OB 3 Flashcards
How long is postpartum phase?
6 weeks, but can be up to months
What is uterine involution?
Uterus size decreasing after birth as expected. Fundus should go down about 1cm/day
What is uterine subinvolution?
When uterus size/fundus not going down as expected
What are the normal ranges of newborn vitals?
HR 110-160
RR 30-60
Temp > 97.6 Axillary
What causes pathological jaundice?
Usually caused by hemolysis
Maternal/NB blood incompatibility (ABO incompatibility)
Sepsis
Trauma
Liver disease
When does pathological jaundice appear?
Within first 24 hours of birth
What causes physiologic jaundice?
Immature liver & extra RBCs
When does physiologic jaundice appear?
After 24 hours of life
Which type of jaundice usually resolves without treatment?
Physiological
Bc it’s due to immature liver
Which type of jaundice can cause neurotoxicity?
Both; acute bilirubin encephalopathy can happen
What treatment is used to treat pathologic jaundice?
Phototherapy; it helps excrete bilirubin faster
What treatment can be given if phototherapy fails to treat jaundice?
Exchange transfusions, but rare.
What are the 4 types of heat loss in NB?
Convection, radiation, evaporation, conduction
When does heat loss by convection occur?
When the room is cold.
Flow of heat from the body to cooler room air
When does heat loss by radiation occur?
When NB is placed near a cold wall/window
Loss of heat from body to cooler solid surface in close proximity (indirect contact)
When does heat loss by evaporation occur?
NB sweating, or right after a bath
Loss of heat when liquid on the body surface evaporates
When does heat loss by conduction occur?
When NB is placed on a cold surface
Loss of heat from body to cooler surfaces in direct contact
Which is more common in NB; hyperthermia or hypothermia?
Hypothermia
What is one way you can prevent heat loss on a NB?
Put hat on their little heads
Which type of heat transfer is occurring with skin to skin contact?
Conduction
What are the s/s of hypoglycemia in infants?
Jitteriness, high pitched cry, irritability, apnea
Can be asymptomatic
How is glucose check performed in infants?
Heel sticks
What level of glucose is considered hypoglycemia in infants?
Less than 40
How is phototherapy done?
Strip newborns naked except for their diapers (covering genitals)
Put goggles on them to protect their eyes
What’s one thing you need to monitor during phototherapy?
SpO2; put pulse ox on them. Goggle can slide down and suffocate them
What is NEC?
Necrotizing enterocolitis. Acute inflammatory disease of the bowel - common in preterm babies
Bowel wall swells and breaks down
What are some signs of NEC?
Increased abd circumference
Bloody stools and vomiting
What’s the possible cause of NEC?
Formula feeding; therefore, to prevent & reduce risk, breastfeed.
How is NEC treated?
NG tube to relieve gas, IV fluids, IV antibiotics, and monitor.
Might need surgery if severe
What medications are given to NB right after birth?
Vitamin K - blood clotting
Erythromycin - eye infection prevention
Hep B
What are the s/s of NAS in NB?
Neuro: seizures, high pitched cry, tremors, hypertonic muscles
GI: poor feeding, V/D
Skin: excoriations, diaper rash
Other: nasal stuffiness, sneezing, frequent yawning
What’s postpartum diuresis?
Peeing and sweating A LOT.
Body is trying to get rid of all the extra fluids from pregnancy.
Tis normal
What scoring tool is used to assess NAS?
Finnegan tool
What’s the treatment goal of NAS?
Stabilize neuro, cardio, GI, social systems
What medication is commonly used to treat NAS symptoms?
Morphine
What are some nonpharmacologic treatment used in NAS babies?
No overstimulation
Rhythmic motion
Swaddling (very tight)
What hormone is associated with postpartum diuresis?
Estrogen
When does postpartum diuresis occur?
Within 12 hours of birth
How long does postpartum diuresis last?
