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Maternal Exam 2 > Study Guide > Flashcards

Study Guide Flashcards

1
Q

Normal blood glucose for new born

A

40-45 mg/dL

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2
Q

Where should your take blood glucose on a newborn

A

Heel stick

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3
Q

Increased risk for hypoglycemia

A

Large for gestational age/SGA, mother is diabetic, late preterm, or low birth weight

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4
Q

When should you check newborn blood glucose

A

30 mins after first feeding, then always before feedings. With diabetics check after feedings

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5
Q

How to prevent hypoglycemia in newborn

A

Ensure effective breastfeeding

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6
Q

When are emergency c-sections performed

A

With prolapse umbilical cord, malpresentation that cannot be resolved, and to preserve the life of the mother and fetus

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7
Q

Normal C-section blood loss

A

Normal <1L

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8
Q

Dilation

A

(0-10 cm), how open/closed the uterus is.

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9
Q

Effacement

A

(0-100%), how much of the uterus has been shed

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10
Q

Station

A

(-5 - +5), the position of the baby, - is deep and + is closer to exit

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11
Q

What is an amniotomy

A

Performed to rupture the membranes of a pregnant woman

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12
Q

What should the nurse monitor after an amniotomy

A

FHR due to the risk of cord compressions (variable decelerations will be present in this case)

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13
Q

What is common after an amniotomy and is common

A

Tachycardia, doesn’t require action

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14
Q

postpartum hemorrhage vaginal birth number

A

> 500mL

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15
Q

Postpartum hemorrhage c-section number

A

> 1L

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16
Q

Postpartum hemorrhage risk factors

A

uterine atony (boggy uterus), genital lacerations, hematomas, retained placenta (especially if its nonadherent)

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17
Q

What is Involution

A

the process when the uterus returns to a nonpregnant state following birth (~6 weeks)

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18
Q

What is Subinvolution

A

the failure of the uterus to return to nonpregnant state. (folds on itself)

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19
Q

What can cause subinvolution

A

Late bleeding, and placental fragments/ pelvic infection

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20
Q

Normal vaginal birth bleeding

A

<500mL

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20
Q

In normal postpartum bleeding, what can be decrease in the blood (levels)

A

Hematocrit (3-4 days, 33% is normal after 8 weeks)
Hemoglobin (11g/dL)

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21
Q

Hypothermia appearance in newborns

A

appear pale and mottled

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22
Q

What can hypothermia progress to and what happens

A

Cold stress, RR increase, and vasoconstriction occurs.
Metabolic acidosis can occur which exacerbates jaundice
Can cause hypoglycemia, can make infants quiver/ shake

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23
Q

Post-term complications for the mother

A

Hemorrhage, infection, dysfunctional labor, perineal injury r/t macrosomia, fatigue, etc.

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24
Q

Post term complications in the newborn

A

LGA/SGA, macrosomia, higher risk for birth injuries

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25
Q

What is forceps-assisted birth

A

Using a tool to wrap around the baby’s head to assist in pulling it out

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25
Q

When are forceps used (fetal)

A

Abnormal FHR, certain abnormal presentations, arrest of rotation, head delivery in breech presentation.

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25
Q

When are forceps used (maternal)

A

Prolonged 2nd stage of labor (delivery)

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26
Q

What should the nurse focus on with the newborn immediately after birth

A

Maintaining clear airways and oxygenation
Maintain body temp., put cap on the baby, prevent cold stress as well as assess for hypothermia
Promote parent-infant interaction, give eye prophylaxis (erythromycin), vit. K (for blood clotting)

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27
Q

Vital signs for newborn

A

RR: 30-60 BPM
HR: 100-160 BPM
Temp: 98-98.9
Weight: 5lbs 12oz- 8lbs-12oz

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27
Q

Vital signs for mother after birth

A

Temp: can be elevated (100.4) during first 24 hours, and normalize after that
HR: remains elevated for one hour after delivery that returns
BP: normally only slightly altered
WBCs: 20,000-25,000 for the first 10-12 days are common

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28
Q

Normal weight for newborns

A

5lbs 12oz- 8lbs 12oz

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29
Q

What is the Ballard Assessment

A

An estimate of gestational age that’s done with babies that have no prenatal care, gives subjective results.
Max 50 points should be done within first 12 hours of birth.

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29
Q

when should Breastfeeding be done

A

first 6 months and up to 12 months, complementary foods can be introduced at 6 months

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30
Q

Breastfeeding tips

A

Baby should have their whole mouth around the nipple (whole face in the breast), should hear audible swallowing.
Baby should have 6-8 dirty diapers a day
Very beneficial for the mother and nutritious from the baby.
Makes the baby poop less than formula (quality over quantity)

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31
Q

What can cause breast engorgement

A

Mastitis (breast infection)

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32
Q

How to prevent breast engorgement

A

Good hygiene, make sure the baby is latching appropriately.
Ice can decrease swelling

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33
Q

Pain assessment scale for children over 5 years old

A

Faces scale

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34
Q

Pain assessment scale for children under 5 or mentally disabled

A

FLACC scale (their appearance/ behavior)

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35
Q

Pain relief for infants

A

Acetaminophen and NSAIDS for mild-moderate pain
Lidocaine, opioids and topical pain relief for moderate-severe pain

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36
Q

What med can you not give infants

A

NO ASPIRIN

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37
Q

Newborn non-pharm relief.

