Nursing Obstetrics Final

Front 1

What phase of maternal adjustment is a time of reflection and the patient is dependent?

Back 1

Taking In Phase

Front 2

During this maternal adjustment phase the patient begins to take action and takes a strong interest in the baby:

Back 2

Taking Hold Phase

Front 3

During this phase of maternal adjustment the patient redefines her role:

Back 3

Letting Go Phase

Front 4

How long is the fundus palpable at the umbilicus after delivery?

Back 4

Approximately 24 hours

Front 5

What factors may reduce/delay the process of uterine involution?

Back 5

multiple fetuses, hydramnios, prolonged labor, grand multiparity, or excessive analgesia.

Front 6

What is termed:
uterine flow, consisting of blood, fragments of deciduas, WBCs, mucus, and some bacteria?

Back 6

lochia

Front 7

This type of lochia is red in color:

Back 7

Lochia Rubra

Front 8

How long should lochia be present after delivery?

Back 8

atleast 1-3 weeks

Front 9

This lochia lasts approximately 1-3 days and is composed of blood, deciduas, and mucus:

Back 9

Lochia Rubra

Front 10

What lochia is white in color?

Back 10

Lochia Alba

Front 11

How long does Lochia Alba typically last? How long can it last?

Back 11

10-14 days but may last 6 weeks

Front 12

Describe lochia surosa:

Back 12

pink in color
lasts 3-10 days
composed of blood, mucous, leukocytes

Front 13

When is a patient considered febrile and postpartal infection should be expected?

Back 13

if temp increases to 100.4 or above after the first 24 hours postpartal

Front 14

What causes the temp to rise slightly during the first 24 hours postpartum?

Back 14

dehydration

Front 15

Describe the pulse of a postpartum patient:

Back 15

slower than normal
60-70 bpm

Front 16

What causes the pulse to be slower in a postpartal patient?

Back 16

stroke volume increase due to increase in blood volume returning to the heart

Front 17

When considering the pulse, what indication would make you suspect hemorrhage?

Back 17

rapid and thready pulse

Front 18

What measurements of blood pressure could indicate PIH?

Back 18

above 140mm Hg systolic
above 90mm Hg diastolic

Front 19

When should menstrual flow return in a nonbreastfeeding mother?

Back 19

6-10 weeks

Front 20

When should a breastfeeding mother expect to have her menstrual flow return?

Back 20

may not return for 3-4 months or for the entire time of lactation

Front 21

What degree of an episiotomy involves the vaginal mucous membrane and skin of the perineum to the fourchette?

Back 21

1st Degree

Front 22

What care measures can be taken for an episiotomy?

Back 22

cortisone-based cream or sitz bath for inflammation and tension relieve
witch hazel for cooling
perineal exercises 3-4 times daily to relieve discomfort
ice or cold pack w/in 24hr to reduce edema

Front 23

What degree of episiotomy involves the vagina, perineal skin, fascia, levator ani muscle, and perineal body?

Back 23

2nd Degree Episiotomy

Front 24

This degree of episiotomy involves the entire perineum and reaches the external sphincter of the rectum:

Back 24

3rd Degree Episiotomy

Front 25

This degree of an eipisiotomy involves the entire perineum, rectal sphincter, and some of the mucous membrane of the rectum:

Back 25

4th Degree Episiotomy

Front 26

Measures of Breast Care for a breastfeeding mother include:

Back 26

wash daily with water only
use expressed colostrum or lanolin for nipples
wear a good support bra
change breast pad frequently and do not use plastic nipple protectors

Front 27

What are some methods to teach to promote uterine involution?

Back 27

lying on abdomen to support abdominal muscles
never assume knee chest position until 3wk postpartal

Front 28

The relaxation of the uterus is termed:

Back 28

uterine atony

Front 29

What is the most frequent cause of postpartal hemorrhage?

