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Mat 9-10-11 CCC 105

Maternity Ch 9-10-11 CCC PN105

3 different characteristics of lochia lochia rubra, lochia serosa, lochia alba
lochia rubra red, mostly blood, for 3 days post birth
lochia serosa pinkish, blood and mucous, 3-10 days post birth
lochia alba mucous, clear and colorless or white, 10-21 days post birth
Why should discharge teaching include if change to lochia from pink to bright red? possible postpartum hemorrhage, infection, thrombosis
What is mastitis? infection of breast, 2-3 weeks postpartum; organisms from skin or infant mouth enter small cracks in nipples or areolae causing redness/heat, tenderness, edema/heaviness, purulent drainage
What is treatment/prevention for mastitis? Antibiotics and continued milk removal are primary treatments; teach proper breastfeeding techniques to reduce risks; warm shower before nursing cleans and stimulates milk flow
What if abscess forms in mastitis? may need incision and drainage of infected area, IV antibiotics
How long to breastfeed with each feeding at least 15 min per breast; may take over 5 min for let down to occur; do not switch back and forth several times during session
How should uterus feel after delivery? should feel firm and size of grapefruit
What are indications of soft, boggy uterus? soft not firm, higher than umbilicus
What are interventions for soft, boggy uterus? locate and massage fundus keeping one hand on lower uterus to prevent inversion; mother to void or insert catheter; medication to stimulate contractions (oxytocin)
Location of uterus after delivery? felt at midline, at or below umbilicus, descending 1cm/day
What indication if uterus is felt 2-3 fingers above unbilicus and to the side? uterine atony with full bladder
Teaching of perineum care in postpartum woman comfort and hygiene - ice pack 12-24h, warm sitz bath after 24h, warm water to wash after voiding or bowel movements; perineal pads removed front to back often
Diet of lactating mother 500 additional calories; follow food pyramid; no caffiene/alcohol/drugs
Menstrual cycle after childbirth during breastfeeding may be delayed past 6-8wks but may occur at any time with or without bleeding
Menstrual cycle after childbirth, not breastfeeding normal cycle resumes in 6-8wks
When should a woman who is not immune to rubella receive the vaccine? Immediately postpartum and not get pregnant for at least one month
Instructions for formula feeding wash hands; follow preparation instructions; do not microwave; place in bowl of hot water to remove chill; do not prop bottle; make sure nipple always full; feed 3-4h
What are afterpains? intermittend uterine contractions similar to cramps
Afterpains occur more commonly in which pregnancy? multipara
What are the phases to Rubin's psychological change to puerperium? Phase 1-Taking In (passive, focus on recovery); Phase 2-Taking Hold (interest in infant, critical of performace); Phase 3-Letting Go (reconcile idealization with reality)
What phase of Rubin's psychological change to puerperium is ideal for teaching? Phase 2 - Taking Hold
4 ways heat is lost evaporation, conduction, convection, radiation
heat loss by evaporation liquid on skin evaporates
heat loss by conduction direct skin contact with cold surface
heat loss by convection heat is drawn away by drafts
heat loss by radiation near (but not touching) cold surfaces
How do newborns lose heat right after birth? amniotic fluid evaporates quickly, drafts move heat away, may contact cold surfaces
Newborn care of umbilical cord prevent infection; initial application of antibiotic ointment; fasten diaper low for circulation of air to cord; baths delayed 10-14 days until falls off
When should woman receive RhoGAM after delivery? within 72 hours after giving birth
Signs of hypovolemic shock tachycardia; drop in BP; decrease in urine output; skin/mucous membranes pale cold and clammy; mental changes like anxiety confusion; lethary
Security measures in hospital for newborns matching wristbands on newborn, parent, and caregivers; recognition of employees; keep infant away from door; do not leave infant alone in room
Hypoglycemic blood glucose level in newborn <40mg/dL
Signs of hypoglycemia in newborn jitteriness, poor muscle tone, sweating, respiratory difficulty, low tempterature, poor suck, high pitched cry, lethargy, seizures
Interventions for hypoglycemia in newborm nurse or give formula to prevent fall in blood glucose level
What is uterine atony? uterus does not contract normally after placental detachment; muscle fibers are flaccid and do not compress blood vessel allowing site to bleed freely and massively; boggy soft uterus above umbilicus
Nursing actions with uterine atony massage uterus until firm but not overly massage; catherize if not able to void on own; uterine contraction by infact sucking or oxytocin; hysterectomy if not controllable
What is oxytocin and its uses? IV medication that causes uterine contraction to firm uterus after placental detachment postpartum
Postpartum discharge instructions self-care teaching, written materials, emphasize importance of follow-up appts, report any complications ASAP
