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88 Cards in this Set
- Front
- Back
What is the most important safety measure for baby who is having phototherapy?
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What is the most important safety measure for baby who is having phototherapy?
- Maintain eye masks over newborn’s eyes (answer) - Keep newborn undressed, place surgical mask over male genitalia - Given to babies with Hyperbilirubinemia |
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What is first thing you would notice on a baby with hydrocephalus?
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What is first thing you would notice on a baby with hydrocephalus?
- Increase in head circumference - Measure the infant’s head circumference daily - Frequently reposition the infant’s head to prevent sores - Assess the infant for signs of increased ICP such as vomiting and a shrill cry |
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What is the Moro reflex?
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What is the Moro reflex?
- Elicited by striking a flat surface that the infant is on, or allowing the head and trunk of an infant in a semi-sitting position to fall backward to an angle of 30 degrees - Infant’s arms/legs extend symmetrically, then abduct, fingers spread to form a “C” |
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Newborns with Galactosemia, what are they unable to metabolize?
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Newborns with Galactosemia, what are they unable to metabolize?
- Inability to metabolize galactose into glucose - Inability to metabolize galactose into glucose which may cause failure to thrive, cataracts, jaundice, cirrhosis, sepsis, and mental retardation if not treated - If a galactosemic infant is given milk, unmetabolized milk sugars build up and damage the liver, eyes, kidneys, and brain - Give infant a milk substitute because galactose is present in milk - DX for Galactosemia – Blood/urine levels for galactose |
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When doing the Phenylketonuria (PKU) newborn screening, what are we trying to prevent?
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When doing the Phenylketonuria (PKU) newborn screening, what are we trying to prevent?
- Mental retardation - Phenylketonuria (PKU) – defect in protein metabolism leading to accumulation of amino acid phenylalanine which causes mental retardation - Provide special synthetic formula - Restrict meat, dairy products, diet drinks, protein, and aspartame - DX for PKU – Guthrie test |
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You are checking the mouth of a newborn, what are you assessing for?
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You are checking the mouth of a newborn, what are you assessing for?
- Cleft Palate - Cleft palate/lip – failure of the lip or hard or soft palate to fuse - Determine the most effective nipple for feeding - Feed infant in upright position, feed slowly, burp frequently, cleanse mouth with water after feedings |
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When putting your finger in the baby’s mouth, what reflex are you checking for?
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When putting your finger in the baby’s mouth, what reflex are you checking for?
- Sucking reflex- begins when a nipple or finger is placed in the mouth of a newborn |
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What is the rooting reflex?
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What is the rooting reflex?
- Rooting – when the cheek of a newborn is stroked, newborn will turn head in direction of stroke; they are hungry |
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Preterm infants, what is the number one priority?
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Preterm infants, what is the number one priority?
- Respiratory Distress Syndrome (RDS) - due to decreased surfactant - Occurs as a result of surfactant deficiency in the lungs - Surfactant assists in alveoli expansion - Characterized by poor gas exchange and ventilator failure due to atelectasis leading to respiratory acidosis and hypoxemia - ABGs show hypercapnia (increase in CO2) - Birth weight is not an indicator of fetal lung maturity - Risk factors that contribute to RDS: decreased gestational age (preterm) - Complications from RDS are related to oxygen therapy and mechanical ventilation: - Pneumothorax - Pneumomediastinum - Retinopathy of prematurity - Bronchopulmonary dysplasia - Infection - Intraventricular hemorrhage - Monitor respiratory rate > 60/min, labored breathing, intercostal and substernal retractions, rales, nasal flaring, expiratory grunting, cyanosis - Monitor pulse oximetry, nutrition, VS, and IV - Suction as needed, provide mouth and skin care, maintain thermoregulation, decrease stimuli - Correct respiratory acidosis with ventilator, correct metabolic acidosis, with sodium bicarbonate, maintain adequate oxygenation - Provide emotional support for the parents |
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With circumcision, we are concerned about what?
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With circumcision, we are concerned about what?
- Worried about bleeding - Monitor for bleeding every 15 min x 1 hour, then every hour x 24 hour |
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When there is an injury to the head, what is of most concern?
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When there is an injury to the head, what is of most concern?
- Swelling |
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Is lanugo more likely with post term or preterm newborn?
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Is lanugo more likely with post term or preterm newborn?
- Preterm - S/S of Preterm – thin, smooth, shiny or translucent skin, visible veins, lanugo, minimal creases in soles/palms |
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Is vernix caseosa more likely with post term or preterm newborn?
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Is vernix caseosa more likely with post term or preterm newborn?
- Preterm - Vernix caseosa – more obvious in creases and folds |
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What are the Post term infant characteristics?
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What are the Post term infant characteristics?
- Rugae on scrotum |
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What are the Preterm infant characteristics?
