OB Exam 3 | Summer 24 | Zakewicz Flashcards
What are the postpartum changes in fluid distribution and Urination?
⁍ Fluid Loss ( EBL; vaginal birth 250-500 mL and C-section 500-100mL)
⁍ Increase in diuresis and diaphoresis
⁍ Urine output occurs within 12 hours of birth, 3000 mL or more each day for the first 2-3 days
Postpartum CBC changes
⁍ H&H decreased for a few days
⁍ WBC elevated for 4-7 days (20,000-30,000)
⁍ Coagulation factors increased for 2-3 wks ( increase risk for thromboembolism = DVT and PE)
VS postapartum
⁍ HR and Bp return to normal within few hours
⁍ o-hTN on first day
⁍ Elevated temp (100.4) within 24 hours
⁍ Postpartum chill - resolves quickly after birth with blankets and warm drink
***Elevated pulse may indicate impending shock
Postpartum Lochia
Rubra (red)
⁍ Blood with debris from uterus lining and placenta
Serosa (pink or brownish)
⁍ Old blood, serum, leukocytes, and debris
Alba (White or yellow)
⁍ Leukocytes, bacteria, mucus and serum
Rubra
Red
Blood from debris
Serosa
Pink or brown
Old blood, debris, and serum
Alba
White or yellow
Infection (WBC, bacteria, mucus, and serum)
Postpartum Perineal Trauma Care
⁍ Ice pack for initial edema r/t pregnancy
⁍ Hemorrhoids: eventually resolve on own, no straining
⁍ Episiotomy: may take several weeks, depending on severity. No straining (laxative). Assess wound.
Breast care for women who are breastfeeding
⁍ Initiate feeding the hour of birth if possible
⁍ Breast milk “comes in” 3-4 days after birth
⁍ Feed 10-12 times a day for 1-3 hours each feed
⁍ Pay attention to latching. Feed until baby stop, then burp, then go to the other breast.
⁍ Engorgement may occur (Edema and venous distention; intervention is to empty breast)
Breast Care for Women who are not breast Feeding
⁍ Avoid stimulation of nipples, support breast (snug bra), acetaminophen.
⁍ Engorgement may occur but it should resolve within 24-48 hours
Location of the Fundus on Different days during Involution
Involution: Return of the uterus to non-pregnant state
⁍ Fundus goes down 1 cm every 24 hours
⁍ Fundus at the umbilicus on birth day
⁍ Uterus not palpable after 2 wks
⁍ Return to nonpregnant sate by week 6
What is the significance of only 2 vessels in the Umbilical Cord?
?????
When is the Apgar Score abnormal?
0-3 critical, 4-6. abnormal, 7-10 normal
Appearance, pulse, grimace, activity, respirations
5 screening Tests/Assessment tools for Newborns
- Universal Newborn Screening (Heel stick and Genetic Testing) - Mandated by US government
- Jaundice/bilirubin screens
- Critical Congenital Heart Disease (O2 comparison of Rarm and either foot)
- Newborn hearing screening
- Newborn Screen (PKU, congenital hypothyroidism, glucosemia, maple syrup urine disease, homocystinuria, and sickle cell
Assessment: APGAR, Ballard score, physical, and NIPS pain scale
Caput Succedeneum
⁍ Edema of the scalp that crosses the suture line
⁍ Normal and gone in days
Cephalohematoma
⁍ Blood between skill bone and periosteum
⁍ Does not cross the suture line
Mongolian spot
Darker skin color on the buttock (sometime it stretches to the back), it disappears after months or years.
⁍ You still have to document this finding
Nevi
Red spots at the back neck or forehead especially when the baby is crying
Erythema Toxicum
Pink rash | Normal
Milia
Whitehead (instead of blackheads) at nose, chin, or forehead| normal
Vernix Caseosa
Protective, thick, “cheesy” covering of the skin; normally in crease and fold. Usually found in preterm infants.
Sucking and Rooting
Turns head toward stimulus
Moro
⁍ “Startle” reaction
⁍ Symmetric abduction and extension of extremities with slight tremor
Swallow
Coordinated with sucking and breathing. Swallowing usually follow sucking
Stepping/Waling
Holding imitated walk
Babinski
Flaring of the foot toes
Care for Circumcision
⁍ Pain management - Oral Tylenol q6hr
⁍ Observe for bleeding, keep petroleum jelly gauze, and observe for voiding
Umbilical Cord Care
Keep Dry
⁍ Clamp stays 24-48 hrs after birth, cord stays outside the diaper and fall off 10-14 days, and sponge bath until cord falls off
Care of a Jittery Baby
Get blood glucose level. If hypo glycemic, try to feed. If the baby is too sleepy, use tube feeding or D10W.
