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Maternety Lowdermilk
Second Year Nursing 1st Obstetrics exam
| Question | Answer |
|---|---|
| First period of reactivity | Lasts up to 30 min after birth Newborn hart rate increases to 160-180 bpm but gradually decreases after 30 min. After this period newborn sleep OR has marked dicrease in motor activity. |
| Second period of reactivity | Occurs 2-8 hours after birth. Lasts from 10 min to several hours Tachycardia, tachypnea occur. Meconium passed |
| Initiation of breathing depends on several factors | Chemical, Mechanical, Thermal and Sensory factors. |
| After respiration is established breaths are | shallow and irregular and range from 30 to 60 breaths per minute. |
| Signs of respiratory distress in an infant: | Seesaw respiration, Chest was retracts and abdomen rises with inspiration. Nasal flaring. Grunting with expiration. Resp. Rate <30 or >60. |
| Hart rate and sounds in the newborn | HR 100-160 beats/minute with brief fluctuation above and below these values. |
| After the first cry HR might accelerate as high as | 180 Beats/minute |
| The range of the HR in the term infant is | about 85- 100 beats/minute during deep sleep and 120-160 while awake. |
| HR that is <100 or >160 should | be evaluated within 30 min to 1h or when the activity of the infant changes. |
| Infant's heart is located | midway between the crown of the head and the buttocks, and the axis is more transverse than that in an adult. |
| Apical pulse rates should be obtained on | all infants. |
| The blood volume of the newborn depends on | the amount of blood transferred placentally. |
| The blood volume in an term infant is about | 86 ml/kg of body weight. |
| Immediately after birth the total blood volume avereges | 300 ml but it can increase by as much as 100 ml depending on the length of time the infant is attached to the placenta. |
| Signs of risk for cardiovascular problems are | ??????? |
| In Newborn's hematopoietic system level of RBC and leukocytes differ from adult but this levels are relatively the same | platelet levels. |
| Red blood cells in infant | At birth the average level of RBC and hemoglobin is higher than those in the adults because fetal circulation is less efficient at oxygen exchange than the lungs so the fetus needs aditional RBCs for transport of oxygen in utero. |
| Blood Pressure in the newborn is | 60-80 mmHg diastolic/ 40-50 mmHg systolic |
| Biological tasks of a newborn's first 28 days of life | 1. Establishing and maintaining respirations 2. Adjusting to circulatory changes 3. Regulating temperature 4. Ingesting, retaining and digesting nutrients. 5. Eliminating waste. 6. Regulating weight. |
| Behavioral tasks of a newborn include | Establishing a regulate behavioral tempo independent of mother Processing, storing and organizing multiple stimuli Establishing a relationship with caregivers and the environment. |
| Transition period | Period between intrauterinee and extauterine existence. |
| The most critical adjustment of the newborn is the | establishment of the respiration. |
| First breeath begins a sequence of | cardiopulmonary changes. |
| How is breathing initiated? | Reflex triggered by pressure changes, chilling, noise, light, other sensations. |
| Exaggurated respiratory reaction occurs within | 1 minute of birth. |
| Newborns are obligate ____ breathers | Nose |
| Crying brings HR to | 180 beats/minute |
| abnormal and decreased chest expansion slow movement of fluid from alvioli and bronchial tree in to the | pulmonary circulation |
| ___________ surface tension requires less pressure to keep the alveoli open | Decreasing |
| Fetal pulmonary maturity is determined by examining | the amniotic fluid for the L/S ratio and other phospholipid levels. |
| Mature fetal lungs have L/S/ ration greater than | 2:1 |
| If newborn is born with L/S ration less than 2:1 the newborn will | have respiratory distress. |
| Immediately after birth HR palpable at | 100 to 160 beats/min |
| Always take apical HR for _________, preferably when _______. | for all infants are asleep. |
| Sinus arithmia is (irregular hart rate) is considered | normal physiologic phenomenon in infancy and an indication of good heart function. |
| Hart sounds in an infant are increased in ___ decreased in and increased in ____ than in an adult. | Increased in pitch, decreased in duration and increased in intensity compared to an adult. |
| Mosth hart murmurs herd in the first few days have ___ pathological significance | NO |