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What are the Preterm infant characteristics?
- Lanugo (hair that covers the baby)- over shoulder, pinnas, and forehead - Vernix caseosa(substance that coats baby’s skin)- more obvious in creases and folds - Undescended testicles, few scrotal rugae |
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What does sparse mean?
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What does sparse mean?
- Thinly dispersed or scattered |
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What does scanty mean?
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What does scanty mean?
- Small or insufficient in quantity or amount - limited or less than sufficient in degree, quantity, or extent |
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What are we checking for in hydrocephalus?
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What are we checking for in hydrocephalus?
- Measure the Head circumference |
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Are these normal or abnormal finding in a newborn?
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Are these normal or abnormal finding in a newborn?
- Bluish discoloration (acrocyanosis) NORMAL - Vernix on the groin NORMAL - A scrotum with numerous rugae NORMAL - Umbilical cord with one artery and one vein ABNORMAL (umbilical cord has 2 arteries and one vein) |
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What is an indication of a POSTTERM newborn?
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What is an indication of a POSTTERM newborn?
- Peeling, cracked, dry, leathery skin, long, thin body - Wasted appearance, thin with loose skin - Lots of creases on feet |
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What is an indication of a Preterm newborn?
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What is an indication of a Preterm newborn?
- Soft pliable ear cartilage - Legs in frog-like position |
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What abnormal finding would you report to the doctor?
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What abnormal finding would you report to the doctor?
- Report any discoloration like jaundice - Hyperbilirubinemia - Elevation of serum bilirubin levels resulting in jaundice - Jaundice appears in a cephalocaudal manner, first being noticed in the head and progresses down the thorax, abdomen, and extremities |
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Are you going to report:
- Heart Rate of 92 – - Weight of 4 pounds – - Head of circumference - 20 cm or inches – - Chest circumference of 13 inches - |
Are you going to report:
- Heart Rate of 92 – Yes - Weight of 4 pounds – Yes - Head of circumference - 20 cm or inches – Yes - Chest circumference of 13 inches - NO |
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Perimeters for Newborn (Normal):
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Perimeters for Newborn (Normal):
- Weight 2,500 to 4,000 grams (5.5 to 10lbs), same time daily - Length- 45to 55cm (18 to 22 inches), top of head to heel - Head circumference- 32 to 36.8 (12.6 to 14.5 inches) at level of infants eyebrows - Chest circumference- 30 to 33 cm (12 to 13 inches) at the nipple line |
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Normal newborn, 39 weeks gestation, do you want a positive or negative Babinski reflex?
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Normal newborn, 39 weeks gestation, do you want a positive or negative Babinski reflex?
- Positive - Babinski – when the sole of the foot on the side of the newborn’s small toes is stroked upward, the toes will fan upward and out - Positive Babinski – abnormal in adults |
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What are normal skin deviations?
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What are normal skin deviations?
- Milia – Small, raised white spots on the chin, nose, and forehead that disappear spontaneously - Mongolian spots – frequently present on dark skinned infants - Epstein pearls - Telangiectatic nevi (stork bites) – flat pink or red marks on neonates upper eyelids, back of neck and middle of forehead - Nevus flammeus (port wine stain) – capillary angioma - Erythema toxicum (neonatorum) – Pink rash during first 3 weeks of life - Cephalohematoma - (ABNORMAL) |
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What is the reflex of the baby when they want to eat?
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What is the reflex of the baby when they want to eat?
- Rooting- when the cheek of a newborn is stroked, newborn will turn head in direction of stroke |
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Is calf pain normal?
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Is calf pain normal?
- No - DVT- unilateral calf tenderness, welling, extremity coolness and pallor - S/S of Thrombophlebitis: Tenderness, pain, heat, increased extremity diameter, low grade fever and chills - Superficial – localized redness and an enlarged, superficial hardened vein |
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At what phase does the mother accept neonate as a separate individual?
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At what phase does the mother accept neonate as a separate individual?
- Letting-go phase: - Client assumes her position at home and her new maternal role, views infant as individual - Focuses on the forward movement of the family as a unit - May reassert relationship with her partner and resume sexual intimacy - Increased demands of home and newborn care may lead to mild depression |
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What is the taking-in phase?
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What is the taking-in phase?
- Begins immediately after birth, lasts a few hours to a couple of days - Passive-dependent behavior, relies on others to meet needs for comfort, rest, closeness, and nourishment, looks at infant - Focuses on her own needs and is concerned about the overall health of her newborn, excited, talkative, repeatedly reviewing and talking about labor and birth experience |
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What is the taking-hold phase?
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What is the taking-hold phase?
- Begins in the 2nd or 3rd postpartum day and lasts 10 days-several weeks - Woman’s focus is on asserting her independence in competently caring for her newborn, kisses, embraces, cares for infant - May verbalize anxiety about exhaustion, feelings of incompetence in new role - Needs nurturing and acceptance, may experience postpartum blues |
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What are s/s of cystitis (UTI)?
