentration, inability to cope, despondency, intense irrational fears, suicidality

FUNCTIONAL IMPAIRMENT

81
Q

Risk Factors for Postpartum Depression

A
  1. Prenatal depression/anxiety, life stress, lack of social support, personal/family hx of depression
  2. Low self esteem
  3. Stress of child care
  4. Low SES
  5. Marital relationship problems
  6. Difficult child temperament
82
Q

Postpartum Psychosis

A

Onset 2-8weeks. Same S/S as PPD but with delusions, hallucinations, thoughts of harm to self or infant, agitation, poor judgement, irrational, overactive, disorganized behaviour, inability to care for infant

PSYCHIATRIC EMERGENCY

83
Q

What are the 3 phases of the “Transition Period”?

A
  1. Period of reactivity
  2. Period of Decreased Responsiveness
  3. Second Period if Reactivity
84
Q

Period of Reactivity

A

Up to 3 hours

HR: increases to 160-180 bpm
Gradual decline to baseline 100-160 bpm, irregular

RR: irregular, 60-80 breaths/min

Alert, startles, cries

85
Q

Period of decreased responsiveness

A

60-100 minutes

HR: normal baseline (100-160 bpm)

RR: rapid, shallow, up to 60 breaths/mi

Sleep or marked decreased in motor activity

86
Q

Second Period of Reactivity

A

4-8 hours to one day

HR: brief periods of tachycardia

RR: brief periods of tachypnea

Increased muscle tone

87
Q

APGAR Score

A

HR, Respiratory effort, muscle tone, reflex/irritability, colour

0-3 (Severe Distress)
4-6 (moderate distress)
7-10 (minimal effort and difficulty)

88
Q

APGAR Scores

A

HR > 100bpm
RR - good, crying, no gasping or nasal flaring

Muscle tone - well flexed, active movements of extremities

Reflex - good cry (moderate= grimace or weak cry)

Colour - pink all over (moderate = cyanosis in extremities)

89
Q

Newborn apnea

A

Lasting <20 seconds WNL

90
Q

Reasons for apnea

A

Rapid increase in body temp or hypothermia, speaks, neuro problem, hypoglycaemia, junk in mouth, crying

91
Q

Factors that trigger newborn’s first breath

A
  • cutting umbilical cord
  • reflex triggered by pressure changes
  • crying from cool air temperature, noise, light, and other sensations
  • chemoreceptors in aorta and carotid bodies initiate reflex when arterial oxygen pressure and pH falls and CO2 pressure rises
92
Q

Foramen ovale

A

Shunt blood from R atrium to L atrium, bypassing the lungs in utero

Permanently closed by 1 year of age.

93
Q

Ductus arteriosus

A

Shunts blood from pulmonary artery tonaorta, bypassing lungs.

Closes in presence of oxygen in blood. Permanently closed by 3 weeks.

First breath inflated lungs/cord cutting, pressure drops, foramen ovale and ductus arteriosus close

94
Q

Newborn Vital Signs

A

HR: 110-169 bpm

RR: 30-60

T: 36.5 - 37.5 degrees C

BP: 60/40 to 80/50

95
Q

Baby’s weight

A

2500-4000g

SGA < 2500g (small gestational age)
LGA >4000g

96
Q

Acrocyanosis

A

Cyanosis in hands and feet

97
Q

Erythromycin ointment

A

Eye prophylaxis 1-2cn ribbon 0.5% within 2 hours of birth.

Adverse reaction 24-48hrs: conjunctivitis temporary blurry vision

98
Q

Vitamin K Prophylaxisis

A

Prevention/tx of hemorrhagic disease in newborns. Promoted clotting factors.

0.5-1mg IM injection within 6 hours after birth.

Adverse reactions: edema, erythema, discomfort/pain at site

99
Q

What are the 2 sleep states?

A
  1. Deep sleep

2. Light sleep

100
Q

What are the 4 awake states?

A
  1. Drowsy
  2. Quiet alert
  3. Active alert
  4. Crying
101
Q

What are the 12 newborn reflexes?

A
  1. Rooting
  2. Sucking
  3. Swallowing
  4. Grasp - Palmar and Plantar
  5. Extrusion
  6. Glabellar
  7. Tonic Neck or “Fencing”
  8. Moro (or startle)
  9. Stepping or Walking
  10. Deep Tendon
  11. Crawling
  12. Babinski
102
Q

Newborn reflex that forced tongue toward when touch or depress tip of tongue

A

Extrusion

103
Q

Newborn reflex to blink first 4-5 taps on forehead, bridge of nose, or maxilla

A

Glabellar

104
Q

Newborn reflex of supine infant turning head to one side and arm and leg on that side extend while opposite limbs flex.

