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OB Lecture > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

4th Stage of Labor

A

Immediate Recovery Period Postpardum - 4-6 hours post delivery with frequent vitals and fundal exams

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2
Q

Oxytocin in postpardum

A

Released by posterior pituitary - leads to afterpains that constrict the vessels at placental separation

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3
Q

Placenta attachment area

A

3-4 inches in diameter, heals via exfoliation and without a scar

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4
Q

Autolysis

A

The self digestion that occurs in tissues or cells by its own enzymes - r/t withdrawls of estrogen and progesterone

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5
Q

Lochia - Postpardum period

A

Measured in scant, light, moderate or heavy
Rubra (Day 1-3)
Serosa (Day 4-10)
Alba (Day 10-3 wks)
Dark red to muscousy discharge colored

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6
Q

Cervix Postpartum

A

Healing from trauma - internally closes in a few days (takes 6 weeks to completely heal)
Edematous, bruised, ragged appearance with small soft tears

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7
Q

Vagina postpartum

A

Thin, rugae absent (expanding lines) dry (muscous increases with the return of estrogen production)

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8
Q

Perineum Postpartum

A

Edema, brusing, altered muscle tone (r/t movement)
Episiotomy healing - absorbable sutures used
Returns to per-birth in 6-8 weeks

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9
Q

Laceration Degrees

A

1st degree: skin and superficial tissue
2nd degree: Through muscles of perineum
3rd degree: Through sphincter muscle
4th degree: involved the anterior rectal wall

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10
Q

Laceration nursing considerations

A

Stool softeners, ice, squirt bottles, wipes, sitz baths and kegal exercises

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11
Q

Hormones postpartum

A

Breastfeeding mimics menopause states
Placenta delivery reverses diabetogenic effect of moms with gestational diabetes (lowers blood sugars)
Estrogen and Progesterone - leads to breast engorgement, diuresis and HCG is gone by day 14

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12
Q

Pituitary effects if breastfeeding

A

Elevated prolactin, suppresses ovulation (may around 6 months)

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13
Q

Pituitary - Not breastfeeding

A

Prolactin levels decline, ovulation is as early as 27 days, most menstruate within 3 months

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14
Q

Urinary system postpartum

A

Delayed, altered voiding relfexes
Interventions: encourage voiding even if they don’t feel it

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15
Q

Gi postpardum

A

Constipation, reluctance (r/t pain) timing can be difficult

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16
Q

Postpartum circulatory changes

A

EBL: ~1000 for Cesarean
Hypercoagulability - more platelets in early postpartum because of vessel damage, and immobility
Increased WBCS r/t stress of delivery

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17
Q

Postpartum assessment (BUBBLE)

A

Breasts
Uterus
Bowels
Bladder
Lochia
Episiotomy/laceration/C-section Incision

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18
Q

RH factor

A
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19
Q

Uterine Atony

A

Hypotonia of the uterus (decreased muscle tone, does not contract)
Risks: Traumatic birth, rapid or prolonged labor, induction, hydramnios, macrocosmic fetus, multifetal

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19
Q

Postpartum hemorrhage (PPH)

A

EBL of >500mL or
10% change in hematocrit
Pt needs RBC infusion

Early/Acute/Primary - within 24 hours of birth
Late/Secondary - More than 24 hours but less than 6 wks

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20
Q

Medical Treatment for Uterine Atony

A

Pitocin, methergine, Hemabate, Cytotec, Dinopro

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21
Q

Surgical management of uterine atony

A

Balloons, packing, foley catheter, artery litigation, hysterectomy, JADA device

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22
Q

Hematoma formation postpartum

A

Vulvar (most common) Vaginal or retroperitoneal
Pain is most common symptom

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23
Q

Retained Placenta

A

Complete or partial retaining of placental (after 30 minutes)
Treatment is manual removal

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24
Q

Placenta Accreta

A

slight penetration of the myometrium by the placenta
Adherent retained placenta (1)

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25
Q

Placenta Increta

A

deep penetration of the myometrium by the placenta
Adherent retained placenta (2)

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26
Q

Placenta percreta

A

Uterus is perforated by the placenta
Adherent retain placenta (3)

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27
Q

Treatment of Adherent retained placenta

A

Blood replacement and hysterectomy, placenta is retained too deep, will continue to bleed

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28
Q

Inversion of the uterus

A

Complete: red mass protrudes 20-30 cm out of the introitus (vagina)
Incomplete: palpated smooth mass that comes through dilated cervix
Can be life threatening
Factors: Fundal implantation, uterine atomy, excessive cord traction, adherent placenta tissue

