Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

WCF > WCF Exam 2 > Flashcards

WCF Exam 2 Flashcards

1
Q

The 5 P’s

A

Passenger (baby)
Position (of the baby)
Passageway (maternal pelvis)
Powers (physiological forces)
Psychological Response of the Pregnant Patient (includes psychosocial influences)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Fetal head molding - conehead

A

collection of fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Position

Fetal Presentation - What’s coming first?

A

Cephalic/vertex (head 1st), breech, and shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Position

Fetal Attitude
Chin to chest = good
Chin extended = bad

A

Flex- chin to chest
Neutral (AKA military)- straight up and down
Extended (AKA face present)- chin extended, head tilted backwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What fetal presentation do you opt for C-section?

A

breech and shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What fetal attitude do you opt for C-section?

A

Extended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Position

Fetal Lie - Are the spines aligned?

A

Longitudinal, transverse (horizontal), or oblique (diagonal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Position

Fetal Position - Direction in the pelvis?

A

Occiput- back of head
Sacrum- butt
Mentum- chin
Sinciput- forehead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Lie: longitudinal or vertical
Presentation: breech
Presenting part: sacrum
Attitude: flexion, except for legs or knees

A

Frank breech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Lie: longitudinal or vertical
Presentation: breech
Presenting part: sacrum
Attitude: flexion, except for one leg extended at hip and knee

A

Single footing breech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Lie: longitudinal or vertical
Presentation: breech
Presenting part: sacrum w/ feet
Attitude: general flexion

A

Complete breech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Lie: transverse or horizontal
Presentation: shoulder
Presenting part: scapula
Attitude: flexion

A

Shoulder presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Fetal position - Three letter designation

A

1) Side of pregnant patient that the baby’s body part is leaning toward - L or R
2) Baby’s body part entering the pelvis -Occiput, Sacrum, Scapula, Mentum
3) Side of the pelvis the baby’s body part is closest to - Anterior (pelvis), Posterior (tailbone), Transverse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Good contractions are every __________ minutes and last __________ seconds.

A

Good contractions are every 2-3 minutes and last 60-90 seconds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How can you check the frequency/duration/intensity of contractions?

A

Palpate the fundus

IUPCD- intrauterine pressure catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

No cervical change (from previous dilation/effacement)
CTX do not intensify and may space out
Can walk/talk through CTX, walking does not make them stronger
Pain medication may stop contractions (Braxton Hicks)

A

False labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Cervical change
CTX get longer, stronger, closer together, & demand attention
Walking may make them stronger
Pain med may slow or speed up labor, never stop
5-1-1

A

True labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is 5-1-1?

A

Occurring every 5 minutes
Lasting 1 minute
Happening for 1 hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Signs of impending labor

A

lightening- baby dropped, irregular contractions (braxton hicks), energy spurt (nesting), increased urinary frequency, bloody show/vaginal discharge, loss of mucus plug, pelvic pressure (mom feels the urge to poo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Maternal response to labor

A

Cardiovascular system- increased BP
Respiratory system- hyperventilation, O2 consumption increased during 2nd stage of labor; use mask (not nasal cannula)
GI system- digestion slows/stops during labor; no eating during labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PMI

A

Point of Maximum Intensity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Use Leopold’s maneuvers to determine fetal presentation and find PMI. This is where you place the

A

fetal monitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Vaginal exam determines

A

dilation, effacement, fetal station/decent, and amniotic membrane/fluid status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Diameter across opening

A

cervical dilation
0-10cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Percentage of ‘shortening’

A

cervical effacement
0-100%

Document anything 50% or greater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Descent of the fetal presenting part in the pelvis in relation to ischial spines

A

Pelvic/fetal station
-5 to +5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Cervical exam example:

3/90/-1

A

3cm dilated
90% effaced
@ -1 station

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

COCA

A

color- pale, straw colored; flecks of lanugo or vernix
odor- no odor
consistency- watery
amount- 1,000 mL around 32-36 weeks; starts to drop at 37 weeks to 700-800 mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

If there is an odor when assessing amniotic fluid, indicative of an

A

infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

SROM

A

Spontaneous rupture of the membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

AROM

A

Artificial rupture of the membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

False labor is what stage of labor?

A

Pre-Labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

True labor is what stage of labor?

0cm to 10cm

A

1st stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Delivery of baby is what stage of labor?

10cm to baby

A

2nd stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Delivery of placenta is what stage of labor?

