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153 Cards in this Set
- Front
- Back
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Dystocia
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labor not progressing as it should be
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Dysfunctional Contractions
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Irregular in strength, timing or both
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Hypertonic Labor
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Ineffectual uterine contractions during latent phase
More frequent but intense and effective. Painful Delays dilation and effacement Prolonged latent stage Prolonged pressure on the fetal head |
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Precipitous Labor & Birth
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Labor that lasts less than 3 hours
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What are contributing factors to Precipitous Labor & Birth
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Multiparity
Large pelvis Previous precipitous labor Small fetus in favorable position |
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Problems with Precipitous Labor & Birth
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Lacerations of the cervix, vagina, and perineum due to the rapid descent of the infant. Rick for PP hemorrhage. Cerebral trauma to the infant and fetal distress.
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What are maternal risks to postterm pregnancy?
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LGA
Increased incidence of forceps, vacuum assisted or C-section Increased psychological stress |
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What are fetal risks to postterm pregnancy?
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Decreased placental perfusion
Oligohydraminos- not enough amniotic fluid Meconium aspiration |
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Hydraminos or polyhydramnios
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More than 2,000ml of amniotic fluid
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What is the cause of polyhydramnios?
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Diabetes can increase the urine prod- baby urinating and inc amniotic fluid
Also with congenital anomolies |
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Oligohydraminios
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Amount of amniotic fluid is severely reduced and is concentrated
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What is the cause of Oligohydraminios?
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Kidney issues with baby cause oligo- not prod urine leads to decrease fluid in sac.
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What is the danger of Oligohydraminios to the baby?
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-Oligo leads to lungs not able to develop properly and can die at birth d/t lung malformation
-Dangers of cord compression and of pulmonary hypoplasia because of the decreased fluid volume for fetal breathing movements. -Can also cause dehydration |
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Prolapse of Umbilical Cord
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Occurs when umbilical cord proceeds the fetal presenting part
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puerperium AKA
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post partal period
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What is the port partal period?
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The 6 week period after childbirth. A time of maternal changes that are retrogressive and progressive
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Retrogressive part of post partal period
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involution of the uterus and vagina
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Progressive part of post partal period
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production of milk for lactations,
restoration of the normal menstrual cycle, and the begging of parenting role |
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How often is Post Partum Assessment done after childbirth?
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Every 30 min x 2
Every Hr x 2 Every 4 hrs x 2 Every 8 hrs |
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What should the nurse have mom do before starting the post partum assessment?
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void
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PIH
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Pregnancy Induced Hypertension- Preeclampsia
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For women with PIH, what is important to assess post partum?
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Watch for edema in face hands and feet
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What can a decrease in BP be a sign of post partum?
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May be due to the decreased intrapelvic pressure or could indicate bleeding.
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Before getting mom out of bed post partum, what precautions to take?
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Watch for orthostatic hypotension. Have mom get up slowly, dangle feet
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Are moms tachycardic or bradycardic after child birth? Why?
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Slightly bradycardic due to fluid loss during labor- now decreased cardiac strain
50-70 bpm for first 6-10 days |
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What will moms temp be after childbirth?
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temp elevated (98-100.4) due to exertion and dehydration. Should be afebrile after 24 hours.
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What is to be suspected if moms temp goes above 100.4?
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Infection should be suspected
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How long is mom at risk for DVTs after childbirth?
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Entire 6 week post partal period
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What is a normal blood pressure finding during post partal period?
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stable ad consistent with BP during pregnancy
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What does bubblehe stand for?
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Breast
Uterus Bladder Bowel Lochia episiotomy Homan's sign/Henorrhoids Emotional Status |
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Post Partum Assessment- Breast:
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Assess for color, temp, and consistency
General appearance: smooth and soft; are nipples intact with or without fissures or cracks; is pt breastfeeding; are breasts engorged, sore or tender; is baby latching on well; production of colosterum or milk |
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Rationale for performing a breast examination post partum?
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Assess milk production,
breastfeeding status, possible infection, blocked duct, yeast infection, engorgement |
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If mom has yeast infection on nipple/breast, where else should we be checking for a yeast infection?
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Babies mouth
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How long does mom produce colostrum?
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first 1-2 days
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When do breasts begin to fill with milk production?
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3rd day
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How do we suppress lactation?
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wear bra continuously for 5-10 days, ice packs to auxiliary area of each breast for 20 minutes 4X/day.
