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OB 3 Flashcards

1
Q

How long is postpartum phase?

A

6 weeks, but can be up to months

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2
Q

What is uterine involution?

A

Uterus size decreasing after birth as expected. Fundus should go down about 1cm/day

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3
Q

What is uterine subinvolution?

A

When uterus size/fundus not going down as expected

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4
Q

What are the normal ranges of newborn vitals?

A

HR 110-160
RR 30-60
Temp > 97.6 Axillary

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5
Q

What causes pathological jaundice?

A

Usually caused by hemolysis
Maternal/NB blood incompatibility (ABO incompatibility)
Sepsis
Trauma
Liver disease

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6
Q

When does pathological jaundice appear?

A

Within first 24 hours of birth

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7
Q

What causes physiologic jaundice?

A

Immature liver & extra RBCs

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8
Q

When does physiologic jaundice appear?

A

After 24 hours of life

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9
Q

Which type of jaundice usually resolves without treatment?

A

Physiological
Bc it’s due to immature liver

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10
Q

Which type of jaundice can cause neurotoxicity?

A

Both; acute bilirubin encephalopathy can happen

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11
Q

What treatment is used to treat pathologic jaundice?

A

Phototherapy; it helps excrete bilirubin faster

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12
Q

What treatment can be given if phototherapy fails to treat jaundice?

A

Exchange transfusions, but rare.

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13
Q

What are the 4 types of heat loss in NB?

A

Convection, radiation, evaporation, conduction

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14
Q

When does heat loss by convection occur?

A

When the room is cold.
Flow of heat from the body to cooler room air

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15
Q

When does heat loss by radiation occur?

A

When NB is placed near a cold wall/window
Loss of heat from body to cooler solid surface in close proximity (indirect contact)

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16
Q

When does heat loss by evaporation occur?

A

NB sweating, or right after a bath
Loss of heat when liquid on the body surface evaporates

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17
Q

When does heat loss by conduction occur?

A

When NB is placed on a cold surface
Loss of heat from body to cooler surfaces in direct contact

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18
Q

Which is more common in NB; hyperthermia or hypothermia?

A

Hypothermia

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19
Q

What is one way you can prevent heat loss on a NB?

A

Put hat on their little heads

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20
Q

Which type of heat transfer is occurring with skin to skin contact?

A

Conduction

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21
Q

What are the s/s of hypoglycemia in infants?

A

Jitteriness, high pitched cry, irritability, apnea
Can be asymptomatic

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22
Q

How is glucose check performed in infants?

A

Heel sticks

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23
Q

What level of glucose is considered hypoglycemia in infants?

A

Less than 40

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24
Q

How is phototherapy done?

A

Strip newborns naked except for their diapers (covering genitals)
Put goggles on them to protect their eyes

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25
Q

What’s one thing you need to monitor during phototherapy?

A

SpO2; put pulse ox on them. Goggle can slide down and suffocate them

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26
Q

What is NEC?

A

Necrotizing enterocolitis. Acute inflammatory disease of the bowel - common in preterm babies
Bowel wall swells and breaks down

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27
Q

What are some signs of NEC?

A

Increased abd circumference
Bloody stools and vomiting

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28
Q

What’s the possible cause of NEC?

A

Formula feeding; therefore, to prevent & reduce risk, breastfeed.

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29
Q

How is NEC treated?

A

NG tube to relieve gas, IV fluids, IV antibiotics, and monitor.
Might need surgery if severe

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30
Q

What medications are given to NB right after birth?

A

Vitamin K - blood clotting
Erythromycin - eye infection prevention
Hep B

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31
Q

What are the s/s of NAS in NB?

A

Neuro: seizures, high pitched cry, tremors, hypertonic muscles
GI: poor feeding, V/D
Skin: excoriations, diaper rash
Other: nasal stuffiness, sneezing, frequent yawning

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32
Q

What’s postpartum diuresis?

A

Peeing and sweating A LOT.
Body is trying to get rid of all the extra fluids from pregnancy.
Tis normal

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33
Q

What scoring tool is used to assess NAS?

A

Finnegan tool

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34
Q

What’s the treatment goal of NAS?

A

Stabilize neuro, cardio, GI, social systems

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35
Q

What medication is commonly used to treat NAS symptoms?

A

Morphine

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36
Q

What are some nonpharmacologic treatment used in NAS babies?

