Postpartum And Newborn Flashcards
0
Q
Sub involution
definition
cause
treatment
A
When the process of uterine contractions does not take place as it should and it’s either prolonged or stops
Retained placental fragments, myomata, infection
Ergotrate or Methergine by mouth for two weeks then reevaluate in two weeks
1
Q
Endometritis
definition
symptoms
A
Postpartum inflammation of the endometrium
Fever to 104, tachycardia, chills, uterine tenderness extending laterally, pelvic pain with bimanual exam, subinvolution, scanty odorless lochia or malodorous seropurulent lochia, variable onset depending on the organism, GBS presents earlier with increased white blood count
2
Q
Kernicterus
Definition
signs and symptoms
A
A form of brain damage caused by excessive jaundice
Bilirubin is so high that it moves out of the blood and into the brain tissue
Excessive lethargy, high-pitched cry, decreased muscle tone with periods of increased tone, arching of head and back backwards, jaundiced in extremities, fever
3
Q
Additional therapy for thrombophlebitis that the midwife can provide
A
Maintaining strict bedrest, monitoring pedal pulses, applying moist heat to affected area
4
Q
Women are predisposed to UTIs postpartum because of:
A
Trauma to the trigone of the bladder
5
Q
Compared with mature breastmilk colostrum contains less:
A
Fat and carbohydrates
6
Q
Breast milk is produced in the:
A
Alveoli
7
Q
What birthweight is the established norm for a diagnosis of a large gestational age baby
A
4000 grams
Between 8 lbs. 13 oz. and 8 lbs. 14 oz.
8
Q
What would be the most helpful in confirming clinical suspicion of IU GR
A
To ultrasound measurements of abdominal circumference at least four weeks apart
9
Q
Failure of tissue perfusion caused by changes in the circulation that occur as a result a severe infection is called:
A
Septic shock
10
Q
Postpartum psychosis
A
Manic or depressive episodes of confusion or disorientation, delusional thinking, suicidal or infanticidal behaviors
Mothers with history of bipolar disorder have increased risk
11
Q
Postpartum blues
A
70% of women, begins 2 to 3 days postpartum, associated with hormonal swings, sleep deprivation, impending lactation
12
Q
Homan’s sign
A
Have the mother sit in bed with her legs straight, then gently press on her knee and dorsiflex her foot. She has pain in her calf the test is positive for thrombophlebitis
13
Q
2–0 chromic suture
A
External anal sphincter, cervical lacerations, lateral vaginal wall, and deep interrupted stitches of pelvic muscles
Muscle requires a stronger suture
14
Q
Hematoma
primary concern
treatment
A
Pooled blood readily permits the growth of bacteria, primary danger is infection
This could lead to breakdown of the repair, because surfaces will not adhere and close properly once sepsis develops
Immediately Refer to the physician, as antibiotic therapy should begin ASAP
15
Q
Hematoma
definition
cause
A
And asymmetrical and painful swelling in the perineal area
Caused by soft tissue trauma and second stage and a faulty repair job, where bleeding vessels continue to seep below the skin. The blood takes time to reabsorb
16
Q
How much water should a nursing mother drink daily ( to meet her own needs and produce sufficient breast milk)
A
3 quarts
17
Q
What time should the midwife refer to the pediatrician if the newborn has not had a bowel movement?
A
48 hours
18
Q
What is a normal temperature increase when the new mothers milk comes in?
A
101°
19
Q
Circumoral cyanosis refers to:
A
Bluish discoloration around the mouth
can indicate heart problems
20
Q
The newborns head is__the size of the body
A
1/4
21
Q
Acrocyanosis in the newborn
A
Usually temporary with rubbing of foot/hand, should pink up
22
Q
Beefy redness color in newborn
A
Normal for the first 24 hours
if prolonged polycythemia
23
Q
Harlequin color
A
Half body pink, half red or paler, normal variation
24
Stork bites
Smooth flat red marks on base of neck, eyelids, bridge of nose
Fades by two years
25
Erythema toxicum
Read spotty rash, fades naturally
26
Transient mottling of skin in newborn
Temperature, should not persist
27
Anterior fontanelle size and shape
Diamond shape, peripheral pulses, 2 1/2 to 4 cm length
28
Posterior fontanelle
| size and shape
1/2to 1 cm
| triangle
29
Fontanelles
depressed
bulging
Depressed =dehydration
| Bulging equals increased intracranial pressure or meningitis urgent
30
Epstein's pearls
| definition
Small white cysts along the hard palate
Normal
Will resolve with sucking
31
Newborn lungs
| Common variations
Momentary apneic spells, should not last longer than 15 seconds
Rales and rhonchi shortly after birth
Rate up to 80 within the first half an hour
32
Transient tachypnea of newborn
Very rapid respiration rate 80 to 120 usually during first 24 hours
Use o2, BF
If not resolved and baby unable to eat in reasonable amount out of time, TP
33
What percent of newborn heart murmurs are normal?
