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90 Cards in this Set

  • Front
  • Back
When to worry if mom febrile
24 h p delivery. May increase first 24 hr r/t dehydration unless >100
Vital signs postpartum
q15min after delivery, on floor: qh or q30min til stable, then q4h
When to use cold compress on breasts
NEVER if Breast feeding, ok if not
tx for mastitis
warm compress and antibiotics (some are c/i for breast feeding). Make sure she continues feeding or pumping to keep milk flowing
Postpartum assessment
B breast
U uterus
B bowel
B bladder
L Lochia (discharge of what's left in uterus, note details)
E episiotomy (did she have one?) p24h shouldn't be red and swollen, no evisceration
H homan's sign. One hand on knee, other dorsiflexes foot, pain a positive sign (bad)
E emotions
Involution of uterus
Contractions: reassure that ok, primipara little pain, multipara more painful. Autolysis (d/c of lochia).

Assess firmness, location in FB (24h p delivery, @U, then progresses 1 FB qd, should be midline, empty bladder to check
Cervical changes postpartum
Soft and swollen, tone improves after 1 week
Vaginal changes postpartum
Some scratching and bruising normal, poor muscle tone, edema, lacerations, episiotomies.
Precipitous delivery
Very quick delivery (2-3 hours), not necessarily a good thing->vaginal injury
Postpartum ovulation can begin 4-6 wks after delivery. Breast feeding does not stop ovulation, wean baby for mom's nutrition in U.S. (may be necessary to continue breast feeding if no clean H2O
C-section assessment
First 24hr very important to monitor firmness of fundus, give meds 30min a assessment b/c very painful, visually examine incision, OOB w/in first 24h (ideally 8-10)
Removal of excess fluid via urine and sweat
Bladder postpartum
Void w/in 6-8hr, freq. small voids may indicate retention and overflow.
Bowel elimination
2-3 days postpartum
Lochia (types)
Rubra-bright red, heavy bleeding right after delivery ~24hr
Alba (white), more clear
Serosa-like regular discharge
Rubin phases
1. Taking in phase, woman laid back and everyone taking care of her. First 8 hr. postpartum
2. Taking hold phase: 8-24h after delivery, pretty independant
Postpartum hemmorrhage
Can occur at any time, why fundus check is crucial. If boggy, give pitocin and massage.
Early: first 24 hr. post, more common
Late: occur after first 24h-6wks
Predisposing factors for postpartum hemorrhage
uterine atony (lack of tone->unable to contract), lacerations, retained placenta fragment, over-distended uterus (grand-multipara)
Puerperal infections
Post partal, after delivery or abortion, an infection of the reproductive tract within the first 10 days after birth or abortion
Admission assessment of newborn
Airway clearance, vital signs, neuro status, ability to feed, assessment for complications
Routine meds for the newborn
Antibiotic opthalmic erythromycin to both eyes, aquamephyton IM to vastus lateralis for coagulation, and hep B vaccine
Distressed newborn glu level
VS of newborn
HR 120-160
BP 72/47
Resp 30-60
Temp 36.5-37 (keep baby warm)
L/S ratio and critical values
Measures maturity of fetal lungs. <1.5:1 indicates RDS at birth, admin. intratracheal surfactant. 2:1 a good value->indicates lung maturity
Periodic breathing vs. apnea
Periodic breathing <15 sec.
Apnea 20+ sec.
Circulatory changes in the neonate
Shunts: Foramen ovale, ductus areteriosis, and ductus venosus
Non-shivering means of producing heat
Brown fat located in midscapular area, around neck, axilla, around trachea, esophagus, abdominal aorta, kidneys, and adrenal gland`
Means of heat loss in an infant
Convection: cool air
Radiation: cool objects near infant
Evaporation: wet skin
Conduction: cool surface exposure on infant
Cold stress def.
Excessive heat loss resulting in compensatory mechanisms (increased respirations and nonshivering thermogenesis) to maintain core temp.