Baby to placenta

A

3rd stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Recovery is what stage of labor?

A

4th stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What stage of labor?

-Begins at onset of true labor
-Ends with cervical dilation of 10cm or complete dilation
-Three phases- latent, active, transition

A

1st stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Three phases of true labor (1st stage)

A

latent (early), active, and transition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

0-3cm w/ mild to moderate contractions is what phase of true labor?

A

latent (early)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

4-7cm w/ moderate to strong contractions is what phase of true labor?

A

active

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

8-10cm w/ strong contractions is what phase of true labor?

A

transition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

SVE

A

Sterile vaginal exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Why should vaginal exams be limited?

A

Avoid infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Nursing assessments/interventions during 1st stage of labor

A

-continuously monitor pain
-palpate contractions every 30 minutes (every 15 minutes during transition phase)
-EFM monitoring (intermittent if low risk/reactive, continuous if high risk/abnormal)
-SVE
-amniotic fluid @ROM (COCA, check FHR)
-assist w/ breathing
-encourage support
-prevent early pushing
-notify provider of any deviations/once 1st stage is complete
-administer medications
-document!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What stage of labor?

-Begins w/ complete or full dilation (10cm)
-“Pushing” stage
-End with delivery of baby
-duration may vary between primiparas and multiparas

A

2nd stage of labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Nursing assessments/interventions during 2nd stage of labor

A

-maternal & fetal assessment
-vaginal exam to assess descent, pushing efforts
-remove foley if pt has an epidural
-promote effective pushing/positioning
-assist w/ delivery
-document!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Body preparation for birth during 2nd stage of labor

A

-bulging of perineum and rectum
-flattening and thinning of the perineum
-increased bloody show
-labia begins to separate
-burning sensation (Ring of Fire)
-intense pressure in rectum
-crowning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Types of lacerations

A

perineal, vaginal & urethral, cervical, and episiotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Episiotomy lacerations

A

-Median “midline”
-Mediolateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Perineal laceration - 1st degree

A

First degree: Skin and structures superficial to muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Perineal laceration - 2nd degree

A

Second degree: Through muscles of perineal body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Perineal laceration - 3rd degree

A

Third degree: Through anal sphincter muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Perineal laceration - 4th degree

A

Fourth degree: Anterior through rectal wall

Rooter to the tooter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What stage of labor?

-Begins with birth of baby
-Ends with delivery of placenta
-Duration may last up to 30 minutes
Longer may lead to D&C due to retained placenta
-Signs that placenta is ready to deliver:
Lengthening of the cord, Gush of dark red blood (which appears after separation), Globular shape of abdomen, Patient feels “like I have to push again”

A

3rd stage of labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Preparation during 3rd stage of labor

A

-APGAR on infant @1min, 5min, & 10min (if low score)
-watch for signs of placental separation (should occur within 30 min)
-vital signs
-baby to chest/warmer to prevent heat loss
-get lidocaine/sutures if episiotomy/laceration is present
-admin pitocin to prevent hemorrhage
-document after placenta delivers!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What stage of labor?

-May last up to 4 hours or more
-Physiologic readjustment begins
-Critical assessments by RN are done
-Fundal assessment is crucial!

A

Recovery stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Three Sources of Labor Pain

A

-Emotional: fear, tension, and pain
-Functional: dilation and contractions
-Physiologic: maternal and fetal position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

PAIN

A

Purposeful
Anticipated
Intermittent
Normal

Pain is serving a useful purpose, is a normal process. (not from illness or injury). Can be anticipated and prepared for with clear ending point.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Pain management in Labor

Nursing Goal

A

Continually assess fetus and client to ensure a safe delivery, facilitate a positive birth experience, assist in the management of pain, advocate for patient needs (patient needs may change throughout labor).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Types of non-pharmacologic pain relief

A

Hydrotherapy, birthing ball, peanut ball, cub, paced breathing & relaxation, music, guided meditation, guided imagery, aromatherapy, acupressure/counterpressure/massage, yoga, application of heat & cold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Warm water promotes comfort & relaxation
Showering or soaking in a tub or whirlpool bath
Helps decrease muscle tension
Buoyancy in tub can help with relief, increases oxytocin and endorphins

A

Hydrotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Diminishes stress, anxiety, and tension (all which can increase sensation of pain)
When tension is reduced, patient breathes more deeply which improves oxygenation

A

Paced breathing & relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Picture a place that is special or focus on a place where client likes to be
Nurse or labor support person can verbalize sights and sounds of the place to distract the client

A

Guided imagery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Use of essential oils
Rose, lavender, frankincense, and bergamot oils
Promote comfort and relaxation, decrease pain
May add to bath, to lotions, or use aromatherapy delivery device

A

aromatherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Can warm washcloths be applied to the perineum to help relieve discomfort from stretching and may help prevent tearing?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Benefits of Non-Pharmacologic Pain Relief

A

No limitations to mobility during labor and after delivery

Fastest recovery (for both patient and baby)

Facilitates partner participation

Minimal intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

A form of massage involving a circular stroking movement made with the palm of the hand.