Back 29

uterin atony

Front 30

Management of uterin atony to prevent postpartal hemorrhage include:

Back 30

attempt uterine massage
IV infusion of pitocin
Methergin IM
bimanual massage: one hand in vagina one on fundus
prostaglandin administration
blood replacement-if loss severe
hysterectomy is last resort

Front 31

Infection of the endometrium of the uterus:

Back 31

endometritis

Front 32

Signs and symptoms of endometritis include:

Back 32

fever on 3rd or 4th day PP
painful uterus
chills
malaise
dark brown lochia
lochia with foul smell
increases or scant amount of lochia`

Front 33

Inflammation of the lining of a blood vessel with the formation of blood clots is termed:

Back 33

Thrombophlebitis

Front 34

Prevention of Thrombophlebitis includes:

Back 34

early ambulation
limiting time in lithotomy position
avoid sitting with knees sharply bent
support hose

Front 35

When assessing someone for signs and symptoms of a pulmonary embolism, what would you look for?

Back 35

sudden, sharp chest pain
increased respiratory rate
increased heart rate
orthopnea
cyanosis

Front 36

What can you do to try to manage an embolism?

Back 36

oxygen immediately
notify doctor immediately
transfer to ICU
heparinization intravenously
have crash cart accessible

Front 37

Mastitis is an infection of the breasts. What causes it?

Back 37

an organism entering through cracked or fissured nipples

Front 38

What assessment signs indicate mastitis?

Back 38

localized pain
swelling
redness
fever
usualy unilateral

Front 39

What can be done to manage mastitis?

Back 39

broad spectrum antibiotic
encourage breastfeeding
cold and warm compresses
teas bags on affected area
massage clogged milk duct while feeding

Front 40

Name some assessment criteria that could indicate a woman is experiencing urinary retention:

Back 40

over 8hrs has passed-no void
voids in small amounts;<100mL
catheterization after voiding reveals more than 100mL of urine left in bladder

Front 41

During what time can a woman experience postpartum depression?

Back 41

1-12 months after birth of infant

Front 42

What are some assessment signs of postpartum depression?

Back 42

overall feelings of sadness
extreme fatigue
inability to stop crying
increased anxiety about her and baby's health
insecurity

Front 43

Management of Postpartum Depression:

Back 43

counseling
antidepressants
support groups

Front 44

Postpartal Psychosis exists when a person has lost contact with reality. What assessment signs would lead to a diagnosis of this sort?

Back 44

voicing thoughts of infanticide or infant is possessed
woman is not functioning in reality

Front 45

What is the normal weight range for a full term infant?

Back 45

2500-4000gms or 7.5-7.7lbs

Front 46

What is the normal temperature range for a newborn?

Back 46

36-37c. or 97.6-98.6 f.

Front 47

What is considered a normal head range for newborns?

Back 47

34-35 cm

Front 48

If an infant's head circumference is greater than 37 cm what should be considered?

Back 48

neurologic involvement

Front 49

What is the normal length range for a newborn?

Back 49

45-55 cm or 18-22 inches`

Front 50

How much bigger should the infants head measure than it's chest?

Back 50

2cm

Front 51

How long should you count a newborn's pulse for?

Back 51

one full minute

Front 52

What is the normal pulse rate for a full term infant at rest?

Back 52

120-160 bpm

Front 53

What is the normal respiration range for a newborn? How high can it be initially?

Back 53

30-60 normal
80 initially

Front 54

What are some signs of respiratory distress in an infant?

Back 54

grunting
nasal flaring
retractions
apnea/gasping

Front 55

What is the average blood pressure for a newborn?

Back 55

80/46

Front 56

What is the full term systolic range for a newborn?

Back 56

55-90 mm Hg

Front 57

What is the full term diastolic range for a newborn?

Back 57

30-55 mm Hg

Front 58

Why is Vitamin K given IM in an infant after birth?

Back 58

Infants are given Vitamin K due to diminished coagulation ability and their intestines are sterile at birth. Lack of Vitamin K leads to faulty blood clotting.

Front 59

Within what time frame is bacteria usually present in the GI tract of a newborn?

Back 59

within 5 hours after birth

Front 60

When do you expect a newborn to pass their first stool; meconium?