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What are s/s of cystitis (UTI)?
- Inflammation of bladder and urethra - Monitor for S/S of UTIs: urgency, frequency, dysuria, retention, hematuria, pyuria, suprapubic pain, costovertebral angle pain, fever, chills, malaise, cloudy, blood tinged, malodorous urine - Fundal height above umbilicus or baseline level, fundus displaced from the midline over to the side, bladder bulges above the symphysis pubis, excessive lochia, tenderness over the bladder |
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What do you suspect when patient has an infection, for example fundal or uterine infection?
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What do you suspect when patient has an infection, for example fundal or uterine infection?
- Pain from the abdomen |
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Patient has mastitis. What is the IMMEDIATE treatment?
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Patient has mastitis. What is the IMMEDIATE treatment?
- Encourage use of ice packs or WARM packs, especially on affected side |
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Patient breasts are engorged. What would be the best intervention for the patient?
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Patient breasts are engorged. What would be the best intervention for the patient?
- Encourage early demand breastfeeding for lactating mother to reduce engorgement - Feed the baby!!!!!!! |
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Are you going to report a mother’s temp of 99.2?
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Are you going to report a mother’s temp of 99.2?
- no – it’s dehydration – hydrate (give fluids) |
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What would be important problems to report?
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What would be important problems to report?
- Redness and bleeding on breast 9 days out - Systolic B/P of <90 |
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What are the positive signs of bonding?
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What are the positive signs of bonding?
- Eye to eye contact, cuddling - Facilitate bonding process by placing infant skin to skin with the mother - Encourage parent to cuddle, feed, diaper, and inspect the infant - Provide quiet, private environment to enhance bonding process - Praise support and reassure the mother - Encourage the mother/parents to discuss feelings, fears, and anxieties - Bonding and attachment describe the emotional process where parents come to love and accept their child and the child comes to love and accept the parents |
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What causes afterpains?
- Pain after breastfeeding |
What causes afterpains?
- Pain after breastfeeding |
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Why do we encourage patient to do Kegal exercises?
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Why do we encourage patient to do Kegal exercises?
- To strengthen perineal muscles |
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Elevation of temperature (low grade) due to dehydration after labor during the first 24 hours
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Elevation of temperature (low grade) due to dehydration after labor during the first 24 hours
- Encourage fluid intake |
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Do wash the nipple with soap and water?
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Do wash the nipple with soap and water?
- No |
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What should you teach a patient who is breasting feeding?
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What should you teach a patient who is breasting feeding?
- Encourage supportive, well fitting bra |
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Assist client into comfortable position for breastfeeding
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Assist client into comfortable position for breastfeeding
- Stroke infant’s lips with nipple, infant takes in part of areola and nipple, not just nipple tip |
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Does Oxytocin cause the Let-Down reflex?
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Does Oxytocin cause the Let-Down reflex?
- Yes |
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What process causes engorgement?
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What process causes engorgement?
- Breast engorgement occurs due to lymphatic circulation, milk production, and temporary vein congestion due to VASODILATION |
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What helps relieve pain with episiotomies?
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What helps relieve pain with episiotomies?
- Apply ice packs |
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On the 10th day is there a palpable fundus?
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On the 10th day is there a palpable fundus?
- No - By ten days postpartum, the uterus lies within the true pelvis and should not be abdominally |
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How fast does the uterus move?
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How fast does the uterus move?
- Fundal height steadily descends into the pelvis approximately 1 fingerbreadth (1cm) per day - Starts at the Umbilical - Lasts 6 weeks |
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What would you expect to see within an hour of full term baby?
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What would you expect to see within an hour of full term baby?
- Expect to see a firm uterus at the level of the umbilicus |
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Second postpartum, what will the discharge look like?
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Second postpartum, what will the discharge look like?
- Rubra (bright red discharge) - Last 1-3 days after delivery |
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What is the sequence for LOCHIA?
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What is the sequence for LOCHIA?
- RUBRA – Bright red color, bloody consistency, fleshy odor, may contain small clots, transient increase during breast feeding and upon rising, lasts 1-3 days after delivery - SEROSA – Pinkish brown color, serosanguineous consistency, contains old blood, serum leukocytes, and tissue debris, lasts from appoximately day 4 to day 10 after delivery - ALBA – Yellowish, white creamy color, fleshy odor, contains leukocytes, decidua, epithelia cells, mucus, serum, and bacteria, lasts approximately day 11 up to and beyond the 6 weeks postpartum |
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4TH stage of labor, what is the pt at risk for?
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4TH stage of labor, what is the pt at risk for?
- Hemorrhage - bleeding |
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If the fundus is displaced, what do you ask the patient to do?