Gentle strokes

A

Effleurage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Injection route IV or IM

A

Parenteral Analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Analgesia

A

pain relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

True or False

Assessment should be completed prior to medication administration

A

True

Check maternal BP, fetal HR, and labor stage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

The safest and most effective form of pharmacological pain relief depends on

A

Stage of labor, progress of labor, medical status of client and fetus, and patient preference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Can non- pharmacological interventions for pain control be used in addition to pharmacological agents as labor progresses?

A

Yes, can promote relaxation and potentiate effects of meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

True or False

Opioids must be administered either more than 4 hours before delivery or less than 1 hour before delivery.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Advantages of Parenteral Analgesia

A

-Ease of administration
Dose can be titrated, Pain relief begins in minutes, No loss of consciousness, Increased relaxation, Decreased pain

-RN can administer
No waiting for anesthesia!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Antiemetics are used for

A

nausea/vomiting

Ex: Zofran, Phenergan-Opioid Catalyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Opiate antagonist are used to

A

reverse opioid

Ex: Naloxone (Narcan)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Opioid agonists/Opioid agonist-antagonists provide

A

Intermittent Relief: reduce the awareness of pain

Ex: Butorphanol (Stadol) IV/IM
Meperidine hydrochloride (Demerol) IV/IM
Hydromorphone hydrochloride (Dilaudid) IV/IM
Nalbuphine (Nubain) IV/IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Disadvantages of Parenteral Analgesia

A

Maternal response- may not relieve pain, cause N/V & drowsiness, confined to bed, continuous EFM

Fetal response- CNS depression (decreased FHR variability), respiration depression, decreased refluxes (sucking), can impair early breastfeeding, decreased ability to regulate temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

-Colorless, odorless gas that is mixed 50/50 Nitrous oxide/oxygen for laboring moms
-Valuable alternative to epidural anesthesia
-When breathed in, it reduces anxiety and increases feelings of relaxation and well-being
-Inhaled though a mask or mouthpiece
-Can utilize at any stage of labor/delivery

A

Nitrous oxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Advantages & disadvantages of nitrous oxide

A

Advantages: Does not impair patient mobility, No additional monitoring required, Self-administration provides patient with control, Medication effects stopped as soon as the mask or mouthpiece is removed

Disadvantages: Nausea and vomiting, Dizziness, Drowsiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Safety concerns when using nitrous oxide

A

Risk of respiratory depression when combined with opioids
Rapidly crosses the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Three types of anesthesia

A

Local, regional, and general

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What type of anesthesia is used for episiotomy/laceration & repair?

A

local

Ex: lidocaine

Given immediately before birth for episiotomy or after birth for repair of lacerations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Types of regional anesthesia

A

-Epidural (Bupivicaine/Fentanyl on PCA Pump)
The epidural space is located between the dura mater and the ligamentum flavum.

-Spinal Intrathecal opioids (Duramorph)
Spinal anesthetic agent is administered into the CSF in the subarachnoid space.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

When is general anesthesia used?

A

stat Cesarean (C-Section), other emergencies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Most commonly used method of pain control during labor (nearly 2/3 of women in US)

A

Epidural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Nursing Care prior to administration of epidural

A

Educate, Consent, Safety check
Prepare the patient (positioning, monitors)
Report HTN, bleeding disorder, systemic infection
Administer fluid bolus to stabilize BP

88
Q

Nursing care after administration of epidural

A

BP q 5 min or per protocol
Review labor progress, FHR & CTX patterns require continuous monitoring
Keep bladder empty (Insert Foley)
Position for Pain and Passenger- Don’t leave supine for an extended period of time!