Newborn Bath
Inner to outer and head to toe. Except for diaper area, clean this area last.
Infant Car Safety
⁍ Adjust strap correctly, and nothing in between the straps (just onsie).
⁍ Back seat, rear facing, angle at 45 degree
Sleep Safety
ABC: Alone, on their Back, and in their Crib
Administering medication to a newborn
⁍IM Vastus lateralis only
⁍ Use oral syringe for oral administration
Care for hypothermia
Dry baby off, pre heat surface, skin to skin, and put hat on
Care for Hyperthermia
Maintain correct balance in warmer, avoid excess clothing/blankets, and sepsis assessment
Convection
⁍Exchange of heat through air.
⁍⁍Maintain cool temperature in the room or keep in warmer
Radiation
⁍Heat exchange from body to cooler surfaces
⁍⁍ No direct contact with colder surfaces
Evaporation Heat transfer
⁍Liquid on body surface evaporates
⁍⁍ Dry baby off
Conduction
⁍Exchange of heat through direct contact
⁍⁍ Skin to skin
Difference Between Physiologic Jaundice and Pathologic Jaundice
Physiologic
⁍Appears after 24 hr - peaks at day 3-4
⁍Resolves without treatment
⁍⁍Causes: Immature liver, extra RBC, polycythemia, preterm, dehydration, bruising
⁍⁍Prevention: Early feeding, promote BM, and phototherapy
Pathologic
⁍Appears within 24 of life, or last longer than 4 days
⁍⁍Serum Bili increases quickly or serum exceeds 15 mg/DL
⁍⁍Causes Newborn blood incapability or underlying disease (sepsis, trauma, liver disease)
How can you Prevent or Minimize Physiologic Jaundice?
Early feeding, promote BM, and phototherapy
What are the best practice for breastfeeding?
⁍ Initiate feeding within the hour of birth if possible
⁍ Avoid supplement feeding unless indicated
⁍ Avoid artificial nipples
⁍Pay attention to latching
⁍Allow feeding at first breast until baby stop, then burp, then go to other breast, no time limit
⁍Offer breast as soon as feeding cues occur, do not wait until crying, feed 10-12 times a day for 1-3 hours.
How do you know the baby is getting enough breast milk?
⁍Measure output: same number of wet diapers as the babies age in days, for the first few day
⁍⁍Weight is not the most reliable method since infant lose 7-10% of body weight in the first few days
What do you recommend a mastitis breastfeeding
Extra rest, empty milk out of breast after each feeding, start breast feeding on unaffected side, thoroughly wash hands prior to breastfeeding, maintain cleanliness of breasts
⁍Infection precaution and monitoring
Breast Engorgement Client Education
⁍Warm shower, apply warm compress, empty breast after feeding (use pump if needed), cool compress after feeding
Nipple soreness Client education
Make sure the infant latches right (lathing techniques) and change position of feeding
Quality Breastfeeding
L: LATCH
A: AUDIBLE SWALLOWING
T: TYPE OF NIPPLE (EVERTED, FLAT, AD INVERTED)
C: COMFORT DURING FEEDING (SHOULD NOT HURT)
H: HELP (How much help does mom need to give the infant with feeding)
2 newborn complications due to shoulder dystocia
Clavicle Fracture and Erb-Duchenne
2 blood type combination incompatible
ABO incapability: Mother blood O and baby’s blood type is A, B, or AB
Rh incapability: Rh+ baby and Rh- mother
4 signs of newborn sepsis - What happen to the baby’s temperature?
Temperature instability
S/S: Poor feeding pattern, central cyanosis, jaundice, irritability, hypotension, and tachycardia.
