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140 Cards in this Set

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Name three drugs that are given Post Partum for Hemorrhage.
Potocin (Oxytocin)
Methergine (Methylergovine)
Hemabate (Prostaglandin F)
Of the three drugs given to help PP Hemorrhage, all all promote uterine contraction, but which one decreases bleeding?
Potocin
Whate are the contraindication for Methergin?
HTN
Cardiac Disease
What are the contraindications of Hemabate?
Asthma
Hypersensativity
Decode BUBBLEHEB.
Breast
Uterus
Bladder
Bowel
Lochia
Episiotomy
Homans Sign
Emotional Status
Bonding
When checking the Breasts, what should be assessed?
Note engorgement, erythema, nipple tenderness, and presence of nodules. Explained self breast exam, answer questions re: breastfeeding/ breast care.
When checking the Uterus, what should be assessed?
Should be palpated to be firm, centered at the umbilicus or below. Note deviations to side as well as excess bleeding upon palpation.
When checking the Bowel, what should be assessed?
Instruct the patient of measures to prevent constipation.

Bowels might spontanously evacuate during early post partum due to stress of birth.

Assure adequate roughage, and water to prevent constipation from opiads.
When checking the Bladder, what should be assessed?
Should be palpated to be firm, centered at the umbilicus or below. Note deviations to side as well as excess bleeding upon palpation.

Mom should void spontaneously within 6-8 hours after birth.
When checking the Lochia, what should be assessed?
Note amount, type (rubra , serosa , alba ), odor and presence of clots. Report malodor, excess bleeding and clots to the physician.
When checking the Episiotomy, what should be assessed?
Note inflammation, edema, hematomas, improper wound healing and complaints of discomfort. Note presence of hemorrhoids.
When checking the Homans Sign, what should be assessed?
A positive Homan's sign indicates thrombophlebitis. Notify the physician.
When checking the Emotional Status, what should be assessed?
Observe for S/S of despondency, mood changes, especially with baby. Inform patient about Post Partum Depression when reviewing discharge information.
When checking the Bonding, what should be assessed?
Check the emotional status of the mother and how she is interacting the the newborn.
Name two incision types for C-Section.
Classic - Vertical - Faster for Emergency

Low Segment. Better VBAC. Decreased blood loss, ease of suturing. Decreased risk for PP GI Complications
What are some indications for C-Section?
Fetal Malpresentations
Fetal Intolerance to Labor
Preeclampsia/Eclampsia
Previous C-Section
Inadequate progress in Labor
Contrast the amount of blood loss between a C-Section and Vaginal Birth.
Vaginal Birth is 500ml
C-Section is 1000ml
List some aspects of Post Operative Care after a C-Section.
-Follow the ABC's.
-Client Should have PCA
-VS q.15m
-Foley Cathetar in place
Describe appropriate formulas and bottle feeding strategies
BF for 12 months recommended. If stopped before 12 months, use Fe Supplemented Formula.
Nursing management for maternal and infant feeding problems (breastfeeding)
First 2 hours after birth are excellent time to encourage first feeding. Aids in contraction of Uterus and prevention of hemorrhage. The infant should be in an alert stage and ready to feed.
Describe signs of feeding readiness; what are the advantages of breastfeeding
Signs of feeding readiness
Reflexes – rooting, sucking, swallowing

Promotes bonding, helps with antibodies.
What are the important aspects of discharge teaching?
Sexual activity
Resume when bleeding stops

Prescribed medications
Prenatal vitamins, iron, stool softners, pain medication prn

