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79 Cards in this Set

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Fundus
upper body of the uterus
if the uterus is firm and the mom is still bleeding what do you do?
look for bleeding somewhere else~ lacerations etc
FB or F
Fingerbreadth (assuming that each finger is a centimeter)
U
Umbilicus
BF
Breastfeeding
Boggy
Soft and “squishy” (use in describing uterus tone) [not good]
Lochia
Drainage from the uterus and vagina after delivery of a baby
Lochia Rubra
First 3 days after child birth, blood
Lochia Serosa
Fourth day lochia changes to pink or brown-tinged
Lochia Alba
white or cream colored by the 11th day may persist to the 6th week after childbirth
Lochia Amount
-Scant: les than 1 inch stain on pad
-Light: 1 - 4 inch stain
-Moderate: 4 - 6 inch stain
-Large: Saturated peripad in 1 hour
-Excessive: saturated pad in 15 minutes
-A constant trickle of lochia indicates excessive bleeding and requires immediate attention
-Foul odor can suggest endometrial infection
Perineal Assessment
-REEDA
-R: redness
-E: edema
-E: ecchymosis (bruising)
-D: discharge
-A: approximation (should be closed as if they were stuck or glued together)
Fundal Height
-Immediately following delivery the fundus can be found midway between the symphysis pubis and the umbilicus
-Then the fundus rises to the level of the umbilicus and remains at this level for 24 hours
-After 24 hours the fundus begins to desend by approximately 1cm, or 1 fingerbreadth per day
-By 10th day it is back in the pelvic cavity
Postpartum Vital Signs
-HR: 50-60 is normal as large amounts of blood return to the maternal circulation after the placenta is born
-B/P: hypotension may indicate a hemorrhage
-Resp: 16-20
-Temp: 100.4 is common during the first 24 hours after birth
Newborn Vital Signs
-Temp:
*Axillary: 97.7 - 99.5
*Rectal: 97.7 - 99.7
-HR: 120-160
-Resp: 30-60
-BG: 40-45
Newborn Measurments
-Weight: 2500-4000g
-Length: 48-53cm
-Head Cir: 33-35.5cm
-Chest Cir: 30.5-33cm
Signs of Delayed Bonding
-Using negative terms to describe infant
-Discussing infant in impersonal or technical ways
-Failing to give the infant a name or to use name
-Visiting or calling infrequently or not at all
-Decreasing number & length of visits
-Showing interest in other infants
-Refusing offers to hold and learn to care for infant
-Showing decrease in or lack of eye contact
Mastitis
-A painful infection of the breast usually caused by the entry of germs, often from the baby's mouth, into a milk duct through a crack or fissure in the nipple.
-Symptoms include fever, soreness, and swelling. It occurs in about one in 20 breastfeeding mothers at some time during lactation, most commonly between the tenth and 28th days postnatally.
Breast Feeding Health teaching tool
-Latch within the first 2hrs of birth
-Offer breast every 2-3hrs
-Feed 20min or longer ea side
-Position: football, cross, cradle, side lying
-Stimulate baby's lower lip
-Support baby's head
-Listen for swallows
-Avoid artificial nipples
-Avoid formula or glucose H2O
-Offer encouragement
-Est. care plan if problems
*begin pumping as soon as problem arises
-Not wanting to breast feed:
*do not take hot showers
*No stimulation of breasts
-Tight fitting bras
S/S Mastitis
-Temp up to 40c
-Hard irregular warm red spot on breasts
-Pain in breasts
-Feel like flu-like symptoms
Avoiding Mastitis Health teaching
-Alternating breasts
-Allow breasts to air dry
-Avoid soap or alcohol
-Proper positioning of baby
-Avoid stasis with warm soaks, freq feedings
SVD
spontaneous vaginal delivery
C/S
Cesarean section – C-section~ opening into the uterus to take the baby out
FP
Family planning
SBE
self breast exam
EBL
estimated blood loss
HNV
has not voided
DTV
due to void
Episiotomy
incision on perineum to assist delivery of infant
Mediolateral
a placement of episiotomy
Cervix
Structure between uterus and vagina
Striae
Stretch marks
Cholasma
mask of pregnancy – darkened area on woman’s face~ around the eyes especially, may darken with sun exposure
Linea nigra
dark line on Mom’s abdomen due to pregnancy~ due to hormones, may also be on the baby
Tubal ligation
cutting of the Fallopian tubes for sterilization
Lochia Health teaching
-Amount should decrease each day.