Back 60

within 24 hours of birth

Front 61

If passage of meconium does not happen within the 24 hours of birth what should be suspected?

Back 61

imperforate anus
meconium ileus
meconium plug

Front 62

On the 2nd or 3rd day the newborn's stool turn to a transitional stool. How is this described?

Back 62

green and loose

Front 63

Stools with increased bilirubin will appear:

Back 63

bright green and loose

Front 64

Describe the rooting reflex:

Back 64

brush cheek and infant will turn head in that direction

Front 65

Describe the moro reflex:

Back 65

if you lightly drop baby, it will act startled

Front 66

Palmar and Plantar grasps are when the hands and toes of the infant grasp an object. When does this disappear?

Back 66

Palmar: 6wks to 3 months
Plantar: 8-9 months

Front 67

How would you identify ortolanis sign when checking an infants hips?

Back 67

you would hear a "clunk" sound when hips were abducted

Front 68

Breast milk has three stages: What are they?

Back 68

colostrum
foremilk
hindmilk

Front 69

When the cord is clamped off when a baby is delivere, how far from the infant's abdomen is it clamped off?

Back 69

8 inches

Front 70

What should be reported to the doctor if observed on an infant's circumcision?

Back 70

rednes
tenderness
odor
discharge
constant crying

Front 71

What are the calorie requirements for an infant?

Back 71

50-55 kcalories/lb/day
or
110-120 cal/kg/day

Front 72

Compared with forumula, what how much nutrition does colostrum contain?

Back 72

1tsp. of colostrum has the same nutrients as 1 oz of formula

Front 73

How long does colostrum last after birth of the infant?

Back 73

2-4 days

Front 74

When is foremilk available after birth?

Back 74

2-4 days

Front 75

When is hind milk formed?

Back 75

after the let down reflex

Front 76

What are the advantages of breastfeeding?

Back 76

protection against breast cancer
aids in uterine involution
gives an empowering felling to woman
passive immunity to baby
contains all essential electrolytes and minerals for infant growth
free/inexpensive
enhances bonding

Front 77

What does the acronymn LATCH stand for in the breastfeeding charting system?

Back 77

L: latch, how well/often baby latches on
A: audible swallowing
T: type of nipple: interverted/flat/everted
C: comfort-soreness of nipples or engorgement
H: hold, how much assistance does mom need

Front 78

What are some steps to take to prevent or promote healing of sore nipples?

Back 78

position infant slightly different each feeding
expose nipple to air 10-15 min after feeding
discourage use of plastic liners with nursing bras
apply Vitamin E or colostrum to nipples
don't allow to use as pacifier

Front 79

How can you evaluate if the infant's feeding is efficient with breastfeeding?

Back 79

nursing at least 8 times/day
mother's breast soften after nursing
6-8 wet diapers every 24hr after 5 days
stools are mustard yellow/cottage cheese consistency
audible swallowing

Front 80

What does the term macrosomia mean?

Back 80

infant is large for gestational age

Front 81

When is an infant considered large for gestational age?

Back 81

if the birthweight is above the 90th percentile on an interuterine growth chart

Front 82

What are some characteristics of a preterm infant?

Back 82

extremeties are thin
minimal creasing on soles and palms
lanugo is present
hair on head is woolly and pathcy
scarf sign
testes undescended on male
labia majora does not cover labia minora or clitoris on female
respirations are irregular/period of apnea
bowel sounds diminished
temperature below normal
difficulty swallowing/sucking
extends extremeties
does not maintain flexion

Front 83

When considering the lecithin/spingomyelin ratio, what is the ideal ratio?

Back 83

the level of lecithin in surfactant exceeds that of sphingomyelin by 2:1, lungs are mature and respiratory problems are likely to not occur

Front 84

What is the lecithin/sphingomyelin ration used to determine?

Back 84

fetal lung maturity

Front 85

When an infant has a large surface area compared to body weight, what are they at risk for?

Back 85

ineffective thermoregulation

Front 86

When an infant has absent, deficient, or altered surfactant in the alveolar lining, they are suject to having:

Back 86

respiratory distress syndrome

Front 87

What are sign/symptoms of respiratory distress syndrome?

