Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
130 Cards in this Set
- Front
- Back
|
What is Puerperium
|
6-8 week period from the end of labor to the complete involution of the uterus and healing of pelvic structures
or Recovery from birth |
|
|
What is the 4th trimester, what happens?
|
3 month period of adjustment for the postpartum woman and her family
|
|
|
what is involution
|
Reduction in the size of the uterus after delivery to the pre-pregnant size caused by uterine contractions that constrict and occlude underlying blood vessels at the placental site.
|
|
|
what are some factors that enhance or speed up involution?
|
umcomplicated labor and delivery
-breastfeeding -early ambulation -complete expulsion of placenta and membranes |
|
|
What are some factors that slow involution>
|
prolonged labor and difficult delivery
-anesthesia -grand multiparity -retained placental fragments or membranes -full urinary bladder -infection -overdistention of the uterus |
|
|
What is Exfoliation of uterus?
|
its the falling off in layers at placental site. process takes about 6-7 weeks
|
|
|
Immediately after delivery: explain location, size and shape of the fundus?
|
-graefruit size
-firm and contracted -midway between the umbilicus and the symphasis pubis |
|
|
Within a few hours after delivery: describe the location of the fundus.
|
-fundus is located at the level of the umbilicus
-fundus descends approximately 1 fingerbreadth per day -by day 13, fundus is no longer palpable. |
|
|
What is a boggy uterus?
|
One that is soft, relaxed, and likely to cause hemorrhage results
|
|
|
What are possible issues if the fundus is displaced to the right?
|
full bladder, noncontracted uterus which can mean increased bleeding
|
|
|
What are some interventions for afterbirth pains?
|
-lying flat on your abdomen
-warm baths -anti-inflammatory drugs -tylenol |
|
|
How does breastfeeding enhance involution?
|
-causes the release of endogenous oxytocin which stimulates the uterus to contract and hastens the process of involution
-causes the relase of a hormone called relaxin which actually causes mom to relax |
|
|
What is subinvolution?
|
failure of the uterus to return to its normal size
|
|
|
Upon uterine palpation your patient is complaining of excessive pain in that area, what are you to suspect?
|
infection
|
|
|
What are some interventions if you find a patient with a boggy uterus, before calling physician?
|
-massage until firm
-check bladder -assess bleeding since last exam -add pitocin to IVF (with md order) -encourage breastfeeding -then if all above has been done call MD or CNM and they will most likely order pitocin IV or methergine PO |
|
|
What medications are ordered if non-invasive interventions fail to repair a boogey uterus?
|
Methergine .2 mg PO or pitocin IV
|
|
|
what should a woman's linea negra look like in postpartum??
|
-should fade to slivery white
|
|
|
What are some effects on the urinary system in postpartum?
|
-edema
-hyperemia -decreased sensation to fluid pressure if patient recieved spinal or epidural -swelling, bruising, -urethra -2-3 liters of extracellular fluid to be excreted |
|
|
how long after birth should they void?
|
1 hour
|
|
|
Why is the bowel so "sluggish" after birth?
|
decreased:
-muscle tone -peristalsis -intra-abdominal pressure -food intake and hemorrhoids- due to 2nd stage of labor |
|
|
How many pounds of weight loss is expected immediatley after delivery?
|
10-12 lbs
|
|
|
what is lochia?
|
is the discharge of bloood and debris following delivery
|
|
|
How much lochia is normal?
how much lochia should worry the nurse that hemmorhage is occuring? |
normal 240-270 ml
hemmorhage more than 500 ml |
|
|
What is lochia rubra and how long should you see it?
|
1-3 days bright red
|
|
|
What is lochia serosa and how long should you see it?
|
4-10 days pink-brown in color
|
|
|
what is lochia alba and how long can you see it?
|
11-21 days whitish color
|
|
|
What characteristics should you tell your patient about the lochia that are warning signs that something might be wrong?
|
-excessive discharge
-foul smelling -should not contain large clots |
|
|
how much soaking of the pad is considered moderate?
|
<6 inches within in an hr
|
|
|
true or false. c-section women have more lochia.
|
FALSE
|
|
|
true or false. Lochia amound increases with breastfeeding.
|
true
|
|
|
what is the estimated blood loss for a vaginal delivery?
|
greater than 500 ml
|
|
|
What is the estimated blood loss for a cesarian section?
|
greater than 1000 ml
|
|
|
Which lab value is an indicator of blood loss?
|
drop in HCT
|
|
|
true or false. afterpains increase when woman is breastfeeding.
|
TRUE
|
|
|
what is a first degree perineal laceration involve?