89
Q

Potential contraindications for epidural anesthesia

A

Structural
-Previous spinal injury/surgery
-Severe scoliosis
-BMI of 50+
-Space-occupying brain lesion (ICP)
-Local or systemic infection

Hematological
-Thrombocytopenia
-Coagulation disorders
-Actual or anticipated maternal hemorrhage

90
Q

Side effects of epidural

A

shivering, pt is cold

hypotension

91
Q

How long until pain relief begins after epidural is inserted & meds are started?

A

15-20 minutes

92
Q

Can an epidural be inserted during contractions?

A

No, in between contractions

93
Q

Advantages of epidural anesthesia

A

Indefinite Duration
-Continuous pain relief, relaxation
-Excellent coverage in labor

Titratable
-In relation to stage of labor
-Patient can administer bolus (PCA pump)
-Remain alert and participate in birth
-No blood loss, no delay in gastric emptying, respiratory reflexes remain intact
-Fetal complications rare

94
Q

Disadvantages of epidural anesthesia

A

Risk of hypotension, strict bedrest, possible post-dural puncture headache, and longer maternal recovery

95
Q

How is a post-dural puncture headache is treated?

Rare, but miserable complication. Occurs within 48 h after puncture from leakage of CSF into dura mater. Intensifies in upright position.

A

Blood patch: 10-20 mL of patient’s blood is slowly injected into lumbar epidural space, clot forms in hole in dura mater which seals from further CSF leakage

Other interventions: oral analgesics, dark room, caffeine, hydration

96
Q

Nursing actions for hypotension

Severe maternal hypotension = drop in baseline BP more than 20% or fetal compromise

A

Left Side, elevate legs
Bolus of IV fluids
Monitor blood pressure and FHR every 5 min until stable
Oxygen by face mask
Summon Help (Alert provider, anesthetist)

97
Q

Spinal blocks are commonly used for

A

C-sections

98
Q

What is a spinal block?

A

anesthetic into CSF

99
Q

What is general anesthesia?

A

induced unconsciousness

commonly used for unplanned, rapid C- sections

100
Q

Complications of general anesthesia

A

-Fetal depression
Anesthetic agents reach fetus in minutes, need to deliver fetus immediately, not advised for high-risk fetus (preterm)
-Greater blood loss- Due to uterine relaxation
-Aspiration- Increased chance of emesis
-Amnesia
-Hypoxia

101
Q

Nursing interventions for general anesthesia

A

-give antacid per-op to reduce the risk of aspiration
-wedge under r hip for l lat tilt to relieve inferior vena cava pressure
-pre-oxygenate
-IV fluid bolus,
-cricoid pressure during ET tube placement

102
Q

Pueriperium

A

Postpartum AKA 4th trimester

immediately after childbirth and lasts for 6 weeks

103
Q

When is infant physiology adapting and risks to mother of post partum hemorrhage the highest?

A

after delivery

This is the immediate postnatal period = first 24 hours after birth

104
Q

How often do you check vitals after a vaginal delivery?

A

Every 15 minutes for 2 hours, every 4 hours for 8 hours, and then every 8 hours until discharge

105
Q

How often do you check vitals after a C-section?

A

Every 30 minutes for 4 hours, then every hour for 3 hours, then every 4-8 hours

106
Q

Post partum normal vital ranges

A

Temp: 98.6-100.4
Pulse: 50-90
RR: 12-20
BP: Baseline BP during first trimester
Assess pain

107
Q

What does the acronym BUBBLE-HE(B) stand for?

A

Breasts
Uterus
Bladder
Bowel
Lochia
Episiotomy (perineum and hemorrhoids)
Homan’s sign (legs)
Emotional support
Bonding

108
Q

What is colostrum?

A

the first milk, yellow fluid, filled with nutrients, optimal feed within first hour of birth

109
Q

Patient education for
non-breastfeeding patient

A

Wear supportive bra (sports bra works well)
Ice packs to axillary area
Ibuprofen or acetaminophen can be taken for discomfort
Educate: use safe water source, mix according to directions for formula

110
Q

Within 48-72 hours
Aka milk “coming in”
Breastfeed frequently to remove milk
Massage breasts before and during feeds
Cold compresses after the swelling (lymphatic and hormonal response)
Will resolve day 4-5

A

Engorgement for BF moms

111
Q

Resolves spontaneously
Discomfort decreases within 24 to 36 hours
Breast binder or tight bra (sports bra works well)
Ice packs, mild analgesics for pain
Avoid stimulation (back to shower)
Cool washcloths, cabbage leaves

A

Engorgement for non BF moms

112
Q

Blocked milk duct/bacteria: Unilateral breast involvement
Fever usually occurs
Treatment: Abx, moist heat, increased fluid intake, Tylenol/Motrin
Continue to breastfeed!

