OB Exam 3 Flashcards
1
Q
uterus adaptation during postpartum ……………………
A
- uterine contraction leads to involution
- measured by assessing fundal height
- involutes 1 fingerbreadth per day
- factors that promote involution
- factors that inhibit involution
- afterpains
- lochia (progresses through 3 stages) : rubra, serosa, alba
2
Q
vital signs during postpartum period ……………………
A
- temperature may be elevated slightly during the first 24 hours
- normal for the pulse to be slow in the 1st week after delivery
- blood pressure should not be elevated
3
Q
ovaries adaptation during postpartum …………………
A
- ovulation can occur as soon as 3 weeks after delivery
- can conceive even if not menstruating
4
Q
small amount of lochia ……………..
A
less than 4 inch stain on peripad
5
Q
moderate amount of lochia …………….
A
less then 6 inch stain on peripad
6
Q
heavy amount of lochia …………….
A
saturated peripad within 1 hour
7
Q
lochia colors with days ……………..
A
- rubra (deep red) : 3 to 4 days postpartum
- serosa (pinkish) : 3 weeks postpartum
- alba (yellow) : 10 days to 6 weeks postpartum
8
Q
cervix, vagina, and perineum adaptation during postpartum ……………
A
- never fully return to pregravid state
- kegel exercises help muscle tone
- lactation can lead to vaginal dryness and dyspareunia (painful intercourse)
9
Q
breasts adaptation during postpartum period ……………..
A
- colostrum
- prolactin
10
Q
cardiovascular system adaptation during postpartum ………………..
A
-high plasma fibrinogen levels and other coagulation factors mark the postpartum period
11
Q
musculoskeletal system during postpartum …………………
A
-abdomen soft and sagging in the immediate postpartum
12
Q
urinary system during postpartum ………………
A
-transient glycosuria, proteinuria, and ketonuria are normal in the immediate postpartum period
13
Q
integumentary system during postpartum ………………..
A
- copious diaphoresis occurs in the first few days
- striae, stretch marks found on abdomen and breasts
14
Q
weight loss during postpartum ……………….
A
- 12 to 14 pounds = baby, placenta and amniotic fluid
- 5 to 15 pounds in the early postpartum period = fluid loss from diaphoresis and urinary excretion
- return to pre-pregnant weight 6 months after childbirth if within recommended weight gain range (25-30lbs)
15
Q
A 26-year-old G1P1 has delivered a healthy baby girl. You are providing patient teaching. One of the subjects you know to cover is the restarting of ovulation and menstrual cycles. One point you need to stress is
a. Lactating women may not restart their menses for more than 24 months
b. Menses always begins before ovulation
c. You can’t get pregnant as long as you are breastfeeding
d. You can conceive even if your periods have not restarted
A
d. You can conceive even if your periods have not restarted
Rationale: The return of ovulation and menstrual bleeding do not always occur together. Explain to the woman that she may be able to conceive even if the menses does not resume immediately.
16
Q
adapting to becoming a mother …………….
A
- begins role change in pregnancy
- two critical elements
- role change is the most significant psychological adaptation the woman must make
17
Q
development of positive family relationships …………………..
A
Attachment
-the enduring emotional bond that develops between the parent and infant
Bonding
-the way the new mother and father become acquainted with their newborn
En face position
-the mother interacts face-to-face with the newborn
18
Q
signs of problems with positive family relationships …………….
A
- making negative statements about the baby
- turning away from the baby
- refusing to name the baby
- refusing to care for the baby
- withdrawing
- verbalizing disappointment with the sex of the baby
- failing to touch the baby
- limited handling of the baby
19
Q
postpartum blues …………….
A
-temporary condition that usually begins on the third day and lasts for 2 or 3 days Contributing factors -psychological adjustment -physiologic decrease in estrogen and progesterone -too much activity -fatigue -disturbed sleep patterns -discomfort also may contribute
20
Q
When providing care to a postpartum patient it is important to assess the new mother’s psychological adaptation to the infant. You know that there are two critical elements to becoming a mother. What is one of these elements?
a. Learning to care for the infant
b. Engagement with the child
c. Redevelopment of love and attachment to significant other
d. Moving towards a new normal
A
b. Engagement with the child
Rationale: The two critical elements of becoming a mother are development of love and attachment to the child and engagement with the child. Engagement includes all the activities of care giving as the child grows and changes.