| Blood volume of the infant depends on the amt of | blood transferred placentally. |
| Early or late clamping of umbilical cord ___ | changes circulatory dynamics. |
| Iron stores in an infant are enough for | normal RBC production for 5 months. |
| Leukocytes at birth are at | 18000 mm3 but range from 9000 to 30 000. |
| Platelet count in the newborn is | the same as in adults. |
| Clotting factors | Decrease during first few days because newborn cannot synthesize vitamin K. |
| Bleeding tendencies in an infants are | RARE |
| Blood group is ____ determined. | genetically |
| Cord blood sample | ID blood type and Rh status. |
| Persistent tachycardia >160 beats/min may indicate | Respiratory distress Syndrome RDS. |
| Prolonged cyanosis may indicate | respiratory and/or cardiac problems. |
| Difference between BP in upper and lower extremity is an early sin of | coarctation of the aorta. |
| Next to resp and heat regulation it is most critical to NB's survival | Thermogenic System |
| Non shivering heat production is accomplished by ______. | Metabolism of body fat Increased metabolic activity in brain, hart and liver Normal flexed position. |
| Brown fat reserves rapidly ____ with cold stress | decrease |
| Brown fat is found in | fat pads. Eg.Interscapular regions and axile. |
| Less mature the newborn the _____ brown fat brown fat reserve is present. | LESS |
| Cold stress increases risk of brown fat | depletion |
| Newborn should void within the first | 24 h |
| Void is usually ____ and ___ in color | clear and pale. |
| If the infant does not void in 24 h assess: | Fluid intake Bladder distention Restlessness Pain |
| Maconium is usually passed ______ | within the first 12 h of life. |
| Maconium is | is formed during fetal life from the amniotic fluid and it contains intestinal secritions and cells. It is greenish black and viscous and contains occult blood. |
| First maconium passes is | STERILE |
| Stool is an indicator of the adequate | nutritional intake. |
| Maconium may be delayed up to 7 days in | very low birth weight newborns. |
| If there is no BM in 24 hours we assess | BS, anal patency, fluid intake, abdominal distention and pain. |
| Normal Physiologic Jundice | occurs in almost all newborns but is more severe in preemies. |
| Jundice persisting >7 days indicates | pathologic process. |
| Kernicterus | bilirubin encephalopathy is the most serious complication of neonatal hyperbilirubinemia. It occurs when bilirubin is deposited in the basal ganglia and brain stem, disrupting neuronal function and metabolism. |
| Vernix ceseosa | a cheeslike whitish substance that is fused with the epidermis and serves as a protective covering protecting infants skin from damage. |
| Acrocyanosis | Hands and feet aper slightly cyanotic cause dby vasomotor instability, capillary stasis and high hemoglobin level. |
| Caput succedaneum | is generalized, easily identifiable edematous area of the scalp, most commonly found on the occiput and caused by slower venous return that causes an increase in tissue fluids within the skin of the scalp. |
| Cephalohemotoma | is a collection of blood between a skull bone and it's periosteum. It does not cross cranial suture line. |
| Desquamation | Peeling of the skin of the term infant that occurs few days after birth. |
| Milia | Distended, small white sebaceous glands that may be noticeable on the newborn's face. |
| Mongolian Spots | bluish-black areas of pigmentation that may appear over any part of the exterior surface of the body, including the extremities. |
| Nevi | Birthmarks. |
| Erythema Toxicum | Newborn rash or flee bite rash. |
| Signs of risk for intergumentary problems are: | Pallor Plethora (deep purplish color from increased RBCs) petechiae Central cyanosis Jundice (should be noted and described) |
| Testies descend in the crotum by birth in ___% of the newborn boys. Dithis percentage ___with primies. | 90% decreases with primmies. |
| Signs of risk for skeletal problems are | clubfoot (foot turns inward and is fixed in plantar-flexion position. Signs of congenital hip dislocation Additional digits or webbing of digits. |
| Hyperestrogenism of pregnancy causes _____ of the breast tissue of both sexes. | swelling. |
| Newborn reflexes are: | Sucking and rooting Swallowing Grasp (palmar and plantar) Extusion (touch or depress tip of the tongue) Glabellar (tap over forhead, brige of nose, or maxilla of newborn, the newborn blinks for irst for or five taps) Tonic neck or 'fencing' |