90%
34
Hypospadias
Urethral opening on the lower side of penis
| corrective surgery at three months
35
Newborn femoral pulses
Right above hip crease
Check both at once. Should be strong and equal
Weak could be a congenital heart defect
If uneven contact pediatrician, coarctation of the aorta
36
Tonic neck reflex
Turn babies head to one side, extremities on same side straighten and on opposite side flex
Fencing position
37
Babinski reflex
Stroking foot upward, toes hyperextend
38
Lanugo in the newborn
term
preterm
postterm
Term: thinning over lower back
Preterm: covered over body no lanugo thinning with some parts still covered
Postterm: half back devoid of lanugo
39
Esophageal atresia
Definition
symptoms
Serious birthday defect in which the esophagus is segmented and closed off at any point
Usually occurs with TEF, unlikely to survive without surgery
Signs and symptoms; excessive drooling, and immediately regurgitate after eating, choking, coughing, aspirations, pneumonia
40
Which assessment finding indicates that phototherapy has been effective for the neonate
Elimination of green urine and greenish loose stools
41
What umbilical cord stump finding is considered normal at three days postpartum
Dryness and atrophy at the stump
42
Which muscle would not be cut in the midline episiotomy
Pubococcygeus
43
What is the main significance of lobulated and succenturiate placentas?
Placenta lobes may be retained and not expelled with the rest of the placenta
44
What is the last step of manual removal of the placenta
Administration of oxytocin
45
A sulcus is which of the following types of laceration?
Second-degree
46
Which hormone stimulates and maintains milk production after childbirth?
Prolactin
47
Shock patients are often thirsty
| true or false
True
48
After shoulder dystocia, once the baby is out you should be prepared for
1.
2.
3.
Hemorrhage
full resuscitation
maternal sepsis
49
A temperature rise may occur up to 24 hours after birth as a result of dehydration or exertion associated with labor
true or false
True
50
Late postpartum hemorrhage can occur in the fourth week following delivery
two or false
True
51
Birth of the head occurs through which of the following mechanisms for an OP delivery?
Flexion then extension
52
Newborn exam on a three week old baby, reflexes (one or more) of the reflex are not present and they were at birth what is the most appropriate response?
Note it as an alarming variation from normal that merits immediate attention by a pediatrician
53
At which of the following times is maternal cardiac output highest?
Immediately postpartum
54
How soon after full-term delivery can a woman who is not breast-feeding safely start taking combined oral contraceptives?
three weeks
55
About how many times should a healthy, well hydrated infant void during a 24 hour time period?
Six times
56
What woman is the most likely to suffer from mastitis?
A breast-feeding woman more than a week postpartum
57
Positive pressure ventilation of the newborn she continue until?
There are spontaneous respirations
58
In what days surrounding childbirth is it most likely the maternal Varcella infection will be passed to the newborn?
Day six before birth to day 2 afterbirth
59
How long after birth just complete regeneration of the endometrium at the placental site take?
6weeks
60
Sign of intracranial trauma and the newborn
Bulging anterior fontanels
61
Ductus arteriosis
| definition
A short broad vessel in the fetus that connects the pulmonary artery with the aorta and conducts most of the blood directly from the right ventricle to the aorta bypassing the lungs
62
Foramen ovale
definition
when/why does it close
Most oxygenated fetalblood bypasses the lungs and instead flows through the opening between the right and left atria called the Foramen ovale
With the newborns first breasts the combo of pressure that is increasing in the systemic circulation causes increase in the pressure of blood flow to the heart. The pressure from increased blood flow into the left side of the heart causes the foreman ovale to shut
63
What does sunlight do for excess bilirubin?
Helps the liver conjugate and eliminate
64
Neonatal infection
| signs and symptoms
Lethargy-especially if mother had signs and symptoms of infection during labor
irritability, jitteriness,
fever- Chorioamnionitis, GBS plus post partum infection
dehydration, tachypnea, cyanosis
65
Lochia Alba
Starts 10 days postpartum resolves over a period of 2 to 4 weeks
Creamy white
Consists of leukocytes and decidual cells
Scant amount
66
Lochia serosa
Paler than rubra. Serous and pink
Days 3 to 10 or 12 days postpartum
Contain serous fluid, decidual tissue, leukocytes, erythrocytes
Small amount
67
Lochia rubra
Contains blood, decidual tissue
Immediately after delivery continues for 2 to 3 days postpartum
Heavy to moderate amount
68
Newborn weight in grams
SGA
AGA
LGA
SGA up to 2500 g
AGA 3,000 to 3,500 g
LGA 4,000 g
69
Velamentous cord insertion
The three vessels attached to the placenta via the membranes rather than staying in the cord. Not protected by Wharton's jelly.