A

No overstimulation
Rhythmic motion
Swaddling (very tight)

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37
Q

What hormone is associated with postpartum diuresis?

A

Estrogen

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38
Q

When does postpartum diuresis occur?

A

Within 12 hours of birth

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39
Q

How long does postpartum diuresis last?

A

First 2-3 days of:
peeing 3000cc or more each day &
profuse diaphoresis nightly

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40
Q

Why is keeping bladder empty important when it comes to postpartum hemorrhage?

A

Distended bladder can push uterus up and to the side, leading to excessive bleeding

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41
Q

Why does postpartum put you at a great risk for urinary retention?

A

Due to swollen uterus and decreased bladder tone

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42
Q

Why is oxytocin given during postpartum?

A

So uterus can contract and control bleeding. Firm uterus prevents excessive bleeding

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43
Q

Breastfeeding stimulates the release of what hormone from the pituitary gland?

A

Oxytocin

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44
Q

Mom can experience menopause-like symptoms after birth. Why is that?

A

Due to estrogen level dropping. It will also cause diminished vaginal lubrication

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45
Q

How long will diminished vaginal lubrication after birth last?

A

Until ovarian function returns and menstruation resumes

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46
Q

Decrease in what hormone during postpartum result in increased muscle tone in body?

A

Progesterone

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47
Q

What hormone suppresses ovulation?

A

Prolactin

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48
Q

What hormone promotes lactation?

A

Prolactin

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49
Q

Mom might feel cramping and gush of blood while breastfeeding. Why is that?

A

Because oxytocin is released when breastfeeding. Oxytocin causes contractions, leading to cramps. Contraction also pushes out pooled blood from vagina

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50
Q

Postpartum ovulation in breastfeeding patients begin…

A

Approximately 6 months

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51
Q

When does ovulation occur in non breastfeeding patients?

A

7-9 weeks after birth

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52
Q

In non breastfeeding patients, menstruation resumes

A

12 weeks postpartum

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53
Q

What does BUBBLE HE stand for for postpartum assessment?

A

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

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54
Q

What would you recommend breastfeeding mom do when her breasts feel engorged?

A

Pump to empty milk out

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55
Q

What would you recommend bottle feeding mom when her breasts feel engorged?

A

Don’t do anything to the boobs, tight sports bra, cold cabbage leaves on boob

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56
Q

At 1 hr postpartum, where should the fundus be at?

A

Level of the umbilicus

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57
Q

Where should be fundus be by the 6th postpartum day?

A

Halfway between symphysis pubis and the umbilicus

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58
Q

Should uterus be palpable after about 2 weeks postpartum?

A

No. Uterus should like within the true pelvis and not be palpable

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59
Q

What does it indicate if the fundus is not going down as it’s suppose to be?

A

Hemorrhaging. Could be from placenta left in the uterus

60
Q

What should you do with boggy fundus?

A

Massage so it can contract and be firm

61
Q

What does it indicate when the fundus is deviated to the right?

A

Bladder is full; go pee

62
Q

What is lochia?

A

Post-birth uterine discharge that contains blood, mucus, and uterine tissue

63
Q

What’s the normal amount of lochia?

A

Similar to heavy menstrual period about 2 hr after delivery and decrease gradually at a consistent rate

64
Q

What’s lochia rubra?

A

Dark red color, bloody consistency, fleshy odor, can contain small clots

65
Q

How long does lochia rubra last?

A

1-3 days after delivery

66
Q

What’s lochia serosa?

A

Pinkish brown color and serosanguineous consistency. Can contain small clots and leukocytes.

67
Q

How long does lochia serosa last?

A

Day 4-10 after delivery

68
Q

What’s lochia alba?

A

Yellowish white creamy color, fleshy odor. Can consist of mucus and leukocytes

69
Q

How long does lochia alba last?

A

Day 10 up to 8 weeks postpartum

70
Q

What would you tell a patient regarding blood clots in lochia?

A

If it’s bigger than a quarter, save it and let me look

71
Q

How is lochia amount assessed?

A

By the quantity of saturation on the peri pad

72
Q

Will amount of lochia/postpartum bleeding be decreased in c-section patients?

A

Yes, because provider cleans out uterus after surgery

73
Q

What does persistent heavy lochia rubra in early postpartum period beyond day 3 suggest?

A

Retained placental fragments

74
Q

Can postpartum patients use tampons for lochia?

A

No. Nothing up the vagina. Increased infection. You are stuck with pads.

