T3 - Advance Organizers (Josh) Flashcards
Patient education r/t circumcision:
do NOT clean off yellow exudate
watch for gauze that could wrap around and cut off circulation
not bath until heals
Plastibell will fall off in diaper
What happens during the first period of reactivity?
HR increases then falls back to b/t 100-120
RR is 60-80
Audible grunting, nasal flaring, and chest retractions (should clear within 1 hr)
Vacuum assisted birth babies can have a — that crosses suture lines.
Caput Succedaneum
An infant may normally lose up to — of birthweight.
5-10%
What happens during the second period of reactivity?
Tachycardia
Tachypnea
Increased muscle tone (Jumpy)
Increased mucous production (monitor for chocking/gagging)
What are characteristics of postterm newborn?
deep sole creases
skin dry and cracked
long nails
meconium staining of skin, nails and cord
loss of subq fat and muscle mass
Normal bilirubin levels?
direct bilirubin at birth = 0-1 mg/dL
**cord blood bilirubin should be
The baby’s head will be — than his chest.
0.5 in larger
PP blues start around — and last —
PP day 2-3
2 wks
REEDA stands for:
Redness Edema Echymosis Drainage Approximation
Normal newborn heart rate is —
Normal newborn respiratory rate is —
120-140
30-60
Interventions to decrease perineal edema?
Ice Pack (first 24 hrs)
Sitz Bath (after 24 hrs)
Blot dry, wipe from front to back
Apply new pad after each void
What could be a possible cause of a high-pitched cry?
hypoglycemia
***obtain blood glucose (
What does the posterm newborn’s skin look like?
dry and cracked
The baby’s head will be — than his chest.
0.5 in larger
Nursing care for baby just circumcised?
Hold feeding until procedure
Document first voiding post procedure
Not tub bath until heals
Check for healing or drainage
— causes milk production
— causes milk letdown.
Prolactin
Oxytocin
Most common symptom of perineal hematoma is —
pain
***retroperitenial hematoma can be life-threatening b/c of tear in hypogastric artery
Which glucose level require intervention?
Breasts:
What should they feel like on PP day 1-2?
What should they feel like on PP day 3-4?
soft (ear)
filling (nose)
An infant loses heat via — when they are covered with a wet gown or AF.
evaporation
SGA =
LGA =
AGA =
SGA = 90th %
AGA = 10th-90th %
What constitutes a dangerous level of bilirubin?
15 mg/dL at any time
***kernicterus (irriversable)
Why is erythromycin given on eyes?
prophylactic protection from blindness caused by gonorrhea
What should we teach about Rubella vaccine?
Two doses
Avoid pregnancy for 1 mth after each dose
Safe for breastfeeding
***May cause rash if allergic to duck eggs
The client is best receptive to teaching during which phase?
Taking Hold Phase
Best prevention for thrombus formation is —
early ambulation
Best time for bonding is —
breastfeeding
***NICU baby will miss this due to being in taken immediately to NICU
— is a collection of blood b/t skull and peritosteum that does NOT cross suture lines
Cephalhematoma
When would Rhogam be administered?
within 72 hrs after delivery
Scant lochia =
Light lochia =
Moderate lochia =
10 cm
How can mastitis be prevented?
wash nips w/ water only
air dry for 20 mins
apply expressed milk or non-alcohol cream to prevent drying/cracking
empty engorged breasts
Circumcision:
—- requires no ointment
—- is bloodless and requires petroleum jelly or antibiotic ointment.
Plastibell
Yellen Mogen clamp
An infant loses heat via — when they remain uncovered in a cold room.
convection
What is a good APGAR score?
7-10
***less than 3-4 will require resuscitation
How much Vit. Ka is given and which size needle?
0.5 - 1 mg
5/8 in needle
What does cold stress lead to?
Cyanosis (uses up O2)
Jaundice/Kernicterus (due to buildup of bilirubin levels)
Hypoglycemia (due to use of glucose for heat production)
S/S of PP shock
Tachycardia
Tachypnea
BP decreases
Skin cool, clammy with pallor
Restlessness and Dyspnea
What is important about the process of exfoliation?
tissue regeneration at site of implantation w/out scar tissue formaion
What is a good APGAR score?
7-10
***less than 3-4 will require resuscitation
Normal newborn RR
30-60 w/ short periods of apnea (
When is the first period of reactivity?
When is the second period of reactivity?
First = Birth to 30 mins
Second - 2-8 hrs after birth and lasts 10 mins to several hrs
What will we see as unconjugated bilirubin is broken down under phototherapy?
stools become more frequent and loose and change color as bilirubin is broken down
urine will be darker as bilirubin is broken down
What is heavy lochia?
one pad within 2 hrs
Which type of jaundice is caused by increased levels of uncongjugated bilirubin?
Pathologic
***within 24 hrs
Late PPH is after — and blood looks —
24 hours
darker red
***retained placental fragments
Normal WBC value during PP period?
20,000 - 25,000 mm3 (slightly elevated)
When is the first period of reactivity?
When is the second period of reactivity?
First = Birth to 30 mins
Second - 2-8 hrs after birth and lasts 10 mins to several hrs
Oxytocin is released from the — pituitary
posterior
Normal blood glucose is —
Treatment is required if blood glucose falls below —
60-70 mg/dL
45 mg/dL
What do the sole creases look like in postterm newborn?
deep sole creases
How is congenital hip dislocation identified?