Back 87

grunting, retractions, nasal flaring
cyanosis on room air
tachypnea

Front 88

When does respiratory distress usually set in?

Back 88

within 6-12 hours of birth

Front 89

How can respiratory distress syndrome be treated?

Back 89

synthetic surfactant replacement at birth by endotracheal tube insufflation, followed by oxygen and ventilatory support

Front 90

What occurs from the infant inhaling meconium stained amniotic fluid during birth?

Back 90

meconium aspiration sydrome

Front 91

Because meconium is irritating to the airway, what can it lead to?

Back 91

airway spasm and pneumonia

Front 92

Treatment of meconium aspiration include:

Back 92

oxygen
ventilatory support
antibiotics

Front 93

When an infant shows signs of increased bilirubin at 3-5 days of life it has developed what?

Back 93

physiological jaundice

Front 94

What are some methods to treat hyperbilirubinemia?

Back 94

phototherapy
early feeding: stimulates bowel peristalsis-eliminates bilirubin in feces
exchange transfusion

Front 95

During phototherapy, how far should the lights be placed above the infant?

Back 95

12-30 inches

Front 96

What are the usual characteristics of an infant's stool when undergoing phototherapy?

Back 96

bright green and loose

Front 97

How often should you monitor the temp of an infant undergoing phototherapy?

Back 97

every 2 hours to prevent overheating

Front 98

How often should you feed an infant undergoing phototherapy?

Back 98

every 2 hours: you may alternate formula and water

Front 99

What is exchange transfusion used for?

Back 99

any condition leading to hyperbilirubin or polycythemia

Front 100

Should an infant undergoing an exchange transfusion get feedings?

Back 100

NO

Front 101

What are care measures that need to be taken during an exchange transfusion?

Back 101

*suction stomach to decrease risk of apiration
*keep warm to prevent energy expenditure
*record incremental amounts of blood withdrawn & infuse
exchange slowly to prevent alternating hypovelemia/hypervolemia
*monitor HR, resp., BP

Front 102

What two medications are given during exchange transfusion?

Back 102

Alumin: given prior to procedure to give more binding sites to bilirubin.
Calcium gluconate: given after each 100cc blood to prevent hyperglycemia which can lead to hypoglycemia

Front 103

After an exchange transfusion, what should you assess for?

Back 103

the umhilical vein for bleeding, redness, or inflammation
vital signs: monitor closely
blood glucose done 1 hr after
bilirubin levels for 2 to 3 days after

Front 104

What medication is given after an exchange transfusion to increase new blood cell growth and prevent anemia?

Back 104

erythropoietin

Front 105

What are some management steps to take with an infant born to a diabetic mother?

Back 105

feed early
maintain IV glucose
monitor blood glucose levels
monitor vomiting, abdominal distention, bowel movement

Front 106

What is caused on the infants head by pressure from the birth canal and crosses the midline of the skull?

Back 106

caput succedaneum

Front 107

This is caused when a small capillary beneath the periosteum of the skull bone has ruptured and does not cross the suture line:

Back 107

cephalohematoma

Front 108

How soon can bowel sounds be heard in an infant after birth?

Back 108

after the first 15 minutes

Front 109

Try to figure the Apgar score:
Infants HR >100, good-strong cry, well flexed, ifant withdraws foot when slapped, extremeties slightly blue.

Back 109

Apgar score is 9
Slightly blue extremeties cause the infant to lose a point on color.

Front 110

In order for an infant to get a perfect 10 on the apgar what would it have to have during the assessment?

Back 110

heart rate >100
good;strong cry
well flexed (muscle tone)
cough or sneeze/cry and withdrawal of foot (reflex irritability)
Normal Skin Coloring

Front 111

Some femal newborns have a mucus vaginal secretion after birth that is sometimes blood tinged. What is this called?

Back 111

pseudomenstruation

Front 112

It is common to observe cyanosis in an infant's feet and hands, what is the term for this finding?

Back 112

acrocyanosis