21
Q
nurses process for early postpartum period …………………
A
Data collection
-initial assessment and prenatal history
Initial physical assessment in first hour following delivery
-early data from L&D nurse
22
Q
complete postpartum physical assessment …………….
A
- performed at least once each shift
- assess following areas: breasts, uterus, lochia, bladder, bowel, perineum, lower extremities, pain, labs
- maternal-newborn bonding
- maternal emotional status
23
Q
areas of focus for nurse in postpartum care ………………..
A
- promoting hemostasis
- providing pain management: breast pain, afterpains, perineal pain
- preventing infection
- preventing injury from falls
- promoting urinary and bowel elimination
- preventing injury from thrombus formation
- restful sleep
- parent-newborn attachment
24
Q
top 3 causes of maternal mortality after cesarean …………………
A
- anesthesia complications
- postpartum infection
- thromboembolism
25
monitor during postpartum ..................
- lungs
- signs of respiratory depression
- IV for rate of flow and correct solution
- sources of pain and discomfort
- incision
- bowel sounds
- urinary output
- signs of thrombus formation
26
nursing process for preparing the postpartum woman for discharge ....................
assess :
- how parents interact
- interactions between other family members
27
top 3 causes of maternal mortality after cesarean .....................
- anesthesia complications
- postpartum infection
- thromboembolism
28
............... for after pain .
600 to 800 mg of motrin
29
implementation for postpartum ..................
- supporting health-seeking behaviors: reinforce positive family behaviors, anticipatory guidance
- preventing injury from Rh-negative blood type or nonimmunity to rubella: is the woman a candidate for Rho(D) immune globulin (RhoGAM)
30
providing patient teaching during postpartum ....................
- breast care
- fundal massage
- perineum and vaginal care
- pain management
- nutrition
- constipation
- proper rest
31
T or F : RhoGam (Rho[D] immune globulin) is given to an Rh- mother who delivers an Rh+ infant to prevent the formation of antibodies that may attack future fetuses.
True
Rationale: If the woman is Rh-negative and the baby is Rh-positive, the woman will need an injection of RhoGAM to prevent the development of antibodies to Rh-positive blood. The woman must receive the RhoGAM within 72 hours of delivery to be most effective.
32
respiratory system during newborn transition .....................
-helps expel fluid
-stimulates surfactant production
-stimulates lung inflation
SURFACTANT KEEPS THE ALVEOLI FROM COLLAPSING AFTER THEY FIRST EXPAND (usually has enough surfactant by the end of 35 weeks gestation)
33
circulation in newborn ....................
- high pressure in the lungs causes the pressure in the right atrium to be higher than the pressure in the left atrium
- pressure differences help route blood: through the foreman ovale and ductus arteriosus, away from the nonfunctioning lungs, back into the general circulation, ductus venosus shunts fetal blood away from the liver
34
birth means .................. must close .
fetal shunts
35
first breath ..................... in .................... causing the ...................... to .................. .
reverses pressure, atria, foramen ovale, close
36
redirects blood to the lungs ..................
- increase in oxygen aids in closing ductus arteriosus
| - ductus venosus closes and blood flows through liver
37
postpartum period lasts ................
6 weeks
38
thermoregulatory adaptation in newborn ........................
- thermoregulation is the physiologic process of balancing heat production with heat loss to maintain adequate body temperature
- newborn has problems with thermoregulation: prone to heat loss, not readily able to produce heat, vulnerable to cold stress
- flexed posture conserves heat- by reducing the amount of skin exposed to the surface and conserving core heat
- burning brown fat produces heat- not renewable, once depleted the newborn can no longer use this form of heat production
39
newborn loses heat 4 ways ...................
- conductive heat loss
- heat loss by convection
- evaporative heat loss
- radiation
40
metabolic adaptation in newborn ......................