70
Three stages of transition of newborn
First period of reactivity birth to first 30 minutes
Period of unresponsive sleep 30 minutes to two hours
Second period of reactivity two hours to six hours
71
Recognizing failure to thrive
Poor weight gain, lethargy, poor feedings, behind on developmental milestones
72
How many cotyledons are there in a healthy term placenta
15 to 20
73
Caput
```
"does not stay put"
Collection of fluid causing swelling of scalp at birth, trauma
Reabsorbed in 12 hours
can cross suture line
appear shortly after birth
```
74
Cephalohematoma
Collection of blood between cranial bone and periosteal membrane
Does not cross suture lines
Appears 1 to 2 days, disappears 2 to 3 weeks or months
Bruising under the skin
75
Most appropriate management for retained placental membranes
Methergine to achieve rapid expulsion of the retained fragments
76
What is the most appropriate management of placenta accreta?
Contact the physician and prepare the woman for immediate surgery
77
Following birth a woman's bowels tend to be sluggish due to
1.
2.
Dehydration from the birth
| effects of progesterone and decreased abdominal muscle
78
Why does the umbilical cord evulse with minimal pressure after the birth or while waiting for the placenta
Velamentous insertion
infection in womb
prematurity
fetal death
79
Percent of diabetic mothers that give birth to LGA babies
40%
80
What factors can increase the incidence of jaundice?
```
Pitocin
IV during labor
vitamin K
Cephalohematoma
liver malfunction
neonatal infection
ABO incompatibility
```
81
Kernicterus
| Lab values
Over 20 for unconjugated bilirubin
82
Newborn reflexes should be present through
The first three months
83
Sepsis in the newborn
| symptoms
Lethargy, irritability, jitteriness, fever, dehydration, tachypnea cyanosis
84
When does the cervix completely close afterbirth?
The external os has assumed it's nonpregnant form by the fourth week postpartum
85
Judging hematocrit by blood loss
Two percentage points is roughly equivalent to a unit 500 mL of blood loss
86
Continuous stitching
| when used
Closure of the subcutaneous layer
87
Continuous mattress stitch
| when used
Subcuticular closure of an episiotomy or perineal laceration
88
Three associations of SGA babies
Mental retardation, visual and hearing defects, poor infant growth and development
89
What can an elevated pulse or temperature indicate postpartum in the mother
1-5
Dehydration, UTI, uterine infection, breastmilk coming, hematoma
90
Hypoglycemia
normal range
when to refer
risk factors
50 to 60 is normal for a newborn
below 30 is of serious concern
Infants at risk
LGA, SGA, premature, postmature, those with diabetic mothers,
Otherwise healthy babies who suffered hypoxia during labor or were depressed at birth
91
Describe IUGR
| Asymmetrical
Normal head circumference
| With decreased weight and decreased body length
92
Deep thrombophlebitis
symptoms
treatment
High fever, severe pain, edema, tenderness along the entire length of the leg
Stay in bed, keep the leg elevated contact a physician immediately
93
Uterine infection postpartum
puerperal infection or Endometritis
risk factors
symptoms
Anemia, compromised immune system, premature rupture of membranes, many vaginal exams in labor, maternal exhaustion, delayed placental delivery, hemorrhage, uterine exploration, postpartum dehydration, improper perineal hygiene
Fever over 101, elevated pulse, pelvic pain, subinvolution of the uterus
94
Newborn general measurements
| head chest abdomen weight length
```
Head 12 1/2 to 14 1/2 inches
Chest 11 1/2 to 14 inches
Abdomen in line with umbilicus
Wait 5.8 to 8.13 pound
Length 18 to 22 inches
```
95
How long does it normally take for the newborns temperature to stabilize
8 to 12 hours
96
Findings in placenta previa
```
Onset: quiet and sneaky
bleeding: external
color of blood: bright red
anemia: =blood loss
Shock: = blood loss
Toxemia:absent
Pain: only contraction
Uterine tenderness: absent
Uterine tone: soft and relaxed
Uterine contour: normal
Fetal heart tones: usually present
Engagement: absent
Presentation: May be abnormal
```
97
Findings in placental abruption
```
Onset: sudden and stormy
Bleeding: external and/or concealed
Color of blood: dark Venous
Anemia: larger apparent blood loss
Shock: larger apparent blood loss
Toxemia: May be present
Pain: severe and steady
Uterine tenderness: present
Uterine tone: firm to stony hard