Routine mother and baby follow doctor visits

Contraception
What is circumcision procedure?
Surgical removal of the end of the foreskin of the penis.
What is nursing care and home care for circumcision?
Q1h for 12h then check for bleeding. Apply pressure if not stopped, 1 nurse apply pressure, other nurse call physician and prep new circ tray. Parents must know circ care if taking baby home early.
What is the difference between Gomco and plastibell circumcision?
Plastibell uses a plastic ring that is inserted into the prepuce and a suture tied around. In 3-7 days it falls off. The Gomco has no bell and is less effective in keeping bleeding down and not sticking to diaper.
Describe holding techniques, cord care, care of the diaper area and bathing.
Holding Position on R Right side to promote gastric emptying into intesting. Support neck at all times. Never prone, but always supine to decrease SIDS.<br /><br />Cord Care<br />Watch cord, and clean with alcohol or triple blue dye or erthromycin. Unclamp after dry which is about 24 hours, and will look for S/S of Infection and Granuloma, and will drop in 10-14 days.<br /><br />Diaper Area<br />Warm moist area promotes growth. Anti Canditial ointment or oral may be used.<br /><br />Bathing<br />Water no soap. No poweer, promotes growth. Immersion better after cord drop, and less crying, and less heat loss.
What is the safe way to perform a heelstick?
Outer third of inside our outside to avoid necrotizing ostem. Pinky side preferred.
What is the normal range for glucose, Hct and bilirubin?
Glucose 40-60mg/dL
Hct 44-64%
Bilirubin Direct 0-1mg/dL
Hgb 14-24g/dL
Page 569
Why is PKU checked?
PKU (phenylketonuria) is an inherited disorder of body chemistry that, if untreated, causes mental retardation. Fortunately, through routine newborn screening, almost all affected newborns are now diagnosed and treated early, allowing them to grow up with normal intelligence.

What is PKU?
Due to a missing or deficient enzyme, children with PKU cannot process a part of the protein called phenylalanine, which is present in nearly all foods. Without treatment, phenylalanine builds up in the blood
Why are the following medications given to the infant?<br />-Erythromycin eye ointment<br />-Vit K<br />-Hepatitis B
Eye ointment given R/T STD passed at birth.

Vitimin K is because we dont' make our own until we have microorganism in the gut.

HBV given at birth to give antibodies to all known subtypes.
What are the infantile reflexes and how are they performed.
Babinski<br /><br />Moro is Startle<br /><br />Plantar and Palmar <br /><br />Grips.
Sucking and Rooting.
What is Meconium?
Tarry Baby Poop that is first passed at 1 day. Skin, Nails, RBC.
What are the biological and behavioral tasks that need to be established by the newborn?
-Establish and Main Respirations
-Adjust to Circulatory Changes
-Regulate Temperature
-Ingesting, Retaining, Digesting Nutrients
-Eliminating Waste
-Regulating Weight
What are the components of the APGAR; when is it assessed?
Heart Rate
Respirations
Muscle Tone
Reflex Irrability
Color

7-10 Good
4-6 Guarded
<4 Resusitate

1 & 5 Minutes
How is gestational age estimated?
Using Ballard Scale. Physical Signs like cross arm test, lines in palms and soles. Posture, Popliteal Angle.
What are the periods of awake states.
First 30 Minutes Very Alert.
Then 60-100 Minutes Sleep.
Then Up 2-5 Hours, passes mecomium
Then 2-3 days of lots of sleep.
Physical assessment- what is average weight, length and head circumference?
45-55 (50) CM Lenght
Weight Boys 3500
Weidht Girls 3400
Head 32-36.8 (33-35_
Chest 2-3cm less
What do the terms- AGA, LGA and SGA mean?
Appropriate for gestational age.
Large for gestational age.
Small for gestational age.
What is normal/abn in the female and male anogenital area?
Males, Testi descent, scrotal size and ruggae. Check circumcision for bleeding and Infection.

Female
Blood tinged discharge. Labia may be engorged from hormones.
What is normal pattern of voiding/ normal color?
Normal Within 24 hours, and then 6-10 times daily.