|
only perineum
|
|
|
What does a second degree perineal laceration involve?
|
perineum through muscle
|
|
|
What does a third degree perineal laceration involve?
|
perineum, through muscle and rectal sphincter
|
|
|
What does a 4th degree perineal laceration involve?
|
perineum, through muscles and rectal shincter and rectal wall.
|
|
|
What are some interventions for perineal lacerations?
|
-ice pack (first 24 hrs)
-sitz bath -analgesia -packing, watch for infection NO SUPPOSITORIES OR ENEMAS -stool softeners and increased PO fluids |
|
|
What is the treatment of hemorrhoids?
|
tucks, creams, stool softeners
-position, donut ring -hygiene, sitz bath -increased fluid and fiber |
|
|
what does the cervix feel like postpartum?
|
soft, irregular, and edematous, may appear bruised with multiple, small lacerations
-closes to 2 to 3 cm after several days, admits a fingertip after 1 week Shape permanetly changes after the first delivery from the round, dimple-like os of the nullipara to the lateral, slit like os of the multiparous woman. |
|
|
How long does it take for the cardiovascular system to return to prepregnant state?
|
within 2 weeks
|
|
|
How does the blood volume decrease its extra 40% that it had during pregnancy?
|
diuresis
|
|
|
What kind of heart beat is normal in the post partum period and what does it mean if it's not?
|
normal- bradycardia for the first 6-10 days
If tachycardia present it can be an indicator of blood loss |
|
|
What increases the risk of thrombophlibitis and clots postpartumly?
|
increased fibrinogen for 1 week after birth
|
|
|
True or false. HCT increases by the 3rd to 5th day postpartum
|
true
|
|
|
IF there is an incrase in temperature after the fist 24 hours of birth (above 100.4) what is this a sign of?
|
infection
|
|
|
what is the normal respiration per minute postpartum?
|
16-24
|
|
|
when does menstration usually resume in a non-breastfeeding woman?
|
6-9 weeks after birth
|
|
|
When does menstration usually resume in a breastfeeding woman?
|
delayed more than 6-9 weeks
|
|
|
What hormorne stimulated milk production after delivery?
|
prolactin
|
|
|
What is colostrum?
|
is the first milk secreted and is rich in protein and immunoglobulins
|
|
|
What stimulates the nipples?
|
oxytocin
|
|
|
What is breast engorgement ?
|
exageration of the normal venous and lympathtic system of the breast
|
|
|
When does breast engorgement happen?
|
occurs 3-5th pp day Q 24-48 hrs
|
|
|
What happens if breast engorgement is unrelieved (lactation)
|
suppresses milk supply and normal lactation
|
|
|
What are some intervention for breast engorgement for LACTATING women? (breastfeeding)
|
encourage breastfeeding
-warmth to breast -manual expression to assist laching on -supportive bra -analgesia |
|
|
What are some interventions for breast engorgement for non-breastfeeding women?
|
-supportive bra
-bind breast -ice packs -analgesia -no heat or massage |
|
|
Why does nipple soreness occur/
|
improper placement - position, or improper latching on
|
|
|
What are some interventions for nipple soreness?
|
-proper placement
-lanolin (pure) -Break suction -no soap;water only to cleanse -expose to air 15-30 minutes after feeding |
|
|
Assessment of a postpartum woman?
|
BUBBLE_HEB
B-Breasts: determine is mother is breast or bottle feeding, palpate for engorgement or tenderness, inspect nipples for redness, cracks and erectility if nursing U- Uterus - palpate the fundus, determine uterine firmness and postiion of fundus midline of abdomen, correlate fundal location with expected descent of 1 cm from umbilicus each postpartal day, inspect any abdominal incisions for redness, edema, ecchymosis, discharge, and approximation of skin edges B - bladder - client should void 6-8 hrs after delivery, assess for signs of infection B - bowel - assess for passage of flatus (gas), inspect ofr signs of distention, auscultate bowel sounds L- lochia - inspect type, amount, quantity and color E- episiotomy or perineal lacerations - inpect the perineum for signs of infection, and hemorrhoids H - homan's sign - pain in calf upon dorsiflexion of foot E- emotional status - assess emotions are appropriate for situation, assess of S&S of PP blues B- Bonding - describe how the parents interact with the infant |
|
|
What is the taking in phase and how long does it usually last?
|
first 3 days postpartum, passive and dependent, energy directed to herself, needs to discuss L&D experience, difficulty making descisions
|
|
|
What is the "taking hold" phase and how long does it usually last?
