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Nur 128 > Postpartum Exams > Flashcards

Postpartum Exams Flashcards

1
Q

Newborn Exam

A

Posture
Skin
Head
Face
Eyes
Nose
Mouth
Ears
Neck
Chest
Abdomen
Male Genitals
Female Genitals
Upper extremities
Lower extremities
Back
Anus

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2
Q

Vital Signs

A

Temp = 36.5- 37.5
Pulse = 110-160
RR = 30-60bpm
BP = (60-80)/(40-50)

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3
Q

NB - posture

A

Normal = flexed, symmetric movement

Abnormal = flaccid, hypertonic, asymmetric movement

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4
Q

NB Skin

A

normal = pink, acrocyanosis, milia, lanugo, vernix caseosa, erythema toxicum, cafe au lait spots, blue nevus, port wine stain, strawberry hemangioma, stork bite

Abnormal = cyanosis (circumoral or central), jaundice, pallor, mottling, harlequin sign

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5
Q

NB Head

A

Normal = fontanels are soft and flat, suture lines, caput succedanum, molding
Measure the head! should be 2cm larger than the chest.
reflexes : blink, suck, rooting reflex, and the fencer’s pose, startle reflex (dropped down & loud noise)

Abnormal = cephalohematoma, bulging or sunken fontanels

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6
Q

NB Face

A

Normal = symmetric size, shape, and movement

Abnormal = asymmetry; check over the bony prominence or in the eyes for jaundice.

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7
Q

NB eyes

A

Normal = symmetric size and shape, clear sclera, blue-gray iris, PERLLA, transient crossed eyes

Abnormal = conjunctivitis, hemorrhage, tears present

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8
Q

NB Nose

A

Normal = nose breather
Abnormal = nose flaring

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9
Q

NB Mouth

A

Normal = pink, moist lips and mucous membranes; tongue is movable; hard and soft palate are intact; epstein pearls

Abnormal = cleft palate, thrush, protruding tongue, circumoral cyanosis.

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10
Q

NB Ears

A

normal = firm pinna, quick recoil. The top of the ear / pinna should be above the top of the eye.

Abnormal = low set ears, tags, hearing loss

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11
Q

NB neck

A

Normal = short, creased, moves freely
Abnormal = webbing

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12
Q

NB chest

A

Normal = barrell shaped, symmetrical, breast engorgement (sometimes some discharge = witch’s milk, caused by withdrawal of hormones)
HR –> 1 minute; 110-160 bpm; murmur is normal right after birth
measure the chest! Head should be up to 2cm larger than the chest.

Abnormal = respiratory distress, retractions, grunting, clavicular fracture (crepitus or a click as we palpate, or the baby’s arm doesn’t move symmetrically)

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13
Q

NB Abdomen

A

Normal = round, soft, 3 vessel cord, bowel sounds present

Abnormal = absent bowel sounds, distended abdomen

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14
Q

NB Male Genitals

A

Normal = meatus centered, testes descended

Abnormal = undescended testes, hypospadias, phimosis, hydrocele

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15
Q

NB Female Fenitals

A

normal = swollen labia at term, mucus discharge, pseudomenses

abnormal = vaginal tag

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16
Q

NB Upper extremities

A

Normal = full range of motion, symmetrical motion (look for a broken clavicle)

Abnormal = asymmetrical movement or Erb’s palsy

17
Q

NB Lower Extremities

A

Normal = full range of motion, symmetrical leg length and gluteal folds, negative Barlow and Ortolani maneuver

Abnormal = club foot, uneven movement, leg length, or gluteal folds, positive Barlow or Ortolani’s maneuver.

18
Q

NB Back

A

normal = spine is intact and flexible

Abnormal = Pilonidal dimple, tuft of hair (suggests spina bifida)

19
Q

NB Anus

A

Normal = patent, passes meconium in the first 24 hours.

