TEST 4 - Tiff Flashcards
Sepsis Neonatorum - EARLY-ONSET SEPSIS
- acquired during birth, often from complications of labor such as prolonged rupture of membranes, prolonged labor, or chorioamnionitis.
- Infants often show signs during the first hours after birth, and 90% show signs within 24 hours
- Rapidly progressive multisystem illness with high mortality and morbidity rates.
- Pneumonia and meningitis are commonly present
Symmetric growth restrictions may be caused by what 5 things?
- congenital anomalies
- genetic disorders
- exposure to infections
- drugs early in pregnancy
- normal genetic predisposition.
Danger signs that women need to seek emergency care POST BIRTH
Pain in chest
Obstructive Breathing
Seizures
Thoughts of hurting yourself or baby
Bleeding Incision that's not healing Red or swollen leg that is painful & warm to the touch Temp over 104 Headache that does not get better
Postpartum Hemorrhage interventions
CALL FOR HELP
- Monitor Fundus
- Monitor bleeding - weigh pads etc
- Check Uterine Tone
- Measure blood loss - 1 gram = 1ml
- A drop of 1 gram in Hgb or 3% drop in Hct is = 500 ml of blood loss
Medications used for Hemorrhage
- Oxytocin 10-40 units (10 units im if not IV access)
- Cytotec (misoprostol) PO, Rectally- 800mcg, Vaginally
- Methergine - 0.2mg IM, IV, or PO
- Prostin (Hemabate) IM 250mcg - Diarrhea, elevated diastolic fever flushing, (DON’T GIVE IF PT HAS ASTHMA)
- Action-prostaglandin to control bleeding after delivery. Side effects-headache, nausea/vomiting, and diarrhea. Note-often given with Lomotil. Don’t give with history of asthma
Interventions for Hemorrhage
- D&C - dilation and curettage (stretching of the cervical os to permit suctioning or scraping of the walls of the uterus)
- Manual removal of placenta
- Bakri Balloon - A balloon may be inserted into the uterus to apply pressure against the uterine surface to stop bleeding
- Hysterectomy is a last resort to save the life of a woman with uncontrollable postpartum hemorrhage.
Asymmetric growth restriction is caused by complications such as preeclampsia that begin in the ____ Trimester and interfere with uteroplacental function
3rd
Physical characteristics of an SGA infant with Asymmetric growth restrictions
- Normal head size but seems large for the rest of the body
- Normal brain growth and heart size
- Normal Length
- Weight is below the 10th percentile
- Abdominal circumference is decreased because the liver, spleen, and adrenals are smaller than normal
An SGA infant with Asymmetric growth restriction appears ………
- The infant appears long, thin, and wasted.
- The dry, loose skin has longitudinal thigh creases from loss of subcutaneous fat.
- sunken abdomen, sparse hair, a thin cord, and the facial appearance of being elderly.
- The anterior fontanel may be large with wide or overlapping cranial sutures
How do SGA infants with Asymmetric growth continue to develop?
- They generally “catch up” in growth, particularly in the first 2 years, if they are adequately nourished after birth.
Risk factors in the immediate post-partum in women related to heart disease
- The fourth stage of labor is associated with special risks.
- To minimize the risks of overloading the heart, abrupt positional changes should be avoided.
- The uterus should not be massaged to expedite separation of the placenta.
- Careful assessment for signs of circulatory overload, such as a bounding pulse, distended neck and peripheral veins, and moist rales in the lungs, is performed throughout labor and the postpartum period.
Although no evidence of distress during pregnancy, labor, and childbirth, women may have cardiac decompensation during the postpartum period due to …….
- After delivery of the placenta, about 500 mL of blood is returned to the intravascular volume. Blood from the placenta and uterus increases the workload on the heart.
What conditions can act together to precipitate postpartum heart failure.
- infection, hemorrhage, and thromboembolism
Signs and symptoms of postpartum congestive heart failure include:
- Cough (frequent, productive, hemoptysis)
- Progressive dyspnea with exertion
- Orthopnea
- Pitting edema of legs and feet or generalized edema of face, hands, or sacral area
- Heart palpitations
- Progressive fatigue or syncope with exertion
- Moist rales in lower lobes, indicating pulmonary edema
Early-onset newborn GBS disease occurs during the first week after birth, often within 48 hours. What are the primary infections in early onset GBS disease?
