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112 Cards in this Set

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What phase of maternal adjustment is a time of reflection and the patient is dependent?
Taking In Phase
During this maternal adjustment phase the patient begins to take action and takes a strong interest in the baby:
Taking Hold Phase
During this phase of maternal adjustment the patient redefines her role:
Letting Go Phase
How long is the fundus palpable at the umbilicus after delivery?
Approximately 24 hours
What factors may reduce/delay the process of uterine involution?
multiple fetuses, hydramnios, prolonged labor, grand multiparity, or excessive analgesia.
What is termed:
uterine flow, consisting of blood, fragments of deciduas, WBCs, mucus, and some bacteria?
lochia
This type of lochia is red in color:
Lochia Rubra
How long should lochia be present after delivery?
atleast 1-3 weeks
This lochia lasts approximately 1-3 days and is composed of blood, deciduas, and mucus:
Lochia Rubra
What lochia is white in color?
Lochia Alba
How long does Lochia Alba typically last? How long can it last?
10-14 days but may last 6 weeks
Describe lochia surosa:
pink in color
lasts 3-10 days
composed of blood, mucous, leukocytes
When is a patient considered febrile and postpartal infection should be expected?
if temp increases to 100.4 or above after the first 24 hours postpartal
What causes the temp to rise slightly during the first 24 hours postpartum?
dehydration
Describe the pulse of a postpartum patient:
slower than normal
60-70 bpm
What causes the pulse to be slower in a postpartal patient?
stroke volume increase due to increase in blood volume returning to the heart
When considering the pulse, what indication would make you suspect hemorrhage?
rapid and thready pulse
What measurements of blood pressure could indicate PIH?
above 140mm Hg systolic
above 90mm Hg diastolic
When should menstrual flow return in a nonbreastfeeding mother?
6-10 weeks
When should a breastfeeding mother expect to have her menstrual flow return?
may not return for 3-4 months or for the entire time of lactation
What degree of an episiotomy involves the vaginal mucous membrane and skin of the perineum to the fourchette?
1st Degree
What care measures can be taken for an episiotomy?
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
What degree of episiotomy involves the vagina, perineal skin, fascia, levator ani muscle, and perineal body?
2nd Degree Episiotomy
This degree of episiotomy involves the entire perineum and reaches the external sphincter of the rectum:
3rd Degree Episiotomy
This degree of an eipisiotomy involves the entire perineum, rectal sphincter, and some of the mucous membrane of the rectum:
4th Degree Episiotomy
Measures of Breast Care for a breastfeeding mother include:
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
What are some methods to teach to promote uterine involution?
lying on abdomen to support abdominal muscles
never assume knee chest position until 3wk postpartal
The relaxation of the uterus is termed:
uterine atony
What is the most frequent cause of postpartal hemorrhage?
uterin atony
Management of uterin atony to prevent postpartal hemorrhage include:
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
Infection of the endometrium of the uterus:
endometritis
Signs and symptoms of endometritis include:
fever on 3rd or 4th day PP
painful uterus
chills
malaise
dark brown lochia
lochia with foul smell
increases or scant amount of lochia`
Inflammation of the lining of a blood vessel with the formation of blood clots is termed:
Thrombophlebitis
Prevention of Thrombophlebitis includes:
early ambulation
limiting time in lithotomy position
avoid sitting with knees sharply bent
support hose
When assessing someone for signs and symptoms of a pulmonary embolism, what would you look for?
sudden, sharp chest pain
increased respiratory rate
increased heart rate
orthopnea
cyanosis
What can you do to try to manage an embolism?
oxygen immediately
notify doctor immediately
transfer to ICU
heparinization intravenously
have crash cart accessible
Mastitis is an infection of the breasts. What causes it?
an organism entering through cracked or fissured nipples
What assessment signs indicate mastitis?
localized pain
swelling
redness
fever
usualy unilateral
What can be done to manage mastitis?
broad spectrum antibiotic
encourage breastfeeding
cold and warm compresses
teas bags on affected area
massage clogged milk duct while feeding
Name some assessment criteria that could indicate a woman is experiencing urinary retention:
over 8hrs has passed-no void
voids in small amounts;<100mL
catheterization after voiding reveals more than 100mL of urine left in bladder
During what time can a woman experience postpartum depression?
1-12 months after birth of infant
What are some assessment signs of postpartum depression?
overall feelings of sadness
extreme fatigue
inability to stop crying
increased anxiety about her and baby's health
insecurity
Management of Postpartum Depression:
counseling
antidepressants
support groups
Postpartal Psychosis exists when a person has lost contact with reality. What assessment signs would lead to a diagnosis of this sort?
voicing thoughts of infanticide or infant is possessed
woman is not functioning in reality
What is the normal weight range for a full term infant?
2500-4000gms or 7.5-7.7lbs
What is the normal temperature range for a newborn?
36-37c. or 97.6-98.6 f.
What is considered a normal head range for newborns?
34-35 cm
If an infant's head circumference is greater than 37 cm what should be considered?
neurologic involvement
What is the normal length range for a newborn?
45-55 cm or 18-22 inches`
How much bigger should the infants head measure than it's chest?
2cm
How long should you count a newborn's pulse for?
one full minute
What is the normal pulse rate for a full term infant at rest?
120-160 bpm
What is the normal respiration range for a newborn? How high can it be initially?
30-60 normal
80 initially
What are some signs of respiratory distress in an infant?
grunting
nasal flaring
retractions
apnea/gasping
What is the average blood pressure for a newborn?