20
Q

Mother Assessment

A

BUBBLE EAR
B –> Breasts
U = Uterus / abdomen
B = Bowel
B = Bladder
L = Lochia
E = Episiotomy / Laceration / perineum

E = Extremities (mild edema)
A = attachment / emotions
R = Rubella / Rhogam

21
Q

Mother - Breasts (Lactating)

A

Normal = soft/filling, nipples erect and intact, colostrum present.

Teaching = benefits of breastfeeding, frequency (10-12/24 hours), positions and latch techniques, add 500 calories to prepregnancy diet, offer lactation consultation.

Report = flat/inverted nipples, nipple trauma, engorgement, unable to feed.

22
Q

Mother - Breasts (non-lactating)

A

Normal = soft/filling

Teach = wear a sports bra, avoid breast stimulation, ice packs/analgesics for comfort, signs of mastitis.

Abnormal= signs of mastitis

23
Q

Uterus / Abdomen

A

Normal = firm fundus, midline, at or below the umbilicus.
for C section - clean, dry intact, REEDA

Teaching = uterine involution is promoted with breastfeeding, voiding, and fundal massage. Fundus descends 1cm per day and returns to the pelvis by day 10.

Abnormal = Boggy uterus, excessive bleeding, multiple clots, displaced uterus, uterine tenderness, fever, malaise, chills, foul smelling lochia

24
Q

Mother - Bowel

A

Normal = abdomen is soft, non-distended, flatus and bowel sounds are present.

Teaching = encourage early ambulation, high fiber diet, fluids, stool softeners prn

Abnormal = distended abdomen, reduced bowel sounds, no flatus

25
Q

Mother - Bladder

A

Normal = bladder should be nonpalpable. Voids within 6 hours after birth (at least 150mL/void)

Teaching = at least 3000mL/day, night sweats. Signs of a UTI.

Abnormal = inability to void.

26
Q

Mother - Lochia

A

Normal = scant to moderate amount of lochia.
Rubra: dark red, days 1-3
Serosa: pink, day 3-10
Alba: yellow, after day 10

Teaching: involution process, uterine massage, and return of menses.
Nonlactatin is at 6-8 weeks
Lactating: amenorrhea while exclusively breastfeeding

Abnormal = excessive bleeding, saturating one pad in less than one hour, constant trickle of lochia or large clots, lochia with foul odor.

27
Q

Episiotomy / laceration / perineum

A

Normal = perineum with mild edema or bruising; episiotomy or laceration should be in tact.

Teaching = peri bottle use for pericare, ice packs, tucks/sprays or sitz bath use for discomfort and hemorrhoid care, kegel exercises to strengthem the perineal muscles; avoid sex and tampons until lochia has ceased and the perineum has healed (4-6 weeks)

Abnormal = hematomas, excessive edema, episiotomy or laceration not well approximated, hemorrhoids

28
Q

Mother - Extremities

A

Normal = mild edema

Teaching = signs of a DVT, apply TED hose or SCDs

Abnormal = excessive edema, pain in the calf

29
Q

Mother - attachment / emotions

A

normal = touching, holding, naming, asking questions, and participating in the care of the newborn

Teaching = self care and rest. Review Postpartum blues (<2 weeks and normal) versus Postpartum depression (> 3 weeks and abnormal, needs counseling)

Abnormal = lack of interest in newborm, symptoms of postpartum depression, suicidal thoughts, or inability to care for themselves or the infant.

30
Q

Rubella / Rhogam

A

Normal: review rubella immunity
review blood type and antibody screen (Rh status)

Teaching = Administer MMR if Rubella non-immune.
Administer Rhogam within 72 hours if mom is Rh (-) and baby is Rh (+)

31
Q

Mother vital signs

A

temp = 37- 37C or 98.6 - 100.4F
HR = 50-90 bpm (report <50 or >120)
RR = 12-20 (report <10 or >30)
O2 = >95%
BP = return to 1st trimester.
between 90-160 Systolic and >100 diastolic

urine output >30mL/hr

Nur 128 (6 decks)

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