-Sepsis, pneumonia, and meningitis
Late-onset GBS disease occurs after the first week of life, and _________ is the most common clinical manifestation.
meningitis
Regarding Late-onset GBS, what patients are neurologic consequences are more likely in
- infants who survive meningeal infections
Optimal identification of the GBS carrier status is obtained by vaginal and rectal culture between _________ weeks of gestation.
- 35 and 37 weeks (BONNIE SAYS 34 - 36)
Maternal THERAPEUTIC MANAGEMENT of GBS includes
- Penicillin is the first-line agent for antibiotic treatment of the infected woman during birth.
- Cephazolin is the alternative for the patient with non–life-threatening penicillin allergy.
- Clindamycin is used for the woman at high risk for anaphylaxis.
NAS Neonatal Abstinence Syndrome
a disorder in which infants exposed to maternal drugs before birth demonstrate signs of drug withdrawal.
Fetal diagnostic tests such as _______, _____ & ______ help identify problems.
- ultrasonography
- nonstress tests
- biophysical profiles
In addition to toxicology screening, a pregnant woman who uses illicit drugs must be assessed throughout pregnancy for ____, _______ , & ________.
- STDs
- hepatitis,
- exposure to HIV.
Define Puerperal infection
- a term used to describe bacterial infections after childbirth.
The most common postpartum infections are
- endometritis (an infection of the inner lining of the uterus)
- wound infections
- urinary tract infections
- mastitis (infection of the breast)
- septic pelvic thrombophlebitis.
What risk factors can contribute to postpartum infections
- lacerations
- Hxt of previous infections
- C-section
- Trauma
- Prolonged rupture of membranes
- Prolonged labor
- Catherization
- Excessive vaginal exams
- Hemorrahage
- Poor general health, nutrition and or hygiene
Deontologic Model.
- The deontologic model determines what is right by applying ethical principles and moral rules.
- does not vary the solution according to individual situations.
***example is the rule, “Life must be maintained at all costs and in all circumstances.” Strictly used, the deontologic model would not consider the quality of life or weigh the use of scarce resources against the likelihood that the life maintained would be near-normal.
Utilitarian Model
- The utilitarian model approaches ethical dilemmas by analyzing the benefits and burdens of any course of action to find one that will result in the greatest amount of good.
- Appropriate actions may vary with the situation when using the utilitarian model.
- concerned more with the consequences of actions than the actions themselves.
- **“The end justifies the means.” If the outcome is positive, the method of arriving at that outcome is less important.
Human Rights Model.
- The belief that each person has human rights is the basis for the human rights model to making ethical decisions.
- The nurse may find personal difficulty in the right of a person to refuse care that the nurse and possibly other care providers believe is best.
- A nurse’s goal is usually to save lives but what if the person’s life is intolerable or care is refused?
Risks and complications of post term infants
- Placental insufficiency
- Some grow to more than 8 lbs placing them at risk for birth injuries or cesarean birth
- decreased amniotic fluid volume (oligohydramnios) due to placental insufficiency
- compression of the umbilical cord may occur.
- When labor begins, poor oxygen reserves may cause fetal compromise.
- fetus may pass meconium as a result of hypoxia before or during labor, increasing the risk of meconium aspiration at delivery
Nursing management for post term infants
- infant is large, the nurse should observe for injury and hypoglycemia.
- The infant with postmaturity syndrome may have an apprehensive look associated with hypoxia
- In cases of asphyxia or meconium aspiration, respiratory support is needed at birth
Lochia Rubia
first 1-3 days after birth
red, mucus, small clots
lochia serosa
days 4-10 after birth
pink-brown, serosanguinous
lochia abla
1-3 weeks
yellow-white, or colorless
nursing considerations critical to remember for lochia post partum
- lochia should be decreasing in amount every day
- it increases in amount or becomes more bright red, a women should rest more
- if a woman increases her bleeding to where it soaks a pad in one hour, even if she is 1day or 4 weeks pp, this needs to be evaluated immediately (could be sign of retained placenta/amniotic sac)
Post partum changes - Cervix and Vagina
- immediately after childbirth the cervix is dilated, edematous and bruised
- by the end of the first week the external os is 1cm in diameter
- the shape of the os is permanently changed
- the vagina and introitus are greatly stretched during childbirht
- the vaginal walls appear edematous and multiple small lacerations may be present, with very few vaginal rugae.