Uric Acid crystals cause Rust Stained Urine which will wash out under running water. Blood will not.
What are the sources of heat loss in the newborn?
Convection body to cooler air.
Conduction body to cooler surface directly.
Radiation body to cooler surface indirectly.
Evaporation by insensible water loss (IWL).
What is brown fat and it’s relationship to thermogenesis?
Page 527
Newborns dont shiver. They have brown fat which they burn as present for several weeks. Quickly depleated with cold stress. The more developed the infant, the more brown fat there is to work with from the start.
What are the normal VS for newborn?
T 36.5-37.2
P 120-160
R 30-60
Periods of appnea less than 15 seconds are normal.
What are normal/abnormal variations of skin?
Vernix - Cheese
Laguno - Hair
Milia - Baby Acne
Stork Bite - Neck, fades 1-2 Y
Mong Spot - POC, especially on buttocks.
What is normal/abnormal variations for back and extremity assessment?
Back, spine straight and easilly flexed, infant able to raise and suport head momentairly.

Shoulders, scapulae and iliac crest line up in same plane.
What is physiologic jaundice, and what is the treatment?
Physiologic occurs in 50% of Full Term and 80% of pre-term.<br /><br />Increased in Asian, Native American and Eskimo.<br /><br />Peaks on day 3<br /><br />First noticed in head, sclera and mucous membranes.<br /><br />Feed early as passage of mecomium and stool gets rid of bilirubin.<br /><br />Kermicterus biliruben in brain
What are the meanings of the following terms- SGA, LGA
Small for Gestational Age
Large for Gestational Age
What is normal glucose and urine output?
Normal Glucose is 40-60mg/dl

Urine 6-10 times each day 40-100ml.
What is respiratory distress syndrome; assessment, management, prevention?
Low levels of surfactant cause alveoli stick on exhale, too weak to force open.
30% of LBW 50% VLBW

Surfactant rescue, O2 administration, ventilition.

Prevent, monitor Lecithen/Spingomyelin 2:1 good, less give Betamethasone
What is hemolytic disease of the newborn?
Rh Factor Mismatch and ABO Mismatch. Hyperbilirubinemia causes jaundice and needs bili lights early and may need transfusion.
What is - Rh incompatibility and ABO incompatibility?
Rh is when Mon Rn- and Fetus Rh+ then mom makes antibodies.

ABO is when Mom is O and baby is A B or AB.
Fetal alcohol syndrome- who are high risk mothers; what are characteristics and long term problems?
FAS prevelent in Native American and African American mothers.

Features tremulous, figety, thin upper lip, pointy upturned nose, flat bridge and wide set eyes.

Longterm is hyperactivity.
Maternal substance abuse- cocaine, methamphet, heroin, methadone- What are the infant effects; nursing management
Baby tremors, tachycardia, irritable, sneezing, shrill cry, poor feed.

Swaddle, protect from environment.

Involve social services, open communication with mom, each bonding.
What is difference between physiological and pathological jaundice and what is its management?
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What are the categories for preterm infants and physical characteristics (Ballard scale)?
Sole creases
Resting posture
recoil of extremities
scarf (Across Midline)
Plantar creases
Breast Tissue
Ears flat and shapeless
Define need for stimulation and bonding?
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What is bronchopulmonay displasia?
Tachypnea, retractions, nasal flaring.

Tx steroids, bronchdialators, and diuretics.

Prog death may occur in 1 year.
What is the patho of bronchopulmonay displasia?
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What is the treatment of bronchopulmonay displasia?
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What is meconium aspiration syndrome- prevention, management, complications
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Infant of diabetic mother- effects on infants and how to prevent.
Infant is Hypoglycemia after cord clamp.

Keep moms sugar 100-120, breastfeed right away.
Large for gestational age- assessment, cause and risk for what problems.
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Small for gestational age- assessment, cause and risk for what problems
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What is meconium aspiration syndrome- prevention, management, complications?
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What is respiratory distress syndrome; assessment, management, prevention
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Nutritional feeding principles for preterm infant- oral, tube feedings
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What are the system disadvantages/risks and management- respiratory function?
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What are the system disadvantages/risks and management cardiac function?
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What are the system disadvantages/risks and management- hematologic function?
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What is intraventricular hemorrhage how to prevent/manage.
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What is necrotizing enterocolitis how to prevent/manage.
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What is retinopathy of immaturity; how to prevent/manage.
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What is psychological depression.
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What is the difference between pp blues and postpartum depression.
PP Blues are common and occur in about 75-80% of women. PP Depression occurs in 10-15% of women who describe having good days, and bad days. The symptoms can make the woman feel as if she is "Going Mad" with feelings of failure, overwhelming guilt, loneliness, low self esteem. Nurses should know and teach the differences, and advise women with PPD to seek help promptly.
What care for Rh negative mom; rubella negative
Women who have not had rubella, or who are not immune should receive SQ Rubella vaccine immediately post partum to prevent possibility of contracting rubella in future pregnancies. It is not passed in the milk, but is in the urine, so immuno suppressed family members need to take care.

