ob test 2 Flashcards
normal blood loss vaginal and c section and how much gram-ml
500ml vaginal
1000ml c section
1gm to 1ml
3 causes of uterine atony
preeclampsia
prolonged use of mag sulfate
prolonged use of betamethasone
What is the balloon called for the uterus and one thing to remember
Bakri post-partum balloon you can use this on a c section.
What to look for when the fundus is hard but the woman is still bleeding? 4
Laceration, episiotomy, hematoma, retained tissue
What is the first-line treatment for post hem? 2 ways?
Potocin IV or IM
hemabate what is it why do we use it?
For postpart hem it’s man-made oxytocin and it is a long-term drug.
Misoprostal what is it why do we use it? one thing to remember about it
Anti-ulcer we use it off label for hem but inserting into vagina or rectum. It is very painful
Methergrine why do we use it? One thing about it?
Post hem it causes problems with nursing so we try to avoid it.
Lysteda why do we use it how do we use it
IV push promotes clotting
What is puerperal infection 2 things to remember about risks and 2 signs
It is when bacteria infects the uterus or surrounding tissues in birth instrument -assisted birth multiple vag exams even before labor foul-smelling lochia WBC-high in pregnancy we are watching trend
How do we assess the perineum?
REEDA
Redness, edema, ecchymosis, discharge, approximation.
Time frame for baby blues and when to go to doctor?
first 3-10 days lasting a few days to a week or two when it lasts more than two weeks
When does postpart depression show up? when is the most common time?
4-6weeks later most common time is 3 months
One tool used to assess postpart depression
Edinbrugh postnatal depression scale EPDS
One thing to remember about post part
Men can have it two but react with anger and other ways
How much can a newborn stomach hold? when to burp? why regurg?
1-2tsp After every oz or between breasts weak sphincters
How often do newborns eat?
Every 2-3 hours
What to remember about the neonates stomach?
It is sterile and does not produce vit k because there is no bacteria.
What is meconium and one thing about it
Black tar stool from amniotic fluid and they may poop in the womb if they are stressed.
What is kernicterus what causes it what are the numbers?
Build up of bilirubin causes toxicity greater than 18
When will jaundice appear in newborn two things
3 days if from breakdown of RBC
sooner if it is a different problem
Neonate bp and hr WNL
pulse- 120-160
BP 60-80/40-45
Normal respiratory findings in a neonate 3
Irregular, 30-60 some fluid in lungs for 24 hrs so might hear crackles
What is kidney function percent in a neonate at birth
About 30-50 percent
Why are neonates more prone to dehydration
Most of their water is extracellular
3 things about urine in a neonate
They can’t concentrate urine well
Don’t handle drugs well
brick dust urine is normal
spinal in neonate 2 things
No curves, soft mostly cartilage
What is molding
Crainial sutures overlap as a result of labor and delivery resolves in 24 hours
What do you want to see with neonates and how to swaddle them
Flexed and swaddle flexed with hands by their face
Never
Swaddle a baby and leave alone
Desquamates and what does this mean
Skin peeling in neonate and normal
Skin and jaundice and babes
Ruddy is normal can blanch to check color or look at mouth or sclera
Mottling and newborn
Means they are cold
milia how to deal with it
Small white/yellow spots on face from clogged sebaceous glands Normal don’t touch it
Erythema toxicum
Newborn acne from moms hormones. Normal
Telangiectatic
Pale pink or red spots on face or neck normal will fade might not go away
Mongolian spots and one thing to remember
Black/blue spots in babe record so in the future they don’t think it is child abuse.
Cephalhemeatoma is one thing wherex2 What will happen x2 what to watch for
Collection of blood from ruptured vessles
does not cross suture line
parietal bone and periosteum
can be unilateral or bilateral
Will stop bleeding because of pressure
blood will get reabsorbed into body in a few weeks
Hyperbilirubinemia
Caput succedaneum 3
Localized swelling
long labor or vacuum
crosses suture line
Subgaleal hematoma What is it? Where? From? When? Identifier? What happens?
