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90 Cards in this Set
- Front
- Back
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3 segments of uterus
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1. corpus (fundus)
2. isthmus (lower uterine segment) 3. cervix |
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how long is the PP period?
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6 weeks (42 days)
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what is uterine involution and what happens (physiologically)?
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uterine involution = rapid return of uterus to its non-pregnant state (contracts/shrinks) immediately PP
what happens: - endogenous oxytocin is released from pituitary --> 2 main processes: 1. ctxs of uterine smooth muscle fibers in fundus (they clamp down on vessels to reduce blood loss) & vasoconstriction 2. continuing ctxs of uterus to reduce its size (smaller SA = less bleeding) |
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stages of uterine involution
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- immediately PP, the uterus contracts so much that it overcompensates --> the fundus will be halfway between symphysis pubis & umbilicus
- over the next 12 hours it slowly rises to 1 fb above umbilicus - from there, it will descend 1-2 fbs every 24 hours until it returns to non-pregnancy size & settles in pubic area |
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what is uterine atony?
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when there is no tone in the uterus (no clamping down/vasoconstriction) --> larger SA --> more risk for hemorrhage
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where is the fundus located immediately PP?
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midway between umbilicus & symphysis pubis
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what is subinvolution of the uterus
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failure or delay (not going at predictable rate) of uterus to return to non-pregnant state
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describe after pains
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after pains = continued uterine ctx into PP period
after pains are worse for multiparas b/c the uterus has been stretched out more and has a harder time contracting/shrinking |
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list PP reproductive changes
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- sloughing off of uterine lining & development of lochia
- drop in pregnancy hormones - cessation of progesterone production until first ovulation - endometrial regeneration within 6 weeks - recovery of vaginal & pelvic floor muscle tone - build-up of breast tissue for lactation |
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4 things to check on your patient first thing on shift
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1. pain
2. is their IV almost dry 3. bleeding 4. hemorrhoids |
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what are the stages of lochia & how many days for each
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1. LOCHIA RUBRA = (bright red) days 1-3
2. LOCHIA SEROSA = (light brown/clearer) days 3-10 3. LOCHIA ALBA = (creamy, white-yellow, light flow) day 10/11-3 weeks, or could last up to 6 weeks PP |
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retrogressive vs progressive endocrine changes
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RETROGRESSIVE: (drop in)
- hPL - hCG - estrogen - progesterone - cortisol PROGRESSIVE: (increase in) - oxytocin - prolactin |
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how does the breast change in the PP period?
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engorgement doesn't happen until day 3-5
first 2-3 days = colostrum |
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when is a baby considered term?
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37-42 weeks
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normal blood loss for vaginal vs c-section
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vaginal = up to 500 ccs
c-section = up to 1000 ccs |
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normal hct & hgb values and general rule for these values
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hct = 36-45
hgb = 12-15 hct is usually 3x hgb value! |
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general rule for blood loss?
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generally there's a 4 point decrease in hct & 1 g decrease in hgb for each 250 mL of blood lost
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PP changes in CV system
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- diuresis (3000 ccs/day) & diaphoresis (especially at night) to get rid of excess plasma volume
- elevated CO for 48 hours as fluid returns to mom's CV system |
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describe the normal findings of a fundal assessment
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fundus should be:
- midline (if it's displaced --> think full bladder) - firm, not boggy - should be at appropriate level of involution |
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what should you do if the fundus feels boggy (like a loaf of bread)?
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massage the fundus!!!!
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how long does it take lacerations/repairs to heal?
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2-3 weeks PP
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describe a 1st degree perineal laceration
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involves superficial vaginal mucosa or perineal skin
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describe a 2nd degree perineal laceration
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involves the vaginal mucosa, perineal skin, and deeper tissue (i.e., muscles inside perineum)
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describe a 3rd degree perineal laceration
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same as second degree but also involves anal sphincter
**dangerous** |
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describe a 4th degree perineal laceration
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extends through anal sphincter into rectal mucosa
**dangerous** |
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what might you suspect if the women has heavy bleeding (especially spurting bleeding) & the fundus is firm?
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probably a cervical laceration (not that uncommon)
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what is a sitz bath?
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a sprinkle system that hits hemorrhoids or lacerations/episiotomies (very soothing)
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describe the phases of maternal PP psychosocial adjustment
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PHASE 1 = dependent ("taking in" --> learning info about new baby)
PHASE 2 = dependent-independent ("taking hold" --> taking in info & processing it/holding onto it) PHASE 3 = interdependent ("letting go" --> doing everything for baby on their own) |
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3 factors necessary for parent-infant attachment?
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1. proximity
2. reciprocity (baby cries, mom picks up baby, baby stops crying) 3. commitment |
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PP warning signs/red flags
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- unable/unwilling to discuss birth experience
- negative reference to self - excessively preoccupied w/ self (not paying any attention to baby) - lack of support system - partner/other family members react negatively to baby - expression of disappointment over baby's sex - see's baby as messy & unattractive - baby reminds mother of person she doesn't like BIG RED FLAGS: - refusal to interact w/ baby - marked depression |
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prevalence of PP blues & signs
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about 50-80% prevalence
emotionally labile & transient crying (crying that's unrelated to events) has to do w/ hormone fluctuation peaks within first week & usually resolves by second week |
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prevalence of PP depression & signs
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PPD occurs in 15-20% of PP women
signs: - **withdrawal & social isolation - **feeling like interacting with baby is burdensome/demanding accompanied by depression - worsening depression & irritability - worsening of sleep disturbances - appetite change - lack of compensatory measures (i.e., overreacting to small events) |
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NPV?
