L&d Exam 2

Front 1

1 unit of whole blood equals

1 unit of PRBC equals

Back 1

500 cc , increase hb by 1 gm & hct by 3%

300cc, increase hb by 1 gm & hct by 3%

Front 2

if hct is less than ______ - call md!

start blood transfusion at ___ml/min and check vitals q ___ for ___ min

Back 2

25%

2ml/min and vitals q5 for first 15 min

Front 3

Febrile Nonhemolytic Reaction

Back 3

MOST COMMON ADVERSE REACTION
onset: within first 6 hours
s/s: fever, flushed, headache, anxious, muscle pain
int: stop transfusion, infuse NS in NEW tube to KVO and notify MD

Front 4

Acute Hemolytic Reaction


Anaphylactic Reaction

Back 4

occurs within 15 mins - s/s include tachycardia, tachypnea, fever/chills, low back pain

Immediate - hives(uticaria), dyspnea, wheezing

Front 5

if a woman is experiencing subinvolution..RN's first intervention

Back 5

palpate symphysis pubis for a distended bladder

Front 6

normal subinvolution rate

location of uterus immediate post birth & a feww hrs post birth

Back 6

1cm or 1 finger-width per day - breastfeeding aides

immediate = midline btwn symphysis pubis & umbilicus, grapefruit like mass
few hrs = level of umbilicus, firm, contx

Front 7

LOCHIA RUBRA

Back 7

pp days 1-3

dark red in color

Front 8

LOCHIA SEROSA

Back 8

pp day 4-10

pink - brown

Front 9

LOCHIA ALBA

Back 9

pp day 11-21
white to yellow in color

Front 10

scant
light
moderate
heavy/large

Back 10

scant = less than 1 inch
light = 1-4 inches
moderate = 4-6 inches
heavy = saturated pad q 1 hour

Front 11

assessing an episiotomy

Back 11

Redness
Edema
Ecchymosis
Drainage
Approximation

Front 12

Thrombophlebitis

Back 12

inflammation of superficial vein - clot may lodge in the inflammed wall. usually in saphaneous vein. nursg. int. inlcude apply heat, TEDS, elevate leg. NO COAG. therapy required to treat

Front 13

BUBBLE HE

Back 13

Breast/Resp Episiotomy
Uterus Homans Sign
Bowel Emotional
Bladder
Lochia

Front 14

Special Needs of c/s delivery pt

Back 14

leg exercises
encourage fluids (no straws)
teach proper breast feed holds (football)
turn, cough, deep breath q 2h
"rooming in" - need another support there

Front 15

Bonding


Attachment

Back 15

bonding = "getting to know" phase - en face, engrossment, progressive touch - initial close contacr

attachment = falling in love, RN can encourage by complementing baby or room in encouraged - ultimate goal. enduring love reciprocated

Front 16

Phases of Maternal Post-Partum Adjustment

Back 16

"taking in" - mom concerned with herself and her needs. days 1-2
"taking hold" - focus shifts to care/needs of baby. days 3-10
"letting go" - moving forward with new normalcy

Front 17

Maternal Role Attainment

AFIP

Back 17

Anticipatory - during pregnancy. look to role models moms
Formal - baby arrives. act as others expect you to act as a mom
Informal - mom makes her own choices/decisions
Personal - in 2-10 months the woman is finally comfortable in her role as MOM

Front 18

The 4 T's of PP Hemorrhage

Back 18

Trauma (laceration, tear)
Tissue (placenta)
Tone (uterus, atony)
Thrombosis (clots)

Front 19

S/S of Hypovolemic Shock


S/S of Hemorrhage

Back 19

cool, clammy, LOC, dizzy, LATE signs = low BP, high Pulse, low U/O

early = heavy lochia soft - boggy uterus
late = low BP, hypovolemic shock

Front 20

Causes of Early PP Hemorrhage

Back 20

number one = uterine atony
trauma = laceration/hematoma

excessive bright red blood loss with clots within the first 24 hours pp

Front 21

Late PP Hemorrhage

Back 21

24 hrs - 6 wks pp
cause = retained placental fragments
also - subinvolution

Front 22

Uterine Atony

Back 22

bright excessive blood loss with clots and uterus is soft & boggy

Front 23

Laceration

Back 23

bright red bleeding in presence of a firm,contracted uterus

Front 24

Hematoma

Back 24

bulging, tense, shiny mass, discolored

IF SMALL = treat with ice packs for 12 hours and then sitz bath

Front 25

Retained Fragments

Back 25

Sudden bleeding without warning, typically not as much blood loss evident

Front 26

Major Goals in 1st 4 hours of babys life

Back 26

1. maintain patent airway
2. maintain temperature
3. document void/stool
4. promote attachment
5. initiate oral feeding
6.prevent hemorrhage/infection at umbilicus