|
2-7 days PP dependent-independent (depends on individual) - more energy, demonstrates independence-self care, may express lack of confidence in caring for NB, may be receptive to self care and infant education
|
|
|
What is the letting go phase ad how long does it usually last?
|
7 days PP-up to 6 weeks pp, interdependent, assumes mothering role, readjusts relationships, recognizes NB as unique person, may experience depression
|
|
|
What is Bonding?
|
or attachment - the process by which parents form an emotional relationship with their infant over time
|
|
|
What is engrossment?
|
the father's absorption, preoccupation and interest in infant shortly after birth, which can be stimulated by witnessing the birth.
|
|
|
what is a nursing intervention when a patient is on methergine?
|
watch blood pressure (goes UP)
|
|
|
If a PP patient needs the rubella vaccine because she was not immune pre-pregnancy then what are some things that must be said prior to administration?
|
tell her that it is a live-attenuated vaccine and that she CAN"T get pregnant for 3 months
ask if she has an allergy to neomycin |
|
|
How and when is Rho-gam given PP?
|
300 UG IM w/in 72 hours of birth if woman is Rh-.
|
|
|
When do you tell pp women sexual activity should resume?
|
after episiotomy has healed and lochia has stopped (about 3 weeks pp) interest in sexual activity and orgasm may take 3 months to return
|
|
|
What is the definition of loss?
|
when an individual is ROBBEd of SoMEONE OR SOMETHING that has PERSONAl SIGNIFICANCE
|
|
|
What is a primary loss?
|
a loss that alter's peoples relationship with others, socially sanctioned to grief
ex: death, divorce, robbery, fire, illness, abduction, relocation, job-loss, ect. |
|
|
What is a secondary loss?
|
come directly from a primary loss - no support system, not a socially accepted loss. example: lossing financial support when spouse dies, loosing parental support when parent dies and so fourth
|
|
|
what are some cognitive symptoms of grief?
|
shock, numbness, disbelief, confusion, organization, preoccupation, hallucinations, dreams, nightmares
|
|
|
Behavioral symptoms of grief
|
wanders aimlessly, things unfinished, carries reminders, treasures objects, need to tell, retell and remember things about loved one and experience of death, sexual disruption/promiscuity
|
|
|
Physical Symptoms of grief?
|
breathlessless, tightness in throat, weakened immune system, Gi issues, dizziness, fatigue, excessive yawning, heaviness in chest, SOB
|
|
|
what are some predictors of how the person will react to grief?
|
HX of losses, type of losses (anticipated, violent, sudden, timelines (baby dying))
type of relationship with deceased social support system types of friends |
|
|
What is a basic care friend?
|
a person who worries about if your eating, sleeping, picking up kids, paying bills and so on
|
|
|
What is an empathic friend?
|
a person who you can cry on and talk to (not opinionated ) just listens and is there for you
|
|
|
what are the 4 Worden phases of mourning?
|
numbness/shock
alarm Reaction disorganization and despair accomadation/acceptance |
|
|
what is the task in the numbness/shock phase?
|
accept reality of loss
|
|
|
what is the task in the alarm reaction phase?
|
experience the pain of the loss
|
|
|
what is the task in the disorganization and despair phase?
|
adjust to the environment with out the deceased
|
|
|
What is the task in WOrden's Accomadation/acceptance phase?
|
reinvest emotional energy into relationships
|
|
|
Which of the worden's phases do a lot of people get stuck in?
|
Alarm reaction phase
|
|
|
What type of relationship with the deceased is the worst type to recover from ?
|
ambivalent - don't know whether love them or hate them. or you were mad at them at the time of death
|
|
|
True or false. Women who experience antepartum depression have a 50% more likely hood to experience postpartum depression.
|
true
|
|
|
what is the most predictable sign that a woman will have postpartum depression?
|
she had antepartum depression
|
|
|
How long do symptoms have to be present to be considered antepartum depression?
|
2 weeks
|
|
|
how long do the baby blues have to be present to be considered postpartum depresssion?.
|
4 weeks
|
|
|
when do the baby blues usually present themselves
|
within first week of birth
|
|
|
HOw late can postpartum depression present itself?
|
up to a year after delivery
|
|
|
what is postpartum psycosis
|
a rare psychotic condition which occurs in 1-2% of every 1000 births. the most extreme form of PP mental illness which happens when the patient becomes psychotic resulting in a loss contact with reality
|
|
|
when does PP psychosis usually present itself?
|
quick, sudden severe, usually after 3 months of delivery
|
|
|
What is the top priority in a newborn assessment>
|
respiratory function
|
|
|
what are the 5 criteria graded on an apgar score?