-neonatal hypoglycemia: occurs when blood glucose falls to 50 mg/dL or lower
risk factors
-inadequate fetal blood flow through placenta
-maternal diabetes
-medications that increase blood sugar (mother)
-prolonged labor
-maternal infection
-respiratory distress
-cold stress
41
early s/s of neonatal hypoglycemia ...................
- jitteriness
- poor feeding
- listlessness
- irritability
- low temperature
- weak or high-pitched cry
- hypotonia
42
late s/s of neonatal hypoglycemia ..........................
- respiratory distress
- apnea
- seizures
- coma
43
T or F : Neonatal hypoglycemia is defined as a blood glucose level of 50mg/dL or lower.
True
Rationale: Neonatal hypoglycemia occurs when blood glucose levels drop to 50 mg/dL or lower.
44
hepatic adaptation in newborn ...............
- liver immature at birth
- bilirubin: conjugated- what normally occurs in adults: water soluble, excreted in feces. -unconjugated- occurs in the newborn because the liver is immature and overwhelmed: fat soluble, enters cells causing jaundice
45
high levels of unconjugated bilirubin in the bloodstream (serum levels of 4 to 6 mg/dL and greater) ................
hyperbilirubinemia
46
yellow staining of the skin ....................
jaundice
- first appears on head and face
- progresses in a cephalocaudal manner
47
physiologic jaundice .................
- jaundice that occurs after the first 24 hours of life (usually on day 2 or 3 after birth)
- bilirubin levels that peak between days 3 and 5
- bilirubin levels that do not rise rapidly (no greater than 5 mg/dL per day).
48
jaundice occurring within the first 24 hours is considered .................
pathologic jaundice
49
hepatic adaptation ..................
- newborn cannot produce vitamin K: can't produce some clotting factors
- newborns receive vitamin K (AquaMEPHYTON) intramuscularly to help prevent hemorrhage
50
behavior and social adaptation ...................
Brazelton's Neonatal Behavioral Assessment Scale
51
six sleep and activity patterns .................
- deep sleep
- light sleep
- drowsy
- quiet alert
- active alert
- crying
52
initial assessments at birth ..................
- success of cardiopulmonary adaptation (assess immediately)
- vigorous or lusty cry
- heart rate greater than 100 bpm
- pink color
- assessment by RN
53
APGAR ..................
- useful to evaluate resuscitation efforts
| - helps determine intensity of care newborn needs
54
5 parameters for APGAR .......................
-HR
-respiratory effort
-muscle tone
-reflex irritability
-color
scored 0-2 points each
55
APGAR is assessed ...................
- at 1 and 5 minutes of life
- score of less than 7 at 5 minutes RN scores every 5 minutes until score is : above 7, intubated, transferred to nursery
56
APGAR 7-10 at 5 mins ..................
doing well
57
APGAR 4-6 at 5 mins .................
need close observation
58
APGAR 0-3 at 5 mins ...................
Severe distress
59
The APGAR score, given at 1 and 5 minutes of life, is an important assessment tool for the newborn. What information is this assessment used for?
a. Guides resuscitation efforts
b. Helps determine intensity of newborn needs
c. Indicates whether newborn is "normal"
d. Used to evaluate resuscitation efforts
b. Helps determine intensity of newborn needs
Rationale: The APGAR score is useful in determining the intensity of the needs of the newborn for the first few days of life.
60
continuing assessments throughout newborn transition ....................
```
-first 2 hours take heart and
respiratory rate every
30 minutes
-take temperature every 30 minutes until stabilized above 97.6° F
-observe for hypoglycemia
```
61
want fundus to be ....................
Firm and midline. NOT BOGGY.
| - if deviated: full and boggy- go pee
62
initial admitting assessment ......................
-review mother's history
-general observations of specific measurements
-head-to-toe approach: general appearance, body proportions and posture
‒Symmetrical
‒Well-nourished
‒Without cyanosis
63
neonatal vital signs ...................
- RR 30-60 bpm
- BP low : 60/40 mmHg
- HR high : 110-160 bpm
- axillary temp : 97.7 - 98.6
64
1. weight ..............
2. length ...............
3. head circumference ................
4. chest circumference ................
