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198 Cards in this Set
- Front
- Back
- 3rd side (hint)
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what is the number 1 cause of hem after delivery?
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fundus not firm
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how far does the fundus decend daily?
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one finger per day
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what is the most important intervention for boddy fundus?
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massage
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what is lochia rubra, lochia surosa, lochia alba described as?
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bright red
not bright yellowish |
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how long do you use peri cleansing bottles for?
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until lochia alba is gone (discharge)
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explain scant, light, moderate and heavy lochia
what is the time frame? |
scant-one in
light-less than 4 in moderate-less than 6 in heavy-saturated all within an hour |
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what kind of saturation do you see in c/s and first day delivery?
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scant-c/s
moderate-vaginal |
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what do you explain to your pt relating to pad saturation?
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1st day after will be more than heaviestday of period
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how many pads are normal and how many indicates a hem?
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1 pad per hour
more than 1 per hour |
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what are the degrees of laceration described as?
1,2,3,4 |
1-just peri;superficial
2-peri muscles 3-goes to anal sphincter 4-goes to rectum |
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with a 4 degree laceration what are the precautions?
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nothing goes into the rectum after stitches-they dissolve
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what is the most painful and bleeds the most kind of episiotomy?
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medial lateral
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what is the more common episiotomy? what is the risk?
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midline-tears into the rectum
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what is the common blood loss with c/s and vag?
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500 c/s
1000 vag |
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at what amount of blood loss do you go into hypovolemic shock? what are the s/s?
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1500-2000
tachycardia,hypotension, dizziness, pale, sweating |
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what are 4 cardiovascular system changes after?
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cardiac output increased
plasma vol decreased increased coagulation abn blood values |
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you must look at H&H after birth, what are the the precautions?
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below 8 call dr
7 needs blood transfusion |
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why does plasma vovlume decrease?
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sweating
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when taking vs of an orthostatic person, what do you see?
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inc b/p and dec p
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if mother cannot urinate after delivery what are the interventions?
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ibuprofen, straight cath
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what are 2 interventions for passing gas?
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simethicone
mint tea |
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after pregnancy what are 7 indications r/t gi system?
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digestion becomes active (not always w c/s)
bowel sounds constipation diuresis inability to urinate hem from bladder displace stress incontinence |
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what are 5 interventions for constipation?
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harris flush
laxative stool softener fleet enema MOM |
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with a full bladder, what side does the fundus tend to go to?
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right side
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what is a diastasis recti and when does this happen?
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midline abd wall tears
big babies |
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ipuprofen is used for muscle pain, what dosage is usually prescribed?
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600mg Q6H do not exceed 3200mg
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what are the 7 neurological system indications?
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numbness (epidural)
dizziness (anesthesia, analgesics) fainting/falls headaches pain |
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headaches from spinal are common but not good what does a pt typically c/o?
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usually ok when laying down but awful while sitting up
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spinal ha are positional what must be done if pt has spinal ha?
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call anesthesiologist for blood patch
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what are the 6 endocrine system indications?
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expulsion of placenta
prolactin-milk production oxytocin-milk ejection menstration lactation weight loss |
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after placenta expulsion, shower or bath?
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only shower or sitz bath
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when does menstration usually start after?
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most dont have period until 7-9 months-with breast feeding maybe a year
can still get preg |
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why do women loss weight?
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breast feeding
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what are the 2 things that should wait until 6 week checkup?
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sex and workingout
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relating to ice packs, when do you use cold, and when hot
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ice for 24hr after then warm
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as for sitz bath, how often can be done?
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3 times per day for 20 min
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what are the 8 postpartum assessments?
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vs
breasts lochia perineum (reeda) fundus bladder abd dressing lower extremities |
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what needs to be assessed for with breasts? lower extremities?
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breasts-engoregement keep on schedule Q3H
homans sign |
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what does reeda stand for?
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red, echymosis, edema, discharge, approximation
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with an abdominal dressing/incision, what needs to be charted?
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sutures, staples? look for reeda
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after placenta expulsion, shower or bath?
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only shower or sitz bath
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when does menstration usually start after?
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most dont have period until 7-9 months-with breast feeding maybe a year
can still get preg |
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why do women loss weight?
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breast feeding
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what are the 2 things that should wait until 6 week checkup?
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sex and workingout
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relating to ice packs, when do you use cold, and when hot
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ice for 24hr after then warm
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as for sitz bath, how often can be done?
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3 times per day for 20 min
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what are the 8 postpartum assessments?
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vs
breasts lochia perineum (reeda) fundus bladder abd dressing lower extremities |
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what needs to be assessed for with breasts? lower extremities?
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breasts-engoregement keep on schedule Q3H
homans sign |
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what does reeda stand for?
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red, echymosis, edema, discharge, approximation
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with an abdominal dressing/incision, what needs to be charted?