Front 27

Endometritis

Back 27

Most common PP infection. inflamm/infected endometrium
s/s: foul smelling lochia lochia scat or perfuse
Risk : c-section delivery & multiple vag exams
treat: antibiotics, rest, fluids

Front 28

Mastitis

Back 28

infection of CT of the breasts. increased risk if breastfeeding.
s/s: flu like - fever/chills, malaise, warm/red painful area
management: good bra, heat to inc circulation ice to increase comfort, freq breast feeds

Front 29

postpartum blues

Back 29

self-limiting, mild depression occurs for pp days 3 upto 2 weeks. very common. mom overwhelmed and tearful

treat by mothering the mother - rest/support

Front 30

postpartum depression

Back 30

pp 3wks- 1 year. sad,anxiety, appetite change, insomnia, hostile, guilt - suicide risk. mom may need antidepressants and therapy

Front 31

Cord Care

Back 31

clean with soap & water, no alcohol

Front 32

APGAR

Back 32

done at 1 & 5 min, 8-10 is best
Hear Rate
Resp Effort
Color
Muscle Tone
Reflexes
good cry = 4 pts for resp & reflex

Front 33

Newborn lungs

Back 33

2/3 of fluid in the lungs must be reabsorbed by infant. only 1/3of the fluid is squeezed out of the thorax

Front 34

Normal Baby Vitals

Back 34

T = 97.9-99.4
BP =80-60/45-40, 100/50 ten days
RR= 30-60/min
P= 110-160

Front 35

Signs of Mature Fetus

Back 35

little lanugo

male testes deep in color with rugae

female labia majora cover minora & clit

Front 36

square window

Back 36

msr the angle formed when flex hand towards the wrist. increased angle indicative of premature baby. small angle = mature

Front 37

scarf sign

Back 37

measure how far elbow goes across chest. if reaches midline or beyond = immature fetus

Front 38

arm recoil

Back 38

msrs how far arms springback to flexed position after extended

Front 39

fetal circulation

Back 39

placenta acts as liver & lungs - so blood is shunted to general circulation and already oxygenated. foramen ovale open right to left atria. ductus arteriousus connects pulm artery to aorta

Front 40

new born weight

Back 40

typically loses 5-10% of weight in first few days

[phone] grams = macrosomic

Front 41

Mongolian Spots

Back 41

dark blue/black spots found on butt/backs of newborn babys of color. will fade away with time

Front 42

Milia

Back 42

baby acne/milk spots
found on the face - cheeks, nose, forehead
goes away on own

Front 43

Telangiectatic Nevi

Back 43

stork bites - flat red areas found on the neck, forehead, eyelids. will fade away

Front 44

Nevus Flammues

Back 44

Port wine stain. due to dense cappilaries at skins surface.

will not go away

Front 45

Erythema Toxicum

Back 45

very common - baby skin adjust to dry environment. raised red rash with pustues that spreads easy - will go away on own, no treatment needed

Front 46

capput succedaneum

Back 46

generalized swelling - crosses suture lines. common with vac extractions

Front 47

cephalohemotoma

Back 47

swelling over one skull bone - does not cross suture line

Front 48

tonic neck reflex

Back 48

"fencing" - baby faces one side. the arm on this side is extended and hand is open. other side is flexed and clenched

Front 49

moro/startle reflex

Back 49

pic up babys arms and let go. baby forms "c" with thumb and index finger and brings arms back in to chest and flex knees

Front 50

Brazeltons Behavioral assessment

Back 50

changed the way people think about newborn capabilities - self quieting, temprement, etc.