A

oral sucrose (sugar water), non-nutritive sucking, breastfeeding, distraction, and swaddling.

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38
Q

What age can kids verbalize pain

A

3-6 (preschoolers age)

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39
Q

Taking vital signs on a child

A

Pulse: taken apically, count for a full min
RR: watch abdomen, count for a full min
Temp: taken rectally only when absolutely necessary
BP: correct BP cuff

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40
Q

How to get correct BP cuff

A

cuff bladder width 40% of arm circumference, length 80-100% of circumference, measured at heart level.

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41
Q

Suicidal Assessment for mother and child

A

Ask straight forward questions about this to the mother before and after birth and include questions about homicidal thoughts. Same goes for child.

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42
Q

Four modes of heat loss

A

Convection, radiation, evaporation, and conduction

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43
Q

Convection

A

Heat is lost due to cooler air around the baby

44
Q

Radiation

A

heat is lost due to cooler solid surface close to baby.

45
Q

Evaporation

A

heat is lost when moisture on the skin vaporizes, especially after failing to dry the baby after a bath. Most significant cause

46
Q

Conduction

A

heat is lost due to direct contact with a cooler surface.

47
Q

Physiologic Jaundice

A

Not present at birth, the liver wasn’t ready to handle all the RBC’s, we want them to poop a lot. Shows up 24 hours after birth.

47
Q

Physiologic Jaundice treatment

A

phototherapy (protect eyes), blood exchange transfusions.

48
Q

Physiologic Jaundice Risk factors

A

premature birth, significant bruising during birth, blood type, breast feeding (less poop=less bilirubin being excreted)
Can lead to kernicterus—> irreversible toxicity that causes brain damage

49
Q

Pathologic Jaundice treatment

A

Phototherapy, exchange transfusions (rare)

49
Q

Pathologic Jaundice

A

happen inside the uterus before birth, shows up within fist 24 hours of birth. Goes higher and farther than phys. and causes more problems

50
Q

Pathologic Jaundice risk factors

A

Premature birth, significant bruising during birth, blood type, breastfeeding.

50
Q

Lochia rubra

A

dark red, musty odor

51
Q

Lochia serosa

A

pink or brown, odorless, watery

52
Q

Lochia alba

A

yellow, white

52
Q

Inversion of the uterus

A

Turning inside out of uterus, (comes out)
Potentially life threatening (1 in 3,000 births)

53
Q

Postpartum peri care

A

Clean it up, give NSAIDs, ice packs.
Wipe front to back

54
Q

Leading cause of death for children

A

preventable causes, such as car accidents or drowning.
Watch for suicidal actions

55
Q

What does umbilical cord prolapse cause to the fetus

A

fetal hypoxia

55
Q

What is umbilical cord prolapse

A

when the cord lies below presenting part of fetus

55
Q

Car seat safety

A

Have a rear facing car seat for the first 2 years, don’t leave child unsupervised.

56
Q

Umbilical cord prolapse treatment

A

with 2 gloved fingers, push the cord back into the uterus and call for help
-Push on presenting part, to not let the cord get compressed.

56
Q

Risk factors of umbilical cord prolapse

A

Long cord (>100 cm)
Malpresentation (breech)
Transverse lie
Unengaged presenting part
Baby’s head is high up
Amniotomy

57
Q

Fentanyl

A

Synthetic opioid used for moderate-severe pain relief

58
Q

Betamethasone

A

Glucocorticoid given in 2 doses to promote fetal lung maturity when a preterm birth goes wrong.
The most significant benefits occur within the first 24 hours.

58
Q

Carboprost (Hemabate)

A

Used for postpartum hemorrhage
The first med used –> crunches the uterus by stimulating contractions

59
Q

Magnesium sulfate dosage

A

4-6g loading dose/ bolus over 20-30 minutes, 2-3g/hr maintenance dose

59
Q

Magnesium sulfate uses

A

prevent/treat convulsions via relaxing uterus smooth muscle. Indicated in severe gestational hypertension and severe preeclampsia. Also prevents contractions in preterm labor.

60
Q

Magnesium sulfate therapeutic level

A

4-7mEq/L

61
Q

Magnesium sulfate toxicity

A

Presents w/ absent DTRs Resp below 12, pulse ox below 95% even with O2
Decreased LOC

61
Q

Magnesium sulfate antidote

A

Calcium gluconate, but stop the IV flow first!