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sutures, staples? look for reeda
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with an incision, what is the most important teaching?
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keep incision dry-if heavy, use pain medication
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during the postpartum period, what are the 5 things that are most important?
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pain relief
comfort measures fluid/food prevent dvt assist with infant feeding |
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how does eating progress after c/s?
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ice chips, water, juice, crackers, food
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what are 2 s/s of morphine?
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n/v, itching, dec resp
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for ppl with morphine epidural, what are they allowed to do for painrelief?
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no narcotics, call anesthesiologist first
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what are the 9 after care plans after c/s?
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pain relief
vs (ortho) abd/fundus lochia assess dressing i/o immobility feedings abd distention(prevent) |
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to help with breathing and gas what is done?
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incentive spirometry
walking to pass gas |
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what are the 8 things that must be looked at on the chart r/t labs?
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rh
blood type/coombs (direct) cbc (H&H) rubella varicella syphillis (RPR, VDRL) hep b GBS |
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if mom is - and baby is + mom gets what?
after coombs testing, + means what, - means what? |
rhogam
+=bad -=good |
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if has type o blood what needs to be checked? what does it mean?
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coombs+
increased billi |
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if mom has hep b, what are the interventions?
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vaccinate baby, give hb immunoglobulin and vaccine within 12hr
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if mom has GBS what are the interventions?
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antibiotics to mom x2 dose before delivery
-make sure to ask if mom got antibiotics |
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what is the 8 d/c criteria?
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normal assessment
lab values v/stooling feeding well (both) mom/newborn care signs of prob follow up apts support persons |
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who needs to v and s before leaving?
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baby mom only needs to void
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what are some signs of problems?
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fever, hem, yellow, uncontrolled pain
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r/t baby and weight loss what is normal and when does baby put on weight?
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10% loss is normal
usually gains back by 2 weeks |
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what are the 4 processes of becoming acquainted?
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bonding
attachment maternal touch verbal behaviors |
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what is puerperal phases?
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taking in, taking hold, and letting go phase
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what % of women have postpartum blues? when does it start?
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70-80%
usually starts 3-4th day |
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how long should a vag delivery wait to workout? c/s?
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6 vag 8 c/s walking ok
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what interventions help postpartum blues?
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eating and sleeping
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what is the only way to 100% tell sex of baby?
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amniocentesis
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what are the 4 cultural influences on adaptation?
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cultural specific care
communication health beliefs dietary practices |
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why would a new mother have the nursing dx of anticipatory grieving?
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delivery not expecting
sex of baby |
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most drs would prefer women to get to what ga before rom?
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at least 37 weeks
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what drug increases lung maturity?
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betamethasone
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what is surfactant?
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a lipoprotein produced at 24-25 weeks that keeps alveoli open
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what weeks allow for adequate surfactant produced for most infants to breath without difficulty?
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34-36
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steroids given w PTL does what?
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increases surfactant production and increases growth of the lungs
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what are 3 things that cause stress to speed lung growth
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IUGR, PIH, PROM
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diabetes has what effect on the lungs?
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diabetes
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with an increased surfactant production what may need to happen?
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an early delivery
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what are the 4 factors that cause respiration?
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chemical, mechanical, thermal and sensory
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how do the chemical factors react?
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chemoreceptors react to decreased po2 and ph in blood, and increased pco2 which stimulates respirations
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how do the mechanical factors react?
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fetal chest compressed with NSVD birth, when pressure is released recoil of the chest draws air into the lungs
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how do the thermal factors react?
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sensors in skin respond to sudden change in temp at birth which stimulates respirations
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how do the sensory factors react?
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tacticle stimulation, sound, light, smell and pain stimulate respirations
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surfactant does what? and allows for what?
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keeps alveoli paartially open
makes so that each breath requires less effort |
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crying does that in the lungs? where does fluid go?
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increaes pressure in lungs keeps alveoli open
fluid moves into the interstitial spaces and is absorbed |
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what do the 3 shunts do and what are they?
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carry blood away from liver and lungs during fetal life
ductus venosus, foramen ovale, and ductus arteriosus |
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what does the ductus venosus do?
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shunts blood away from the liver to inferior vena cava
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what does the foramen ovale do?
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opening between r atria and l atria so blood bypasses lungs
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what does the ductus arteriosus do?
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carries blood from pulmonary artery to aorta, bypassing the lungs
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what is another name for heart murmur?
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patent ductus arteriosus
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what are the 4 methods of heat loss for baby?
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evaporation
conduction convection radiation |
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how does evaporation and conduction loss weight?
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evap-wet diaper, skin, hair
cond-contact w cold objects; hands, scale |
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how does convection and radiation loss height?