| Vison it the ____ mature at the term. | mature |
| Hearing is | similar to adult |
| Infants are attracted to _____smell and turn away from ______ strong smell. | sweet, strong |
| Infants taste and ____ at the same time | touch |
| Nursing care of newborns begins | immediately after birth and focuses on assessing and stabilizing the newborns condition. |
| Nurses have ______ responsibility for the infant during this period | primary |
| APGAR score is | rapid assesment of need for resuscitation based on 5 signs that measure physiological status. |
| APGAR score of 0-3 indicate | severe distress |
| APGAR score of 4-6 indicate | moderate difficulty |
| APGAR score of 7-10 indicate | that the infant should have no difficulty adjustin to extruterine life. |
| APGR scores do not predict_______ | neurologic al outcome, but 5 minute scoore does correlate with the degree of risk for NB morbidity and mortality. |
| Immediate interventions on an infant are to: | Stabilize and resucitate Identify with bands Eye prophylazis Vitamin K Cord care Promote parent-infant interaction Evaluate |
| Large for gastational age LGA | Weight above 90th percentile at any week |
| Apropirate for gastetional age | weight falls between the 10-90th percentile |
| Small for gastationasl age SGA | weight is below 10th percentile at any week. |
| Low birth weight LBW | Weight of 2500g or lessat birth. |
| Very low bith weight VLBW | weight of 1500g or less at birth. |
| Interuterine growth restriction IUGR | term applied to the fetus whose rate of growth does not meet expected norms. |
| Im injection in newborn | Vitamin K .5 to 1mg |
| Phototherapy | to decrease serum bilirubin levels |
| Exchange transfusion through UVC (umbilical venous catheter. | ????????? |
| newborn nutrition and feeding | can establish a basis for developing a good eating habits that last a lifetime. |
| Mommercial infant formulas provide | satisfactory nutrition for most infants. |
| Health teach parents about: | types of formulas, preparation and feeding techniques. |
| Unmodified cow's milk is _____ for infants during 1st year. | innapropriate |
| Solid foods start at | >6 months of age. |
| Some things to consider in newborn nutrition and feeding | frequency, duration, indicators of effectivness in feeding, pacifiers, sleepy babies, fussy babies, weight gain,jundice,pre-term infants and feeding twins. |
| Contraception | Is the voluntary prevention of pregnancy |
| More than 1/2 of all pregnancies in women < 20 are | unintended despite contraception |
| Informed consent | is a vital component in contraception education |
| Education about Contraception includes: | B - benefits R - risks A - alternatives I - inquires D - decisions E - explanation D - documentation |
| Contraceptive failure rate | …is defined as the % of contraceptive users expected to have an accidental pregnancy during 1st year even when they use a method consistently and correctly. |
| Coitus Interruptus | Male partner withdraws penis from vagina before ejaculation Effectiveness depends on ability to withdraw on time Failure rate is ~ 19% Does not protect against STD’s or HIV |
| Natural Family Planning | Intercourse is avoided during fertile periods Typical failure rate is 25% during the first year |
| Techniques used to determine fertility include: | calendar method cervical mucus ovulation-detection method the basal body temperature method symptothermal method |
| Pregnancy is unlikely to occur if the couple abstains from intercourse for | 4 days before and 4 days after ovulation |
| Barrier Methods | Male and female condoms provide protection against STDs and HIV Latex condoms break down with oil-based lubricants, therefore only water based lubricant should be used Typical failure rate is 15% |
| Spermicides | Are a physical barrier to sperm penetration Must make contact with the cervix when inserted into the vagina Should be inserted no longer than 1 h before intercourse Typical failure rate is about 29% |
| The Diaphragm | Is a shallow dome-shaped rubber device with a flexible rim that covers the cervix Must be fitted and replaced q 2 yrs, after a change in weight, birth or 2nd trimester abortion Should be left in place for at least 6 h after last intercourse. |
| Hormonal Methods | Over 30 different contraceptive formulations are available Typical failure rate based on omission is ~ 8% |