Hemorrhagic birth injury between the scalp and aponeurosis From vacuum extract With in 12-72 hours Crosses suture nothing to stop bleeding NICU
3 things about vision and a newborn
Light sensitive
Likes light/dark contrast
Focuses about 12 in from face
Hearing and infant 3
Recognizes voices from in utero
Turns head toward sound
hearing is acute
Taste and baby
Sweet and sour
What sense is least developed in a newborn
Touch/ pressure
When is APGAR done what do the score ranges mean? and One thing to remember about it
1 min and 5 mins 8-10-excellent 4-7 need stimulation 0-3 needs resuscitation The nurse needs to do it
What does APGAR stand for? how are they scored?
Appearance (Color) Pulse (HR) Grimace (Reflex irritability) Attitude (mm tone) Respirations 0-2
How to use a bulb syringe
Mouth first then nose
optimal temp in newborn and where was it taken
97.7-99.5 axillary
What does cold stress do to the baby? 3
Hypoglycemia, respiratory distress, acidosis
Evaporation
Convection
Radiation
Conduction
E-Wet
C-lg surface area transfer heat to air
R-Heat goes to cooler things not in contact with babe
C- Heat loss goes to cooler things in contact with baby
Identification 2 things
Prints of both infants feet and one of mom right index finger
2 bands for baby 1 for mom and 1 for whoever she designates
What is a normal newborn Bloodsugar?
45
When to encourage Breastfeeding after birth?
With in 1 hr
Vital signs during transition?
q15mins
When Will vit k production happen on its own in a newborn? When will a babe not be at risk for vit k bleeding?
1 week 6-15 weeks
llotycin
Drops in eyes to prevent bacterial infection
llotycin
Drops in eyes to prevent bacterial infection
3 things to remember during nursing care on a newborn
Wash hands
nonsterile gloves until after birth
gloves for diaper changes
2 things about cord
remove cord clamp in about 24 hours
cord falls off in 7-10 days
2 things about babe and sleep
newborn sleeps about 15-20hrs a day
3-4 months sleeping on own
Weight loss in babe and when to be concerned
can lose 10 percent but we are worried at 7 percent
How often do we observe breast feeding?
At least once a shift
One thing that needs to be in formula
IRON
4 things that need to happen before a circumcision
void, vit k, after 24 hours, has not eaten in one hour
Gomco vs plastibell main difference
Plasti has a tie around it and will fall of and gomco needs to have dressings and vaseline
What does the nurse do at the beginning of anneuraxial admin
at bedside checking vitals every 3-5 mins
When does Hep b shot need to be given and one thing
With in 1st hour you need parental consent
Puerperium
The six week period when moms body is returning to normal
What does mom need to do before you assess the fundus post
pee
When should the size of the uterus return to normal?
6 weeks
Rubra serosa alba
r-first three days deep red with a few clots
serosa- day 4-10 pink brown
Alba 10-6 creamy white to light brown
What to know about the placenta site
Blood vessels compress to heal and can heal for 6 weeks
Peri bottle 3
Warm water each time they go to the bathroom blot dry until no discharge
What are tucks and dermoplast?
Tucks are medicated pads that decrease swelling and dermoplast is a numbing spray
When do you change moms pad?
after every void
Lab values postpartum in mom and time
Clotting factors
WBC
blood volume
Increased CF 2-3 weeks
Increased WBS 4-6 days
Blood volume normalizes by 4 weeks
Temp and postpartum and mom
Slightly elevates in first 24 hours and when milk comes in
HR in postpart mom
Bradycardic for 6-9 days
Late stages of Shock 3
Increased HR decreased BP and decreased urine output
When will ovulation return? mens? and one thing to remember
O not nursing 2-4 weeks o nursing- 6 months mens not nursing 7-9 weeks Maybe weaning if nursing ovulation occurs before mens
Oxytocin and prolactin
O- In charge of let down
P-in charge of producing milk
When does engorgement usually take place?
3-5 days
How many times to breastfeed in 24 hours
8
Rule of five in post part
5 days of life- 5 poops- 5pees
In breast feeding, which is more important duration or frequency
Frequency
Maternal role therapy and days
Taking in phase- days 1-3 dependency
Taking hold phase 3-10 control autonomy
Letting go phase- 10-14 adjustment to new role
Partner stages post pat
Expectation
reality
transition to mastery
LATCH
L = Latch -on= The infant's ability to latch correctly onto the breat A = Audible swallowing = The amount of audible swallowing noted T = Type of nipple = The mother's nipple type C= Comfort = The mother's confort H= Help/Holding = The position used by the mother and the amount of help she requires