|
heart rate
respiratory effort muscle tone reflex irritability color |
|
|
On what scale is the APGAR Score?
|
0-2
|
|
|
An apgar score of 0 in the color area means what>
|
baby is pallor and/or cyanotic
|
|
|
An apgar score of 1 in the skin area means what?
|
pink body blue extremities
|
|
|
An apgar of 1 in the heart rate area means what >
|
less than 100 beats/minute
|
|
|
A newborn within the 1st minute of life has an apgar score that reads the following:
HR:1 Resp.effort: 1 muscle tone:0 reflex irritability:1 color:1 what is the clinical picture of this newborn |
heart rate of less than 100 beats/minute, slow irregular respiratory effort, flaccid muscle tone, weak cry, and a pink body with blue extremities.
|
|
|
when is an apgar performed
|
at 1 minute after birth and 5 minutes after birth
|
|
|
what is the highest score that can be assessed?
|
10
|
|
|
What do you check first when doing an APGAR
|
heart rate
|
|
|
when is a PKU drawn?
|
after days of feeding but prior to D/C
|
|
|
what is the normal vital signs of a newborn?
|
HR: 120-160 bpm
Respirations: 30-60 temp: 97.7-98.6 BP: 80/46 |
|
|
Normal head circumference of newborn?
|
32-37 cm or 2 cm greater than chest
|
|
|
what is the Rooting reflex?
|
infant turns to side stimulated and opens mouth to suck (stimulated by rubbing cheeks gently)
|
|
|
Sucking reflex?
|
when object placed in mouth or touches lips baby begins to suck
|
|
|
Tonic neck reflex?
|
when head is turned to one side extremities on same side extend and estremities on opposite side flex
|
|
|
Grasp reflex?
|
newborn grasp when object is placed in hand
|
|
|
Babinski reflex?
|
stroking sole upward and across the ball of the foot elicits fanning and extension of toes
|
|
|
moro reflex?
|
elicited by startling the newborn
|
|
|
What are periods of reactivity?
|
pattern of behavior during first several hours after birth
|
|
|
What is the first period of reactivity
|
30 to 60 minutes after birth; awake and alert; may display nursing and attachment behaviors with random diffuse movements
|
|
|
Second period of reactivty of the newborn?
|
awakes from deep sleep, lasting 4 to 6 hours
|
|
|
what is acrocyanosis and is it normal in a newborn?
|
bluish discoloration of the hands and feet - normal for a short time after birth
|
|
|
What is mottling?
|
lacy pattern of dilated blood vessels under skin caused by fluctuation of general circulation
|
|
|
What are mongolian spots and are they normal?
|
yes - bluish pigmented areas on dorsal area of buttocks of asian, afrrican american, or hispanic descent
|
|
|
What is lanugo?
|
downy, fine hair of fetus between 20 weeks of birth, noticeably found on shoulders, forehead, and cheeks
|
|
|
What is vernix caseosa?
|
a white, cheesy protective coating composed of desquamated epithelial cells and sebum
|
|
|
What is erythema toxicum?
|
is a very common rash in infants. It appears in up to half of newborns carried to term, usually between day 2-5 after birth.
|
|
|
what is caput succedaneum
|
swelling of soft tissue under the scalp
|
|
|
What is cephalhematoma?
|
collection of blood beneath the cranial bone and the periosteum
|
|
|
When newborns form tears
|
about 2 mnths
|
|
|
HOw should concentrated formulas be mixed?
|
1:1 ratio
|
|
|
How should a powder formula be mixed?
|
with water, usually 1 scoop to 2 oz
|
|
|
What is reccommended for circumcision care?
|
Three or four times a day, you will need to clean the area with warm water. Soap is not necessary. If you were given a peri-bottle at the hospital this is an excellent way to apply the water. Try to avoid getting the umbilical stump wet while cleaning.
At each diaper change, you will want to apply a small amount of petroleum jelly. Make sure that the petroleum jelly is pure, without perfumes or other additives. If your doctor sent you home with an antibiotic ointment you will want to use this as directed. |
|
|
What is recommended for umbilical cord care?
|
Healing takes place quickly when the cord is kept clean and dry. You can clean the cord by gently rubbing a cotton ball soaked in rubbing alcohol over the cord and surrounding area. Do this at every other diaper change, and be sure to fold your baby's diaper down slightly to prevent rubbing and irritation. You can also buy special newborn diapers that have a crescent cut out of the top just for this purpose.
|
|
|
what are the bathing recommendations of a newborn
|
until cord falls off - sponge bath
after - tub bath at least 2 times a weeks |