Front 51

States of alert/sleep

Back 51

drowsy alert
quiet alert = best play time
active alert = must decrease stimuli and comfort baby
crying

active rem sleep/deep sleep

Front 52

newborn hypoglycemia

Back 52

less than 40mg/dl
jittery, high pitch weak cry, seizures, coma, tremors

Front 53

radiation

conduction

Back 53

heat lost from warm surface to cooler one not in direct contact

in direct contact

Front 54

convection

evaporation

Back 54

heat lost to cooler air current

moisture evaporates into dry air

Front 55

intervention for preventing heat loss

Back 55

swaddle baby
knit cap to head
use warmer for assessment
skin to sin contact
stable temp before bath
freq temp checks

Front 56

hypotonic labor

Back 56

in active phase. less than 2-3 cont over 10 min period. or less than 1 cm dil/hr or no change. can give oxytocin but not induction bc labor already started
can use AROM to stimulate labor

Front 57

hypertonic labor

Back 57

persistent, painful, ineff. contx during latent phase. uterus does not return to a state of rest from contx. increased risk for utero-placental probs (late decels)
if early: sedate/BR
if late: induce with arom/oxy

Front 58

percipitpous labor & birth

Back 58

last only 3hours or dilate 5-10 cm/hr

can have a long labor and percipitous BIRTH

inc risk for laceration/meconium aspiration/hypoxia

GIVE tocolytics: mag sulfate & terbutaline to slow contx

Front 59

postterm

Back 59

beyond 42 wks gestation

inc risk for meconium, LGA,
do NST to check function of placenta

Front 60

shoulder dsytocia

Back 60

may lead to brachial palsy

Front 61

Fetal Malposition

Back 61

OP not OA - increased back pain & longer labor required b/c fetus must rotate 135 degrees to OA not 45 degrees. can facilitate by position change - sims on same side as babys spine, used to be hands/knees pos

Front 62

Fetal Malpresentation

Back 62

BREECH = most common, risk is cord proplapse, if part not engaged and ROM. c/s required

maybe brow/face = can deliver vag

Front 63

shoulder dystocia

Back 63

difficult delivery of shoulders

risk for brachial palsy - partial/complete paralysis of arm RT traume to brachial plexus

can apply pressure to suprapubic area to fold shoulders

Front 64

multiples

Back 64

dyzygotic - 2 ova fertilized. fraternal

monozygotic - 1 ova splits = identical

RISK = preeclampsia/HTN

Front 65

macrosomic

Back 65

inc risk for should dystocia - no pressure to fundus b/c further impacts shoulder

Front 66

abruptio placentae

Back 66

placenta separated from uterine wall prematurely. can be marginal, central or complete. significant abd pain - rigid board like abdomen.
RISK = DIC
CAUSE: cocaine, pih
MANAGE: replace clot factors IV with FFP and cath to monitor UO

Front 67

placenta previa

Back 67

placenta implanted in low uterine segment involving cervical os
RISK: multipara, multiples, acreta, prior C/S
S/S: no pain, bright red blood
Manage: identify source of bleeding and delivery safe/healthy fetus,NO VAG EXAMS

if less than 37 wks - give mom betamethasone to help infant lungs mature

Front 68

cord prolapse

Back 68

variable decels
inc risk with rom, breech
put 2 fingers gloved pressure on presenting part - knees to chest, call md - stay with pt!!!

Front 69

hydramnios

Back 69

+2000cc amniotic fluid
TEF - non patent esophagus/cant swallow - priority is to assess newborn feeding!
amnio to remove fluid, inc fundal height

Front 70

oligiohydramnios

Back 70

less then 500cc AF - low fundal height
RT fetal kidney anomalies - no urine produced! inc risk for cord compression

give fluids first - antenatal tests - amniofusion

Front 71

CPD

Back 71

common with android/platypelloid

allow TOL if no progress - c/s required

due to narrow true pelvis

Front 72

retained placenta

Back 72

beyond 30 mins not delivered
may require manual/surgical removal

Front 73

accreta

Back 73

deeper attachment of placenta into myometrium, inc risk for retained placenta

Front 74

IUFD

Back 74

intrauterine fetal death

demise post 20 wks gestation

RISk: DIC - due to release of thromboplastin from degenerating fetl tissue
wait 2 ws for spontaneous labor or induce