62
Q

Magnesium sulfate interventions

A

Padded siderails
Dim lights
Lower activity (seizure precautions)
VS q 15 min
Excreted through urine so I&O are important

63
Q

Rho immune globulin

A

Given to Rh- mothers when they have a Rh+ fetus, prevents the mom’s immune system from attacking the body.
Always given to Rh- moms for amniocentesis

64
Q

Physical Dependance

A

when abrupt cessation of the opioid results in a withdrawal state

64
Q

Tolerance

A

When chronically administered opioid require higher doses to be effective indicated by needing to increase the amount or frequency of doses of medication to achieve initial effect of drug

65
Q

Addiction

A

Pattern of dysfunctional opioid use

66
Q

General anesthesia

A

Given for c-section in emergency situations
Monitor VS closely
Usually causes hunger afterwards

67
Q

Bulb suctioning use

A

to clear the airways of infants with excess mucus in them

68
Q

Bulb suctioning approach

A

suction mouth before the nose.
compress the bulb before inserting, and insert into the side of the mouth
suction the nostrils one at a time
clean with soapy warm water with each use

69
Q

Bulb suctioning stop

A

when the infants cry becomes clear and doesn’t sound muffled by mucus

70
Q

Vaginal laceration causes

A

use of forceps to rotate the fetal head, rapid fetal descent, or precipitous birth

71
Q

vaginal laceration appearance

A

circular, can extend deep
fundus can be firm or uterus boggy with this kind of bleeding

71
Q

What cause vaginal lacerations lead to

A

postpartum hemorrhage, often accompanied by perineal laceration

72
Q

Ineffective breastfeeding fetal signs

A

inadequate weight gain
minimal output and feeding constantly.

72
Q

Uterine infection risk factors

A

amniocentesis
prolonged labor

72
Q

Uterine infection intervention

A

antibiotics
analgesics
adequate nutrition/hydration
good hang hygiene

72
Q

Uterine infection signs and symptoms

A

Temp >100.4
abnormal lochia
tachycardia
delayed involution of uterus
pain/tenderness
inflammation of perineum
backache, fatigue, malaise, chills
abnormal labs
causes the urge to pee to decrease

73
Q

Cephalhematoma

A

Skeletal injury head bleed that doesn’t cross sutures.
Between the scalp and the skull, this is a concern!

73
Q

Cephalhematoma

A

Caused from birth, occurs more with quick births

74
Q

Tetanus (Tdap)

A

vaccine given at 2,4,6 months.
Booster is recommended every 10 years for adults, within 5 years for children

75
Q

Hep. B

A

Vaccine is given right at birth, another dose a month later, and a 3rd before 15 months

75
Q

Anterior Fontanels close

A

by 12-18 months (LAST)

76
Q

Posterior fontanels closing

A

by 2-5 months (FIRST)

76
Q

What percentile indicates obesity

A

above 95%

77
Q

What percentile indicates underweight

A

below 10%

77
Q

What percentile indicates overweight

A

85-95%

78
Q

What percentile indicates failure to thrive

A

below 5%

79
Q

Age 3-6 (preschool) weight gain

A

4.4-6.6lbs in a year

80
Q

Age 6-12 (school age) weight gain

A

2-3 kgs a year

81
Q

Postpartum Blues

A

Mild depression after birth that usually resolves in a few days without help, occurs in 80% of women.
Women become emotionally labile and cry easily, restlessness, fatigue, insomnia, HA, and anger
Usually follows the first day or two of birth

81
Q

Postpartum Depression

A

An intense and pervasive afterbirth with severe and labile mood swings (irritable) accompanied by guilt and a feeling of inadequate sleep and diet changes may occur, lasts longer than 2 weeks

81
Q

Postpartum depression treated

A

with anti-depressants, antitoxic agents, mood stabilizers and electroconvulsive therapy.
psychotherapy focuses on fears and concerns of new responsibilities and roles, monitoring for suicidal or homicidal thoughts

82
Q

Postpartum depression with psychotic features

A

syndrome characterized by depression, delusions, and thoughts of harming either infant of self after birth that come and go frequently, usually occurs within first 2 weeks.
supervised visits to baby and give meds

82
Q

Postpartum depression with psychotic features risk factor

A

Bipolar disorder

83
Q

Miscarriage

A

A pregnancy that ends as a result of natural causes before 20 weeks of gestation

84
Q

Miscarriage signs and symptoms

A

bleeding, contractions, and abdominal pain

84
Q

Miscarriage risk factors

A

1-12 weeks –> diabetes, hypothyroidism, and endocrine disorders
12-20 weeks –> age extremes, minority group, and history of miscarriage.

84
Q

Threatened Miscarriage

A

bed rest, FHR is not great but still alive, some bleeding but cervix is closed, can be saved.

85
Q

Inevitable Miscarriage

A

Heavy bleeding, cervix opens and the baby is going to die no matter what

85
Q

Incomplete Miscarriage

A

The placenta isn’t delivered early along with the fetus, can occur with contraception, requires procedure to get placenta out

86
Q

Complete Miscarriage

A

All products of conception are evacuated

86
Q

Missed Miscarriage

A

the baby died but is still in the mom, they need to deliver the still born. They come into the office for a checkup.

86
Q

APGAR score

A

score of 0-10 to determine fetal well-being.
Appearance, pulse, grimace, activity, and respirations.
0 = none/ no response
1 = some/ weak/ low
2 = normal/ above

Maternal Exam 2 (1 decks)

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