Post Partum

Front 1

What is the most important safety measure for baby who is having phototherapy?

Back 1

- Maintain eye masks over newborn’s eyes (answer)
- Keep newborn undressed, place surgical mask over male genitalia
- Given to babies with Hyperbilirubinemia

Front 2

What is first thing you would notice on a baby with hydrocephalus?

Back 2

- 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

Front 3

What is the Moro reflex?

Back 3

- 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”

Front 4

Newborns with Galactosemia, what are they unable to metabolize?

Back 4

- 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

Front 5

When doing the Phenylketonuria (PKU) newborn screening, what are we trying to prevent?

Back 5

- 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

Front 6

You are checking the mouth of a newborn, what are you assessing for?

Back 6

- 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

Front 7

When putting your finger in the baby’s mouth, what reflex are you checking for?

Back 7

- Sucking reflex- begins when a nipple or finger is placed in the mouth of a newborn

Front 8

What is the rooting reflex?

Back 8

- Rooting – when the cheek of a newborn is stroked, newborn will turn head in direction of stroke; they are hungry

Front 9

Preterm infants, what is the number one priority?

Back 9

- 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

Front 10

With circumcision, we are concerned about what?

Back 10

- Worried about bleeding

- Monitor for bleeding every 15 min x 1 hour, then every hour x 24 hour

Front 11

When there is an injury to the head, what is of most concern?

Back 11

- Swelling

Front 12

Is lanugo more likely with post term or preterm newborn?

Back 12

- Preterm
- S/S of Preterm – thin, smooth, shiny or translucent skin, visible veins, lanugo, minimal creases in soles/palms

Front 13

Is vernix caseosa more likely with post term or preterm newborn?

Back 13

- Preterm
- Vernix caseosa – more obvious in creases and folds

Front 14

What are the Post term infant characteristics?

Back 14

- Rugae on scrotum

Front 15

What are the Preterm infant characteristics?

Back 15

- 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

Front 16

What does sparse mean?

Back 16

- Thinly dispersed or scattered

Front 17

What does scanty mean?

Back 17

- Small or insufficient in quantity or amount
- limited or less than sufficient in degree, quantity, or extent

Front 18

What are we checking for in hydrocephalus?

Back 18

- Measure the Head circumference

Front 19

Are these normal or abnormal finding in a newborn?

Back 19

- 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)

Front 20

What is an indication of a POSTTERM newborn?

Back 20

- Peeling, cracked, dry, leathery skin, long, thin body
- Wasted appearance, thin with loose skin
- Lots of creases on feet

Front 21

What is an indication of a Preterm newborn?

Back 21

- Soft pliable ear cartilage
- Legs in frog-like position

Front 22

What abnormal finding would you report to the doctor?

Back 22

- 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

Front 23

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 -

Back 23

- Heart Rate of 92 – Yes
- Weight of 4 pounds – Yes
- Head of circumference - 20 cm or inches – Yes
- Chest circumference of 13 inches - NO

Front 24

Perimeters for Newborn (Normal):

Back 24

- 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

Front 25

Normal newborn, 39 weeks gestation, do you want a positive or negative Babinski reflex?

Back 25

- 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

Front 26

What are normal skin deviations?

Back 26

- 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)

Front 27

What is the reflex of the baby when they want to eat?

Back 27

- Rooting- when the cheek of a newborn is stroked, newborn will turn head in direction of stroke

Front 28

Is calf pain normal?

Back 28

- 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

Front 29

At what phase does the mother accept neonate as a separate individual?

Back 29

- 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

Front 30

What is the taking-in phase?

Back 30

- 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

Front 31

What is the taking-hold phase?

Back 31

- 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

Front 32

What are s/s of cystitis (UTI)?

Back 32

- 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

Front 33

What do you suspect when patient has an infection, for example fundal or uterine infection?

Back 33

- Pain from the abdomen

Front 34

Patient has mastitis. What is the IMMEDIATE treatment?

Back 34

- Encourage use of ice packs or WARM packs, especially on affected side

Front 35

Patient breasts are engorged. What would be the best intervention for the patient?

Back 35

- Encourage early demand breastfeeding for lactating mother to reduce engorgement
- Feed the baby!!!!!!!

Front 36

Are you going to report a mother’s temp of 99.2?

Back 36

- no – it’s dehydration – hydrate (give fluids)

Front 37

What would be important problems to report?

Back 37

- Redness and bleeding on breast 9 days out
- Systolic B/P of <90

Front 38

What are the positive signs of bonding?

Back 38

- 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

Front 39

What causes afterpains?
- Pain after breastfeeding

Back 39

- Pain after breastfeeding

Front 40

Why do we encourage patient to do Kegal exercises?

Back 40

- To strengthen perineal muscles

Front 41

Elevation of temperature (low grade) due to dehydration after labor during the first 24 hours

Back 41

Elevation of temperature (low grade) due to dehydration after labor during the first 24 hours
- Encourage fluid intake

Front 42

Do wash the nipple with soap and water?

Back 42

- No

Front 43

What should you teach a patient who is breasting feeding?