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nothing per vagina --> no sex, tampons, douches for 6-8 weeks PP (until after seeing provider)
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normal # of wet diapers day? general rule?
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6-8 wet diapers/day
OR minimum of the # of days in age/day (up until 6 days) |
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normal # of stools per day?
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3-4 stools/day
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stages of breastmilk
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1. COLOSTRUM = for first 2-3 days = thick (newborn isn't great at swallowing yet), dense, yellow, lower quantity but higher quality (very high in nutrients)
2. TRANSITIONAL MILK = from days 2/3 - 10 = all the same nutrients in colostrum but a slightly different consistency (b/c baby can swallow better now) 3. MATURE MILK = day 10 (***remember: mature milk has 10 letters, comes in a 10 days) |
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describe the lactation amenorrhea method
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method of contraception during the PP period:
with exclusive breastfeeding (no pumping, only suckling) & no return of menses, and for only up to 6 months, the woman has a very small chance of getting pregnant (1.6%) |
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caloric intake for breastfeeding moms? what if she's breastfeeding & pregnant?
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breastfeeding moms must increase caloric intake by 500/day from pre-pregnancy diet
pregnant & breastfeeding moms must increase intake by 800 calories/day |
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common substances that are contraindicated for breastfeeding?
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- alcohol in large quantities (1-2 drinks/day is fine)
- antihistamines (dry up milk supply) - cyclosprine (immunosuppressant drug) - lithium - methadone & suboxone |
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2 major divisions of breast tissue
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1. parenchyma = lactiferous ducts (orderly & tree-like) that open onto surface of nipple; also the lobular-alveolar structure
2. stroma = connective tissue, fat, blood vessels, lymphatics |
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functional unit of milk-making
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alveolar cell (alveoli in lobules) --> produces milk & excretes it into lumen of alveolar sack
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how many ducts are there are on the breast?
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15-25
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what are montgomery's tubercles and what do they do?
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they're small pimples that secrete a lubricating/antimicrobial substance
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how long does it take to stop lactation?
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2 weeks (wearing a tight bra speeds the process up)
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3 stages of lactogenesis
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lactogenesis I = initial synthesis of milk components (colostrum); begins during pregnancy
lactogenesis II = begins after deliver of placenta (rapid fall in progesterone stimulates increase in prolactin release); copious secretion of milk 2-3 days PP occurs lactogenesis III (galactopoiesis) = ongoing production of mature milk |
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describe breast involution
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- secretory cell undergo apoptosis
- mammary glands' basement B membrane undergo proteolytic degradation & mammary epithelium is reabsorbed |
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optimal # of feedings/day?
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8-12 (about 2-3 every hours, but babies cluster feed sometimes)
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tx for nipple candidiasis (thrush)?
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topical nyastatin
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ointment frequently prescribed to breastfeeding women?
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lanolin --> prevents nipple discomfort
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what is engorgement and how can it be treated?
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engorgement = excessive fullness in early PP period that can cause discomfort to mother
tx: unlimited feeding for baby, gentle manual expelling, comfortable positioning for feedings, warm shower, massage, cabbage leaves |
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CV changes in newborn?
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the 3 shunts close & pulmonary vessels dilate
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conduction vs convection
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conduction = heat loss by direct contact (i.e., touching something cool)
convection = heat loss through the air (i.e., being placed near a cool window, air currents from people moving around) |
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how to babies increase body temperature (thermogenesis)?
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- increasing basal metabolic rate (requires glucose & O2)
- increasing muscular activity (ditto) - non-shivering thermogenesis (brown fat metabolism) - vasoconstriction (look pale, mottled) |
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where is brown fat located on baby?
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primarily around back of neck & in armpits
also around kidneys & adrenals, sternum, and along abdominal aorta preterm/LBW babies may have inadequate brown fat for NST (since its developed primarily in 3rd trimester) |
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when should first stool occur?
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probably within 12 hours, definitely within 48 hours
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what is a stork bite?
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it's a type of birth mark --> flat, pink/red discoloration over eyelids or at nape of neck
disappears by 2 yrs (although the ones at the nape of the neck could stick around) |
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what is languno?
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fine hair that usually appears on shoulders, forehead, ides of face, and upper back
term infants may have a small amount, but a large amount of languno indicates pre-term/early GA |
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what is erythema toxicum?
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red, blotchy areas with white or yellow papules or vesicles in the center
usually appears b/w 24-48 hrs PP (but can show up after 1-2 weeks) not caused by infection (unknown etiology) occurs in 50% of term babies disappears within hours - up to 10 days |
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what is milia?