Uterine contour: May enlarge and change shape
Fetal heart tones: present or absent
Engagement: May be present
Presentation: zero relationship
```
98
Conditions under which fetal asphyxia is likely:
Cord prolapse, placenta previa, abruptio placentae, cord compression, fetal isoimmunization, placental insufficiency, maternal vascular disease, maternal hypotension, uterine overstimulation
99
Signs of normal newborn transition
Tone: flexed
sucking reflex: intact
behavior: alertness alternating with sleep
Bowel sounds: present after 30 minutes
Heart rate: 120 to 160, 100 to 180 with sleep or crying
Respirations 30 to 60, diaphragmatic with abdominal movement
Temperature: 97.7 to 98.6 axillary 96.8 to 97.7 skin
100
Puerperal infection
| definition
A bacterial infection originating from the reproductive track during labor or the puerperim
Historically known as childbed fever
Still responsible for a significant percent of puerperal morbidity
101
What is the most frequent reason for seizures in the neonatal period
Hypoxic ischemic encephalopathy
102
Bulbocavernosus muscle
Arise in the perineum, pass around the vagina and embed in the clitoris
103
The pelvic floor
| superficial muscle layer
Smaller than Levatol ani, but important in maintaining the overall strength of the pelvic floor
Includes:ishiocavernosus muscles
Bulbocavernosus muscles
Transverse perineal muscles
104
The pelvic floor
| deep muscle layer
More important of the two muscle layers
directly supports the vagina
indirectly supports the uterus
collectively known as the levator ani muscles
105
What is the leading cause of perinatal mortality and morbidity as it accounts for 75% of all perinatal deaths and up to 50% of the neurological handicaps found in infancy?
Preterm labor
106
Any woman had one preterm birth in the past pregnancy, has ___ percent risk of reoccurrence
20 to 40%
107
Define puerperal morbidity
A fever of 100.4- the temp to occur on any two of the first 10 days postpartum except for first 24 hours and to be taken PO at least four times a day
Morbidity may be caused by infections and conditions other than puerperal infection- such as dehydration, UTI, upper respiratory infection, and mastitis
108
Transient tachypneaof the newborn
| TTN
Inadequate absorption of lung fluid after the birth
signs and symptoms: tachypnea, rales or rhonchi, nasal flaring, intercostal retractions
Only last 48 to 72 hours, newborns may need assistance with feedings and extra 02
109
Levels of uterine involution postpartum
Immediately after delivery: 2/3 to 3/4 of the way between pubis and umbilicus
Day of delivery and day one: at umbilicus
Day 2 to 10: gradually descends
Day 10+: nonpalpable above the symphysis pubis
110
Crown stitch
when used
purpose
To reunite the cut bulbocavernosus muscle
To reduce gaping of the vagina introitus and to facilitate the return of good muscle tone by deliberate approximation of this muscle
Facilitates enjoyable sex
111
Treatment for colic
Massage and warm compresses on belly
chiropractic/craniosacral therapy
fennel, Caraway, chamomile, gripe water
112
Newborn appearance
| recognize glucose disorders
If chest is the same or larger than the head, and the baby is over 9 pounds the mother may have some degree of glucose intolerance and the baby should be checked for hypoglycemia
jittery
Lethargic
113
Newborn appearance
| recognize polycythemia
SGA
LGA
beefy redness color, prolonged (normal in first 24 hours)
check hematocrit and refer to pediatrician
114
Postpartum trickle bleed
| response
```
Assess origin
assess fundal height and uterine size
fundal massage
assess vital signs
BF or nipple stem
express clots
nonallopathic treatment
```
115
What inhibits ovulation during breast-feeding
The hormone prolactin
116
What is the most appropriate time to cut an episiotomy in relation to contractions
As the contraction ends, position two fingers inside the perineum to protect the head, insert scissors between them and as the next contraction brings the head forward, cut straight down about a half to 1 inch
Give counterpressure and support the wound to prevent any extension
117
A woman's vitals should be monitored how often during the normal fourth stage of labor
At least every 15 minutes until stable at prelabor levels
118
To elicit the plantar reflex you should:
Press the ball of the newborn's foot
119
What is the most likely cause of asymmetrical IUGR?