| OCPs: Potential Complications | A - abdominal pain C - chest pain or shortness of breath (clot problems within lungs or heart) H - sudden or persistent headaches (CVA or hypertension) E - eye problems CVA or hypertension) S - severe leg pain (thromboembolic process) |
| We should teach women to | stop taking the pill and to report any of the following symptoms to the health care provider immediately→ |
| Emergency Contraception | Should be used within 72 h of unprotected sex Is accomplished by 3 methods: High dose oral progestins Combined oral contraceptives (COCs) Insertion of copper IUD Is ineffective if pregnancy already exists Reduces pregnancy rates by 60% - 85% |
| Different emergency contraception products are available by prescription and major sidefect is | nausea |
| Intrauterine Device (IUD) | s a small T-shaped device inserted into the uterus: loaded with either copper or a progestational agent impregnated with barium sulfate for radiopacity Can be inserted: any time during menstrual cycle immediately after birth or 1st trimester abort |
| Intrauterine Device (IUD) is removed by | HCP when pregnancy is desired or occurs (1st trimester) ↑ risk of PID in 1st 28 days after insertion Offers no protection against STDs or HIV Check presence of IUD threads monthly after menstruation to R/O expulsion |
| Signs of Potential Complications RT IUDs | P- late period, spotting, bleeding A- abd pain, pain with intercourse I- infection exposure, abnormal vaginal discharge N- not feeling well, fever or chills S- string missing, shorter or longer |
| Sterilization | Is a surgical procedure intended to render a person infertile Woman - fallopian tubes are occluded Man - sperm ducts (vas deferens) are occluded NOTE: There is a small but definite failure rate |
| Induced Abortion | Is the purposeful interruption of pregnancy before 20 wks gestation 1st trimester abortions are safer (Ideal is 8 - 12 wks after last menstrual period) |
| Complications of abortion | Complications: infection, retained products of conception, and excessive vaginal bleeding |
| Vacuum Aspiration Abortion | The most common procedure performed Facilitated by the insertion of a small laminaria tent (cone of dried seaweed that swells as it absorbs moisture and dilates the cervix) retained by a vaginal tampon for 4 - 24 h |
| Intrauterine Device (IUD) is removed by | HCP when pregnancy is desired or occurs (1st trimester) ↑ risk of PID in 1st 28 days after insertion Offers no protection against STDs or HIV Check presence of IUD threads monthly after menstruation to R/O expulsion |
| Signs of Potential Complications RT IUDs | P- late period, spotting, bleeding A- abd pain, pain with intercourse I- infection exposure, abnormal vaginal discharge N- not feeling well, fever or chills S- string missing, shorter or longer |
| Sterilization | Is a surgical procedure intended to render a person infertile Woman - fallopian tubes are occluded Man - sperm ducts (vas deferens) are occluded NOTE: There is a small but definite failure rate |
| Induced Abortion | Is the purposeful interruption of pregnancy before 20 wks gestation 1st trimester abortions are safer (Ideal is 8 - 12 wks after last menstrual period) |
| Complications of abortion | Complications: infection, retained products of conception, and excessive vaginal bleeding |
| Vacuum Aspiration Abortion | The most common procedure performed Facilitated by the insertion of a small laminaria tent (cone of dried seaweed that swells as it absorbs moisture and dilates the cervix) retained by a vaginal tampon for 4 - 24 h |
| The Postpartum Period…Is also called the: | “puerperal” “4th trimester” |
| Postpartum period is | the interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state. |
| Postpartum lasts for | 6 weeks |
| Complex changes that occur after birth: | Physical changes Psychosocial changes Most dramatic physical changes occur in the reproductive system |
| Nursing assessment & care during postpartum focuses on the mother’s: | physiological recovery psychological well-being ability to care for herself/baby strategies to assist family adjustment |
| Initial Assessment & Care: Immediate PP Period | Most critical time because of great risk for pp complications AKA “4th stage of labour” |
| Nursing assessment in postpartum mother focuses on: | location & tone of fundus amount & character of lochial flow |
| 3 PP physiologic changes protect pp women from excessive blood loss: | elimination of uteroplacental circulation loss of placental endocrine function mobilization of extravascular water stored during pregnancy |