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white cysts on face (usually forehead, nose, cheeks, & chin), 1-2 mm in size
disappear without treatment |
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what is caput succedaneum?
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localized edema over the vertex of baby's head, caused by pressure from the cervix during labor & delivery, which interferes with blood flow from the area (could also result from a vacuum extractor)
feels soft, varies in size, and resolves quickly (12-48 hours) |
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what is cephalohematoma?
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bleeding between periosteum (membrane covering bone) and skull as the result of pressure during birth
can occur on one or both sides, usually over parietal bones (sometimes occipital) may develop within 24-48 hrs PP, resolves by reabsorbing slowly (takes between 6-8 weeks) swelling has clear edges that end at suture bones |
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what is one risk with cephalohematoma?
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increased risk of jaundice
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how can you tell the difference between caput and cephalohematoma?
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the swelling in caput crosses suture lines, while the swelling in cephalohematoma does not (swelling has clear edges AT suture lines)
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how long does the change in head shape from molding take to resolve?
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generally a few days to a week
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what are fontanels? compare the 2 fontanels in newborns
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fontanels = soft areas of head where sutures meet --> in a newborn, these aren't calcified and are just covered with a membrane (which allows space for the brain to grow)
ANTERIOR FONTANEL = diamond-shaped; where frontal & parietal bones meet. 4-5 cms, closes at 18 months. POSTERIOR FONTANEL = triangular; where occipital and parietal bones meet. much smaller than anterior --> only 0.5-1 cm (may be difficult to palpate with molding). closes at 2-4 months. |
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normal temperature for newborns
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taken axillary every 30 minutes until newborn has been stable for at least 2 hrs after birth
97 - 99.5 F |
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normal respiratory rate for newborns
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30-60 rpm
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normal HR for newborns
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120-160 bpm
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normal BP for newborns
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systolic: 65 - 95
diastolic: 30-60 |
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normal measurement of length for newborn
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19-21 inches (from had to heel)
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normal measurement of head circumference for newborns
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13-15 inches (measured just above eyebrows)
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normal measurement of chest circumference for newborns
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12-13 inches (usually 2-3 cms smaller than head)
(measured at nipple level) |
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normal weights for newborns
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5.3 - 8.5 lbs (2500 - 4000 g)
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what is postmature syndome
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when a baby is postterm (>42 weeks GA but with signs & symptoms of placental insufficiency)
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how are LGA, AGA, and SGA classified?
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LGA = above 4000 g or 90th percentile
AGA = between 10th & 90th percentile SGA = below 10th percentile |
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what weight is classified as LBW?
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below 2500 g
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what weight is classified as VLBW?
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below 1500 g
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what is IUGR?
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intrauterine growth restriction --> when fetus doesn't grow at normal rate in utero
puts babies at risk for LBW & lots of other complications on the more serious side, it can cause long-term growth problems and even stillbirth |
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list most important to least important factors measured by the APGAR scale
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most important = heart rate
respiratory effort muscle tone reflex irritability least important = color |
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why would you give a 0, 1, or 2 to a baby's HR for APGAR?
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0 = absent HR
1 = HR<100 2 = HR>100 |
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why would you give a 0, 1, or 2 to a baby's reflex irritability for APGAR?
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0 = no response
1 = grimace 2 = good cry |
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what are the ranges for APGAR scores and what do they signify
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0 - 3 = serious distress (infant needs resuscitation)
4 - 6 = moderate difficulty (infant should be gently stimulated by rubbing their back while possibly administering O2 --> you should look at whether or not mom received narcotics during labor b/c baby may need Narcan 7 - 10 = no difficulty adjusting to extra-uterine life (no interventions besides normal promoting of respiratory efforts) |
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what is the extrusion reflex?
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when the newborn's tongue is pressed it pushes forward --> signals that baby isn't ready to eat solid foods (goes away around 6 months)
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what is the traction reflex?
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when the baby is held by both wrists & gently lifted forward, the neck will first lag back and then straighten and fall forward
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how would you tell the difference between physiologic and pathologic jaundice?
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by when they appear
physiologic jaundice appears on 2nd or 3rd day of life pathologic jaundice appears more quickly (TSB levels rise fast) and stays elevated for longer |
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treatment for physiologic jaundice?
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early & frequent feeding and phototherapy
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what is kernicterus?
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bilirubin encephalopathy from bilirubin toxicity
results in acute symptoms & long-term neurological damage 50% of infants survive |
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some effects of cold stress in a newborn?
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- increased basal metabolic rate --> requires oxygen & glucose (so hypoxia/respiratory distress & hypoglycemia may result)
- NST (metabolism of brown fat) --> causes increased production of acids (acidosis is a risk) & could cause jaundice - vasoconstriction --> pale, mottled skin (could even lead to the return to fetal circulation patterns) |
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signs of respiratory distress in a newborn
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- flaring nares
- retractions - grunting - respiratory rate below 30 or greater than 60 at rest - apnea for greater than 20 secs |
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signs & symptoms of hypoglycemia in newborn
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- JITTERINESS
- irregular resps/apnea - cyanosis - weak, high-pitched cry - feeding diffuculty - hunger - lethargy - twitching - seizures - eye rolling |