Positive Ortoloni test
Asymmetry of gluteal folds
Limited hip abduction
Apparent shortening of femur
Interventions for episiotomy discomfort?
warm sitz bath after 24 hrs
anesthetic spray
witch hazel pads
peri hygiene
Where should fundus be after birth?
firm, midline, and 1-2 cm below umbilicus
***rises in first 12 hrs before dropping 1-2 cm every 24 hrs
Which phase?
a. Focused on forward mvmt of family as a unit w/ interacting members
b. Reassertion of relationship w/ partner
c. Resumption of sexual intimacy
d. Resolution of individual roles
Letting Go Phase
Afterpains are more common with — and —
multigravidas
breastfeeders
Late PPH is after — and blood looks —
24 hours
darker red
***retained placental fragments or infection
Normal cord blood bilirubin
What is number one cause of a boggy uterus?
full bladder
An infant loses heat via — when they come into direct contact w/ a cold scale.
conduction
When should postpartum assessments be done?
q15 * 4
q30 * 2
q1hr * 4
q8hr
Which type of jaundice is self-limiting (resolves in 1-2 wks) and occurs after 24 hrs (peaks at days 3-5)?
Physiologic
When is PKU screening done?
after ingesting sufficient milk
***phenylalanine is an essential amino acid found in milk
Normal newborn HR
120-140
***4th ICS MCL
Normal cord blood HGB and HCT
HGB = 17 g/dL
HCT = 55%
— jaundice occurs after 24 hrs
— jaundice occurs within 24 hrs
Physiologic (self-limiting and self-resolves)
Pathologic (requires phototherapy, etc)
Which enzyme is necessary to conjugate (breakdown) bilirubin?
glucornyl transferase
***newborn liver is immature and doesn’t produce enough
What is number one cause of excessive bleeding?
uterine atony
Sign of Down’s Syndrome
low set ears
simian hand crease
palpable fissures of eyes
What happens during the second period of reactivity?
Tachycardia
Tachypnea
Increased muscle tone (Jumpy)
Increased mucous production (monitor for chocking/gagging)
S/S of DVT
Reddened, warm area over affected vein
Pain/Tenderness on ambulation
What is the priority intervention when a PP client is bleeding excessively or if they pass a clot?
check consistency and location of fundus
Diffuse swelling that crosses suture lines is —-
Swelling from blood confined within suture lines (doesn’t cross) is —-
Caput succedaneum
Cephalhematoma
What are risk factors for a PP thrombosis?
Increased clotting factors
Immobility
Sepsis
Maternal age > 35
Multiparity
Smoking
History of CVD or Diabetis
When would the fundus be nonpalpable?
by 2 wks
What bilirubin levels will lead to staining of body?
4-6 mg/dL
***starts first in head and face then progresses to trunk
Which phase?
a. First 1-2 days
b. Introspective and preoccupied w/ own needs rather than baby
c. Passive/dependent behavior
d. Excited & talkative
e. Touches and explores infant
f. Needs to verbalize L&D experience
Taking In Phase
Which glucose level require intervention?
An infant loses heat via — when they are placed too close to a cool wall.
radiation
What would breast fed baby stool look like?
What about bottle fed?
breast fed = seedy, mustard colored, loss and aromatic
bottle = pale yellow to brown; more firm
Normal WBC levels in newborn
9,000 - 30,000 (slightly elevated)
Early PPH is with — and blood looks —
24 hours
bright red
***lacerations
If Lochia reverts to previous state or lasts longer than should, what do we suspect?
uterine infection
- foul odor as well
Normal newborn heart rate is —
Normal newborn respiratory rate is —
120-140
30-60
Normal WBC value during PP period?
20,000 - 25,000 mm3 (slightly elevated)
What does cold stress lead to?
Cyanosis (uses up O2)
Jaundice/Kernicterus (due to buildup of bilirubin levels)
Hypoglycemia (due to use of glucose for heat production)
Why suction mouth before nose?
to prevent infant from inhaling pharyngeal secretions by gasping as the nares are touched
Nursing interventions for afterpains
NSAIDs before breastfeeding
Self-resolves in 3-7 days
Good sign that uterus is contracting
What maternal labs are drawn 12-24 hrs post delivery?
Hgb and HCT
Urinalysis sometimes
Rubella and Rh if unknown
What days?
Lochia Rubra =
Lochia Serosa =
Lochia Alba =
Days 1-3
Days 4-9
Days 10 and up
What are parameters for infection in the PP client?
eleveated temp of 100.4 or more 2 SUCCESSIVE DAYS during first 10 PP days
***Not counting first 24 hrs
How can a Cephalhematoma lead to increased bilirubin?
as RBCs in the bruise break down, they increase bilirubin levels
What happens during the first period of reactivity?
HR increases then falls back to b/t 100-120
RR is 60-80
Audible grunting, nasal flaring, and chest retractions (should clear within 1 hr)
What stools are a sign of sickness?
constipation or diarrhea
A newborn needs — cal /day
110 cal/day
Treatment for DVT
Bedrest
Moist heat
Heparin
What is initial treatment of hypoglycemia?
feeding (breastmilk)
bottle feeding (D5W)
Calories for lactating mom
2700 total
***450-500 more than recommended pregnancy calories
Suction — before —
mouth
nose
When is Sitz Bath given for episiotomy care?
after first 24 hrs
TID for 20 mins
What could be a possible cause of a high-pitched cry?
hypoglycemia
***obtain blood glucose (
What maternal labs are drawn 12-24 hrs post delivery?
Hgb and HCT
Urinalysis sometimes
Rubella and Rh if unknown