Newborn serum glucose level
45-96 mg/dL, assess @ 4hr old
Newborn stools and urine
Breastfed: 6-8 small, semiliquid, yellow stools qd by 3rd or 4th day after milk production established
Fomula-fed: 1-2 more formed, yellow or yellow brown stools qd
Urine: 5-8 qd
hair covering fetus, lessens during third trimester
little white bumps on newborn
Mongolian spots
Black/blue spots that appear on back and buttocks of AA, latino, and meditteranean kids
Newborn Reflexes
Tonic neck
Moro: when startled, pull hands and legs in
Rooting: turn head to nipple
Babinski: goes away w/in a few wks, absent->neuro deficit
APGAR numbers
8-10 No intervention
5-7 Bag em
1-4 Rescucitation needed
urethral opening on ventral side of penis
failure of teste to fully descend
Secretion of sebaceous glands, specifically, the thick, cheesy, odoriferous secretion found under the labia minora about the clitoris or under the male prepuce.
Small, appropriate, and large for gestational age
Immediate care of the newborn
clear airway (if merconium present->need RT & Peds), thermoregulation, vit. K (b/c imperfect clotting), opthalmic ointment, initiate first feeding, and attachment facilitation
Ongoing newborn care
Thermoregulation (due to loss), safety, circumcision (2nd or 3rd day), attachment, care of baby, screening and immunization
Caloric needs and fluid intake of the newborn
105-108 kcal/kg/day
140-160 cc/day
yellowish, creamy fluid, thicker than milk, contains protein, fat soluble vitamins, minerals, passive immunity. Lasts for several days after delivery
Transition milk
Produced from end of colostrum until 2 wks postpartum, contains more fat, lactose, vitamins, and calories than colostrum
Mature milk
10% solids(CHO, pro, fats) plus water. Foremilk at beginning of feeding contains more water, hindmilk contains higher fat.
20 kcal/oz Recommended for first 6-12 mos.
Milk storage
Refrigerator 3 days
Freezer Weeks
Never thaw in microwave or hot water
Signs of successful breastfeeding
Feed 8x's qd (Q3h), 6-8 wet diapers qd (~1 per feeding)
Preterm labor
labor occuring b/w 20-37 wks, have potential to produce viable fetus outside of body
Risk factors for pre-term labor
Multiple gestation(twins), multiparity, infection, previous preterm, teen pregnancy, smoking, ETOH, drugs, polyhydramnios, stress, poor diet
S/S of preterm labor
Same as true labor, just early
Tocolytic drugs
Attempt to stop uterine contractions, relax uterine muscles. B-adrenergic agonists, terbutaline (relaxes smooth muscle->+chronotrope), mag sulfate (relax muscles for PIH)
Mag sulfate S/E and signs of toxicity
S/E: relaxes smooth muscles
Signs of toxicity: depression or absence of reflexes, oliguria, confusion, resp. deprssion (relaxes intercostal muscles), circ. collapse
Nursing considerations for mag sulfate
V.S. and reflexes at least q4h, mag levels q6-8h, urinary output, fetal monitoring, calcium gluconate at bedside.
Measures to prevent preterm labor
Bedrest w/ BRP, force fluids, don't work, no sex, don't stimulate breasts, stress mgt (w/ or w/o meds)
Delivering preterm baby
Take to hospital in utero, no analgesia if possible, prepare for resuscitation
Diabetes and changes with pregnancy
Changes in insulin requir: decr. in first trimester, mom's glu sucked by baby. Second trimester, baby making own glu, mom needs reg. amt. of insulin

May accelerate vascular dz, pregnancy exacerbates DM. The longer she's been diabetic, greater likelihood that kidneys and eyes affected
Effects of DM on pregnant woman
hydramnios, dystocia (diff. labor that doesn't progress well), infections (exacerbated by pregn.), PIH, retinopathy (change in vascularity)
Diabetes effects on baby
LGA-hyperinsulinism (as a response to mom) acts as HGH
IUGR-poorly controlled insulin dependant moms->poor vascularity, baby not getting enough O2
Congenital anomalies
Hypoglycemia after birth
Hyperbilirubinemia-hypoglycemia releases fatty acids that dissociate bilirubin from albumin, meds compete w/ bilirubin on albumin->hyperbilirubinemia
Etiology of Gestational diabetes
hypoglycemic during first trimester->pancreas starts making less insulin->2nd trimester, baby making own insulin->insulin needs go back to normal but pancreas can't make enough or won't->dx w/ GDM->maj. resolve after delivery
non-stress test. Mom hooked up to fetal monitor->watch fetal activity->give her a cracker->baby moves good!