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29
Q

Subinvolution of Uterus

A

Late pp bleeding r/t retained placenta fragments, pelvic infection
SS: prolonged lochial discharge, irregular or excessive bleeding, hemorrhage, larger than normal uterus + boggy
Treat cause - may include remove fragments and treat with antibiotics

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30
Q

Hypovolemic shock

A

Emergency, vessels constrict so the blood goes to vital organs, cell death occurs, lactic acid and acidosis increases
Management: Restore blood volume (fluids and replacement) Treat cause of hemorrhage

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31
Q

Hypovolemic shock interventions

A

Signs may not appear until 30-40% of volume has been lost, improve/monitor perfusion, take vitals, watch I/O

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32
Q

DIC

A

Form of clotting where all the clotting factors are consumed leads to widespread bleeding
SS: Unusual bleeding from IV site, venipuncture sites or petechia under BP cuff

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33
Q

DIC management

A

Treat underlying cause (arrest, hemorrhage, preeclampsia, sepsis)
Replace volume, replace blood, apply oxygen, monitor labs and perfusion + IO

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34
Q

Thromboembolic Disease

A

Formation of clot in vessel but inflammation
Risk: hypercoagulation, venous statis, obesity, smoking
Increasing ambulation decreases risk

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35
Q

Thromboembolism Superficial

A

Pain and tenderness in lower extremities with warmth, redness and enlarged vein over the site

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36
Q

Deep thromboembolism

A

More common in pregnancy, unilateral leg pain, calf tenderness, swelling, redness and warmth, positive homans (flex knee and ankle causes pain in leg)

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37
Q

PP Infection risk

A

Prolonged labor, c section, internal monitoring, diabetes, immunosuppression

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38
Q

Endometritis

A

Most common PP infection - begins as localized infection at placenta site
SS: fever, chills, pelvic pain, foul smelling discharge

39
Q

Mastitis

A

Unilateral, after flow of milk has been established, edema obstructs flow, can progress into an abscess, most common staph aureus
SS: chills, fever, malaise, local tenderness, pain, swelling, redness
Treatment: antibotics and frequent emptying

40
Q

Best way to prevent infections

A

Hand hygiene

41
Q

Physiologic Adjustment of the NB

A

Establish and maintain respirations, circulatory changes, regulating temperature, ingesting retaining and digesting nutrients, eliminating waste and regulating weight
Breathing, Temp, Nutrients, Waste and Weight

42
Q

NB Behavioral Adaptation Tasks

A

Pattern of sleep, regulating arousal, processing storing and organizing stimuli and relationship with providers

43
Q

Transition period for NB

A

First 6-8 hours

44
Q

What does clamping the cord do?

A

Increase the baby BP, increased circulation and lung perfusion

45
Q

Chemical stimulation of respiratory

A

Decreases prostaglandin, causes fetal hypoxia
Contractions lead to decreased Po2, increased PCO2 and a lowered pH
Planned C-Section babies at risk because they did not get this benefit

46
Q

Mechanical Respiratory stimulation

A

Intrathoracic pressure when the fetus is going through the uterus

47
Q

Thermal Factors stimulating respiration

A

Extrauterine environment is colder (72 standard) than the uterus, the skin

48
Q

Sensory Factors stimulating respiration

A

handling of baby, suctioning (mouth then nose or will aspirate) drying, pain, lights/sounds/smells

49
Q

Surfactant

A

Alveoli are lined with this and the lung expansion at birth releases it.
The surfactant reduces the pressure required to keep the alveoli open

50
Q

Respiratory Vitals in NB

A

30-60 per minute with pauses of 15 seconds normal
If pause is >20 it is apnea and that is problematic

51
Q

Signs of respiratory distress

A

Nasal flaring, retractions, grunting, seesaw respirations, pallor, central cyanosis

52
Q

Cardiovascular NB adaptations

A

Increased pulmonary blood flow will close the foramen ovule over time can lead to a transient (come/go) murmur
Immediate closure of the ductus arteriosus and ductus venosos

53
Q

Normal NB HR

A

100-160
Crying or deep sleep can alter values, count for a full minute at the fourth intercostal space and to the left of the midclavicular line

54
Q

Signs of CV dysfunction, what should you do?