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Post Partum Assessment- Uterus:
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Appearance: is fundus midline or displaced
Palpation: firm or boggy (massage if fundus is boggy) Fundus: how many finger from the umbilicus (above or below) Inspect incision site if present |
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Rationale for performing a uterus examination post partum?
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Assess location, status of involution/contraction and return to normal position,
possibility of hemorrhage, infection (excess pain), clots |
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What should the fundus feel like on palpation?
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Grapefruit
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How long do we palpate fundus?
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10 minutes each time to help uterus contract and not fill up with blood
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Where will the fundus be located immediatly post delivery?
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situated in the midline of the abdomen and half way between umbilicus and symphysis pubis.
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Where will the fundus be located 6-12 hrs post delivery?
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It will have risen to the umbilicus, it will be midline
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If fundus is above midline, it may be ______
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boggy
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What will happen to the fundus if moms bladder is full?
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Fundus will be pushed away from the midline and will prevent moms uterus from contracting by pushing it upward. This will allow uterus to fill with blood and allow for hemorrhage
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Then fundus descends approximately _ fingerbreadth per day until __th day when it is not palpable.
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1
10th |
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On first post partum day that fundus is located how far below umbilicus?
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1 cm
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Post Partum Assessment- Bladder:
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Palpation: is bladder distended, should not be palpable
- when last time voided - encourage fluid intake Want to void at least every 4-6 hrs |
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Rationale for performing a bladder examination post partum?
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Full bladder can displace uterus (deviated to the right) and interfere with contraction/involution and can lead to hemorrhage
Want to assess bladder function especially if F/C was in |
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Post Partum Assessment- Bowel:
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- Bowel sounds
- last BM - Passing gas - need for ambulation - need for stool softener |
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Rationale for performing a bladder examination post partum?
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Assess constipation- want to prevent this because bearing down will cause pain on perineum, esp if episiotomy or laceration present
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Post Partum Assessment- Lochia:
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Assess amount (scant, light, moderate, heavy- heavy abnormal),
color, odor, clots |
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Rubra- color? How long will this last?
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dark Red
1st 1-3 days |
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Serosa- color? How long will this last?
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lighter red - 3rd to 10th day
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Alba- color? How long will this last?
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creamy yellow - beyond 10th day
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Rationale for performing examination of lochia post partum?
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Assess hemorrhage and healing of uterus at placental site
abnormal bleeding (> 4-8 partially saturated pads daily) large clots infection |
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Post Partum Assessment- Episiotomy or C-section:
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Episiotomy: assess area for erythema, edema, ecchymosis, and assess sutures and pain
C-Section: assess incision for erythema, edema, and assess staples and pain |
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For Episiotomy we assess REEDA, what is that?
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Redness
Edema Ecchymosis Discharge Approximation |
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Rationale for performing examination of Episiotomy or C-section post partum?
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In case of infection, and to make sure it is healing properly- no excessive bleeding.
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Post Partum Assessment- Homan's Sign/Hemorrhoids:
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Assess for pain with dorsiflexion. We do not do this
Assess for edema, redness, tenderness, heat pain Visually inspect anus for hemorrhoids |
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Rationale for performing examination of Homan's Sign/Hemorrhoids post partum?
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Hemorrhoids will be a problem- painful defecation can lead to constipation
Homan's Sign- assess for DVT/thrombophlebitis- these are potential problems. Can throw a clot |
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Post Partum Assessment- Emotional state:
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Assess general attitude
Bonding with Baby Happy/Sad/Overwhelmed Support System |
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Rationale for performing assessing Emotional state post partum?
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To assess family bonding and baby
Early detection of baby blues can help in preventing post partum depression Assessing the family environment and what is safe for baby |
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What is Homan's sign?
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Homans' sign is a sign of deep vein thrombosis (DVT) positive sign is present when there is pain in the calf or popliteal region with examiner's abrupt dorsiflexion of the patient's foot at the ankle while the knee is flexed to 90 degrees.
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Why do we not perform Homan's sign?
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it may dislodge a thrombus leading to a thromboembolic event.
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What is normal urine output for mom after birth?
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In 1st 24 hrs diuresis happens- 1500 mL per day and amount can double during the second to 5th day- lots of trips to the bathroom!
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Why are we pushing fluids after birth?
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For lactation
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When should mom void by after delivery?