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conv-drafts from open doors, air conditioner
radiation-near cold surfaces, window, walls, crib |
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what are the characteristics of heatloss in a newborn? 3
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thin skin, vessels close to skin surfaces, large surface area
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what are the characteristics of heatloss in preterm newborn? 2
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less fat, thinner skin
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cold stress increases the need for what? and why
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oxygen bc less surfactant produced
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what are the 2 major problems r/t heat loss?
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hypoxia and hypolycemia
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babies lose what % of heat from head?
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40
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metabolized brown fat does what?
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generates heat
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where is located where on the baby?
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neck, axillae, kidneys, adrenals, and sternum
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blood gets warmed by circulating through brown fat, heat generated through what?
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metabolism
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what two types of babies have trouble keeping warm and why?
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preterm and IUGR
they have inadequate brown fat |
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what is the average blood volume in a term newborn?
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85ml/kg
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increased rbc=polycythemia increases risk for what?
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jaundice, hyperbillirubinemia
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what are the hemoglobin levels for newborn?
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14.5-22.5
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what are the hematocrit levels for newborn?
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48-69%
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what are the wbc levels for newborn?
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9000-30000
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what is the platelet levels for newborn and what are they at risk for?
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84000-478000
clotting deficiency due to lack vit k |
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what is the stomach capacity at birth and what is it by the first week? what does feeding stimulate?
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6ml/kg
90ml/kg peristalsis |
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the intestines have large surface area for what?
when do you hear bowel sounds? |
absorbtion
within one hour |
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the digestive system doesnt have what? when does it come in?
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pancreatic amylase
4-6 months |
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lipase is present where and used for what?>
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mouth, stomach, breast milk used for fat digestion
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meconium is passed when? and how many transitional stools per day?
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12-48 hours after birth
4 stools per day |
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glucose was supplied by the placenta and where is it stored?
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fetal liver, muscles
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what is the blood glucose level in a term infant? first and second day?
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40-60 first day
50-90 after first day |
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infants are at risk for what?
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hypoglycemia
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what are the 7 risk factors for hypoglycemia?
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preterm, postterm, diabetic mom, stress, hard delivery, LGA, SGA
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what is considered LGA, SGA
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L-4000gm
S-2500gm |
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what are the 2 risks for bilirubin?
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hemolysis of RBC
liver immature |
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what are the 3 factors that may increase bilirubin?
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jaundice
kernicterus trauma |
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kernicterus is fatal-what does it do?
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stains brain cells
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what are 4 risks for hyperbilirubinemia?
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physiologic jaundice
pathologic jaundice breastfeeding jaundice true breast milk jaundice |
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what is breastfeeding jaundice?
early or late? |
early onset just because not getting much to eat
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pathologic jaundice shows up when? when does it peak?
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before 24hr peaks 2-4 days
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true breast peaks when?
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3-5 days
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where does jaundice start?
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head then goes to body
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physiological jaundice happens when?
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24 hr after delivery
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which jaundice is most common
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physiologic
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kidneys produce urine at how many weeks?
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9-10
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urine is a source of what?
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amniotic fluid
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kidney nephrons form at what weeks?
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34-36 weeks
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usually void within what hours of birth?
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12-24
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how many voids are there per day for the first two days?
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1-2
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how many voids are there by the 4th day?
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6
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why do they usually void on day 4?
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milk comes in that time
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when do mothers pass antibodies and how?
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last trimester
breastmilk |
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immunoglobulin G does what? cross placenta?
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crosses placenta
gives immunity to bacteria and viruses |
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immunoglobulin M is what? cross placenta?
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gram negative bacteria and does not pass placenta
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immunoglobulin A does what? cross placenta?
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protects GI and respiratory systems and does not cross placenta
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babies have what kind of tachypnea?
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transient
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what are the 6 behavior states?
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quiet sleep
active sleep drowsy quiet alert active alert crying |
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what is the resp rate of a baby? what do the lungs sound like?
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30-60
clear |
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what are 5 signs of resp distress?
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tachypnea
retractions nares flaring cyanosis grunting |
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what are the normal heart sounds? what about when sleeping and crying?
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120-160
sleeping 100 crying 180 (may sound like murmur) |
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what is the normal temp of a baby? what are the two ways to take the temp
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36.5-37.3 c
97.7-99.1 f axillary and rectal |
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what is an intervention and what do you check?
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radiant warmer
blood glucose |
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what are the 4 assessment for anomalies regarding head?
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fontanels
molding caput succedaneum cephalhematoma |
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what are the 3 assessment for anomalies regarding face?
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neck and clavicles
cord extremites |
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what are the 2 assessment for anomalies regarding face and hands?
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count fingers/toes
vertebral column |
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what are the measurements that need to be taken?
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weight
length head chest |
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what are the normal bilirubin levels for face and abdomen?
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face-5-7mg/dl
abdomen-15mg/dl |
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what do you assess for female and male genitalia?