A

tachypnea, tachycardia, pallor, cyanosis, absence of peripheral pulses, poor perfusion
Do: Obtain 4 pt blood pressures - if the MAP is below the gestational age it is hypotensive
Hypertensive is a MAP between 50-70

55
Q

Blood volume of NB

A

85 ml/kg at birth 300 ml (if delayed clamping extra 100 ml)
Late clamping increases HR, increases systolic, increases respirations

56
Q

Pathologic jaundice

A

Occurs before 24 hours related to availability of RBCS or RH issues
Abnormal destruction of RBC’s leads to jaundice

57
Q

Signs of NB sepsis

A

Low temp, decreased WBCS, pallor

58
Q

Thermoregulation in NB

A

maintaining balance - not losing heat or producing heat
97.8-98.8 use clinical judgement for higher temps
At risk for loss r/t less adipose tissue, vessels close to skin, large surface area to body weight

59
Q

Convection - Heat loss

A

Losing heat to cooler air

60
Q

Radiation - heat loss

A

Loss of heat due to cooler surface that is not in direct contact

61
Q

Evaporation - heat loss

A

Losing heat turning liquid to vapor (sweating)

62
Q

Conduction - Heat loss

A

Loss of heat bc of contact with a cooler surface

63
Q

NB thermogenesis

A

Generating heat by increasing muscle activity, crying/restless

64
Q

Brown fat

A

Unique to NB, richer vascular and nerve supply that increases heat production, located over important organs

65
Q

NB cold stress

A

Respirations increase, burning glucose in the blood, increases risk of acidosis and hyperbilirubinemia

66
Q

Hyperthermia

A

Skin vessels dilate, flushed skin, warm to touch, extension of limbs
Septic hyperthermia: constricted, pale, hands/feet cold

67
Q

Red Brick Staining

A

uric acid crystals in urine that can look like blood

68
Q

When should babies first void

A

Most void within 30 hours if not before 48 consider renal impairment

69
Q

Daily fluid requirements

A

First 2 days: 40-60 mL/kg
Then: 100-150 ml/kg

75% of body weight is water
40% of body weight is extracellular

70
Q

Loss of fluid after birth

A

Baby should lose 5-10% of birth weight in the first 3-5 days then regain that by day 14

71
Q

Epstein perals

A

White cysts present in the gums of NB, retention cysts

72
Q

Stomach capasity of NB

A

30-90 ml, avoid over feeding

73
Q

When should baby pass meconium what is it composed of

A

Within 24 hours of life has amitotic fluid, intestinal secretions and cells

74
Q

Blood sugar of NB and signs of hypoglycemia

A

40-80
Jitters, tremors, irregular RR, difficulty feeding, lethargy, apnea, cyanosis

75
Q

Bilirubin

A

Yellow pigment that comes from the break down of RBCs and breakdown of myoglobin in muscle cells

76
Q

Jaundice (Physio and Pathologic)

A

Hyperbilirubinemia

77
Q

Vernix caseosa

A

White stuff covering baby to keep skin safe in utero

78
Q

Acrocyanosis

A

Blue hands/feet pink body

79
Q

Mongolian spots

A

Spots on the back of baby, harmless, need to be noted at birth or could be seen as abuse later

80
Q

Caput succadanem

A

edematous swelling that crosses suture lines, disappears in 3-4 days common with vaccum extraction`

81
Q

cephalhematoma

A

collection of blood between skull bone and periosteum that does not cross the suture line

82
Q

NB vision

A

React to light, track objects, 12 inches of vision and prefer patterns

83
Q

Pain in neonate

A

Increased RR and HR, shallow respirations, pallor, dilated pupils, grimacing ,eye squeezing, quivering of tongue, open mouth

84
Q

Maternal adjustment - taking in

A

self focus, relies on other for needs, exited, relives the birth experience

85
Q

Taking hold - maternal adjustment

A

focus on baby, taking charge, eager to learn and practice, still needs help from others

86
Q

Letting go = maternal adjustment

A

forward as fmaily unit, resuming individual roles, resuming relationship with partner including sexual intimacy

87
Q

Breast feeding contraindications

A

HIV, TB, HSV on breasts, galactosemia in NB, humal t-cell, chemo in mom and radioactive isotopes

88
Q

mL for babies

A

20-40 mL/kg (until day 2)
100-140 mL/kg

89
Q

protein values needed for nb

A

2.25-4g/kg/day

90
Q

fat values needed for nb

A

5-7g/kg
15% of calories must come from fat
corn oil is fat in formula

91
Q

what produces the milk in breasts

A

alveoli

92
Q

what are the alveoli surrounded by

A

myoepithelial cells - that contact the milk and send it inot the ductules

93
Q

purpose of the ductule

A

collects the milk, becomes larger ducts where the milk collects behind the nipple

94
Q
A

OB Lecture (11 decks)

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