Test 3 Flashcards
3 signs that baby is having problems with temperature, oxygenation, or hypoglycemia?
Jitters, Grunting, hypotonia
How often do we assess mother in 4th stage of labor?
q. 15 for 1 hour minimum
Characteristics of fundus after birth?
Firm
At or below the umbilicus and midline
If bladder not firm and above midline what does that mean?
Bladder is full or uterus is full of blood clots
What do we do for a boggy uterus?
- Massage no matter if vaginal or c-section diet.
- Notify physician or midwife
- Oxytocin therapy
- Methylergonovine or carboprost
way by which the uterus returns to pre=pregnant size, shape, and location, and the placement site heals.
Involution
Fever in the mother first 24 hours usually do to?
Dehydration
How many extra calories do breastfeeding mother need?
500 calories per day
at least 2000 ml of fluids/day
What are the five aspects of APGAR scoring
Heart rate Respiratory Rate/effort Muscle tone Reflex irritability Skin color
What are the levels of the APGAR scoring
0-3-indicates severe distress, full resuscitation reuired
4-6 moderate difficulty with transition extrauterine life, rub newborns head, stimulate, administer O2
7-10 indicates stable status, no intervention required
peripheral cyanosis of hands and feet of newborn for first few hours and intermittenly after birth to 7-10 days and is normal?
Acrocyanosis
small white sebaceous glands that appear on the forehead, nose, and chin
Milia
Signs of respiratory distress in newborn?
Grunting Flaring Retracting(if get to this point severe resp depression) Cyanosis Decreased muscle tone Low blood pressure
BUBBLEHE for assessment postpartum
Breast, uterus, bladder, bowel, loch, episiotomy/laceration, homan’s/hemorrhoids, emotional/bonding
What are breast like first three days after delivery?
1st 24 hours- soft, non-tender
2nd day- slightly firm, slight tender
3rd day-firm, tender, and warm to touch
How soon after delivery must the mother have a bowel movement?
24 hours
A blood loss of ________ after a vaginal delivery and _______ after a c-section indicate hemorrhage?
500-vaginal
1000 c-section
3 causes of post part hemorrhage?
Uterine atony
Retained placenta
lacerations
3 phases of maternal attachment (both parents)
- Acquaintance phase
- Phase of mutual regulation
- Reciprocity
Fingertip exploration, en face position, responds verbally to sounds of infant, first few hours
Acquaintance phase
adjustment between needs of mother and needs of infant first few days
Phase of mutual regulation
mutually gratifying interaction, 1-6 weeks
reciprocity
Four stages of Maternal/Paternal Role Attainment
- Anticipatory-during pregnancy
- Formal- when baby is born
- informal-3-10 months after delivery
- Personal-3-10 months after delivery
Transient period of depression
Occurs first few days after delivery
Resolves without intervention in 10-14 days
S/s tearfulness, anorexia, difficulty sleeping, feeling of letdown
Causes: changing hormone levels, psychologic adjustments, unsupportive environment, fatigue, discomfort, overstimulation
Postpartum blues
When does menstration begin in non-lactating women?
6-10 weeks
When does ovulation occur in non-lactating woman?
within 6 month
What does breast milk contain
Protein Lactose Cholesterol-brain development Vitamins and Minerals Antibodies
When should you feed baby after delivery?
Within 1st hour
How do you know the baby is latched on correctly in breast feeding women?
More areola visible on top than bottom, nipple in back of mouth, swallowing can be heard, discomfort first 5-10 seconds, breasts becomes soft
When should baby regain birth weight?
within 2 weeks
If patient with postpartum hemorrhage goes into shock what should you do?
IV fluids,
Trendleburg postion
Meds-Pitocin
Pressure on uterus (one hand fundus other on symphysis pubis to make sure uterine doesn’t come out.
Signs and symptoms of thrombophlebitis
Pain, heat, redness, positive Homan’s sign
Symptoms of postpartum depression. (Remember must have 5 of these present for more than 2 weeks for diagnosis)
trouble sleeping lack of interest feeling of guilt loss of energy difficulty concentrating changes in appetite restlessness or slowed movement thoughts or ideas of suicide
Visual or auditory hallucinations
delusional thingking
want to kill baby/self
delirium and or mania
Postpartum psychosis
Where is Brown Fat or Brown Adipose tissue found?
neck, thorax, axially area, intrascapualar areas, and around adrenal glands and kidneys
4 reasons newborn predisposed to heat loss?