1. 2500 to 4000 g, 5lb 8 oz to 8lb 13oz
2. 48 to 53 cm, 19 to 21 in
3. 33 to 35.5 cm
4. 30.5 to 33 cm
65
head to toe ...................
skin, hair, nails
66
tiny white papules resembling pimples ........................
milia
67
a bluish color to the hands and feet of the newborn; normal in the first 6 to 12 hours after birth ..................
acrocyanosis
| not a good indicator of oxygen status
68
red and white lacy pattern sometimes seen on the skin of newborns who have fair complexions ...................
mottling
69
characterized by a clown-suit like appearance of the newborn .................
harlequin sign
| caused by constriction and dilation of blood vessels
70
....................... is the best environment to assess jaundice .
natural sunlight
| press the newborn's skin over the forehead or nose with your finger and note if the blanched area appears yellow
71
evaluate the sclera of the eyes ............
yellow tinge to the sclera indicates jaundice
72
bluish-black areas of discoloration on the back and buttocks or extremities of dark-skinned newborns ..................
Mongolian spot
73
pale pink or red marks found on the nape of the neck, eyelids, or nose of fair-skinned newborns .................
telangiectatic nevi AKA stork bites
74
dark reddish-purple birthmark that most commonly appears on the face .................
nevus flammeus AKA for wine stain
75
Baby Girl Smith, a healthy newborn female weighing 8 lbs. 2 oz., was born 2 hours ago. You note that her hands and feet are blue in color and her trunk is pink. What would you document?
a. Mongolian spots noted on extremities
b. Telangiectic nevi noted on extremities
c. Acrocynosis present
d. Milia present
c. Acrocynosis present
Rationale: Acrocyanosis, blue hands and feet with a pink trunk, results from poor peripheral circulation and is not a good indicator of oxygenation status.
76
elongated head shape ...............
molding
77
Swelling of soft tissue of the scalp
Caput succedaneum
78
Swelling that occurs from bleeding under the periosteum of the skull
Cephalohematoma
79
on the head/face make sure ........................
- sutures palpable
- fontanels open
- facial movements symmetrical
- eyes : strabismus (cross eyes), "doll's eye" reflex
- nose
- mouth : pink and moist, strong suck reflex, epstein's pearls, ABNORMAL (TRUSH, CLEFT LIP/PALATE)
- ears even and symmetrical
- neck short and thick without webbing
- chest movements should be equal bilaterally
- abdomen dome shaped and protuberant
80
genitourinary .....................
- void within first 24 hours
- "brick dust" in urine
- genitalia may be swollen
- smegma : cheesy white substance
81
female baby assessments .................
- hymenal tag may be present
- imperforate hymen
- pseudomenstration
82
male baby assessments ...............
- epispadias
- hypospadias
- phimosis
- cryptorchidism
- hydrocele
83
the urinary meatus is located abnormally on the dorsal (upper) surface of the glans penis .................
epispadias
84
the urinary meatus is located on the ventral (under) surface of the glans .....................
hypospadias
85
tightly adherent foreskin
| a normal condition in the term newborn .....................
phimosis
86
undescended testicles : requires medical evaluation ...............
cryptorchidism
87
fluid within the scrotal sack .................
hydrocele
88
extremities .................
- flexed position
- simian crease
- ortolani's maneuver and barlow's sign
89
back and rectum ................
- spine is straight and flat
| - anus should be patent
90
neuro assessment ......................
reflexes
- suck reflex
- palmar grasp
- stepping reflex
- moro reflex
- tonic neck reflex (fencer's position)
91
behavioral assessment .....................
| gestational age assessment ...........
bonding
| critical evaluation
92
At least __ wet diapers in 24 hours
6
93
Jaundice level past 20
at risk for brain damage
94
your role with a newborn ....................
- support them
- quickly recognize the development of complications
- report changes in condition to the RN to facilitate rapid intervention
95
current standard of care for resuscitation of the newborn immediately after birth .....................
neonatal resuscitation program (NRP)
96
who is NORMALLY not responsible for a complete resuscitation?
LPN
| -must be able to initiate resuscitation and assist throughout the process
97
first ................... after birth are a critical transition period for the newborn .
6 to 12 hr
- must be alert to early signs of distress
- must be ready to intervene quickly to prevent multiple complications and poor outcomes
98
assessment in immediate stabilization ...................