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Need to void 4 hrs post delivery and 4 hrs after removal of f/c
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Why is it important for mom to ambulate after C-Section?
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Post op C section have a lot of gas, they need to walk around, also have risk for constipation
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What does lochia consist of?
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blood, fragments of decidua, WBC’s, mucus and some bacteria.
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What size clots are normal post delivery?
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should not expect to see large clots above size of nickel, may see larger at first or when the women gets up for the first time because of pooling of blood in uterus due to reclining position.
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Woman's avg blood loss for vaginal birth
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300 to 500 ml
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Woman's avg blood loss for C-Section
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500 to 1000 ml
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What does lochia tell us?
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Lochia tells stages of healing of the placental attachment site
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What should lochia smell like?
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Lochia has a musty stale odor that is not offensive – any foul smell to the lochia or used perineal pad suggests infection and the need for prompt additional assessment
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When should lochia be heavy?
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Never, it should never exceed a moderate amount
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How many peri pads a day and how much saturation?
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4-8 pads a day partially saturated
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When is discharge greater?
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In the morning due to pooling
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What happens to the amount of lochia with breastfeeding?
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Discharge will be greater
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Lochia amount documentation- heavy amount
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perineal pad has been completely saturated in 1 hr or less
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Lochia amount documentation- Moderate amount
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perineal pad has a stain less than 6 inches in length within 1hr
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Lochia amount documentation- Small amount
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perineal pad has a stain less than 4 inches in length after 1hr
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Lochia amount documentation- Scant
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perineal pad has a stain less than 1 inch in length after 1hr or lochia is only on tissue when the woman wipes
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When is onset of menstruation after birth when mom is breastfeeding?
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delayed for up to 3 months
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When is onset of menstruation after birth when mom is not breastfeeding?
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6-10 weeks after birth,
average time 45 days, resume menstruation by 6 months |
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How is moms emotional status in the first 24 hrs?
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passive & preoccupied with own needs ***this helps her integrate what just happened and come to terms with her own experiences.
Food and sleep are major needs |
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How is moms emotions by second or third day after birth?
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By the second or third day the mother is ready to resume control of her mothering and her life in general: Taking hold period
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Post partum blues
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manifested by mood swings, anger, weepiness, anorexia, difficulty sleeping
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When does Post partum blues occur?
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occurs during the 1st few day after birth and resolves within 10-14 days
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What causes Post partum blues?
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it is caused by hormonal shifts, unsupportive environment, insecurity.
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NSVD
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normal spontaneous Vaginal Delivery
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FM
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fetal monitoring
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EDD
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estimated date of delivery
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G- gravida
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any pregnancy regardless of duration
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P- Para
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birth after 20 wks gestation
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T- term
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# infants born at completion of 37 weeks
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P- Preterm
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# infants born after 20 wks before 37 wks
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A- abortion
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# pregnancies ending in abortion 20wks
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L- living
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# of living children
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TPAL
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Term
Preterm Abortion Living |
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Car seat safety
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New borns must go home in car seat designed for newborns
Rear Facing Back Seat 5 point harness Safest spot middle of back seat |
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SIDS
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Sudden Infant Death Syndrome- the sudden unexpected death of an infant less than 1 year of age, with onset of the fatal episode apparently occurring during sleep, that remains unexplained after a thorough investigation
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What is the cause of SIDS
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unknown
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How can risk of SIDS be reduced?
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keep lose items out of crib,
no crib guard, lay baby supine, no feeding while sleeping, use firm mattress, no co-sleeping, keep babies face uncovered, use blanket sleeper instead of blanket, avoid overheating, no smoking, use pacifier |
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What should mom use if there is discomfort or burning after urination or defecation?
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peri-bottle (warmish water)
witch hazel / tucks pads sitz bath Dermacare- topical skin spray icepack |
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How often should mom change peri pads?
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After each urination or defecation- regularly to prevent infection
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How long can ice pack be applied to perineal area?
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20 min on and then 10 min off, do not apply directly to skin, wrap in towel
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When can mom return to her regular activity after D/C?
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capable of resuming most regular activities by 4-5 weeks when lochia flow has stopped
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When can mom return to her exercise routine
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After 6 weeks
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When can sexual activity be resumed?
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between 3-6 wks after birth
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What is important discharge teaching about risk of pregnancy
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that pregnancy can occur before the first menstrual period returns and contraception should be used
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What are the benefits of breastfeeding for baby?