A

Mastitis

113
Q

Is uterine involution normal?

A

Yes, uterus returns to non-pregnant state following birth

Decreased by 1cm/day

114
Q

What is uterine subinvolution?

A

Uterus is not decreasing in size.

Uterine involution may be inhibited by multiple births, hydramnios, prolonged labor or difficult birth, infection, grand multiparity, or excessive maternal analgesia. In addition, a full bladder or retained placental tissue may prevent the uterus from sustaining the contractions needed to prevent hemorrhage or to facilitate involution.

115
Q

Signs and symptoms of pelvic infection

A

-prolonged lochial d/c
-irregular or prolonged bleeding; sometimes hemorrhage

Give antibiotics

116
Q

Afterpains education

A

-Most severe 2-3 days after delivery
-Similar to menstrual cramps
-Multiparas and patients with larger uterine distention (large baby) experience more vigorous contractions
-Ibuprofen or naproxen

117
Q

Placenta has to be delivered within __ minutes of delivery.

A

30

118
Q

Retained placental fragments produces progesterone. Progesterone _________ the uterus.

A

relaxes

119
Q

Methergine PO __________ the uterus. Preventing and treating postpartum hemorrhage.

A

contracts

120
Q

Leading cause of maternal morbidity and mortality in the U.S. and around the world

A

Postpartum hemorrhage

121
Q

Early postpartum hemorrhage

A

first 24 hrs after delivery

Greatest likelihood within 4 hours after delivery

122
Q

Late postpartum hemorrhage

A

24 hrs to 12 weeks after delivery

Usually caused by retained placental fragments

123
Q

Diagnosis of postpartum hemorrhage

A

Vaginal Delivery= >500mL EBL
Cesarean Section= >1000mL EBL
HCT levels drop more than 10%

Need for RBC transfusion because of anemia or hemodynamic instability

124
Q

Postpartum hemorrhage T’s:

A

Tone, trauma, tissue, & thrombin

125
Q

What is uterine atony?

Leading cause of early PPH

A

Intermittent/Continuous dark red blood with clots, uterus soft & boggy

Caused by: Pitocin use- Induction, over distended uterus (macrosomia, multiple gestation), obesity, prolonged labor, previous history, trauma during birth, manual placental removal, use of anesthesia

126
Q

Placenta previa and placenta accreta are at a higher risk for

A

retained placental fragments

127
Q

Deficiency of platelets

A

thrombocytopenia

Results in delayed blood clotting

Normal platelet count is around 150,000 to 400,000 platelets per microliter (μl) of blood

128
Q

How often should a fundal massage be completed the first hour following delivery?

A

every 15 minutes

129
Q

_________ _________ is a risk factor for hemorrhage during the first hours after delivery.

A

Urinary retention; Ask pt to void before fundal massage, this will help promote uterine contractions

130
Q

A full uterus will displace the uterus. Should you take a pt who is actively hemorrhaging to the bathroom to void?

A

No, insert a foley

131
Q

Meds to increase uterine tone

A

Pitocin IV-Bolus rapidly
Cytotec PR (per rectum)-Make sure to use lubricating jelly
Methergine IM-DO NOT GIVE to HYPERTENSIVES
Hemabate IM-DO NOT GIVE to ASTHMATICS

132
Q

Initial management and care for PPH

A

Palpate fundus: location, tone, & lochia
Massage if boggy
Express clots, note length of time to saturate pad
Assess perineum for hematoma, unrepaired lacerations
Empty bladder (bedpan, straight cath or foley)
IV – large bore 18 gauge - rapid infusion 1-liter fluids, preferably NS or LR
Pitocin 20 – 40 units/1 liter
Oxygen 10-12 L/min for compromised perfusion

133
Q

PPH Med

Pitocin

A

Action: Stimulates contractions (uterine smooth muscle)
Route: IV, IM if no IV access
Contraindications: hypersensitivity
Nursing considerations: First line for PPH (uterine atony). Bolus can lead to hypotension and cardiac arrythmias.

134
Q

PPH Med

Methylergonovine maleate (Methergine)

A

Action: Stimulates contractions (uterine and vascular smooth muscles)
Route: IM followed by PO
Contraindications: Hypersensitivity, history of HTN or current high BP
Nursing considerations: do not mix with other meds

135
Q

PPH Med

Carboprost tromethamine (Hemabate)

A

Action: Stimulates contractions (myometrium)
Route: IM or directly into uterus
Contraindications: Asthma, hepatic, renal, cardiac disease
Nursing considerations: VERY expensive. Do not administer if patient demonstrating s/s of shock.

