OB - Exam Three Flashcards
First sign of hypovolemic shock
Increase heart and respiratory rate
What do you do for a boggy fundus that is deviated?
Massage uterus until firm
Have woman urinate or catheterize
What would the physician order if we could not get boggy fundus firm?
Pitocin
Methylergonovine
Prostaglandins
Discharge teaching for postpartum moms that delivered vaginally
a. Follow up appointments at week 2 and 6
b. Daily shower
c. Perineal care until lochia stops
d. No sex until episiotomy healed and lochia stops
e. Use protection
f. High fiber foods
g. Well-balanced diet
h. Moderate exercise
i. Continue prenatal for 6 weeks
j. Report the following
1. Fever higher than 100.4
2. Persistent lochia rubra or lochia with foul odor
3. Bright red bleeding, especially if lochia has changed from serosa or alba
4. Prolonged after pains, pelvic, abdominal pain, or constant backache
5. Signs of UTI
6. Pains, tenderness, redness in calf
7. Localized breast tenderness, or redness
8. Prolonged and pervasive feelings or depression and being let down, not enjoying life
Signs of late postpartum hemorrhage
a. Happens 24 hours to 6 weeks after childbirth
b. Causes= retention of placenta fragments and subinvolution of uterus
c. Persistent red bleeding
d. Return of red bleeding after it has changed to pinkish or white
Teaching for moms with mastitis
Heat promotes blood flow to the area
a. Wash hands thoroughly before breastfeeding
b. Maintain breast cleanliness with frequent breast pad changes
c. Expose nipples to air when possible
d. Ensure correct newborn latch and removal from breast
e. Enourage newborn to empty breast
f. Frequently breastfeed
g. Breastfeed from uninfected side first at each feeding to initiate let down in affected breast
h. Massage distended area as newborn nurses
i. Report redness and fever to healthcare provider
j. Apply ice packs or most heat to relieve discomfort
Postpartum complications if mom delivers a large baby vaginally
a. More at risk for uterine atony
b. More at risk for postpartum hemorrhage
c. May have a large episiotomy or laceration
What do we suspect if the uterus is firm but mom is still bleeding?
a. Blood clots retained
b. Infection
Where does a patient feel the pain with a positive Homan’s sign?
Pain in calf when leg is dorsiflexed
Risk factors for postpartum shock
o Placental abruption. The early detachment of the placenta from the uterus. o Placenta previa. ... o Overdistended uterus. ... o Multiple pregnancy. o High blood pressure disorders of pregnancy. o Having many previous births. o Prolonged labor. o Infection.
Signs and symptoms for mastitis
Redness and heat in the breast Tenderness Edema and a heaviness in the breast Purulent drainage May have fever and chills
What would a nurse expect to assess if the peri-pad has no lochia on it shortly after delivery?