Large surface area
thin layer of subcutaneous tissue
cannot shiver to produce heat
new environment is 20-30 degrees cooler
4 ways newborns lose heat?
Evaporation
Conduction
Convection
Radiation
Loss of heat that occurs when water on the neonates skin is converted to vapors, such as bathing or directly after birth.
How to prevent?
Evaporation
Dry neonate at time of birth, bathe small areas at a time, keep body covered
Transfer of heat to cooler surface by direct skin contact, such as cold hands of caregiver or cold equipment
How to prevent?
COnduction
Warm mattress, nurse hands, equipment
Loss of heat from the neonates warm body surface to cooler air currents, such as air conditioners or oxygen masks. How to prevent?
Convection
Keep neonate covered
Keep room air warmed
Transfer of heat from the neonate to cooler objects that are not in direct contact with the neonate, such as cold walls of the isolate or cold equipment near the neonate.
How to prevent?
Radiation
Cover neonates head
Naked neonate under radiant warmer
Signs and symptoms of heat loss?
Axillary temp less than 36.5 (97.7) Cool skin lethargy Pallor Tachypnea Grunting Hypoglycemia Hypotonia Jitteriness Weak suck
Signs and symptoms of hypoglycemia
Jitteriness, respiratory distress, poor suck, low temperature, lethargy, blood sugar less than 40 mg/dL
Normal blood glucose newborn?
40-60 mg/dL
Normal respiratory rate newborn?
30-60, irregular
dark bluish spots on low back/buttocks, normal
Mongolian spots
Dark pink patch on back of neck and eye lids, disappear around 1 year
storkbite
red wine colored spot anywhere on body, do not disappear
port-wine stain
raised birght red lesion, disappear
Strawberry hemangioma
newborn rash resembling mosquito bite, disappear
Erythema toxicum
When is jaundice NOT ok?
Within the first 24 hours
soft tissue swelling of the scalp, crosses suture line, present at birth
caput succedaneum
hematoma between periosteum and skull with unilateral swelling, does NOT cross suture line, shows up few hours after birth
cephalohematoma
Normal fetal heart rate
120-160
How many wet diapers should a newborn have per day?
6-8
How many stools should an infant have? breastfeed, bottled
Breastfed- 3-10
Bottle- 1-4
What is the characteristics of lochia on days 1-3?
Bloody with small clots
Moderate to scant amount
Increaed flow on standing or breastfeeding
Fleshy odor
Characteristics of lochia on days 4-10
Pink and brown color
Scant amount
Increased flow during physical activity
Fleshy odor
Characteristics of lochia on day 10
Yellow to white color
Scant amount
Fleshy odor
Less than 1 inch of lochia on pad
scant
less than 4 inches of lochia on pad
light
less than 6 inches of lochia on pad
moderate
pad is saturated in 1 hour with lochia
Heavy
A temperature of what postpartum indicates infection?
greater than 100.4 on 2 occasions 6 hours apart within first 24 hours
Emotional feeling that begin during pregnancy or shortly after birth between the parent and the newborn. Unidirectional from parent to newborn
Bonding
Emotional connection that forms between the infant and parents. It is bidirectional from newborn to parent and parent to newborn
Attachment
a phenomenon in which the newborn and infant moves his or her arms and legs in rhythm with speech pattern of an adult.
Entrainment
blood loss greater than 500 mL or vaginal delivery and 1000ml for c-section with a 10% drop in hemoglobin and hematocrit
Postpartum hemorrhage
amniotic fluid that contains fetal cells, lanugo, and vernix enters the maternal vascular system and initiates a cascading process that leads to cardiorespiratory collapse and DIC.
Amniotic fluid embolism
most common postpartum infection, an infection of endometrium, myometrium, and/or parametrical tissue that usually starts at the placenta site and spreads to encompass the entire endometrium
Metritis