A

Tonic Neck or “Fencing”

105
Q

Newborn reflex of symmetrical abduction and extension of arms when loud or abrupt sound

A

Moro or Startle Reflex

106
Q

Newborn reflex to hyperextend toes into dorsiflexion when touch moves from sole of foot up and across ball of foot

A

Babinski Reflex

107
Q

What are the 4 mode did heat loss?

A
  1. Radiation
  2. Evaporation
  3. Conduction
  4. Convection
108
Q

What are contributing factors to newborn thermogenesis?

A
  1. Less subQ
  2. Larger body surface to body mass
  3. Larger head
  4. Higher metabolic rate with limited stores
  5. Poor shivering response
109
Q

Cold Stress

A
  1. Increased O2 consumption
  2. Increased RR
  3. Pulmonary vasoconstriction
  4. Decreased O2 uptake
  5. Peripheral vasoconstriction
  6. Decreased O2 to tissues
  7. Increased anaerobic glycolysis
  8. Decreased PO2 and pH
  9. Metabolic acidosis
110
Q

Signs of cold stress

A
  • crying/restlessness, cool to touch
  • increased RR initially
  • pronounces acrocyanosis
  • resp distress
  • circumpolar cyanosis
  • hypoglycaemia
111
Q

Brown fat

A

Superficial deposits along scapula, anilla, around kidneys, and thoracic inlet. Activated by cold, run lipids through mitochondria to create HEAT (instead of ATP).

112
Q

Bones on baby’s head are not secured and move to fit through vago al cavity

A

Moulding

113
Q

Fine hair covering baby’s body

A

Lanuga

114
Q

Swelling of head due to pressure of delivery, usually disappears in 3-4 days.

A

Capital succudaneum

115
Q

Fontanelles

A

Anterior (diamond) stays open until 18 months

Posterior (triangle) closes by 6-8 weeks

116
Q

Collection of blood within skull bone and periosteum due to sheering force. Does not cross suture lines, spontaneously resolves in 3-6 weeks.

A

Cephalhematoma

117
Q

Bluish black area of pigmentation

A

Mongolian spot

118
Q

Odourless, skin cells and sebaceous cells moisturizer baby’s skin

A

Vernix

119
Q

Distended small white sebaceous glands on newborns face

A

Milia

120
Q

Respiratory Red Flags

A
  • Tachypnea
  • Bradypnea
  • Nadal flaring
  • Retractions/I drawing
  • Grunting
  • unequal bilat breath sounds
  • cyanosis
  • apnea
121
Q

Cardiovascular Red Flags

A
  • tachycardia (sustained)
  • bradycardia (sustained)
  • abnormal heart sounds
  • abnormal location of heart sounds (dextrocardia=opposite side)
  • weak, absent or unequal pulses
  • cyanosis
122
Q

Newborn Neuro Red Flags

A

Jitteriness/tremors (bilateral, not stopped when held)

  • Lethargy
  • irritability
  • bulging fontanelles
  • hyper or hypotonia
  • seizure activity
123
Q

Hyperbilirubinemia

A

Jaundice
= elevated UNconjugated bilirubin

Due to:

  • more RBC breakdown
  • immature liver
  • lower albumin
124
Q

Physiological Jaundice

A

60% newborns

>24hrs old

125
Q

Pathological Jaundice

A

<24hrs old, or longer than 2 weeks

Hemolytic anemia (breaks down RBCs too fast)

Septic, hyperthyroidism, G6PD Deficiency

126
Q

Breastfeeding Jaundice

A

2-5 days old, due to ineffective breastfeeding, decreased hepatic clearance

127
Q

Contraindications for infant breastfeeding

A
  • Galactosemia

- Metabolic disorders

128
Q

Mother contraindications for breastfeeding

A
  • chemotherapy
  • TB or Varicella
  • HIV
  • Herpes
  • Substance abuse
  • Human T-Lymphotrophic Virus
  • Select meds
  • Chagas Disease
129
Q

BFI step most correlated with long- term breastfeeding

A
  1. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospital
130
Q

What are the 3 stages of Lactogenesis?

A
  1. Differentiation
  2. Activation
  3. Maintenance

(DAM)

131
Q

Lactogenesis 1 - Differentiation

A

Occurs mid pregnancy, Prolactin stimulates cells to differentiate. Progesterone inhibits the onset of copious milk secretion.

132
Q

Colostrum

A
  • 2-20 mls/feed
  • lower in fat and sugar than mature milk
  • high protein and minerals
  • contains IgA
  • laxative effect
133
Q

Decreased in progesterone, estrogen, placental Lactogen

Increased in oxytocin and prolactin

A

Lactogenesis 2 - Activation

134
Q

Feedback inhibitor of lactation (FIL)

A

Small whey protein acts as local negative feedback mechanism to signal sloe or stop milk production and visa versa

135
Q

Milk Production feedback loop

A
  1. Suckling causes hypothalamus to signal anterior pituitary to release prolactin
  2. Alveoli in breast make milk in response to the release of prolactin
  3. Oxytocin contracts muscle cells causing “let down”
136
Q

Inverted nipple

A

Pinch test = if areola and nipple goes in

137
Q

What are the 6 P’s that affect labour?