- concerned with the success of cardiopulmonary adaptation
- transition period: first 6-12 hours of life
- heart and respiratory rates at least every 30 minutes during the first 2 hours of transition
99
HR and RR rates assessed at least .........................
every 30 minutes during the first 2 hours of transition
100
temp assessment ..................
axillary every 30 minutes until it stabilizes
| -expected between 97.7 and 99.5
101
full physical assessment including .................... completed within ....................
gestational age, first few hours of life
102
Nursing diagnoses
- Impaired spontaneous ventilation related to ineffective transition to newborn life
- Risk for injury: hypoglycemia related to immature metabolism and/or presence of risk factors
- Ineffective thermoregulation related to immature heat-regulating mechanisms
- Risk of infection related to immature immune system, possible exposure to pathogens in the birth canal or in the nursery, and umbilical cord wound
- Risk of imbalanced fluid volume related to immature blood clotting mechanisms
- Risk of injury: misidentification related to failure of delivery room personnel to adequately identify the newborn before separation from the parents
103
Which of the following is within your role as an LVN/LPN?
a. To resuscitate newborn
b. To complete initial newborn assessment
c. To support the newborn
d. To support the family of the newborn
c. To support the newborn
Rationale: The role of the LVN/LPN is to support the newborn, quickly recognize the development of complications, and report changes in condition to the RN to facilitate rapid intervention.
104
primary goal of nursing care immediately after delivery and in the first 6-12 hours of life ....................
maintaining the safety of the newborn during transition
105
appropriate patient goals ...................
- newborn will experience adequate cardiovascular, respiratory, thermoregulatory, and metabolic transitions into extrauterine life
- newborn will remain free from signs and symptoms of infection, maintain hemostasis, and be adequately identified before separation from the parents
106
supporting cardiovascular and respiratory transition ..................
- nursing interventions to support newborn vital functions begin before the birth occurs
- ensure that adequate supplies are present
- ensure that all equipment is functioning properly
107
observe the newborn carefully at birth ...............
if the newborn cries vigorously:
- palpate the base of the umbilical cord and count the pulse for 6 seconds and multiply by 10
- pulse above 100 bpm and a vigorous cry are reassuring signs
108
if the newborn does not cry immediately ..................
- transport him or her to a preheated radiant warmer for prompt resuscitation
- dry him or her quickly to prevent heat loss
- bag and mask connected to 100% oxygen are used to provide respiratory support
109
signs that a baby is not breathing well ...................
- grunting
- nasal flaring
- substernal or subcostal retractions
110
most newborns don't require resuscitation ...................
however, a very small number of infants require chest compressions, intubation, and medications
111
a .................... is used to suction the .................. first and then the ......................
bulb syringe, mouth, nose
112
if the nose is suctioned first ................
the newborn may gasp or cry and aspirate secretions in the mouth
113
maintaining thermoregulation .........................
critical to protect the newborn from chilling
- cold stress increases the amount of oxygen and glucose needed by the newborn
- can quickly deplete glucose stores and develop hypoglycemia
- can also develop respiratory distress and metabolic acidosis if exposed to prolonged chilling
114
if the newborn cries vigorously and has an adequate HR ....................
- quickly dry the newborn on the mother's abdomen
- swaddle him snugly, and apply a cap to prevent heat loss
- kangaroo care
- thermoneutral environment
115
preventing injury form hypoglycemia .....................
- best way to prevent injury from hypoglycemia is to prevent the condition altogether
- when a newborn displays signs of hypoglycemia:
1. perform a heel stick
2. glucose level of less than 50 mg/dL
3. immediately initiate treatment
116
Why is it important to suction the mouth of the newborn before suctioning the nose?
a. The parents would not like it if you put something in their babies nose and then their mouth
b. If the nose is suctioned first, the newborn may gasp or cry and aspirate secretions in the mouth
c. You would spread any infection the newborn might have
d. The newborn is a natural born mouth breather
b. If the nose is suctioned first, the newborn may gasp or cry and aspirate secretions in the mouth
Rationale: When you suction a newborn's nose you irritate the baby and he or she cries. If they gasp and cry they can aspirate whatever is in their mouth.