Back 43

- Encourage supportive, well fitting bra

Front 44

Assist client into comfortable position for breastfeeding

Back 44

- Stroke infant’s lips with nipple, infant takes in part of areola and nipple, not just nipple tip

Front 45

Does Oxytocin cause the Let-Down reflex?

Back 45

- Yes

Front 46

What process causes engorgement?

Back 46

- Breast engorgement occurs due to lymphatic circulation, milk production, and temporary vein congestion due to VASODILATION

Front 47

What helps relieve pain with episiotomies?

Back 47

- Apply ice packs

Front 48

On the 10th day is there a palpable fundus?

Back 48

- No
- By ten days postpartum, the uterus lies within the true pelvis and should not be abdominally

Front 49

How fast does the uterus move?

Back 49

- Fundal height steadily descends into the pelvis approximately 1 fingerbreadth (1cm) per day
- Starts at the Umbilical
- Lasts 6 weeks

Front 50

What would you expect to see within an hour of full term baby?

Back 50

- Expect to see a firm uterus at the level of the umbilicus

Front 51

Second postpartum, what will the discharge look like?

Back 51

- Rubra (bright red discharge)
- Last 1-3 days after delivery

Front 52

What is the sequence for LOCHIA?

Back 52

- 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

Front 53

4TH stage of labor, what is the pt at risk for?

Back 53

- Hemorrhage - bleeding

Front 54

If the fundus is displaced, what do you ask the patient to do?

Back 54

- Void, empty bladder

Front 55

To prevent hemorrhage of the uterus what do you do?

Back 55

- Massage the uterus

Front 56

When do you massage the fundus?

Back 56

- When it is boggy

Front 57

What do you see with Holman's sign?

Back 57

Dorsiflexion

Front 58

S/E of breastfeeding?

Back 58

- After Pains (Uterine Contractions)

Front 59

S/S of dehydration?

Back 59

- Tachycardic, Low grade fever

Front 60

Don't teach patient to have baby just grab end of nipple

Back 60

Don't teach patient to have baby just grab end of nipple

Front 61

Let down reflex?

Back 61

- Responsible for milk in 2-3 days

Front 62

Why is pericare important after delivery?

Back 62

- To prevent infection

Front 63

What do you do if uterus is off to one side?

Back 63

- Bladder is full
- Catheterize

Front 64

Puerperium lasts for how long?

Back 64

6 weeks

Front 65

Risk bladders full and bleeding

Back 65

Hemorrhage

Front 66

When is milk produced?

Back 66

- 2-3 days after delivery of the infant
- Let-down affect

Front 67

With Uterine atony?

Back 67

- Make sure bladder is empty

Front 68

Risk factors for DIC?

Back 68

- Abruptio placenta, amniotic fluid embolism, missed abortion, fetal death in utero, severe preeclampsia or eclampsia, septicemia, cardiopulmonary arrest, hemorrhage, hydatidiform mole

Front 69

S/S of pulmonary Embolus:

Back 69

- Dyspnea, tachypnea, cough, hemoptysis, pleuritic pain, murmurs, right sided heart failure, peripheral edema, distended neck veins, fever, chills, hypotension, apprehension

Front 70

Mouth (first) and nose must be cleared of excess secretions upon delivery of the head

Back 70

Mouth (first) and nose must be cleared of excess secretions upon delivery of the head

Front 71

What is newborn circulation?

Back 71

- Readjustment of atrial pressure in the heart

Front 72

How does baby lose heat?

Back 72

- Baby loses heat through conduction, convection, evaporation, and radiation

Front 73

Neonatal morbidity and mortality are related to gestational age and birth weight

Back 73

Neonatal morbidity and mortality are related to gestational age and birth weight

Front 74

Is cephalohematoma abnormal?

Back 74

- YES
- Blood between periosteum and skull

Front 75

Why do we give erythromycin eye drops?

Back 75

- To prevent blindness in baby's with gonorrhea

Front 76

Cleft mouth, check for cleft palate

Back 76

Cleft mouth, check for cleft palate

Front 77

What is a protruding tongue a sign of?

Back 77

- Down syndrome

Front 78

When is a circumcision contraindicated?

Back 78

- When hypospadias or epispadias is present

Front 79

S/S of cold stress

Back 79

- Cyanotic trunk, depressed respirations can lead to hypoxia, acidosis, and hypoglycemia, avoid infant heat loss

Front 80

S/S of hypoglycemia?

Back 80

- Jitteriness, irregular respirations, cyanosis, weak high pitched cry, lethargy, twitching, eye rolling, seizures, BS <40, give oral glucose or formula immediately, have mother breastfeed

Front 81

What is a failure to gain weight called?

Back 81

- Failure to Thrive

Front 82

Birth weight is not an indicator of fetal lung maturity

Back 82

Birth weight is not an indicator of fetal lung maturity

Front 83

Baby with Respiratory distress syndrome?

Back 83

- Provide emotional support for the parents

Front 84

Untreated Hypoglycemia causes?

Back 84

- Mental retardation

Front 85

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

Back 85

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

Front 86

During phototherapy, maintain eye mask over newborn's eyes to prevent inflammation and injury

Back 86

During phototherapy, maintain eye mask over newborn's eyes to prevent inflammation and injury

Front 87

S/S of Hydrocephalus?

Back 87

- 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