A 
Passenger
Passageway
Powers (contractions and pushing) 
Position
Psychological Response 
People
138
Q

Primary contractions

A

Involuntary, every 2 minutes in labour

139
Q

Secondary contractions

A

Pushing, mostly voluntary

140
Q

What are the 4 Fetal Presentations?

A
  1. Occiput
  2. Brow
  3. Breach
  4. Shoulder
141
Q

What are the 3 Fetal Lies?

A
  1. Longitudinal = vertex or breach
  2. Transverse
  3. Oblique
142
Q

Fetal attitude

A

Fetal body parts related to each other. Well-flexed.

143
Q

Fetal Positions

A 
O = occiput
R = right 
L = left 
A = occiput facing anterior 
P = occiput facing posterio
T = transverse (occiput facing sideways)
D = direct
144
Q

Fetal station

A

0 at ischial spine of ischial tuberosity

145
Q

What are the 4 stages of labour?

A

1st stage = onset of uterine activity to complete effecement and dilation (100% and 10cm)
Latent (0-4cm) and Active (4-10cm)

2nd stage = full dilationto birth of fetus (pushing stage)

  1. Birth of fetus to birth of placenta
  2. 2hrs post birth
146
Q

Latent Labour

A 
0-3cm dilated 
75% effaced 
6-8 hrs
Contractions = mild to moderate, irregular, q5-30min, 30-45 sec
Station: 0 to -2
Bloody show: Brownish-pale pink, scant
147
Q

Active & Transition Labour

A 
4-10cm dilated 
75-100% effaced 
3-6hrs 
Contractions: Moderate-Strong, regular, q2-4 min, 45-90secs
Bloody pink mucous, scant-copious
148
Q

Amniotic Membranes (COAT)

A

Colour
Odour
Amount
Time

Nitrizine to test presence

149
Q

PROM

A

Premature Rupture of membranes
(Without labour)
Often administered oxytocin

150
Q

PPROM

A

Preterm Premature ROM (less than 37wks without labour)

Hook to tear sac

151
Q

Labour dystocia

A

Delayed, arrests or not progressing.

Stress response releases cortisol which release catecholamine secretions, reducing contractions.

152
Q

Spinal Block

A

Between L3 and L4 in subarachnoid space. No catheter left in, usually during C/S.

153
Q

Epidural Block

A

Between L5 and L6 in epidural space. Catheter to continuos pump.

154
Q

What is a risk of an increased length of 3rd stage of labour?

A

Increased risk of hemorrhage

155
Q

When is fetal heart rate present?

A

12-13 weeks

156
Q

Positive Goodall Sign

A

Softening of cervix, increased vascularity

157
Q

Positive Chadwick Sign

A

Deepening colour of vagina mucosa

158
Q

Beta hCG

A

Rise until day 60-70, number amount in bloodwork, pos or neg in urine

Low levels = miscarriage
High levels = ectopic pregnancy, multiples, or Down Syndrome

159
Q

Nazgele’s Rule

A 
Lunar months (28 days)
280 days, 40 weeks gestation

LMP - 3 months + 7 days + 1 year = EDB (by dates)

LMP +7 days + 9 months = EDB

160
Q

Parental Development for mothers

A
  1. Accepting the pregnancy
  2. Identifying with role of mother
  3. De-ordering personal relationships
  4. Establishing relationship with fetus
  5. Preparing for childbirth
161
Q

Fatherhood stages

A
  1. Announcement Stage
  2. Moratorium (often philosophical)
  3. Focussing Phase (active involvement in pregnancy)
  4. Relationship with fetus
  5. Identifies as father
162
Q

GBS Test

A

35-37 weeks

163
Q

Pregnancy Red Flags

A
  1. Severe Headaches (preeclampsia)
  2. Visual disturbances (preeclampsia)
  3. Fever
  4. Accidents/falls/injuries
  5. Vaginal bleeding/discharge
  6. Contractions
  7. Pain
  8. Decreased Fetal Movement
  9. SOB, Chest pain
164
Q

Fundal height

A

20-22 weeks = umbilicus
18-32 weeks = equals GA
38-48 weeks = May drop in preparation

165
Q

Where would the nurse expect to palpate the fundus 24hrs postpartum?

A

At umbilicus, same as 20 weeks

166
Q

What is the reason for a sitz bath?

A

Helps promote episiotomy/Laceration healing and comfort

167
Q

Characteristics of contractions

A
  1. Frequency
  2. Resting tone
  3. Intensity
  4. Duration
168
Q

When is uterine involution expected to start?

A

Immediately after birth of placenta

Nursing - Bloomberg (52 decks)

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