| : Hypovolemic shock does not occur usually in women who | experience a normal blood loss (vag delivery = < 500 cc; C/Section < 1000 cc) during the early pp. |
| PP Assessment of VS | During 1st h pp P, R & BP monitored every 15 min T monitored at the bigining and the end of recovery period. During 2nd h pp BP, P, & R monitored q 30 minutes |
| PP Nursing Assessment: THINK “BUBBLE –HE” | B – Breasts & Nipples U – Uterus – tone, location B – Bladder B - Bowel L – Lochia E – Episiotomy, lacerations, incision H – Homan’s Sign E - Emotions |
| B = Breasts (& Nipples) | Before lactation: breasts feel hard colostrum expressed After lactation: breasts feel warm & hard true milk expressed |
| When lactation is well established (1-2 weeks pp) | filled milk sac felt; duct will shift position from day to day |
| Breasts may be assessed & described as: | Soft – colostrum only, true milk not yet in Filling – true milk supply is establishing Full – true milk in Engorged – venous & lymphatic congestion |
| Breasts & Nipples: Engorgement | A pp complication Can occur in BF & non-BF mothers Caused by _______???__________ to breasts before lactation Treatment depends on BF or non-BF |
| Colostrum – the 1st milk | talk about it... ?????????????? |
| Nipples should be: | Soft Supple Pliable Erect Intact May be tender if BF |
| Nipples should NOT be: | Inverted Flat Bruised Blistered Cracked Bleeding Painful |
| Uterine Involution refers to: | return of the uterus to a nonpregnant state after birth. |
| At term, the uterus is ~ 11 x its pre-pregnant weight or | or 550 – 650 g |
| At 6 wks pp, it has returned to its | non-pregnant size of about 50 - 60 g |
| Fundus descends ~ 1 cm/day after 12th hour, so that: | By 6th day fundus is halfway between the umbilicus & symphysis pubis By 10th day fundus should be ____???______________ |
| Assessing Fundal Height | Before assessing fundus, assist client to: void lay supine with head flat & knees flexed |
| How do Uterine contractions prevent hemorrhage? | When uterus contracts, myometrial blood vessels compress to slow & stop bleeding |
| Hormone oxytocin | strengthens and coordinates uterine contractions |
| In first 1 - 2 h pp, UCs may | ↓ in intensity & become uncoordinated |
| Effect of Breastfeeding | BF helps to prevent PPH BF stimulates the release of colostrum promoting ↑ uterine contractions |
| Uterine Afterpains | Periodic relaxation and vigorous contractions are more common in subsequent pregnencies and me bye uncomfortable cramping. Intensified by breastfeeding or oxytocin. |
| Bladder | Takes ~ 2-8 wks for hypotonia, & dilation of ureters & renal pelvis to return to normal pre-pregnant state Dilation of urinary tract ↑ risk for infection |
| Mild proteinuria occurs b/c of | breakdown of excess protein in uterine muscle for 1 - 2 days pp in ~ 50% of clients |
| PP Diuresis | Loss of excess fluid that accumulates during pregnancy starts within 12 h pp |
| PP Diuresis causes | ↑ urinary output, night sweats, & profuse diaphoresis common in 1st 2 - 3 days pp |
| PP Diuresis accounts for | 2.25 kg weight loss |
| Damadge to urethra and bladder can cause | ↓ urge to void RT trauma, ↑ bladder capacity, & effects of anesthesia |
| ↓ voiding & pp diuresis → | bladder distention which → excessive vag flow |
| Bladder tone restored in ~ ____ days pp IF emptied adequately | 5-7 |
| BM may be delayed up to 3 days pp due to: | Decrease muscle tone in the intestines during labor Immediate puerperium Prelabor diarrhea Lack of food Dehydration |
| Operative vaginal births & anal sphincter lacerations (3º & 4º)are associated with | ↑ risk of pp anal incontinence. |
| Hemorrhoids are assessed at the same time as _________ | other gastrointestinal assessments. |
| Assess for hemerrhoid: | size, number, colour & need for nursing intervention |
| Lochia | Defined as the post-birth uterine discharge |
| Lochia may | contain small cloths or blood and is similar to heavy menstrual flow in the 1st 2h post delivery. |
| Lochia should decline and stop | ater 2 h |
| Lochia | Has a characteristic fleshy or menstrual odour which should never smell foul |
| Rubra (red):Lochia | stops after 3-4 days and consists mainly of trophoblastic debris. |
| Serosa (pink):Lochia | occurs from about day 22 to day 27(varies) pink or brown contains blood, mucous, serum debris and leukocytes |
| Alba (clear, white or yellow):Lochia | In most women, occurs in about 10 days, continues for 10-14 days (total 3 - 4 wks pp) |
Created by:
knnmala
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