o Normal postpartum changes
Lochia rubra should be bright red
Amount during first few hours should be no more than on saturated perineal pad per hour
A few small clots may appear but large clots are NOT normal
Check fundus - if it’s not contracting, it can’t get rid of blood
Interventions for hypovolemic shock
o Stop the blood loss
o Give IV fluids to maintain the circulating blood volume and to replace fluids
o Give blood transfusions to replace lost erythrocytes
o Give oxygen to increase the saturation of remaining blood cells
Place pulse ox on patient
o Place an indwelling (Foley) catheter to assess urine output, which reflects kidney function
Molding
Conforming of the fetal head to the size and shape of the birth canal
Caput succedeum
Swelling of the soft tissues of the scalp
(Glossary – pg 807) swelling or edema of the newborn scalp that crosses the suture lines
Cephalohematoma
Subperiosteal swelling containing blood, found on the head of some newborns
The swelling does not cross the suture lines
• Often appears unilateral
Usually disappears within a few weeks to 2 months without treatment
Moro reflex
Sudden jarring causes extension and abduction (an embracing motion) of the extremities and spreading of the fingers, with the index finger and thumb forming a C shape
If unilateral – could indicate a clavicle fracture
Appears at birth; disappears around 3-6 months
Tonic neck reflex
Turn infant’s head to one side and the arm and leg will extend on that side with a flexion of the opposite arm and leg
Appears at birth; disappears around 5-7 months
Palmar grasp reflex
Place object in the hand of the newborn, and the newborn will grasp it tightly
Appears at birth; disappears around 4 months
Babinski reflex
Stroke the side of the foot, the big toe will dorsiflexion and the toes will flare out
Appears at birth; disappears before infant begins walking (variable)
Blinking response
Infant blinks when hearing a loud noise
Appears at birth; never disappears
Turning response
Infant will turn its head towards the source of the noise
Appears at birth; never disappears
Eye opening (Infant reflex)
Holding the newborn infant upright, under the arms, and tipping the infant forward will induce eye opening
Appears at birth; disappears at 3 months
Blinking to threat
Bringing an object close to the eye at a fast pace will induce blinking
Appears around 6-7 months; never disappears
Horizontal following
Moving an object side to side within the infant’s visual field will elicit this response
Appears around 4-6 weeks; never disappears
Vertical following
Moving a colorful object up and down within the visual field of the infant will induce this response
Appears around 2-3 months; never disappears
Rooting response
Infant’s head turns in the direction of anything that touches the cheek in anticipation of food
Appears at birth; disappears around 3-4 months
Sucking response
Infant will suck on a finger or nipple placed in the mouth
Appears at birth; disappears around 7-12 months
Stepping reflex/”dancing reflex”
Hold infant upright above a table; the infant will life the foot up on contact with the firm surface of the table
Appears at birth; disappears around 4-5 months
What should the fontanels feel like in a normal healthy newborn?
o Fontanelles are unossified spaces or soft spots on the cranium of a young infant. They protect the head during delivery by permitting the process of molding and allow for further brain growth during the next 1.5 years
o Anterior fontanelle is a diamond shape and located at the junction of the two parietal and two frontal bones
Usually closes by age 12-18 months
o Posterior fontanelle is triangular and is located between the occipital and parietal bones
Smaller than the anterior fontanelle
Usually ossified by the end of the second month
Depressed = dehydration
Bulging = ICP
Should be soft
Normal vital signs of a newborn
o Temperature = 97.1 – 99.8 degrees Fahrenheit/36.2 – 37.7 degrees Celsius
o Heart rate = 110 – 160 beats/min
o Average blood pressure at birth is 80/46 mm Hg
o Respirations = 30 – 60 breaths/min
What causes the blood vaginal discharge of a newborn baby girl?
o Psuedomenstruation
o This discharge is caused by hormonal withdrawal from the mother at birth
How many hours a day does a newborn baby sleep?
Approximately 15-20 hours
What should a parent call their physician regarding their newborn?
o Temperature greater than 100.4 F by axilla o Refusal of two feedings in a row o Two green watery stools o Frequent or forceful vomiting o Lack of voiding or stooling
Steps of using a bulb syringe to suction baby’s nose and mouth
o Compress the ball of the bulb syringe
o Insert narrow portion into the side of the infant’s mouth to avoid stimulating the gag reflex. suction mouth first! Then nose
Prevents inhalation and aspiration of mucus during a gasp reflex stimulated by nasal suctioning
o Release the pressure on the ball of the bulb syring and listen for the sound of mucus being suctioned
o Remove the bulb syringe and empty the contents into a receptacle by compressing the bulb
o Compress the bulb syringe and insert into one nostril; then release the pressure on the bulb to suction the mucus out
o Remove the bulb syringe and empty it into a receptacle. Repeat for other nostril
o Demonstrate to parents the technique and review cleaning and storage of bulb syringe
Components of APGAR score
o Standardized method of evaluating the newborn’s condition immediately after delivery. Assessed at 1 min and again at 5 min.