117
ophthalmic agents approved for eye prophylaxis ...............
- 1% silver nitrate : used infrequently
- 0.5% erythromycin
- 1% tetracycline
118
preventing infection in umbilical stump ...................
- use strict aseptic technique when caring for the cord
| - triple dye, bacitracin ointment, or povidone-iodine
119
preventing imbalanced fluid volume ..................
- vitamin K
- within the first hour after birth, 0.5 to 1 mg of vitamin K (AquaMEPHYTON) is given intramuscularly
- potential source of hemorrhage is the clamped umbilical cord
120
preventing misidentification of newborn .....................
- delivery room nurse must take the utmost care to positively identify the newborn before he or she is separated from the parents
- most hospitals use some form of bracelet system
- instruct the parents to always check the bands when the newborn is brought to them
121
assessment of normal newborn ..................
potential for aspiration
-signs of respiratory distress or central cyanosis should not be present
potential for infection
122
signs on infected umbilical cord ...................
Redness, edema, purulent drainage
123
early signs of sepsis in newborn ..................
- poor feeding
- irritability
- lethargy
- apnea
- temp instability
124
late signs of sepsis in newborn .....................
- enlarged spleen and liver
- jaundice
- petechiae
125
perform a thorough skin assessment ....................
- turgor should be present and the skin should be intact
- inspect the diaper for signs of rash or breakdown
- assess for jaundice
126
............................. is the aim of most newborn care interventions .
monitoring for and preventing complications
127
after the transition period ..................
appropriate goals include:
- the newborn's maintenance of a clear airway
- freedom from infection
- clean intact skin
- freedom from abduction from the hospital
- responsive to the environment in an organized way
128
implementation with healthy newborn ...................
- keeping the airway clear
- preventing transmission of infection
- providing skin care
- providing safety
- enhancing organized infant behavioral responses
129
It is important to prevent the misidentification of a newborn. Most hospital use identification bands. What is it important for you to do?
a. Instruct the parents to always check the bands when the newborn is brought to them
b. Always check the mothers identification band with the fathers identification band
c. Always check the fathers identification band with the newborn's
d. Instruct the parents to never take the newborns' identification band off
a. Instruct the parents to always check the bands when the newborn is brought to them
Rationale: Instruct the parents to always check the bands when the newborn is brought to them.
130
discharge prep : assessment .....................
- respiratory
- cardiovascular
- thermoregulatory
- nutritional and hydration status
- monitor for signs of infection
- check vigilantly for developing jaundice
- watch for signs of pain: injections and heel sticks, circumcision
- pay attention to behavior, such as crying, sleeplessness, facial expression, and body movements
- heart and respiratory rates, blood pressure, and oxygen saturation
- assess the adaptation of the mother and father to the parenting role
131
outcomes in discharge ................
- prevention of, and relief from, pain are applicable goals throughout the newborn's stay in the hospital
- protection from infection and injury from preventable diseases
- evaluate parental knowledge and ability to care for the newborn throughout the hospital stay
132
implementation in discharge ..................
- preventing and treating pain
- assisting with circumcision
- preventing infection through neonatal immunization
- preventing injury through neonatal screening
133
supporting the parent's role through discharge teaching ...............
- handling the newborn
- clearing the airway
- maintaining adequate temperature
- monitoring stool and urine patterns
- providing skin care
- maintaining safety
134
T or F : The way to tell if a newborn is in pain is that he or she sleeps all the time.
False
Rationale: Pay attention to behavior, such as crying, sleeplessness, facial expression, and body movements. Heart and respiratory rates, blood pressure, and oxygen saturation should also be monitored.
135
Conductive heat loss
Lying on cold surface
136
Convection heat loss
Air current blows over baby
137
Evaporative heat loss
Moisture evaporates off the skin
138
Radiative heat loss
Heat goes to something cold close by
139
Neuromuscular
- Posture
- Square window (wrist)
- Arm recoil
- Popliteal angle
- Scarf sign
- Heel to ear
140
Physical
- Skin
- Lanugo
- Plantar surface
- Breast
- Eye/ear
- Male genitals
- Female genitals