Maternal Diabetes affects on newborn blood glucose
Newborn can have a low blood glucose 24-48 hour of life
S/S of NAS
S/S Poor feeding, jitteriness, tremors, irritability, high pitched cry, hypertonia, seizures, excoriation, and sneezing
Medication for NAS
Opioid: Morphine
NEC - 4 signs
Necrotizing enterocolitis: Bacterial inflammatory infection that affects cell death of areas of the intestinal mucosa
Abdominal distention, green vomit or stool, blood in stool
Cause of SGA/IUGR and LGA and common complications of each
Causes: preterm, genetics, maternal infection/malnutrition, gestational HTN/diabetes, maternal smoking/drug/alcohol use, multiple gestations
Complications: possible stillbirth, hypothermia, polycythemia
Preterm babies - week and concerns
20-37 wks
Immature organs, LBW, hypotonia
Concerns: RR distress syndrome, aspiration, apnea, bleeding brain, patent ductus arteriosus, NEC
Late Preterm - weeks and concerns
34-37 wks
Concerns: thermoregulation, hypoglycemia, hyperbilirubinemia, sepsis, and respiratory issues
Post term - weeks and concerns
42+ wks
Concerns: aspiration on meconium, LGA, toxic appearance, neuro deficit, peeling/cracked skin
5 TORCH infection
Infections that can cross the placenta
Toxoplasmosis
Other Infections (Hep(s))
Rubella Virus
Cytomegalovirus
Herpes
Risk Factors Toxoplasmosis
Raw or undercooked meat
Cat feces
Risk Factors for Rubella
No live viral vaccine during pregnancy
And beware of ppl with rashes!
Risk factor for Cytomegalovirus
Droplet infection - Cyto is passed through bodily secretion
Risk Factors for HSV
Oral or genital lesions
Common Congenital Anomalies and Nursing Concerns for Each
Neurologic: protect membranes, observe for leakage, prevent infection, monitor for increased ICP
Hydrocephalus: repositioning, and monitoring for increased ICP
Patent ductus arteriosus: educate on surgical treatment
Tetralogy of Fallot: prevent infection and respiratory distress through positioning (knee-chest position) and reducing workload on the heart
Cleft lip/palate: monitor for dehydration and maintain airway
Signs of TED, prevention, and complication
Signs: unilateral calf pain, redness, hardened area of vasculature
Prevention: hydration, ambulation, SCDs, enoxaparin
Complications: superficial venous thrombosis, DVT, acute PE
Cannot use warfarin during pregnancy
4 medication to treat postpartum hemorrhage
Oxytocin and misoprostol causes hypotension
Oxytocin: monitor for water intoxication
Misoprostol: monitor for fever/diarrhea
Methylergonovine and carboprost causes hypertension
Methylergonovine: use cautiously with asthma as well
Carboprost tromethamine
Differentiate between postpartum “blues”, postpartum depression, and postpartum psychosis.
Postpartum blues
Symptoms resolve within 3-10 days, no medical treatment
Transient, self limiting
Postpartum depression
Persistent, lasting longer than 2 weeks
Sx: fatigue, frustration, anger, isolation, irritability, alcohol/drug use, somatic disruptions
Intense sadness with severe mood swings
Postpartum psychosis
2 weeks postpartum; very rare
Delusions, hallucinations
Psychiatric emergency
Describe management of early and late postpartum hemorrhage.
Early management
⁍Stop bleeding, fundal massage
⁍Fundal massage: do not stop until firm
⁍Empty bladder, express clots from uterus
⁍Uterine stimulants as ordered
Late management
⁍Bimanual massage, bakri balloon to put pressure on placental site, IR to plug uterine arteries, ligation of uterine arteries, hysterectomy as life saving measure
⁍If still bleeding lochia rubra 2 weeks later, could be retained placental fragments
Nursing care for mastitis
Nursing care
Extra rest, empty milk out of breast, start breast feeding on unaffected side, thoroughly wash hands prior to breastfeeding, maintain cleanliness of breasts
Antibiotic treatment
Common Congenital Anomalies
Neurologic
Hydrocephalus
Patent Ductus Arteriosus
Tetralogy of Fallout
Cleft lip/palate
Down Syndrome
Neurologic
Protect membranes, observe for leakage, prevent infection, monitor for increased ICP
Hydrocephalus
Repositioning, and monitoring for increased ICP
Patent ductus arteriosus
Educate on surgical treatment
Tetralogy of Fallot
Prevent infection and respiratory distress through positioning (knee-chest position) and reducing workload on the heart
Cleft Lip/Palate
Monitor for dehydration and maintain airway