-Color should progress from bright red to pinky red to brownish-red/white
-Should not go back in color or amount
-Fleshy odor – not foul smelling
Lochia –changes in amount
-when getting OOB and standing up
-with breastfeeding- uterus clamps down better and that is cause
-with massage –dark = pooled. Red=fresh
-with exertion – esp. when goes home
-with C/S and Pitocin use the flow is little to none
Perineum – Health teaching
a. Wash hands before and after BR
b. Peri bottle q void
c. Change pad q void
d. Apply pad front to back
e. Report any foul drainage
f. Kegals exercises
Newborn Tests
-heel stick for
*B/G
*PKU (Phenal Ketone Uria)
*bilirubin test
*Coomb's test
-Auditory test
Bilirubin
-With breakdown of RBCs, bilirubin is an usable product that needs to be excreted
-it can be toxic at high levels
-it is fat soluble so it can be absorbed by the SQ fat
Causes yellowish discoloration of skin and scolera (white) of eye
Teratogenic
-Any substance that is capable of interfering with normalembryonic development and can produce non-heritable birth defects
-teratogenic substances are most often radiation or chemicals
-drugs given to the mother that can cross the placental barrier to the unborn child. they are capable of interfering with the development of the fetus, thus causing birth defects
Acrocyanosis
Bluish discoloration of the hands and feet due to reduced peripheral circulation
-normal in the newly born infant
should go away after the first couple of hours of life to 1-2 days after birth
Umbilical cord care
-cord should be check for bleeding and oozing
-cord clamp should be securely fastened
-parents should clean the cord with alcohol at least TID
-fold diaper below the cord
-clamp can be removed 24 hours after birth if the cord is dry
Involution
Retrogressive changes that returns the reproductive organs, particularly the uterus, to their prepregnancy size and condition
Signs of respiratory distress
-tachypnea: >60
-retractions: sternal, substernal, suprasternal, intercostal
-flaring of the nares
-cyanosis: generalized
-grunting: end expiratory pressure against a closed glottis
-seesaw respiration
-decreased breath sounds
-crackles
Nursing postpartum care for a C-Section
*VS q5 min then q15 min when stable
*o2 status, pulse ox, and tdbc, I&O, NPO, IV and foley
*the IV will be 10-20U of pitocin used to help cause involution of the uterus
*incision and dressing: if bleeding, circle, date and time
*fundus and lochia checks
*assess post anesthesia state, epidural and general
Subinvolution
-This is the failure of the uterus to shrink according to normal progression
-caused by retained fragments or infection
-S&S
*fundus that does not shrink one cm/day
*lochia that deviates from rubia-serosa-alba, varies in amt
*uterine tenderness, heaviness, bachache
Physiologic Jaundice
-occurs when bilirubin reaches 5-7
-never present during he first 24 hours of life
-appears on day 2 or 3
-normal in newborns
-levels begin to fall about a week after birth
-phototherapy may be used
pathologic jaundice
-occurs during the first 24 hours of life
-a bilirubin level above 1 or a total bilirubin concentration that increases by more than 5 per day or is higher than 12 or persists after the second week
-due to abmormalities causing excessive destruction of RBCs
-can be due to incompatable blood (mothers/infants), infection, metabolic disorders
cephalhematoma
-does not cross the suture line
-check for jaundice
-does not appear until 24-48 hours after birth
-gone within a few weeks
meconium aspiration
may be caused by:
-hypoxia- creating a relaxation of the anal sphincter
-vagal stimulation possible from cord compression
-GI motility, norm for term or post-term infant
->38 weeks, less amniotic fluid, increased cord compression