Uteroplacental insufficiency
120
Ortolani's sign
| definition
A test of hip laxity used, to diagnose hip dysplasia
A positive sign is a snap as the head of the femur moves back into the acetabulum after being moved to the rim of the acetabulum
121
Direct Coombs' test versus indirect Coombs test
Direct: for newborn (direct anti-globulin test)
Indirect: for mom
antibody screen
122
What does it mean if the neonates wrists and ankles looks cracked and wrinkly
Baby is dehydrated needs to nurse more often
123
Ways to facilitate perineal wound healing postpartum:
Diet high in protein and vitamin C
perineal cleanliness
warm sitz bath
these actions are aimed at: infection prevention, provision of tissue building and healing, increased circulation to the area
124
Treatment for a plugged breast duct
Apply warm moist heat to area before and during feedings
feed first from the sore breast
Press from behind the sore area toward the nipple during feedings massage breasts while showering
Change nursing positions to change pressure from babies mouth check fit of bra and baby carrier
125
Care of uncircumcised penis
Regular bathing will keep the area clean
| do not try to pull back the foreskin
126
Rectocele
Bulging at the lower (vulvar) end of the posterior vaginal wall by bulging upward into the vagina and outward toward the introitus
First, second, third degree
Ask the woman if she has difficulty with bowel elimination
127
Treatment of thrush
Dry nipples after nursing
wash hands
nonallopathic topical acidophilus swabs three times a day gentian violet and calendula
allopathic antifungal nipple cream
128
Care of cradle cap
Apply a natural oil to the scalp before bed and leave it on all night
the scales can then be removed with a soft toothbrush and natural shampoo
129
A condition in the newborn that is commonly associated with Polyhydramnios is:
Urinary problems
130
Interrupted stitches
| when used
For deep muscle repair
131
Blanket stitch
| when used
Closing the vaginal mucosa
132
Levator ani muscles
definition
main groups
They are attached anteriorly to the pubic bone laterally to the ischial spines and posteriorly to the coccyx and sacrum
Three main muscle groups make up levator ani
Pubococcygeus muscle
Iliococcygeus muscle
Ishiococcygeus muscle
133
Pubococcygeus muscles
Extend from inner aspect of pubic bone to the coccyx
three main bands
surrounds urethra
surrounds vagina, vaginal walls, perineum
surrounds anus into anal canal
most vital of deep muscles supports urethra, lower one third of vagina and rectum
134
During the newborn exam the midwife would expect the chest circumference to be_____ related to the head circumference
1inch smaller
135
```
Cystocele
identification
first-degree
second-degree
third-degree
```
Evidence by bulging of the anterior vaginal wall. Nearly every woman who has born a child has first-degree
First-degree: bulging of anterior vaginal wall
Second degree: bulging reaches The vaginal orifice, without stress incontinence/sexual problems, it is considered asymptomatic
Third-degree: bulging extends beyond the introitus requires physician consultation for possible surgical repair
136
What muscle group is the most likely to be damaged during birth
The perineal body
137
External sphincter of the urethra
Arises and embeds in the pubic bone, having passed above and below the urethra
138
Regardless of whether the postpartum woman has received RhoGAM during pregnancy, any postpartum woman who meets the following criteria or should receive RhoGAM:
She is Rh negative
she is not sensitized to Rh D antibodies based on a current screen
the infant is Rh+
that infant had a negative Coombs test
139
Perineal body
| definition
Muscles and connective tissue situated between the vaginal and rectal canals
Triangular with the base being the skin lying between the vaginal and anal orifices, and the apex the point where the vagina and rectum are in close proximity. Each side of the triangle is 3.5 to 4 cm long
140
Breast milk culture
| when and why
Culture may be done in the cases of stubborn breast infections that are recurrent, don't respond to the usual nonallopathic remedies, or in cases that the milk is lumpy, chunky, discolored or foul-smelling
141
Physiologic jaundice
| definition
Wollin you to Rosa, the babies need for O2 is often met by a high percentage of red blood cells in it's bloodstream, higher than in most adults. Once the baby is born and breathing, it no longer needs all the red cells, so the excess are broken down for illumination. A byproduct of the breakdown is billirubin which imparts a yellow tinge to the baby skin.