136
Q

PPH Med

Misoprostol (Cytotec)

A

Action: Stimulates powerful contractions (myometrium)
Route: rectal, PO, sublingual
Contraindications: Hypersensitivity to prostaglandins
Nursing considerations: Rectal much slower than IV.

137
Q

PPH Med

Dinoprostone (Prostin E2)

A

Action: Stimulates powerful contractions (myometrium)
Route: Vaginal or rectal suppository
Contraindications: Hypersensitivity to prostaglandins, severe HTN
Nursing considerations: If vaginal bleeding, vaginal suppository likely ineffective. Fever is common.

138
Q

Hypovolemic shock caused by PPH

Classic signs

A

-Maternal dyspnea, tachycardia, thready pulse
-Dropping blood pressure, increasing tachycardia

139
Q

Nursing interventions for hypovolemic shock

A

-Summon help: Especially Anesthesia
-#1 Massage fundus (atony)
-Assessment: Must know client’s risk factors!
-Rapid infusion of crystalloids: NS/RBC’s
-Airway – O2
-Monitor status

140
Q

How to have the best postpartum poo experience?

A

Increase water intake, don’t ignore the urge, pamper the perineum, use stool softener, take walks, and eat healthy

141
Q

What is the lochia progression?

A

Rubra –> Serosa –> Alba

142
Q

Lochia

Dark red, lasts 3-4 days

A

Rubra

143
Q

Lochia

Pink/brown, lasts 4-10 days

A

Serosa

144
Q

Lochia

Whiteish-yellow, lasts 10-28 days

A

Alba

145
Q

Can the lochia progression go in reverse?

A

No, should never go in reverse

146
Q

What does REEDA stand for? What is it used for?

A

Assessing episiotomy healing

Redness
Edema
Ecchymosis (bruising)
Discharge
Approximation

147
Q

Nursing interventions for perineal discomfort

A

Assess perineum for hematoma, bleeding, s/s of infection

Ice Pack
Ice-filled glove wrapped in wash cloth (avoid latex gloves if patient allergic)
Peri bottle
Sitz baths to start after first 24 hours
Instruct patient: Nothing in the vagina for a minimum of 6 weeks
Kegel Exercises
Give stool softener

148
Q

What pts typically feel perineal discomfort?

A

Patients who would experience perineal discomfort experienced a fast and expeditious delivery, had an episiotomy, or a long, difficult vaginal delivery

149
Q

Transient period of depression
Occurs first week or two after birth
Mood swings, anger, weepiness, anorexia, sleeping problems, feeling letdown, fatigue
Functioning not impaired
Normal and usually resolves naturally esp. with support and understanding

A

Baby blues

150
Q

Abnormal intense, pervasive sadness with severe and labile mood swings, fear, anger, anxiety - persists past 2 weeks PP
Sleep difficulty

Impaired: Unable to care for self or baby
Medical management: psychotherapy/medication

Rarely seek help and feel guilty: 10-15% of mothers

A

Postpartum depression

151
Q

What scale is used to assess postpartum emotions?

A

Edinburgh Postpartum Depression Scale

152
Q

Risk factors for postpartum depression

A

Chronic/Prenatal depression
Low self-esteem
Stress of childcare
Prenatal anxiety
Life stress
Lack of social support
History of depression (HIGH ALERT)
Multiple births / fatigue

153
Q

-Abnormal depression, delusions, thoughts of harming infant or self
-Usually evident within first 8 weeks
-May present with symptoms of PPD
-Signs: hallucinations, delusions, agitation, confusion, disorientation, sleep disturbances, loss of touch with reality
-Possible suicide and/or infanticide
-Psychiatric emergency: Hospitalization and medical management necessary
-Most improve with treatment (antidepressants, antipsychotics, antianxiety meds, long term therapy)

A

Postpartum Psychosis

154
Q

Bonding questions

A

Does the patient seem eager to care for her infant?

Is the patient touching the baby, making skin-to-skin contact?

What is the patient’s response when the baby cries?

Does she make eye contact when holding and feeding her baby?

Does the mother show warning signs of appearing dazed and detached?