Rh immune globulin is given within 72hours after birth which prevents sensitization in Rh-Negative mothers. The Rh-Positive fetal blood cells are lysed before mom can create antibodies against them.
Substance abuse- what ethical/legal implications
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When is the postpartum period; 4th trimester.
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What happens to uterus, placenta site and endocrine system during postpartum?
The uterus begins involution.

The placental site is reduced to a nodular elevated area and sloughs off as necrotic tissue which prevents a scar so that normal menses can return, as well as future implantatoin. Normal endometrial regeneration is complete at 3 weeks except at placental site which takes 6 weeks.

Estrogen and porgesterone levels drop dramatically after the expulsion of the placenta.
When is C Section indicated?
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what are the systemic responses to C section?
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What are postpartum Blues?
The "Blues" follow the "Pink" period in about 75-80% of PP women of all ethnic and racial groups.
Women become emotionally labile, crying often and easilly for no apparant reason. Seem to peak about day 5, subsiding by day 10. Etiology no clear.
"Am I Blue" is a tool to differentiate between Baby Blues and Post Partum Depression.
What discharge teaching for mom postpartum?
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What are the predisposing factors for Thrombophlebitis?
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How is Thrombophlebitis identified?
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What is the cause and management of Early Hemorrhage?
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What is the cause and management of Late Hemorrhage?
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Whare is Oxytocin used for?
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Whare is Methargine used for?
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Whare is Hemabate- used for?
Uterine bleeding when mom has HTN or Cardiac Disease.
Describe Physical abuse.
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Infection-what are the predisposing factors and symptoms?
Puerperal infection
UTI
Mastitis
what is endometritis?
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what is mastitis?
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How does the nurse promote attachment behaviors?
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What maladaptive signs of trouble of atachment?
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Describe the Rubin Phases?
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Describe paternal and sibling adjustment strategies.
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What is normal involution of abdomen?
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What happens to the urinary system post-partuum?
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What happens to the GI system post-partuum?
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Differentiate between the four amounts of blood loss.
Scant < 2.5cm
light <10.0cm
Moderate >10.0cm
Heavy Pad Soaked within 2 hours
What are the three phases that are evident as the mother adjusts to her parental role?
Dependent/Taking In
Dependant-Independant/Taking Hold
Interdependant/Letting Go
Describe the Dependant Adjustment Phase
Taking In-First 24 Hours (1-2 Days)
-Mom focuses on self and relives the birth experience
-Excited and talkative
-Reliant on others for comfort, nurishment and rest
Describe the Dependant*independant Adjustment Phase
Taking Hold-2nd or 3rd Day and last 10 days to several weeks
-Focus on care of baby and mothering skills
-Desire to take charge
-Optimal period for nurse teaching as mom is eager to learn and practice
Describe the independant Adjustment Phase
Letting Go-After 10 days
-Forward movement of family
-Resumption of partners relationship
-Resumption of Sexual Intimacy
How many women experience the post partum blues?
About 75-80%
What is the most common cause of Post Partum Hemorrhage?
It occurs in 1/20
Uterine Atony followed by retained placenta, placneta accreta, cervical or vaginal lacerations.
What is the timeframe for Uterine Involution?
Returns to true pelvis within one week

At full term uterus weighs 500 gms; 6 weeks after birth weighs 50-60 gms
How quickly post partum does ovulation begin?
Ovarian functioning – can occur as early as 27 days after birth