Manifests on the second to third day
142
Jaundice from ABO incompatibility
| Definition
If blood from an O type mother transfers to her A or B type baby during the birth, the baby will have more trouble illuminating excess red blood cells and so will have excess billirubin
143
4.0 chromic suture
For repair of anterior rectal wall, clitoral laceration
delicate areas
very fine suture
144
3.0 chromic suture
Repair of vaginal mucosa, subcutaneous stitches, subcuticular stitches, periurethral lacerations
145
What size suture is used to repair cervical laceration
20 chromic strongest suture for muscle
146
Ishiocavernosus muscles
Extend from each ischial tuberosity to the clitoris
147
Ishiococcygeus muscles
Arise from the ischial spines and pass to the lower sacrum and upper coccyx
these muscles help support the sacroiliac and sacrococcygeal joints of the pelvis
148
External anal sphincter
Surrounds the anal orifice, with some fibers extending back through the perineal body to attach to the coccyx
149
Perineal body
| function
To assist in the process of birth and defecation
| maybe torn during birth and need suturing
150
Iliococcygeus muscles
Extends from the inner aspect of the iliac bone, and fibers from each side meet in the middle in the perineum, before extending into the coccyx
151
Average total amount of lochial discharge ____ ounces
8 to 9 ounces
152
Postpartum sudden reoccurrence of bright red bleeding
Not a normal finding requires evaluation
| Causes: excessive physical activity, retained placental/membranous product, uterine atony
153
In shock, a person's pulse: and the respirations?
Rises
| rise
154
In shock a person's blood pressure:
Rises then falls
155
As the blood pressure falls, the perfusion of vital organs falls with it; the best indication of whether the brain is being adequately perfused is the:
Level of consciousness
156
if there is arterial bleeding the blood will:
Spurt
157
Defined the fourth stage of labor
The period beginning with the birth of the placenta and ending one hour later
158
Breastmilk jaundice
| definition
Non-threatening condition caused by a hormone in the mothers milk that can interfere with the babies ability to process billirubin. It manifests after the milk comes in
159
Perineal body
| consists of
Place where many of the muscles of the pelvic floor join
consists of
one layer of skin that the base
bulbocavernosus and transverse perinei of the superficial muscles
the pubococcygeus of the deep muscles
160
Transverse perineal muscle
Extend from the ischial tuberosities to the perineum, where they intermingle with the muscles of the perineal body
161
Postpartum if the mother complains of chronic fatigue, nervous irritability, or upper respiratory infection prescribe______
More protein, more calories, good sources of vitamins B and C, and trace mineral supplements
162
Symptoms of hypoglycemia in the newborn
| risks
```
Apathy
irregular respirations
inability to regulate body temperature
refusal to nurse
irritability
tremors
CNS damage can result if levels are insufficient. Consulting physician is levels dip below 45
```
163
Separation of symphysis pubis
| management
A wide lateral stance must be avoided for 2 to 3 months
| if the condition does not gradually improve improve refer care
164
Meconium aspiration syndrome
| signs and symptoms
Uneven breath sounds
barrel chested appearance
rails and rhonchi
cyanosis
165
Hematoma
| risk factors
Unrepaired laceration of a blood vessel
rough handling of tissues
operative delivery
causes extreme pain
166
Hematoma
| Management
Small and moderate sized hematoma may be spontaneously absorbed
if the hematoma continues to enlarge, the midwife should notify physician
there may be a need for surgical intervention, blood replacement, antibiotics
vulvar are most obvious
vagunal are generally identifiable with care inspection
167
Iron supplementation
low dose
how taken
Low dose: 20 mg/day, from week 20 to birth
Taken by mouth best when taken with vitamin C as this enhances absorption and should not be taken with calcium this decreases absorption
168
What substances can be used to relieve postpartum cramping
```
Ibuprofen
acetaminophen
Blackhaw
Comfort measures: heat, pressure on uterus
Motherwort tincture
```
169
Predisposing factors to puerperal infection
Prolonged labor, prolonged rupture of membranes, lots of vaginal exams, poor aseptic technique, poor handwashing, intrauterine manipulation, extensive tissue trauma, hematoma, hemorrhage greater than 1000 mL, operative delivery, C-section, retention of placental fragments and membranes, improper perineal care, untreated vaginal/cervical infection or STD
170
Organism in puerperal infection come from three sources
Those that normally exist in the lower genital tract or in the bowel infections of the lower genital tract
bacteria that are in the nasopharynx or on the hands of the attending personnel or in the air and dust of the environment
171
Treatment for an infected episiotomy or laceration
First removing the sutures, opening the debriding and clearing the wound, and administering a broad spectrum antibiotic, resuturing the laceration