Stress test
Two types: nipple stimulation and oxytocin, look to see if labor will be dangerous for fetus. Decels indicate unsafe labor, done late term
What happens if Rh abys enter fetal circulation?
Sensitivation (hemolysis, generalized edema, CHF, and jaundice)
Indirect Coomb's Test
Measures number of Rh abys in maternal blood. Negative: fetus at no risk. Positive: fetus at risk
Direct Coomb's Test
On infant, to detect aby coated Rh+ blood cells
Given w/in 72 hr. of every birth, IM in deltoid, give w/ abortions too
PIH def.
An increase in blood pressure after 20 wks. gest. accompanied by proteinuria. Only cure is birth
S/S of preeclampsia
Edema (dilutional hypoalbuminemia), elevated BP, proteinuria, hyperactive reflexes, no seizures, vasoconstriction->reduction of O2 to fetus
S/S of worsening preeclampsia
Incr. in edema in AM, worsening ha, epigastric pain (liver involvement r/t hypoxia), visual disturb, decr. output, n/v, bleeding gums, disorientation, not feeling good, hypernatremia
Characterized by convulsion or coma (sometimes pass out w/o seizure). May occur antepartum, L and D, or postpartum
Mgt. of eclampsia
Monitor output qh (Foley), reflexes, maintain airway (turn to side and suction after seizure), prevent injury, mag sulfate, dilantin, prepare for birth
HELLP syndrome
H hemolysis
E elevated
L liver enzymes
L low
P platelets
Placenta previa
Placenta partially or totally blocks cervical os. Can be total, partial, marginal, or low-lying. PAINLESS contractions w/ bleeding
Abruptio placenta
premature separation of a normally implanted placenta from the uterine wall. Can be partial, complete, or hidden. PAINFUL, some go into shock, bright red bleeding, surgical abdomen
Causes of abruptio placenta
Smoking (vasoconstriction), incr. maternal age, ETOH, cocaine, short umbilicus, multiparity, trauma
Classification of spontaneous abortion
Threatened: <20 wks w/ bleeding and contr.
Imminent: contractions don't stop
Complete: all products of conception expelled
Missed: fetal death but no expulsion, do D and C or low-dose chemo
Habitual: 3+
Septic: infection from abortion
Ectopic pregnancy causes
Tubal obstruction/damage, delayed tubal transport, congenital anomalies, altered hormonal status, scarring of fallopian tubes secondary to STDs, PID
S/S of ectopic pregnancy
Amenorrhea, breast tenderness, nausea, SHARP, ONE-SIDED PAIN, vaginal bleeding. Usually aborts @6-8 wks, if ruptures->surgical abdomen
Interventions for an ectopic pregnancy
Methotrexate (low dose chemo), Surgery, rhogam
Incompetent cervix and causes
Painless dilation of the cervix w/o labor or uterine contractions, habitual abortions->never can carry to term. Caused by previous traumatic delivery, forceful D&C, congenital defect
Gestational trophoblastic dz
"Molar pregnancy" Placenta develops but fetus does NOT, will never reach viability, will do D&C to remove products of conception
S/S of molar pregnancy
Brown vaginal bleeding, anemia, hydrophobic vesicles, abnormal uterine enlargement, absence of FHT, marked hCG elevation, hyperemesis R/T Hcg
Adolescent pregnancy at risk for...
Titer 1:18 is "rubella immune," pregnant women canNOT be vaccinated
Group B strep
Give antibiotics, at risk for: Premature labor, PROM, prolonged ROM (>12 hr), fever, hx of GBS
Drugs used w/ AIDS infected mom
CV disorders of baby
Congenital heart defects, rheumatic heart dz->valve disorders, peripartum cardiomyopathy, mitral valve prolapse
Implications of multiple gestation
Spontaneous abortion, HTN, hydramnios, PROM, incompetent cervix, IUGR, PP hemorrhage, abnormal presentation (placental attachment lower, can't all attach at fundus, possibility of prolapsed cord)
CV disorders of baby
Congenital heart defects, rheumatic heart dz->valve disorders, peripartum cardiomyopathy, mitral valve prolapse
Implications of multiple gestation
Spontaneous abortion, HTN, hydramnios, PROM, incompetent cervix, IUGR, PP hemorrhage, abnormal presentation (placental attachment lower, can't all attach at fundus, possibility of prolapsed cord)