155
Q

Mothering Role
Phase 1
Taking-In
Day 1-2

A

Recovering from immediate exhaustion of labor
Relatively dependent on others to meet physical needs
Expressions of excitement

156
Q

Mothering Role
Phase 2
Taking-Hold
Day 2-3

A

Starts to initiate action and to begin some of the tasks of motherhood

157
Q

Mothering Role
Phase 3
Letting-Go
Weeks 2-6

A

Mother is redefining her new role
Able to focus on partner, other children, family issues

158
Q

Partial or complete separation of the six-pack muscles which meet at the midline of the stomach, they separate because as the uterus stretches and baby grows, the muscles have to accommodate

Return to pre-pregnancy state ~ 6 weeks+

A

Abdomen/ Diastasis Recti Abdominus

159
Q

Late sign of hemmorhage

A

BP drop

160
Q

Delivery of the baby, expulsion of the placenta, and loss of amniotic fluid can create cardiovascular __________.

When does cardiac output return to normal?

A

instability

Within 2-4 weeks after birth

161
Q

When is APGAR completed?

A

@ 1 min, 5 min, and again every 5 minutes if score is low (under 7).

162
Q

Medications for baby at birth

A

Erythromycin
Vitamin K
Hep B

163
Q

Normal respiratory assessment findings of newborn

A

Shallow, irregular breathing
30-60 breaths/min
Short pauses less than 20 seconds (If over 20 seconds, that is apnea)
Abdominal breathers —> nasal obligate breathers

164
Q

Abnormal respiratory assessment findings of newborn

A

70+ breaths/minute
Nasal flaring
Grunting (singing)
Retractions
Paradoxical breathing

165
Q

When baby takes first breath, pulmonary vascular resistance decreases, increasing pulmonary blood flow. This increases pressure in L atrium and decreases pressure in R atrium –>

A

Closure of Foramen ovale

166
Q

Increased systemic vascular resistance, closure of ductus venosus via umbilical vein, increased aortic pressure –>

A

Closure of Ductus arteriosus

167
Q

Normal cardiovascular assessment findings of newborn

A

Murmurs if asymptomatic
Most not pathological
Over half disappear by 6 months

168
Q

Abnormal cardiovascular assessment findings of newborn

A

If murmur occurs with apnea, cyanosis/pallor, poor feeding

Murmur sounds like a washing machine

169
Q

Perfect APGAR score is

A

10 (rare)

170
Q

Most babies APGAR score is 9, losing 1 point for

A

color

Acrocyanosis

171
Q

Acrocyanosis

A

Bluish discoloration of extremities

May persist up to 24 hours until peripheral circulation improves

172
Q

Normal temp for infant

A

36.5-37.5C (97.7-99.5F)

173
Q

Can occur during birth or bathing from moisture on skin, as a result of wet linens or clothes, and from insensible water loss

A

Evaporation

174
Q

Occurs when the infant comes in contact with cold objects or surfaces such as a scale, a circumcision restraint board, cold hands, or a stethoscopre

A

Conduction

175
Q

Occurs when drafts come from open doors, air conditioning, or even air currents created by people moving about

A

Convection

176
Q

Heat is lost when the infant is near cold surfaces. Thus, heat is lost from the infant’s body to the sides of the crib or incubator and to the outside walls and windows

A

Radiation

177
Q

What does the Vitamin K injection do?

A

stimulates blood clotting

178
Q

What is the Opthalmic Erythromycin ointment used for?

A

Prevent gonococcal ophthalmia neonatorum and chlamydial conjunctivitis

179
Q

Newborn Head to Toe exam includes

A

Vitals
Weight
Measurements
Initial Assessment- Fontanelles, Palate, Fingers/Toes, Back, Testes, & Anus

180
Q

Ballard scoring is useful for discrepancies with

A

LMP or no prenatal care

181
Q

Umbilical cord consists of

A

2 arteries and 1 vein

182
Q

What is lanugo?

A

fine hair

Most often on premies, helps anchor vernix caseosa

183
Q

What is vernix caseosa?

A

Vernix caseosa is a white, creamy, naturally occurring biofilm covering the skin of the fetus during the last trimester of pregnancy.

It is protective. Try to keep some on after birth for at least 6-24 hours.

184
Q

Mongolian spots are

A

congenital birthmarks, not bruises

185
Q

Blood pools beneath scalp, crosses suture lines (like a cap!)

Can result from vacuum birth.

A

Caput

186
Q

Blood below periosteum of skull, does not cross suture lines

Results from trauma to the skull. Common in large babies, instrument assisted, head not in optimal position, or scalp electrode.