172
Signs and symptoms of infected episiotomy, lacerations, or other trauma:
Localized pain, dysuria, low-grade temp seldom above 101, edema, red and inflamed repair edges, oozing or pus, separation or dehiscence
173
Signs and symptoms of Endometritis
Persistently elevated fever to 104, tachycardia, chills with severe infection, uterine tenderness extending laterally, pelvic pain with bymanual exam, sub involution, scanty, odorless lochia, or malodorous lochia, variable onset depended on organism, GBS early, elevated white blood count
174
Parametritis
Bacterial infection of parametrium
Extension of infection via the blood vessels and lymphatics from a primary wound infection in the external genitalia , perineum, vagina,cervix, or uterus
175
Parametritis
s/s
Treatment
Fever, uterine sub involution, chills, sweats, abdominal pain that spreads laterally, and if untreated, the formation of a large abscess and signs of peritonitis, it occurs btw the 3-9th day
Antibiotics, bed rest, IV fluids, and drainage of any abscess
Possibly oxytocics to augment involution
176
Peritonitis
Def
s/s
Sepsis that affects not only the uterus, but the pelvic ligaments, connective tissue, and the Peritoneal cavity from untreated uterine sepsis
Acute onset of severe steady pain in abdomen, pain worsened by movement or pressure on abdomen. Board like rigidity of abdomen, swollen, bloated, chills and fever, profuse sweating, and N & V, weakness, pale cold skin and shock
177
Peritonitis
Diagnosis
Treatment
Diagnosis based on exam in which the abdomen is tender to the touch. Abdomen is also rigid, usually bowel sounds are absent
Treatment: massive antibiotic therapy, nothing by mouth, analgesics, surgery may be needed
178
Superficial thrombophlebitis
```
Leg pain
localized heat
tenderness
inflammation at site
palpation of a knot/cord
```
179
Deep venous thrombophlebitis
| signs and symptoms
Possible temp elevation
mild tachycardia
abrupt onset of severe leg pain worsening with motion or when standing
edema of ankle, leg, and thigh
positive Homan's sign
pain with calf pressure
tenderness along the entire course of that involved vessel and palpable cord
180
Treatment for thrombophlebitis
```
Bed rest
elevation of extremity
hot packs
elastic stockings
analgesia if needed
referral for antibiotics anticoagulant
no massaging
```
181
Which organism is the most common cause of mastitis
Staph aureus
182
` Course of healing of the vagina perineum from birth and on
Immediately after delivery of the vagina remains stretched open, may have edema and bruising
1 to 2 days postpartum it regains enough tone that it does not gate open, is now smooth walled and generally lax
Size decreases with the return of the vaginal rugae by approximately three weeks postpartum
183
Mastitis
cause
Prevention
Non infective may result from plugged ducts
Infective is associated with nipples fissure or other trauma creating an entryway. The most common organism is staff aureus
Ensure adequate drainage of the breast, continued on demand breast-feeding
Avoid milk back up and open wounds on nipples/areolas
184
After delivery, A cardiac patient should not breast-feed if she is
Receiving warfavin Coumadin therapy
185
Battledore placenta
The umbilical cord inserts in the edge or margin of the placenta
186
A condition caused by failure of the uterine muscle to stay contracted after delivery is
Uterine atony
187
Average weight loss following delivery
Women lose an average of 12 lbs at the time of delivery
Represents weight a baby, placenta, amniotic fluid
Another 5 pounds maybe lost during the first week postpartum as a result of fluid loss
188
Maternal mortality refers to death attributed to complications of pregnancy per ______women
100,000
189
Rubella vaccine
| Timing
Women should have dependable birth control for three months after vaccine to prevent CRS
190
Wound healing
| three phases
Inflammation
proliferation
maturation
191
Amniotic fluid embolism
| symptoms
```
Usually during hard labor
gasping for air
drop in blood pressure
depressed cardiac function
hypoxia
seizures
DIC
```
192
For non-breast-feeding women menstruation typically resumes in
8-12 weeks
193
When does the bladder, urethra, rectum return to normal function postpartum
Immediate postpartum the bladder is edematous, congested and hypertonic which may result in over distention, incomplete emptying
Urethra maybe sensitive as a result of prolonged labor with the fetal head in the pelvis
Unless a woman develops a UTI, the effects of labor on the bladder and urethra diminish in the first 24 hours postpartum
194
Immediate postpartum
| respirations
Resolves to the woman's normal range during the first hours postpartum
SOB, rapid respiration or other changes warrant valuation for conditions ranging from fluid overload to an asthma exacerbation to pulmonary embolism
195
Immediate postpartum
| pulse
```
Resolves over the first few hours postpartum to its normal level
Affects the normal decrease:
hemorrhage
fever during labor
acute/persistent pain
```
196
Pulmonary embolism
| Signs and symptoms