75
Q

What are some symptoms of uterine atony?

A

Uterus larger than normal and boggy with possible lateral displacement
Prolonged lochial discharge
Irregular/excessive bleeding
Tachycardia and hypotension

76
Q

What are the nursing interventions for uterine atony?

A

Massage fundus, make sure bladder is empty, IV fluids, O2 2-3L NC

77
Q

How does retain placenta cause uterine atony/subinvolution?

A

Placenta or fragments will prevent uterus from contracting

78
Q

How much blood loss indicates postpartum hemorrhage and possible hypovolemic shock?

A

> 500cc after vaginal
1000cc after c-section

79
Q

What are the nursing interventions for postpartum hemorrhage?

A

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

80
Q

What medication is used to treat postpartum hemorrhage?

A

Oxytocin

81
Q

What’s an adverse effect of oxytocin that you need to monitor for?

A

Water intoxication; lightheadedness, N/V, headache, malaise

82
Q

How does methylergonovine (methergine) help treat postpartum hemorrhage?

A

It’s a vasoconstrictor.
So don’t give to patients with HTN

83
Q

What are some S/E of methylergonovine (methergine)?

A

Hypertension, headache, N/V

84
Q

How does misoprostol (cytotec) help with postpartum hemorrhage?

A

Misoprostol is a synthetic prostaglandin, which stimulates uterus

85
Q

How does carboprost (hemabate) help with postpartum hemorrhage?

A

Similar to misoprostol (cytotec); it’s a synthetic prostaglandin which stimulates uterus.

86
Q

Carboprost (hemabate) needs to be used cautiously in patients with…

A

Asthma, HTN

87
Q

What are some S/E of Carboprost (hemabate)?

A

Fever, HTN, chills, headache, N/V/D

88
Q

What’s the difference between postpartum blues and depression?

A

Postpartum blues is transient and self limiting while postpartum depression extends beyond

89
Q

Why is postpartum psychosis dangerous?

A

Will have behaviors indicating hallucinations/delusional thoughts of self-harm or harming the infant

90
Q

What’s the first breastmilk called and what does it do to the baby?

A

Colostrum; it coats GI tract

91
Q

Which newborn reflexes help with latching?

A

Sucking and rooting

92
Q

How do we determine if infant is getting enough input?

A

Output monitoring
Weight gain

93
Q

If the mom has sore nipples, what should be done first?

A

Check the latch

94
Q

How long can breastmilk refrigerated for?

A

up to 8 days

95
Q

How long can you store breastmilk in the freezer?

A

Up to 6 months

96
Q

How long can you deep-freeze breastmilk for?

A

up to 12 months

97
Q

Can you re-freeze thawed breastmilk?

A

No. Throw it away

98
Q

Right after birth, newborn has fine crackles, audible grunting, nasal flaring, and chest retraction. When can you expect these to resolve?

A

Within first hour of life

99
Q

When should meconium be passed?

A

Within 12-24 hours

100
Q

What should be done to the newborn immediately after birth?

A

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

101
Q

What’s Ballard score and what is it used for?

A

Maturity rating; figuring out gestational age

102
Q

Why do babies pass meconium in utero?

A

Either baby is very term or in fetal distress

103
Q

What does the surfactant do to newborns?

A

Lines alveoli, allowing them to pop open with less air pressure
It’s like blowing up a balloon for the first time
Easier breathing

104
Q

What is Respiratory Distress Syndrome (RDS)?

A

Abnormal breathing in newborns. It just happens because they don’t know how to breathe yet.
Late surfactant development

105
Q

What are some s/s of RDS?

A

Tachypnea, cyanosis, apnea, nasal flaring, retractions, grunting, etc. Anything abnormal

106
Q

Apnea greater than what is concerning?

A

> 15 seconds

107
Q

Baby just got delivered by he is not breathing even with stimulation. What do you need to do next?

A

Use positive pressure ventilation

108
Q

Cord clamping can be beneficial but can also cause polycythemia (hct > 65). What can polycythemia cause?

A

Jaundice, requiring phototherapy

109
Q

Why is breastfeeding within 1 hr of birth important?

A

To better connect with mom BUT also because glucose level decrease 30-90 min after birth. Feeding is needed to stabilize BG

110
Q

How long does acrocyanosis last?

A

A day or two

111
Q

What’s milia?