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female-labia, edema
male-edema, hydrocele, cryptorchidism, urethral meatus at tip, hypospadias, epispadias |
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what are the 4 types of birthmarks?
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mongolian spots
nevus simplex flammeus vasculosus cafe au lait spots |
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what are the 4 types of burn injuries?
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bruises
petechiae puncture forceps |
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what are the 7 skin assessments"?
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color
vernix caseosa lanugo milia breasts hair/nails erythema toxicum |
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what are the 6 neuromuscular ballard score based on?
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posture
square window arm recoil popliteal angle scarf sign heel to ear |
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what are the 6 physical ballar score based on?
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skin (veins, dry)
lanugo plantar surface breasts eyes/ears genitalia |
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AGA ballard score is what?
SGA? LGA? |
AGA-10-90th percentile
SGA-below 10th percentile LGA-over 90th percentile |
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what is the generic name of vit k? what route is it given?
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phytonadione
vastus lateralis |
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vit k injection is given with what guage/length? what degree? what time after birth?
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25 guage
5/8 in 90 degree within one hr of birth |
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why is vit k given? and what are the medication handling?
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to prevent bleeding
newborns cant sythesize vit k without bacterial flora store away from light |
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why is erythromycin ophthaimic ointment given?
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prevents ophthalmia neonatorum
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what is ophthalmia neonatorum?
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neisseria gonorrhoeae and chlamydia trachomatis
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how do you apply EOO? when is it given? what is the precaution?
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apply to each conjunctival sac
give within one hour of birth do not touch tube to eye |
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the american academy of pediatrics recommends the hep b vaccine in all newborns when? what about 2nd and 3rd dose?
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at birth or by 2 months
2nd-1-2 months 3rd-6 months |
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hep b vaccine is given at birth IM per protocol and to all newborns of hep b pos mothers within what time frame? what about immune globulin?
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12 hrs of birth
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what are 3 signs of resp distress?
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r over 60
nasal flaring retractions |
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what are 2 interventions for resp distress?
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positioning
suctioning |
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to assess for thermoregulation how often does the temp need to be assessed? what are the interventions to prevent heat loss?
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Q30min
radiant warmer, dry newborn, remove wet blankets |
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how often do newborns at risk for hypoglycemia need to be assessed?
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30-60 min and prn
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what infants are at risk for bilirubin?
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type o blood mom
coombs + jaundice |
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what is the removal of foreskin called?
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prepuce
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what are 3 methods of circumcision?
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gomco
mogan plastibell |
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besides a hearing test what are the 5 other screening tests?
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phenylkentonuria
congenital hypothyroidism galactosemia hemoglobinopathies congenital adrenal hyperplasia |
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the infant care seat rear must be facing until when and at what weight?
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until 1 year
and 20 lbs |
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a car seat is used until when and what weight?
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6-8 years and 60-80 lbs
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what are some medical conditions that may affect fetal well being? 7
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GDM
DM HTN STD infection anemia genetic disorder |
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what are some ob issues what may affect fetal well being? 11
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less than 2500gm
more than 4000gm less than 37 weeks more than 42 weeks malpresentation mmultifetal IUGR IUFD oligohydramnios polyhydramnios decreased FM |
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what are some maternal factors that may affect fetal well being? 5
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under/overweight
poor/excessive weightgain alcohol drugs smoking |
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ultrasonography uses high frequency sound waves to make what?
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2d, 3d, 4d images
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what does an ultrasound visulaize?
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fetus
placenta umbilical cord amniotic fluid gender |
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what is it used to determine?4
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fetal well being
number of babies presentation placenta location |
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ultrasonography must be assisted with what two things?
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amniocentesis and external version
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what are the 6 things assessed with biophysical profile?
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FHR on NST, breathing, movements, muscle tone, amniotic fluid index
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during the first trimester ultrasound where is the probe inserted?
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into vag
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what does the first trimester ultrasound visualize? 5
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uterus
gestational sac embryo fallopian tubes ovaries |
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when is the fetal heart beat seen at?
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5-6 weeks or 38 days since LMP
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what is the procedure like for first trimester ultrasound?
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lithotomy position
transvaginal probe with cover and gel takes 10-15 min |
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the second and third trimester ultrasound is transabdominal and used for what 7 things?
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confirm viability
fetal anatomy GA fetal growth AFI placenta location fetal presentation |
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the ultrasound is used for needle guide with what? 2
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amniocentesis and percutaneous umbilical blood sampling
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utz used to determine weight and GA by what 3 things?
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head biparietal diameter
abd circumference femur length |
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GA after the 1st trimester is what?
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less accurate
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anatomy survey is at what weeks? what is it ussed for
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18-20 weeks
to r/o fetal anomaly |
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what is the procedure like?
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supine, gel on abd, full bladder needed, takes 10-30 min
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