3 types of thromboembolic disorders SVT superficial; DVT deep; PE pulmonary embolism
SVT superficial venous thrombosis painful, hard, reddened warm vein easily seen; treat with analgesics, heat, and elevation; do not cross legs, early ambulation/ROM, antiembolic stockings
DVT deep vein thrombosis pain, calf tenderness, leg edema, color changes, pain when walking, positive Homans sign; treat as SVT, add anticoagulants for 6 wks
PE pulmonary embolism sudden chest pain, cough, dyspnea, decreased consciousness, heart failure; treat in ICU and notify physician immediately
What is Homans sign? pain when foot is dorsiflexed
What is normal WBC for early postpartum period? as high as 12.000-20,000 due to inflammation, pain and stress; protects mother from infection, returns to normal within 12 days
IUD teaching to patient requires prescription and provider to insert; Paragard (copper) good 10yrs, Mirena (LNG) good 5yrs; produces sterile inflammatory reaction toxic to blastocyte, impedes sperm transport/cervical viability
How does oral contraceptive prevent pregnancy? Prevents ovulation, makes cervical mucous thick and resistant to sperm
Side effects to oral contraception nausea, headaches, breast tenderness, weight gain, spotting, amenorrhea
Diaphragm use instructions apply spermicide inside center and around rim; compress between thumb and finger; insert towards/behind/below cervix; tuck rim behind pubic bone; leave in place at least 6h after; hook finger over top rim and break suction to remove
Signs of ovulation rise in basal temperature; change in cervical mucous consistence; date of last period
Cervical mucous based family planning Billings Method - as ovulation nears, mucous increases and becomes thin, slippery, and lcear like egg whites - avoid sex 5 days prior and during; mucous thickens again after ovulation
What is Clomid (clomiphene)? therapy for infertility to induce ovulation; can be used with hcG; continued for 6-9 cycles for optimum outcome
What is menopause? cessation of period for 12months d/t estrogen production changes; approx. age 51; decreasing estrogen increases risk for osteoporosis, arterioschlerosis, and increases blood cholesterol; may be induced by surgery, pelvic irritation, or extreme stress
Prevention of osteoporosis clacium intake from dairy, dark green leafy vegetables, soybeans, wheat breat, and calcium supplements as child and throughout adulthood
TSS (toxic shock syndrome) Staph strain that produces toxins causing shock, coagulation defects, and tissue damage in enteres bloodstream; associated with trapping bacteria within reproductive tract for prolonged period
TSS symptoms sudden spiking fever, flulike symptoms, hypotension, generalized rash that resembes sunburn, skim peeling on palms and soles 1-2 wks after illness
What is a vasectomy? Cut made in each side of scrotum and cut each vas deferens to stop sperm ; outpatient surgery
Vasectomy instructions Some pain, bruising, swelling; rest and mild analgesic; ice pack for comfort; report bleeding or substantial bruising, separation of sutures, drainage, or increased pain; use back up contraception for one month
Diagnosis of ovarian cyst transvaginal ultrasound and laproscopy to view ovaries
What is candidiasis? yeast infection; itching and burning on urination; inflammation of vulva and vagina, cottage cheese discharge
C-Section postpartum instructions encourage frequent position changes q2h; support body with pillows and pillow against incision when coughing; medications as prescribed; report fever pain discharge suture separation; clean in shower with warm water and mild soap; no lifting over 10 lbs
Types of formula preparations ready to feed; concentrated liquid; powder
4 types of shock after delivery cardiogenic, hypovolemic, anaphylactic, septic; body compensation can mask until condition becomes life threatening
Cardiogenic shock PE, anemia, HTN, cardiac disorders
Hypovolemic shock hemorrhage or blood clotting disorders
Anaphylactic shock allergic response to drugs given
Septic shock puerperal infection
Contraindication of breastfeeding maternal medications passed to milk; true galactosemia; untreated active TB, HIV, active herpes zoster; drug or alcohol abuse
What is prolactin? hormone from anterior pituitary gland causing production of breast milk
What is cystocele? anterior vaginal wall becomes too weak to support bladder containing urine; may lead to stress incontinence
What causes stress incontinence? cystocele, genital trauma, antidepressants, diuretics, caffiene, anticholinergenics, alcohol, beta blockers, ACE inhibitors
What is stress incontinence? urine leakage caused by sudden increase in intraabdominal pressure like coughing or sneezing
Ways to help pelvic floor dysfunction surgical correction is most definitive relief; can use pessary in vagina for those contraindicated to surgery
Pessary device device to support pelvic structures, used for pelvic floor dysfunction when surgery is contraindicated
Created by: cmp12345
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