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If the fundus is displaced, what do you ask the patient to do?
- Void, empty bladder |
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To prevent hemorrhage of the uterus what do you do?
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To prevent hemorrhage of the uterus what do you do?
- Massage the uterus |
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When do you massage the fundus?
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When do you massage the fundus?
- When it is boggy |
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How long does postpartum last?
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How long does postpartum last?
- 6 weeks |
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What do you see with Holman's sign?
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Dorsiflexion
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S/E of breastfeeding?
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S/E of breastfeeding?
- After Pains (Uterine Contractions) |
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S/S of dehydration?
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S/S of dehydration?
- Tachycardic, Low grade fever - give fluids |
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Don't teach patient to have baby just grab end of nipple
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Don't teach patient to have baby just grab end of nipple
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Let down reflex?
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Let down reflex?
- Responsible for milk in 2-3 days |
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Why is pericare important after delivery?
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Why is pericare important after delivery?
- To prevent infection |
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What do you do if uterus is off to one side?
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What do you do if uterus is off to one side?
- Bladder is full - Catheterize |
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Puerperium lasts for how long?
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Puerperium lasts for how long?
- 6 weeks |
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Risk bladders full and bleeding
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Risk bladders full and bleeding
- Hemorrhage |
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When is milk produced?
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When is milk produced?
- 2-3 days after delivery of the infant - Let-down affect |
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With Uterine atony?
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With Uterine atony?
- Make sure bladder is empty |
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Risk factors for DIC?
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Risk factors for DIC?
- Abruptio placenta, amniotic fluid embolism, missed abortion, fetal death in utero, severe preeclampsia or eclampsia, septicemia, cardiopulmonary arrest, hemorrhage, hydatidiform mole |
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S/S of pulmonary Embolus:
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S/S of pulmonary Embolus:
- Dyspnea, tachypnea, cough, hemoptysis, pleuritic pain, murmurs, right sided heart failure, peripheral edema, distended neck veins, fever, chills, hypotension, apprehension |
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Mouth (first) and nose must be cleared of excess secretions upon delivery of the head
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Mouth (first) and nose must be cleared of excess secretions upon delivery of the head
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What is newborn circulation?
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What is newborn circulation?
- Readjustment of atrial pressure in the heart |
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How does baby lose heat?
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How does baby lose heat?
- Baby loses heat through conduction, convection, evaporation, and radiation |
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Neonatal morbidity and mortality are related to gestational age and birth weight
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Neonatal morbidity and mortality are related to gestational age and birth weight
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Is cephalohematoma abnormal?
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Is cephalohematoma abnormal?
- YES - Blood between periosteum and skull |
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Why do we give erythromycin eye drops?
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Why do we give erythromycin eye drops?
- To prevent blindness in baby's with gonorrhea |
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Cleft mouth, check for cleft palate
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Cleft mouth, check for cleft palate
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What is a protruding tongue a sign of?
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What is a protruding tongue a sign of?
- Down syndrome |
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When is a circumcision contraindicated?
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When is a circumcision contraindicated?
- When hypospadias or epispadias is present |
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S/S of cold stress
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S/S of cold stress
- Cyanotic trunk, depressed respirations can lead to hypoxia, acidosis, and hypoglycemia, avoid infant heat loss |
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S/S of hypoglycemia?
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S/S of hypoglycemia?
- Jitteriness, irregular respirations, cyanosis, weak high pitched cry, lethargy, twitching, eye rolling, seizures, BS <40, give oral glucose or formula immediately, have mother breastfeed |
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What is a failure to gain weight called?
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What is a failure to gain weight called?
- Failure to Thrive |
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Birth weight is not an indicator of fetal lung maturity
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Birth weight is not an indicator of fetal lung maturity
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Baby with Respiratory distress syndrome?
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Baby with Respiratory distress syndrome?
- Provide emotional support for the parents |
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Untreated Hypoglycemia causes?
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Untreated Hypoglycemia causes?
- Mental retardation |
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Kernicterus (bilirubin encephalopathy) can result when bilirubin levels are at or > 25 mg/dL can cause cerebral palsy, epilepsy, or mental retardation
- May require and exchange transfusion |
Kernicterus (bilirubin encephalopathy) can result when bilirubin levels are at or > 25 mg/dL can cause cerebral palsy, epilepsy, or mental retardation
- May require and exchange transfusion |
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During phototherapy, maintain eye mask over newborn's eyes to prevent inflammation and injury
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During phototherapy, maintain eye mask over newborn's eyes to prevent inflammation and injury
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S/S of Hydrocephalus?
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S/S of Hydrocephalus?
- Excessive spinal fluid accumulation in the ventricles of the brain causing the head to enlarge and the fontanels to bulge: sunsetting sign is common in which the whites of the eyes are visible above the iris |