70% of non-breastfeeding women – resume menstruating by 3 mos.
After birth Mean ovulation time for breastfeeding women = 190 days
How long does it take the abodmen to retuen to pre-pregnancy state after birth.
Six Weeks
Why is there an increased chance of UTI Post Partum?
Dilation of ureters and renal pelvis during delivery.
How long does it take the abdomen to return to a pre-pregnancy state?
Six Weeks.
What is Diastasis recti abdominis?
A separation of abdominal wall due to overdistention by large fetus or multiple births
How long does it take Rental Function to return after birth?
About 1 month.
Why is there an inceased risk for UTI Post Partum?
Dilation of ureters and renal pelves duing birth.
What happens to blood volume during preganancy?
Blood volume increased during pregnancy is 1000-1500 ml, eliminated during first 2 weeks after birth
What happens to H&H Post Partum?
Hematocrit and hemoglobin – greater loss in plasma volume leads to rise in H&H until 7th day postpartum
What happens to WBC Post Partum?
WBC – leukocytosis (An increase in the number of leukocytes) for 10-12 days after birth.
What happens to coagulation factors Post Partum?
Clotting factors and fibrinogen levels increased; increased risk for thromboembolism
What needs to be assessed with Chills and Involuntary Shaking?
If BP and Bleeding are WNL, assure the client it is normal and get them a warmed blanket.
When thinking about the "BUBBLE" Acronym, which to assessments are most criticle during the 4th Stage of Labor?
Uterus and Lochia due to the chance for Hemorrhage.
What happens to the breasts during the first three days after birth.
Days 1-2: soft, intact, secreting colostrum

Days 2-3: engorged, tender, full, tight and painful

Day #3 – secreting milk
What is the most important factor to consider when trying to prevent Sore Nipples?
The Correst Breastfeeding Technique. You might need to refer Mom to a Lactation Consultant.
What breastfeeding schedule should be followed to prevent engorgement?
Breastfeed at least every 2-3 hours; 15-20 minutes on each breast
Name two benefits of Colostrum.
High Protein Levels promote binding of Biliruben.

Laxative action promotes passage of mecomium.
When is colostrum replaced by milk?
Three to Five Days After Birth.
What is the progression of milk during each feeding?
Initial milk is bluish white and part skim (60% of volume) and part whole milk (35% of volume); provides lactose, protein, and water soluble vitamins

10-15” after feeding begins, cream milk (5% of volume) – contains denser calories from fat needed for optimal growth and contentment between feeds
By Two Weeks Post Partum, how much milk is Mom Making q.24h?
720-900 ml
How often is the Fundus Assessed after birth?
q15 for one hour
q8h for 48 hours
Then Daily
What are some abnormal fundal findings and the nursing inteventions?
Boggy Fundus - immediately massage gently until firm; report to physician and observe closely; empty bladder; medicate with pitocin if ordered

Fundus Misplaced one to two fingerbreadths from midline = full bladder (client must void or be catherized)
What are some nursing interventions for hemorids?
Sitz baths, suppositories,
Stool softners. Increase fluids and fiber Promote exercise
What are some causes of urinary retention?
Diminished bladder tone
Edema from trauma
Fear of discomfort
What is the assessment timeline for Lochia?
Assessment – every 15 minutes x one hour, q8h x 48h, then daily
What are the Colors and Timelines of Lochia?
Rubra – 3 days postpartum, dark red
Serosa: 4-10 days postpartum, clear pink
Alba: 10-21 days postpartum, white
Describe Mediolateral Episoiomoty.
Incision made at 45 degree angle to either side of vaginal opening
Healing process quite painful
Incision harder to repair
Greater blood loss
Describe Midline – Episiomoty
Incision from posterior margin of vaginal opening directly back to anal sphinctor
Healing less painful
Incision easy to repair
What is important about Rubella Vaccine and Teratogens?
Avoid pregnancy for 3 months.
What are some early attachment enhancers?
dim lights
timing of care
breastfeeding
What are some later bonding enhancement techniques?
Rooming in
Decrease fatigue and promote rest
Be their cheerleader Be their role model
Describe En face position.
A face to face position in which the parent’s face and the infant’s face are about 8 inches apart and on same plane