80/46
What is the full term systolic range for a newborn?
55-90 mm Hg
What is the full term diastolic range for a newborn?
30-55 mm Hg
Why is Vitamin K given IM in an infant after birth?
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.
Within what time frame is bacteria usually present in the GI tract of a newborn?
within 5 hours after birth
When do you expect a newborn to pass their first stool; meconium?
within 24 hours of birth
If passage of meconium does not happen within the 24 hours of birth what should be suspected?
imperforate anus
meconium ileus
meconium plug
On the 2nd or 3rd day the newborn's stool turn to a transitional stool. How is this described?
green and loose
Stools with increased bilirubin will appear:
bright green and loose
Describe the rooting reflex:
brush cheek and infant will turn head in that direction
Describe the moro reflex:
if you lightly drop baby, it will act startled
Palmar and Plantar grasps are when the hands and toes of the infant grasp an object. When does this disappear?
Palmar: 6wks to 3 months
Plantar: 8-9 months
How would you identify ortolanis sign when checking an infants hips?
you would hear a "clunk" sound when hips were abducted
Breast milk has three stages: What are they?
colostrum
foremilk
hindmilk
When the cord is clamped off when a baby is delivere, how far from the infant's abdomen is it clamped off?
8 inches
What should be reported to the doctor if observed on an infant's circumcision?
rednes
tenderness
odor
discharge
constant crying
What are the calorie requirements for an infant?
50-55 kcalories/lb/day
or
110-120 cal/kg/day
Compared with forumula, what how much nutrition does colostrum contain?
1tsp. of colostrum has the same nutrients as 1 oz of formula
How long does colostrum last after birth of the infant?
2-4 days
When is foremilk available after birth?
2-4 days
When is hind milk formed?
after the let down reflex
What are the advantages of breastfeeding?
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
What does the acronymn LATCH stand for in the breastfeeding charting system?
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
What are some steps to take to prevent or promote healing of sore nipples?
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
How can you evaluate if the infant's feeding is efficient with breastfeeding?
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
What does the term macrosomia mean?
infant is large for gestational age
When is an infant considered large for gestational age?
if the birthweight is above the 90th percentile on an interuterine growth chart
What are some characteristics of a preterm infant?
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
When considering the lecithin/spingomyelin ratio, what is the ideal ratio?
the level of lecithin in surfactant exceeds that of sphingomyelin by 2:1, lungs are mature and respiratory problems are likely to not occur
What is the lecithin/sphingomyelin ration used to determine?
fetal lung maturity
When an infant has a large surface area compared to body weight, what are they at risk for?
ineffective thermoregulation
When an infant has absent, deficient, or altered surfactant in the alveolar lining, they are suject to having:
respiratory distress syndrome
What are sign/symptoms of respiratory distress syndrome?
grunting, retractions, nasal flaring
cyanosis on room air
tachypnea
When does respiratory distress usually set in?
within 6-12 hours of birth
How can respiratory distress syndrome be treated?
synthetic surfactant replacement at birth by endotracheal tube insufflation, followed by oxygen and ventilatory support
What occurs from the infant inhaling meconium stained amniotic fluid during birth?
meconium aspiration sydrome
Because meconium is irritating to the airway, what can it lead to?
airway spasm and pneumonia
Treatment of meconium aspiration include:
oxygen
ventilatory support
antibiotics
When an infant shows signs of increased bilirubin at 3-5 days of life it has developed what?
physiological jaundice
What are some methods to treat hyperbilirubinemia?
phototherapy
early feeding: stimulates bowel peristalsis-eliminates bilirubin in feces
exchange transfusion
During phototherapy, how far should the lights be placed above the infant?
12-30 inches
What are the usual characteristics of an infant's stool when undergoing phototherapy?
bright green and loose
How often should you monitor the temp of an infant undergoing phototherapy?
every 2 hours to prevent overheating
How often should you feed an infant undergoing phototherapy?
every 2 hours: you may alternate formula and water
What is exchange transfusion used for?
any condition leading to hyperbilirubin or polycythemia
Should an infant undergoing an exchange transfusion get feedings?
NO
What are care measures that need to be taken during an exchange transfusion?
*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
What two medications are given during exchange transfusion?
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
After an exchange transfusion, what should you assess for?
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
What medication is given after an exchange transfusion to increase new blood cell growth and prevent anemia?
erythropoietin
What are some management steps to take with an infant born to a diabetic mother?
feed early
maintain IV glucose
monitor blood glucose levels
monitor vomiting, abdominal distention, bowel movement
What is caused on the infants head by pressure from the birth canal and crosses the midline of the skull?
caput succedaneum
This is caused when a small capillary beneath the periosteum of the skull bone has ruptured and does not cross the suture line:
cephalohematoma
How soon can bowel sounds be heard in an infant after birth?
after the first 15 minutes
Try to figure the Apgar score:
Infants HR >100, good-strong cry, well flexed, ifant withdraws foot when slapped, extremeties slightly blue.
Apgar score is 9
Slightly blue extremeties cause the infant to lose a point on color.
In order for an infant to get a perfect 10 on the apgar what would it have to have during the assessment?
heart rate >100
good;strong cry
well flexed (muscle tone)
cough or sneeze/cry and withdrawal of foot (reflex irritability)
Normal Skin Coloring
Some femal newborns have a mucus vaginal secretion after birth that is sometimes blood tinged. What is this called?
pseudomenstruation
It is common to observe cyanosis in an infant's feet and hands, what is the term for this finding?
acrocyanosis