o Measure signs: heart rate, respiration, muscle tone, reflexes, and color
o Scored 0, 1, or 2
What does “level of maturation” mean for a preterm infant?
o Refers to how well developed the infant is at birth and the ability of the organs to function outside the uterus
An infant with jaundice is at risk for what?
o The liver of a newborn is immature
o Liver is unable to clear the blood of bile pigments that result from the normal postnatal destruction of blood cells
o The amount of bile pigment in the blood serum is expressed as mg/dL
o The higher the blood bilirubin level, the deeper the jaundice, and the greater the risk for neurological damage
o An increase of more than 5 mg/dL within 24 hours or a level of 12.9 mg/dL require further investigation
o At risk for hyperbilirubinemia, or excessive bilirubin levels in the blood
a. Neurological damage
b. Kernicterus- serious neurological complication that can cause brain damage, which is also known as bilirubin encephalopathy
Reason for gavage feeding a premature infant
o The ability to coordinate breathing, sucking, and swallowing does not develop before 34 weeks of gestation; therefore, a very preterm infant may require gavage feedings (via a tube placed through the nose or mouth into the stomach)
What is ordered to speed up fetal lung maturity?
o Physician may order the woman steroid drugs (glucocorticoids) to increase the fetal lung maturity if gestation is between 24 and 34 weeks
Signs of respiratory distress in an infant
o Typically apparent after delivery but may not manifest for several hours after delivery
o Respirations increase to 60 beats/min or more
o Gruntlike sounds
o Nasal flaring
o Cyanosis
o Intercostal and eternal retractions
o Edema, lassitude, and apnea occur as the condition worsens
Signs of hypoglycemia
Tremors Weak cry Lethargy Convulsions Plasma glucose level lower than 40 mg/dL (term) or 30 mg/dL (preterm)
Signs of necrotizing enterocolitis (NEC)
Abdominal distention
Bloody stools
Diarrhea
Bilious vomitus
What does a premature infant catch up with his peers?
o In the absence of severe birth defects and complications, the growth rate of the preterm newborn nears that of the term infant by about the second year
What might a postterm infant look like?
o Long and thin
o Looks as if weight has been lost
o Skin is loose, especially around thighs and buttocks
o Little lanugo (downy hair) or vernix caseosa
o Loss of cheese like vernix caseosa leaves the skin dry; it cracks, peels, and is almost like parchment texture
o Nails are long (may be stained with meconium)
o Thick head of hair
o Looks alert
How fast does surfactant work to improve the lungs of an infant?
o Surfactant can be administered through an ET tube at birth or when symptoms of RDS occur, with improvement of lung function seen within 72 hours
What assessment findings of a premature infant should be reported?
a. Increase or decrease in movements, lethargy, twitching, frequency and quality of cry, hyperactivity
b. Fontanelle- sunken, flat, or bulging
c. Discharge from eyes
d. Respirations- apnea, sternal retractions, labored breathing
e. Pulse rate- rate and refularity
f. Discharge and odor from cord
g. Feeding- sucking ability, vomiting or regurgitation, degree of satisficaiton
h. Voiding- initial, frequency
i. Stools- frequency, color, consistency
j. Mucus membranes- dryness of lips and mouth, signs of thrush
k. Color- paleness, cyanosis, jaundice
l. Skin- rashes, irritations, pustules, edema
What is a postterm infant at risk for?
o Asphyxia caused by chronic hypoxia while in the uterus because of a deteriorated placenta
o Meconium aspiration – hypoxia and distress may cause relaxation of the anal sphincter, and meconium can be aspirated into the fetal lungs
o Poor nutritional status; depleted glycogen reserves causes hypoglycemia
o Increase in RBC production because of intrauterine hypoxia
o Difficult delivery because of increased size of infant
o Birth defects
o Seizures as a result of hypoxic state
What is an appropriate urine output for a premature infant?
1-3 mL/hr