```
Tachypnea
Dyspnea
sharp chest pain of sudden onset
altered lung/heart sounds
apprehension as the woman's blood O2 level decreases
```
urgent physician a valuation
197
Mastitis
| signs and symptoms
```
Severe engorgement
flu like symptoms
rapid increase of temp up to 103/104
increased pulse
chills
general malaise
painful swollen and inflamed hard area of the breast
```
198
Broad ligament hematoma
```
Lateral uterine pain sensitivity to
Extension of pain into the flank
Painful swelling with high rectal exam
Ridge of tissue just above the pelvic brim extending
Abdominal distention
Contact physician
```
199
Care of circumcised penis
Vaseline gauze covered for 24 hours
| Watch for bleeding, inability to urinate, or swelling
200
The new Ballard scale
| newborn maturity
Assessed neuromuscular activity and physical maturity
Can date newborns of gestational age as low as 20 weeks
Accurate within a range of two weeks
Newborn is either: preterm, term or postterm
201
Normal range of newborn respirations is ___ to ___ 1 min
30-60
202
In CPR for the newborn, you should compress the heart ____ timed per min
90
203
Square window, popliteal angle, and scarf sign are all tests that refer to
Neurological maturity
204
During phototherapy for neonatal jaundice, the midwife should cover up ____ and _____ on a baby boy and also ___________
Eyes and genitals
| Turn him frequently
205
Mongolian spots
More common with darker skin pigmentation
usually over sacrum
fade by two years
206
Petechiae in NB
Pinpoint, flat, round, red spots
| clears in first weeks
207
Milia
Blocked sebaceous glands on face
| Clears in first month
208
The first period of newborn reactivity is
First 30 minutes after the birth
209
When is maternal to infant (vertical) transmission of HIV most likely to happen
Labor and delivery
210
Gastroschisis
Intestines on the outside of the body
| newborn most at risk for dehydration
211
What percent of infants born with only one umbilical artery will have multiple, severe malformations
30%
212
What is the effect on the newborns cardiovascular system of clamping of the umbilical cord
Interesting systemic vascular resistance
213
The effects of cold stress on the newborn
Metabolic acidosis
pulmonary vasoconstriction
hypoglycemia
214
Which is most directly responsible for closure of the Foramen ovale
Increased pressure in the left atrium
215
Delee
| Steps
Check that the lid is screwed on tight
insert tubing 4 1/2 inches into babies mouth
withdraw slowly while sucking sharply and repeatedly
216
Normal weight gain in the newborn is between______ and _____ oz. per week
Four and eight
217
Desquemation
Peeling skin
218
An abnormal inability to retract foreskin
Phimosis
219
What is the largest diameter of the fetal head
Occipitomental
220
Breast-feeding and HIV
HIV can be transmitted through breastmilk about 15% rate
Mother can start breast-feeding or bottlefeeding, but cannot start bottlefeeding and then switch to breast-feeding
Formula creates microfissures. in the intestines, making the baby more susceptible to infection if then exposed breast milk
221
What is the function of surfactant in the lungs of the newborn
Reducing the pressure needed for respiration by stabilizing the walls of the alveoli
222
Newborn ears
| normal findings
A direct horizontal line with the eye and top of the ear
223
Newborn female genitalia
| common findings
```
Swelling of labia and clitoris
majora should be covering minora at full-term
hymenal tag
urethral meatus just below clitoris
Vernix between labia
```
224
Newborn male
| Common findings
```
Urethral opening at tip of penis
testes palpable on both sides
scrotum large, edematous, pendulous
deeply pigmented in non-Caucasians
Rugae
```
225
Newborn extremities
| usual finding
10 fingers 10 toes
full ROM
nailbeds pink
crease on anterior two thirds soles of feet
symmetry of crease on back of legs and hips
bilaterally equal muscle tone
226
Popliteal angle
Preterm
term
postterm
```
Thigh held in the knee chest position
knee will naturally bend
leg extended toward head
Pre180 degrees
Term 130
Post 90
```
227
Scarf sign
Pre
Term
post
NB hand, try to put towards back of neck on opposite side of the baby
where does elbow lineup with newborns midline
Pre- elbows across midline
Term- elbow at midline
Post-elbow does not reach, closer to arm being flexed
228
Which reaction would indicate possible esophageal atresia in the neonate?
a baby ingesting colostrum
Choking
229
At what age should a newborn receive her initial dose of the dtap vaccine
Two months
230
Baby boy is undergoing phototherapy for jaundice, covering the genitals prevents
Priapism-sustained painful erection
231
In a neonatal with erythoblastosis fetalis, it is known that the disease results from
Destruction of red blood cells
232
Unequal bilateral femoral pulses in the neonate typically indicates
Coarctation of the aorta
233
To assess the integrity of the neonate spinal nerves the midwife should attempt to elicit the
Crossed extension reflex
234
Breast milk while feeding a term infant who is 2 weeks old typically looks
Bluish white and thin