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Immunity
sustains optimal growth and hydration for first 6 mos Gastrointestinal Brain development Bonding Better health Lowered infection rates Happier baby |
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What are the benefits of breastfeeding for baby?
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Healthier baby
Lower cancer risks Delayed return of period/less bleeding Weight loss Time savings Bonding Relaxation Saves money improved recovery after birth higher self esteem, lower chance of depression |
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The AAP recommends exclusive breastfeeding for how long?
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For 6 months
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When should foods be added to baby's diet?
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At 6 months
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How long does AAP recommend moms breastfeed in total?
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1 yr and beyond
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What are the two hormones that make milk?
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Prolactin and oxytocin
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What does prolactin do in relation to breast feeding?
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Stimulates breast development
Causes milk cells to produce milk |
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What does incomplete removal of the placenta do to milk production?
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it blocks prolactin- A piece of placenta as small as a thumbnail can keep a mother’s milk from coming in.
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What causes further production of prolactin after birth?
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breast stimulation- suckling/breast emptying
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When do prolactin levels peak?
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45 min after a feeding and return to baseline in 3 hrs
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What does oxytocin do in relation to breast feeding?
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Causes uterine contractions (like pitocin)
Causes milk ejection Causes feelings of trust and bonding |
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How big is an infants stomach 1st day of life?
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5-7 ml
Shooter marble size perfect for the amount of colostrum mom has |
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How big is an infants stomach 3rd day of life?
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22-27 ml
Ping-pong ball size |
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How big is an infants stomach 10th day of life?
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60-81 ml
Extra large egg size |
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How many mL in 1 oz?
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30
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By the time the baby is 6 weeks old, he will eat approximately ___ to ___ ounces per feeding.
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2 to 3
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How soon should mom breastfeed after delivery?
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Initial feeding as soon as possible after delivery (30-60 minutes)
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How long will a baby feed on one breast?
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10-40 min per breast
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What are feeding cues from a newborn?
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Chewing hands
Smacking lips Tongue motions Fussing Fidgeting Rooting Crying |
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Is crying a sign of hunger
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Yes... a late sign and the baby may be inconsolable
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How many times should newborns eat in 24 hours?
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8-12 times
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How many wet diapers should a newborn have per day?
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6 to 8 wet diapers per day
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How many stools should an infant haver per day?
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2-3 soft yellow stools per day.
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How much weight should a newborn gain per week... in a month?
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Gain 3-4 oz. per week or 1 lb. a month
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How can mom increase her breast milk supply?
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Increase breast stimulation (nursing, pumping)
Increase fluid and food intake Get adequate rest estrogen in B/C can cause mom to dry up- stop taking it |
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How can mom treat sore nipples?
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lanolin products after feeding
air drying expressed breast milk on their nipples keeping area dry nipple ointment/cream |
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How to treat engorgement
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Occurs on day 3-5
Heat Emptying breast Maintain latch Pumping Cold treatment Cabbage Medications |
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How long can breast milk be stored at room temp?
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4 hours
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How long can breast milk be stored in a cooler with ice packs?
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24 hours
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How long can breast milk be stored in the refrigerator?
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5-7 days
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How long can breast milk be stored in the freezer?
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3-4 months,
standalone deep freezer 6-12 months |
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Can you refreeze thawed breastmilk?
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NEVER refreeze thawed breast milk,
thawed milk can last in the refrigerator ONLY for 24hrs |
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Infant should double birth weight by __-__ months
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4-5 months
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Birth weight should triple by...
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1 year of age.
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Can breastmilk be shared between children?
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No- Milk must never be given to the wrong child.
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Should we wear gloves when handeling breastmilk?
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Yes- it is a body fluid!
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Can breast milk be microwaved?
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Never warm breast milk in a microwave. Microwaving breast milk kill antibodies and nutrients in the milk. It can also scald a baby’s mouth, because microwaves heat liquids unevenly.
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When should rice cereal be introduced to baby?
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3 months
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What is the rule when introducing new foods to baby?
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1 new food every 3 days
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When does baby start to roll?
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4 months
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When do infants receive vaccinations?
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2, 4, 6 months
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Infants Resp Rate
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30-60
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Cessation of breathing lasting more than __ seconds is defined as apnea and is abnormal in term newborns
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20 seconds
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