- rugae begin to reappear by 3-4 weeks
- vaginal mucosa becomes atrophic until estrogen production by the ovaries is reestablished
- women may experience dyspareunia
Post partum changes - gastrointestinal
- Constipation is a common problem
- -Bowel tone, motility, pain - Listen for bowel sounds- post cesarean
- -Paralytic ileus
- -Distention - Early ambulation
- High fiber, lots of fluids
- Stool softeners and minimize narcotics
- Abdominal tightening
Post partum changes - urinary system
- Diuresis
- -Up to 3000ml days 2-5 - Uti
- -Due to trauma from birth, catheters, overdistention - Distention
- -Increase in bleeding
- Urinary retention
- -First vaginal delivery
- -Regional anesthesia
- Stress incontinence
- -Resolves with pelvic floor exercises- Kegels
Post partum changes - musculoskeletal
- Muscle fatigue and joint pain 1-2 days or more after birth.
- Relaxin hormone gradually subsides and joint and cartilage of the pelvis begin to return to prepregnancy positions
-Abdominal wall stretches during pregnancy
–Diastasis recti- may be minimal or extensive
With exercise can return to normal by 6 weeks after birth.
Post partum changes - integuementary
- Gradually changes to the non pregnant state.
- -Melasma “mask of pregnancy”
- -Linea nigra
- -Spider nevi and Palmar Erythema - However Stretch marks only fade
- -Striae gravidarum fade to silvery lines but do not disappear.
Post partum changes - endocrine
-Ovulation and Menstruation
–Ovulation can occur before the first menses.
Sometimes as early as 3 weeks postpartum.
–40%-45% of non nursing mothers resume menstruation within 6 to 8 weeks.
–75% by 12 weeks and all by 6 months.
–Breastfeeding delays the return of menstruation
–If breastfeeding frequently and not using supplements, contraception should be used by 6 months.
when should you do assessments for the post partum patient?
- q 15 min for first hour
- q 30 mins for 2nd hour
- q 4 hours for the first 24 hours
- q 8-12 hours depending on policy and status
Vitals signs after birth of baby - temperature
- may be slightly elevated
- if greater than 100.4 could be sign of infection
Vitals signs after birth of baby - pulse
bradycardia
tachycardia
-could be due to hemorrhage, pain, fatigues, excitement, dehydration, infection
Vitals signs after birth of baby - respirations and BP
-Should be back to normal
- Hypoventilation….
- -Possible as a result of spinal or epidural - BP
- -Varies with maternal position
what is the purpose of critical thinking?
to help nurses make the best clinical judgements
what are the steps to critical thinking?
- recognizing assumptions
- examining biases
- determining the need for closure
- becoming skillful in data management
- acknowledging emotions and environmental factors
Acronym for assessment:
BUBBLE HEP
breasts uterus bowels bladder lochia episiotomy
homan’s
emotions
pain
Acronym for assessment of incisions:
REEDA
redness edema ecchymosis discharge, drainage approximation
Chart Review:
Gravida, Para
Time and type of delivery
Presence and degree of episiotomy/ laceration
Anesthesia, any medications administered
-Medications in the OR and time given
Significant medical/ surgical history
Current medications
Food and drug allergies
Chosen method of infant feeding
Condition of the baby
Laboratory data
Need for Rho (D) immune globulin (RhoGAM)
Need for Rubella, TdAP
Risk for hemorrhage, infection
Vital signs
Skin color
Location and firmness of the fundus
Amount and color of lochia
Perineum- epis, laceration, hemorrhoids
Pain- present? Level of? Location?
IV- Type of fluid, rate of administration and any additives
- Patency of the line
- Condition of the IV site- redness, edema, pain
Urinary output-
- Time and amount of last void
- Presence of catheter
Abdominal incision
-Dressing type, drainage
If anesthesia used, level of feeling and ability to move.
Nursing management post term infants
- Assess for Hypoglycemia (b/c rapid use of glycogen stores)
- Temp - loss of subcutaneous fat can put infant at risk for low temp
- Apgar scores less than 7 are more likely
- Respiratory support incase meconium aspiration
