Ob Flashcards
Respiratory distress causes and symptoms
Surfactant deficiency, poor gas exchange, asphyxia, meconium aspiration. Symptoms: tachypnea (>60/min), nasal flaring, retractions, cyanosis, flaccidity
Types of jaundice
Physiologic jaundice (benign; caused by shortened lifespan of fetal RBCs; increased bilirubin 72 to 120 hours after birth and a rapid decline 5 to 10 days after)
Pathological jaundice (caused by blood group incompatibility or infection; appears before 24 hours of age)
S/s newborn hypoglycemia and treatment
Poor feeding, jitteriness/tremors, hypothermia, weak cry, lethargy, flaccidity, seizures/coma, irregular respirations, cyanosis, apnea
Treatment: check if sugar less than 45 mg/dl, initiate early and often feedings if stable, IV glucose if unable to feed, skin to skin contact (thermoregulation)
Preterm newborn care (after 20 weeks before 37 weeks)
Assessment, vitals, Assess ability to consume nutrients, maintain thermoregulation, i’s/o’s, daily weight, respiratory support, minimize stimulation (cluster care), position prone or side lying, encourage skin to skin, observe for infection/dehydration/overhydration
Sga vs lga and interventions for sga
Sga (birth weight at or below 10th percentile)
Lga (above 90th percentile or >4000g)
Interventions for sga: respiratory support and suctioning to maintain open airway, thermal regulation, early feedings, adequate hydration, conserve energy, prevent skin breakdown, protect from infection
Neonatal abstinence syndrome
Perform ongoing assessment using neonatal abstinence scoring system, elicit/assess newborn’s reflexes, offer small frequent feedings, swaddle with legs flexed, offer non-nutritive sucking, monitor fluid/electrolytes, reduce stimuli
Medications can include morphine sulfate and phenobarbital
Post partum assessment and interventions
Breasts
Uterus (fundal height, uterine placement, and consistency)
Bowel (and GI function)
Bladder (and function)
Lochia (color, odor, consistency, and amount)
Episiotomy (edema, ecchymosis, approximation)
Interventions: prevent postpartum hemorrhage, assist in client’s recovery, identify deviations in expected recovery process, provide comfort/pharmacological pain relief, education, promote bonding
Postpartum fundal assessment and interventions
Document fundal height (cm or fingerbreadths above/below/or at umbilical level) Document location (midline or displaced laterally by full bladder) Document consistency (firm or boggy; massage if not firm)
Interventions:
- administer tocolytics to promote uterine contractions and prevent hemorrhage (oxytocin, methylgernovine, carboprost, misoprostol)
- encourage early breastfeeding which will stimulate oxytocin And prevent hemorrhage
- encourage emptying of bladder to prevent uterine displacement
Post-partum hemorrhage – S/S, interventions, & meds
Leading cause of postpartum morbidity!!
EBL > 500 with vaginal delivery
EBL > 1000 with c-section
Predisposing factors
Causes:
Uterine atony
Lacerations
Retained placenta
Blood clotting disorder
Overextension of uterine muscle→ from large baby, multiples, prolonged labor, polyhydramnios, trauma, assistance during birth (forceps, vacuum), retained placental fragments
Meds:
Oxytocin – Pitocin
Stimulates uterine smooth muscle contractions
10 units IM
10-40 units in 1000 ml crystalloid IV flu
Methylergonovine maleate – MethergineStimulates uterine and vascular smooth muscle causes uterine contractions
o – 0.2 mg IM every 2-4 hours,
▪ Followed by 0.2 mg PO every 4-6 hours X 24 hours (for 6 doses)
▪ Contraindicated with high blood pressure(!!)
o Carboprost tromethamine – Hemabate
▪ Stimulates contractions of the myometrium (prostaglandin analogue)
▪ 0.25mg (250 mcg) IM
▪ Contraindicated with asthma (as well as hepatic, renal, and cardiac disease)(!!)
▪ Causes diarrhea
o Misoprostol – Cytotec
▪ Stimulates powerful contractions of the myometrium (prostaglandin analogue)
▪ 800-1000 mcg rectally (good, if N/V resulting from blood loss!)
o Dinoprostone – Prostin E2
Differentiate post-partum blues, depression, & psychosis – nursing care/prioritization
Postpartum blues
Tearfulness, insomnia, lack of appetite, feeling let down or inadequate
Usually resolves in 10 days without intervention
PP depression
Persistent feelings of sadness & intense mood swings
Occurs within 6 months of delivery
Interventions usually necessary
PP psychosis
Confusion, disorientation, hallucinations, delusions, obsessive behaviors, paranoia
Develops within the first 2-3 weeks PP
The client may attempt to harm herself or her infant
Psychiatric care
Maternal role attainment phases
Taking- in phase First 24-48 hours Focus on personal needs Rely on others for assistance Excitement and talkative Recounts birth experience with others Taking-hold phase Starts day 2 or 3 and lasts 10 days to several weeks Focus on baby care and newborn skills and improving competency as caregivers Need acceptance Want to learn and practice Experiencing physical and emotional discomforts Letting-go phase Focus on the family as a unit Resumption of role Signs that bonding is NOT occurring: disappointment in baby, turning away from them, not wanting to be close, not talking about baby and/or pointing our physical appearances that are similar to parents, handling baby roughly, apathy when baby cries, ignoring baby/not including them in family
Engorgement vs mastitis
Engorgement
Excessive swelling due to increase in blood flow and milk production- so encourage good emptying of breasts at each feeding and frequent feedings - every 2-3 hours- to minimize stasis of milk
Mastitis
s/s- red hard painful area usually in one breast, commonly in upper outer quadrant of breast, flu-like symptoms- client is sick! Notify provider
Breastfeeding technique and timing
Breastfeed within 30 min of birth. Newborn’s mouth covers as much areola/nipple as possible. Teach four most common positions: football hold (across the arm), cradle (most common), modified cradle (across the lap), or side-lying. Breastfeed at least 15 to 20 min per breast. Feed 8 to 12 times in a 24 hour period
Differentiate between caput and cephalhematoma and skin variations
Caput-swelling that DOES cross suture line- goes away in a few days
Cephalhematoma- collection of blood vessels on head - stays at one spot - does NOT cross suture line
Skin – pink or acrocyanotic, should not have jaundice during first day
Normal variations: milia (raised white spots on nose, chin, forehead), Mongolian spots (purple/blue on back), stork bites (telangiectatic nevi), nervus flammeus (port wine stain), erythema toxicum (newborn rash), vernix (skin cheese)
Assessment of hip dysplasia
Asymmetric gluteal and thigh folds
Thigh on affected side is shorter
Intervention: Harness/traction/cast
Allow the child to participate in normal developmental activities