First 2-3 days of:
peeing 3000cc or more each day &
profuse diaphoresis nightly
Why is keeping bladder empty important when it comes to postpartum hemorrhage?
Distended bladder can push uterus up and to the side, leading to excessive bleeding
Why does postpartum put you at a great risk for urinary retention?
Due to swollen uterus and decreased bladder tone
Why is oxytocin given during postpartum?
So uterus can contract and control bleeding. Firm uterus prevents excessive bleeding
Breastfeeding stimulates the release of what hormone from the pituitary gland?
Oxytocin
Mom can experience menopause-like symptoms after birth. Why is that?
Due to estrogen level dropping. It will also cause diminished vaginal lubrication
How long will diminished vaginal lubrication after birth last?
Until ovarian function returns and menstruation resumes
Decrease in what hormone during postpartum result in increased muscle tone in body?
Progesterone
What hormone suppresses ovulation?
Prolactin
What hormone promotes lactation?
Prolactin
Mom might feel cramping and gush of blood while breastfeeding. Why is that?
Because oxytocin is released when breastfeeding. Oxytocin causes contractions, leading to cramps. Contraction also pushes out pooled blood from vagina
Postpartum ovulation in breastfeeding patients begin…
Approximately 6 months
When does ovulation occur in non breastfeeding patients?
7-9 weeks after birth
In non breastfeeding patients, menstruation resumes
12 weeks postpartum
What does BUBBLE HE stand for for postpartum assessment?
B - breasts (breast feeding vs bottle)
U - uterus (fundal height, placement, consistency)
B - bowel and GI function
B - bladder function
L - lochia (color, odor, amount, consistency)
E - episiotomy/other trauma
H - hemorrhoids/hemovascular
E - emotions
What would you recommend breastfeeding mom do when her breasts feel engorged?
Pump to empty milk out
What would you recommend bottle feeding mom when her breasts feel engorged?
Don’t do anything to the boobs, tight sports bra, cold cabbage leaves on boob
At 1 hr postpartum, where should the fundus be at?
Level of the umbilicus
Where should be fundus be by the 6th postpartum day?
Halfway between symphysis pubis and the umbilicus
Should uterus be palpable after about 2 weeks postpartum?
No. Uterus should like within the true pelvis and not be palpable
What does it indicate if the fundus is not going down as it’s suppose to be?
Hemorrhaging. Could be from placenta left in the uterus
What should you do with boggy fundus?
Massage so it can contract and be firm
What does it indicate when the fundus is deviated to the right?
Bladder is full; go pee
What is lochia?
Post-birth uterine discharge that contains blood, mucus, and uterine tissue
What’s the normal amount of lochia?
Similar to heavy menstrual period about 2 hr after delivery and decrease gradually at a consistent rate
What’s lochia rubra?
Dark red color, bloody consistency, fleshy odor, can contain small clots
How long does lochia rubra last?
1-3 days after delivery
What’s lochia serosa?
Pinkish brown color and serosanguineous consistency. Can contain small clots and leukocytes.
How long does lochia serosa last?
Day 4-10 after delivery
What’s lochia alba?
Yellowish white creamy color, fleshy odor. Can consist of mucus and leukocytes
How long does lochia alba last?
Day 10 up to 8 weeks postpartum
What would you tell a patient regarding blood clots in lochia?
If it’s bigger than a quarter, save it and let me look
How is lochia amount assessed?
By the quantity of saturation on the peri pad
Will amount of lochia/postpartum bleeding be decreased in c-section patients?
Yes, because provider cleans out uterus after surgery
What does persistent heavy lochia rubra in early postpartum period beyond day 3 suggest?
Retained placental fragments
Can postpartum patients use tampons for lochia?
No. Nothing up the vagina. Increased infection. You are stuck with pads.
What are some symptoms of uterine atony?
Uterus larger than normal and boggy with possible lateral displacement
Prolonged lochial discharge
Irregular/excessive bleeding
Tachycardia and hypotension
What are the nursing interventions for uterine atony?
Massage fundus, make sure bladder is empty, IV fluids, O2 2-3L NC
How does retain placenta cause uterine atony/subinvolution?
Placenta or fragments will prevent uterus from contracting
How much blood loss indicates postpartum hemorrhage and possible hypovolemic shock?
> 500cc after vaginal
1000cc after c-section
What are the nursing interventions for postpartum hemorrhage?
Firmly massage fundus
Assess for source of bleeding
Assess bladder for distention - insert foley to assess kidney function and accurate urinary output measurement
IV fluids to replace lost volume
O2 via NC
Elevate legs to increase circulation to essential organs
What medication is used to treat postpartum hemorrhage?
Oxytocin
What’s an adverse effect of oxytocin that you need to monitor for?
Water intoxication; lightheadedness, N/V, headache, malaise
How does methylergonovine (methergine) help treat postpartum hemorrhage?
It’s a vasoconstrictor.
So don’t give to patients with HTN
What are some S/E of methylergonovine (methergine)?
Hypertension, headache, N/V
How does misoprostol (cytotec) help with postpartum hemorrhage?
Misoprostol is a synthetic prostaglandin, which stimulates uterus
How does carboprost (hemabate) help with postpartum hemorrhage?
Similar to misoprostol (cytotec); it’s a synthetic prostaglandin which stimulates uterus.
Carboprost (hemabate) needs to be used cautiously in patients with…
Asthma, HTN
What are some S/E of Carboprost (hemabate)?
Fever, HTN, chills, headache, N/V/D
What’s the difference between postpartum blues and depression?
Postpartum blues is transient and self limiting while postpartum depression extends beyond
Why is postpartum psychosis dangerous?
Will have behaviors indicating hallucinations/delusional thoughts of self-harm or harming the infant
What’s the first breastmilk called and what does it do to the baby?
Colostrum; it coats GI tract
Which newborn reflexes help with latching?
Sucking and rooting
How do we determine if infant is getting enough input?
Output monitoring
Weight gain
If the mom has sore nipples, what should be done first?
Check the latch
How long can breastmilk refrigerated for?
up to 8 days
How long can you store breastmilk in the freezer?
Up to 6 months
How long can you deep-freeze breastmilk for?
up to 12 months
Can you re-freeze thawed breastmilk?
No. Throw it away
Right after birth, newborn has fine crackles, audible grunting, nasal flaring, and chest retraction. When can you expect these to resolve?
Within first hour of life
When should meconium be passed?
Within 12-24 hours
What should be done to the newborn immediately after birth?
Rub hard (drying them off, tactile stimulation)
Make them cry (breathing)
Wet linens out
Head to toe, palpate umbilical cord
APGAR scoring
Put them under warmer
Suction baby
Hand baby to mom
What’s Ballard score and what is it used for?
Maturity rating; figuring out gestational age
Why do babies pass meconium in utero?
Either baby is very term or in fetal distress
What does the surfactant do to newborns?
Lines alveoli, allowing them to pop open with less air pressure
It’s like blowing up a balloon for the first time
Easier breathing
What is Respiratory Distress Syndrome (RDS)?
Abnormal breathing in newborns. It just happens because they don’t know how to breathe yet.
Late surfactant development
What are some s/s of RDS?
Tachypnea, cyanosis, apnea, nasal flaring, retractions, grunting, etc. Anything abnormal
Apnea greater than what is concerning?
> 15 seconds
Baby just got delivered by he is not breathing even with stimulation. What do you need to do next?
Use positive pressure ventilation
Cord clamping can be beneficial but can also cause polycythemia (hct > 65). What can polycythemia cause?
Jaundice, requiring phototherapy
Why is breastfeeding within 1 hr of birth important?
To better connect with mom BUT also because glucose level decrease 30-90 min after birth. Feeding is needed to stabilize BG
How long does acrocyanosis last?
A day or two
What’s milia?
Little sweat/sebaceous glands. Looks like little acne but don’t mess with it. It will go away on its own
What’s Mongolian spots?
Blue-purple ish spot usually right above the butt or in between shoulders
What’s vernix?
Cheesy white stuff. More on preterm babies.
What are some skin signs that are problematic?
Petechiae
Central cyanosis
Jaundice
Signs of birth injury
What’s Caput succedaneum?
Edema on scalp
Usually over occiput (back of head)
Crosses suture line
What’s Cephalohematoma?
Blood between skull bone & periosteum
Does not cross suture line
Can occur with caput
Does cephalohematoma resolve on its own?
Yes; within 3-6 weeks.
Why is bulb suctioning important?
Airway maintenance
What is the correct order of bulb suctioning?
Mouth then Nose
How is neurologic exam done in a newborn?
By assessing reflexes
What does AGA mean?
Appropriate for gestational age
What does LGA mean?
Large for gestational age; above 90th percentile
What does SGA mean?
Small for gestational age; below 10th percentile
What are the 2 common birth injuries?
Soft tissue injuries (from pressure during birth)
Skeletal injuries (esp. clavicle)
How do you properly perform a heel stick?
Warm heel first
Puncture edges of the heel
What are some newborn screenings?
Heel stick
Genetic diseases
Hearing screening
Congenital hypothyroidism
Sickle cell
Galactosemia
Maple syrup urine disease
Which muscle should be used for NB IM injections?
Vastus lateralis (thigh)
Can you give a full bath (dunk baby into water bath) immediately after birth?
No. Sponge bath only until cord is healed
What are the s/s of newborn sepsis?
Lethargy, poor feeding, irritability, hypothermia, hypoglycemia, pallor/mottling
What are the complications of meconium-stained amniotic fluid?
Meconium Aspiration Syndrome. Fetus inhales meconium contained amniotic fluid with first breath
What medication is given to Rh- mothers of Rh+ infants?
RhoGAM or RhIG
Within 72 hours of birth/abortion
What are TORCH infections?
T - toxoplasmosis (cat litter)
O - other (Hep B, HIV, Parovirus, Syphilis)
R - rubella (check immunity)
C - cytomegalovirus
H - herpes simplex virus (anti-viral prophylaxis)
Why does AGA,LGA,SGA matter?
It’s a way to classify high risk infants.
What are the 4 risk factors for Intrauterine Growth Restriction (IUGR)?
Vascular, infection, anomalies, drug use
What’s one advantage of IUGR?
Stress lead to early surfactant = less respiratory distress syndrome
What is nurses’ responsibility when it comes to birth injuries?
Identify trauma rapidly by performing immediate head to toe
What is Erb-Duchenne paralysis?
Damage to upper plexus - pulling on head/neck (shoulder dystocia)
Arm hangs down
How is meconium aspiration syndrome managed?
Intubation and suction unless baby crying
Observe closely for chemical PNA
NICU for oxygen and respiratory therapy and ABX
How is neonatal sepsis treated?
IV ABX
Breastmilk feeding ASAP (bc breastmilk got antibodies from mom)
Why is staying away from TORCH infections important?
It can result in fetal loss, illness, or malformations because fetus has limited capacity to fight infections
Another name for TORCH infections is
Mother to fetus infections
When does ABO incompatibility occur?
When mom is O but the baby is anything other than O
What test is done at first prenatal visit to detect ABO incompatibility?
Direct Coombs test
What therapies are done with respiratory distress syndrome?
Surfactant treatment
Oxygen supplementation (needs to be careful though)
CPAP
Special ventilators (oscillators)
Intubation
Motrin and Toradol are both
NSAIDs
Nifedipine is used for
Preterm labor; relax uterus
Methyldopa is an alpha 2 agonist that can be safely used to treat pregnant people with
HTN