-can cause pnemonia, asphyxia, pneumothorax, distress
Newborn Reflexes
-Moro: allow the head and trunk of newborn to fall backward (arms and legs should extend and abduct)
-Palmer grasp: when infant's hand is touched at the base of the fingers the hand should close into a tight fist
-Plantar grasp: same as above except on the feet
-Babinski: stroking the sole of the infant's foot causing the toes to flare
-Rooting: when infant's check is touched near the mouth the head turns toward that side
-Sucking: when the mouth or palate is touched the infant should begin to suck
-Tonic neck: arm and leg should extend on the side of the body in which the head is turned (fencing reflex)
-Stepping: when infant is held upright w/their feet touching a hard surface they should lift one foot then the other as if they were walking
Moro Reflex
allow the head and trunk of newborn to fall backward (arms and legs should extend and abduct)
Palmar grasp
when infant's hand is touched at the base of the fingers the hand should close into a tight fist
Plantar grasp
same as palmar except on the feet
Babinski reflex
stroking the sole of the infant's foot causing the toes to flare
Rooting reflex
when infant's check is touched near the mouth the head turns toward that side
Sucking reflex
when the mouth or palate is touched the infant should begin to suck
Tonic neck reflex
arm and leg should extend on the side of the body in which the head is turned (fencing reflex)
Stepping reflex
when infant is held upright w/their feet touching a hard surface they should lift one foot then the other as if they were walking
Signs of neonatal hypoglycemia
-Jitteriness
-Poor muscle tone
-Diaphoresis
-Poor suck
-Tachypnea
-Dyspnea
-Cyanosis
-Apnea
-Low temp
-High-pitched cry
-Irritability
-Lethargy
-Seizures, coma
-Some infants may be asymptomatic
Respiratory Distress Syndrome
-Increases w/decreased gestational age, multiple gestation and uncontrolled DM
-A deficiency of surfactant production
-Surfactant keeps the aveoli surface tension down to prevent aveoli from collapsing at the end of expiration
gravid
pregnant, the state of being pregnant
gravida (g)
a pregnant woman
Primigravida
a woman who is pregnant for the first time
multigravida
a woman who has been pregnant more than once
nulligravida
a woman who has never been pregnant
para (p)
a woman who has delivered a viable infant (over the age of 20 weeks gestation), whether alive or stillborn~ refers to the number of deliveries not infants
parity
the number of times a woman has delivered a viable infant or infants
nullipara
one who has never borne a viable child
Primipara
a woman who has had one delivery of a viable infant or infants
multipara
a woman who has had two or more deliveries of viable infants
puerperium
the 6 week postpartal period. It nds with the resumption of ovulatory menses. It is broken down into three phases:
*immediate~ first 24 hours
*early~ second to seventh day
*late~ seventh day through the sixth week
rate of involution
Faster in primip than in multip due to better muscle tone in the primip. this is also faster in breast feeding mothers than non-breast feeding due to stimulation of oxytocin. slower when the uterus is overdistended (ex~ polyhydraminos, twins, large baby)
gestation
period of fetal development from conception to birth
trimester
refers to a period of 3 months. pregnancy is divided into a 1st, 2nd and 3rd trimesters
term
beginning of the 38th week to the end of the 42nd week
pre-term
20th week to the end of the 37th week
abortion
Spontaneous or therapeutic cessation of pregnancy before 20 weeks (ab or ETP)
Ectopic pregnancy
development of an embryo outside the uterine cavity. Not viable. Removed surgically approximately 6-8 weeks of pregnancy (usually in fallopian tubes could also present in the abdominal cavity)