A

Little sweat/sebaceous glands. Looks like little acne but don’t mess with it. It will go away on its own

112
Q

What’s Mongolian spots?

A

Blue-purple ish spot usually right above the butt or in between shoulders

113
Q

What’s vernix?

A

Cheesy white stuff. More on preterm babies.

114
Q

What are some skin signs that are problematic?

A

Petechiae
Central cyanosis
Jaundice
Signs of birth injury

115
Q

What’s Caput succedaneum?

A

Edema on scalp
Usually over occiput (back of head)
Crosses suture line

116
Q

What’s Cephalohematoma?

A

Blood between skull bone & periosteum
Does not cross suture line
Can occur with caput

117
Q

Does cephalohematoma resolve on its own?

A

Yes; within 3-6 weeks.

118
Q

Why is bulb suctioning important?

A

Airway maintenance

119
Q

What is the correct order of bulb suctioning?

A

Mouth then Nose

120
Q

How is neurologic exam done in a newborn?

A

By assessing reflexes

121
Q

What does AGA mean?

A

Appropriate for gestational age

122
Q

What does LGA mean?

A

Large for gestational age; above 90th percentile

123
Q

What does SGA mean?

A

Small for gestational age; below 10th percentile

124
Q

What are the 2 common birth injuries?

A

Soft tissue injuries (from pressure during birth)
Skeletal injuries (esp. clavicle)

125
Q

How do you properly perform a heel stick?

A

Warm heel first
Puncture edges of the heel

126
Q

What are some newborn screenings?

A

Heel stick
Genetic diseases
Hearing screening
Congenital hypothyroidism
Sickle cell
Galactosemia
Maple syrup urine disease

127
Q

Which muscle should be used for NB IM injections?

A

Vastus lateralis (thigh)

128
Q

Can you give a full bath (dunk baby into water bath) immediately after birth?

A

No. Sponge bath only until cord is healed

129
Q

What are the s/s of newborn sepsis?

A

Lethargy, poor feeding, irritability, hypothermia, hypoglycemia, pallor/mottling

130
Q

What are the complications of meconium-stained amniotic fluid?

A

Meconium Aspiration Syndrome. Fetus inhales meconium contained amniotic fluid with first breath

131
Q

What medication is given to Rh- mothers of Rh+ infants?

A

RhoGAM or RhIG
Within 72 hours of birth/abortion

132
Q

What are TORCH infections?

A

T - toxoplasmosis (cat litter)
O - other (Hep B, HIV, Parovirus, Syphilis)
R - rubella (check immunity)
C - cytomegalovirus
H - herpes simplex virus (anti-viral prophylaxis)

133
Q

Why does AGA,LGA,SGA matter?

A

It’s a way to classify high risk infants.

134
Q

What are the 4 risk factors for Intrauterine Growth Restriction (IUGR)?

A

Vascular, infection, anomalies, drug use

135
Q

What’s one advantage of IUGR?

A

Stress lead to early surfactant = less respiratory distress syndrome

136
Q

What is nurses’ responsibility when it comes to birth injuries?

A

Identify trauma rapidly by performing immediate head to toe

137
Q

What is Erb-Duchenne paralysis?

A

Damage to upper plexus - pulling on head/neck (shoulder dystocia)
Arm hangs down

138
Q

How is meconium aspiration syndrome managed?

A

Intubation and suction unless baby crying
Observe closely for chemical PNA
NICU for oxygen and respiratory therapy and ABX

139
Q

How is neonatal sepsis treated?

A

IV ABX
Breastmilk feeding ASAP (bc breastmilk got antibodies from mom)

140
Q

Why is staying away from TORCH infections important?

A

It can result in fetal loss, illness, or malformations because fetus has limited capacity to fight infections

141
Q

Another name for TORCH infections is

A

Mother to fetus infections

142
Q

When does ABO incompatibility occur?

A

When mom is O but the baby is anything other than O

143
Q

What test is done at first prenatal visit to detect ABO incompatibility?

A

Direct Coombs test

144
Q

What therapies are done with respiratory distress syndrome?

A

Surfactant treatment
Oxygen supplementation (needs to be careful though)
CPAP
Special ventilators (oscillators)
Intubation

145
Q

Motrin and Toradol are both

A

NSAIDs

146
Q

Nifedipine is used for

A

Preterm labor; relax uterus

147
Q

Methyldopa is an alpha 2 agonist that can be safely used to treat pregnant people with

A

HTN

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