A

Cephalohematoma

187
Q

Startle reflex

A

Moro

188
Q

This reflex starts when the corner of the baby’s mouth is stroked or touched. The baby will turn his or her head and open his or her mouth to follow and root in the direction of the stroking. This helps the baby find the breast or bottle to start feeding.

A

Rooting

189
Q

Positive when toes fan up and out when stroked

Normal until around 2 years old

A

Babinski

190
Q

When a baby’s head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow.

A

Tonic neck

AKA fencing

191
Q

This reflex is also called the walking or dance reflex because a baby appears to take steps or dance when held upright with his or her feet touching a solid surface.

A

Stepping

192
Q

When pressure is put on an infant’s palm & they reflexively curl their fingers to grasp whatever is in their palm.

A

Palmar

193
Q

Why should talc powders not be used to treat diaper rash?

A

can cause respiratory issues

194
Q

The normal total serum bilirubin level at birth is

A

3 mg/dL or less

195
Q

Renal function fluid requirements

A

60-80 mL/kg

196
Q

First stool is called

A

meconium

Dark, tarry poop

197
Q

Can babies have water?

A

No.

Only drinking formula or BM! Cannot digest other liquids.

198
Q

Behavioral transition phases

A

Phase 1: 0-30 minutes
Reactivity

Phase 2: 60-100 minutes
Sleep

Phase 3: 10 minutes to several hours
Reactivity & Readjustment

199
Q

Behavioral transition - Phase 1

A

Increase in HR, irregular respirations, might have some grunting and retractions, spontaneous startle with tremors and side to side head movements, increasing muscle tone

200
Q

Behavioral transition - Phase 2

A

Decreased responsiveness, sleeps, normal tone, fast shallow breathing, HR 100-120, spontaneous jerks and twitches but returns to rest quickly

201
Q

Behavioral transition - Phase 3

A

Return of exaggerated responsiveness, periods of tachycardia, brief periods of rapid respirations, newborn hunger cues

202
Q

Family Care

A

Encourage bonding
Skin-to-skin care
Rooming in = demand feeding
Baby care and safety = changing diapers, learning cues, burping, getting comfortable holding
Circumcision
Preferences (feeding, pacifier, etc.)

203
Q

What does skin to skin do?

A

Calms and relaxes, regulates baby’s heart rate and breathing, stimulate digestion and interest in breastfeeding, helps milk production, regulates temp, reduces cortisol levels, regulate blood sugar, less crying, bonding for parents and baby

204
Q

It is recommended to exclusively breastfeed until

A

6 months, can go longer if mutually desired

205
Q

When can solid foods be introduced?

A

around 6 months of age

206
Q

Breastfeeding positions

A

cradle, cross-cradle, laid back, side-lying, pillow, football

207
Q

Breastmilk storage parameters

A

Label that pumped milk!

Fresh milk
Room Temp 4-6 hours
Refrigerator 3-8 days
Freezer 6-12 months
Deep freezer 12 months+
Thawed milk good for 24 h. Don’t refreeze.

208
Q

Contraindications for breastfeeding

A

Infant with galactosemia, PKU
Mother with HIV, illicit drug use
Mother with active TB, active influenza, or active herpes on the breast

209
Q

Normal Intake in the first 96 hours

A

In 1st 24 hrs- 2-10 mL
24-48 hrs- 5-15 mL
48-72 hrs- 15-30 mL
72-96 hrs- 30-60 mL

210
Q

Feeding cues

A

crying, rooting, closed fists, open mouth, awake, tongue movements

211
Q

Satiety cues

A

lets go of breast, opens hands, falls asleep

212
Q

Types of formula

A

Cow based: made with cow’s milk altered to resemble breast milk

Soy based: useful to exclude animal protein based on preference or baby not tolerating cow-based

Protein hydrolysate: don’t tolerate either of the above, option for babies with protein allergies

213
Q

Indications of intolerance to formula

A

GERD
Vomiting
Bad mood

214
Q

Discharge prep & education

A

discharge measurements, confirm pediatrician appointments are scheduled, Critical congenital heart defect (CCHD) apparent in first 24 hrs of life, car seat safety, education using bulb syringe & thermometer, signs of jaundice, umbilical cord care, and when to call doctor

215
Q

Umbilical cord care info

A

-keep dry
-no alcohol or lotion
-no submerged baths
-diaper placement

WCF (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions