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nursing

maternity exam 2 study guide

QuestionAnswer
Dyspareunia: Difficult or painful coitus
Involution: Retrogressive changes that return the reproductive organs, particularly the uterus, to their non-pregnant size and condition
Kegel exercises: Alternately contracting and releasing pelvic floor muscles to strengthen muscles surrounding the urinary meatus and vagina
Lactation: Secretion of milk from the breasts
Prolactin: Hormone that stimulates milk production
Puerperium: Period from end of childbirth until involution is complete -- ~ 6 weeks
Lochia Alba: white, cream-colored vaginal discharge
Lochia Rubra: Reddish or red-brown vaginal discharge
Lochia Serosa: Pink or brown-tinged vaginal discharge
Taking in/Taking hold/Letting go: 1st, 2nd, 3rd phases of maternal adaptation, each with specific behaviors
Attachment: Strong ties from infant to parent (other)
Bonding: Strong ties from parent to infant
En face: Position with mother facing infant
Fingertipping: 1st tactile experience w/mom touching infant
4th Trimester: 1st 12 weeks after birth
Postpartum blues: Temporary, self-limiting period of tearfulness experienced by new moms
Mastitis Etiology Clinical signs and symptoms Therapeutic management Etiology Usu 2-4 weeks after birth Staph aureus or strep Engorgement; stasis of milk Clinical signs and symptoms Flu-like; fatigue; aching; fever, chills, malaise Therapeutic management Antibiotics Pump/b’feed; ice packs; breast support
Mastitis (cont’d) Nursing considerations Nursing considerations Teaching Completely empty breast at each feeding B’feed, pump more, especially on affected breast Massage affected area Support, encouragement for new moms who are trying to b’feed
Endometritis Etiology Clinical signs and symptoms Etiology Endomyometritis or Metritis w/pelvic cellulitis Clinical signs and symptoms Fever, usu w/in ~36 hrs of birth, chills, abdominal pain, foul smelling lochia
Endometritis (Cont’d) Therapeutic management Therapeutic management IV antibiotics; Prevent infection from spreading Sometime prophylactically before cesarean Improvement usu w/in 2 days
Endometritis (Cont’d) Complications Nursing considerations Complications May spread to fallopian tubes or ovaries, resulting in sterility Peritonitis may occur Nursing considerations Fowler’s to promote drainage Medication VS q2, while fever Warm blanket; cool compress; hot/cool drinks
1st, 2nd, 3rd phases of maternal adaptation, each with specific behaviors Taking in/Taking hold/Letting go:
Taking in/Taking hold/Letting go? 1st 24 hrs: Passive; preoccupied with own needs; elated, or very quiet
Taking in/Taking hold/Letting go? After first 24 and for several days: Demonstrates autonomy for her own care; teaching time; easily feels overwhelmed
Taking in/Taking hold/Letting go? Before d/c: Parents focus on giving up the “ideal” birth and the “ideal” infant Not the sex hoped for Fantasy baby doesn’t match real infant Feelings of loss and grief
Verbalize attachment Attachment – development of ties between infant and another
Verbalize bonding Bonding – immediate attraction of Parents to Infants
PP assessment of the mother (BUBBLEHE) BUBBLEHE Breast,Uterus,Bowel,Bladder,Lochia,Episiotomy/incision, Homan’s sign & Pedal,pulses, Emotions OTHER Assessments Vital signs, Lungs & heart, neurological system, CVA tenderness, Rest & sleep,Nutrition
Care Post Cesarean Birth – 1st 24 Major abdominal surgery, Pain relief 1st 24, Respirations:Pulse ox – 1st 24, Q15 x 1st hr,Q 30 x 3-6 hr, Qh x 24 hrs ≤12-14 bpm – notify, Bowel sounds, Surgical dressing, REEDA, I&O, 1st 24
Care Post Cesarean Birth – 1st 24 continued Pain management Anesthesiology Turn, cough Q2, while awake Flex feet, knees
,Sedatives Used in early latent phase Relieves anxiety & induces sleep Augments analgesics Decreases nausea Can cause resp depression in infant in active labor Minimal analgesic effect
Name sedative Too much = floppy NB Diazepam (Valium) Lorazepam ( Ativan) Benzodiazepines
Valium is a popular _______ Used to treat _______ Some _______ have undesirable amnesic effect E.g., Low Apgar scores if given within 5 min of birth Usually not used in _______________ benzodiazepine; anxiety; benzodiazepines; childbearing women
Drugs that occupy receptors and activate them Agonist
Drugs that occupy receptors but do not activate them. They block receptor activation by agonists. Antagonists
Name the analgesic? No amnesic effects Stimulate opioid receptors Create euphoria Decrease GI emptying Increase N&V; may inhibit bowel & bladder Dizziness Bradycardia Tachycardia Hypotension Resp depression Opioid Agonist
Name the analgesic? Hydromorphone hydrochloride (Dilaudid) Meperidine (Demerol) Fentanyl (Sublimaze Opioid Agonist
Name the analgesic? Stimulates certain receptors & blocks others Analgesia without resp depression Less N&V May have more sedation Used more often than the opioid agonist analgesics Agonist-Antagonist
Name the analgesic? Stadol (Butophanol) Full term Early labor, 1-2mg IV/IM, no nasal spray, repeat 4h Not effective alone for pain associated with delivery If used in conjunction affects might be potentiated Not a lot of research Agonist-Antagonist
Nubain Placental transfer is rapid; high (1:0.4-1:6) NB brady, r depression, apnea, hypotonia Agonist-Antagonist
APGAR Appearance; skin color-Pulse-Reflexes-Activity; muscle tone-Respiration; Crying 7-10 = Normal newborn; good condition <7 = Neonate needs assistance making transition.Apgar may be repeated at 10 min after interventions May have 3 readings, e.g., 4/7/9
~ 72 – 96 hrs after birth Common if born h <38 wks, GA Physiologic jaundice
A yellow, lipid-soluble pigment “Conjugated” in liver (converted from fat to water-soluble) Is toxic in unconjugated form; diff to excrete = build up Becomes visible ~ 5-7mg/dL; Head to toe ~ peaks days 4-5; can continue to show later in BF infants Bilirubin
What type of jaundice? Nonpathologic (transient) Appears ~ day 2 Normal phenomenon Totals usu not above 12 mm/dL Physiologic
What type of jaundice? Destruction of RBCs (1st 24 h) NOT Nl = Rises faster, higher Blood incompatibility Infection Tx = light therapy Nonphysiologic
What type of jaundice? Early or late Not good feeders (lack colostrum) May supplement feedings Breastfeeding (Early)
What type of jaundice? After 3-5 days Last weeks – months Cause unknown Increase feedings/lights Breast pump Breastfeeding (True)
Bilirubin moves from bloodstream to brain Krenicterus
Preventing High Bilirubin Levels Prevent cold stress Encourage early feeding, especially breastfeeding Monitor stools No stooling in 24 h is reported
Onset less than 24 hrs Erythroblastosis fetalis (hemolytic DZ of NB) Maternal/fetal blood incompatibility Rh Infection Toxoplasmosis, rubella, CMV – (congential,Postnatal infection,Increased hemolysis Treatment:Increase fluid intake,Phototherapy Non-Physiologic/Pathologic Jaundice
Rare in US: Neuro damage,Athetosis,Spasticity,Hearing defects,Mental defects Causes Extreme prematurity Hemolytic dz; Sepsis Hypothyroidism Maternal DM Excessive bleeding Kernicterus (Bilirubin Encephalopathy)
Assessment of Gestational Age Ballard Score Scoring Gestational age and infant size Small for gestational age (SGA) Large for gestational age (LGA) Appropriate for gestational age Monitor for complications common to age and size of infant
Assessment of Gestational Age: Ballard Score Neuromuscular Square window Arm recoil Popliteal angle Scarf sign Heel to ear
Assessment of Gestational Age: Ballard Score Physical characteristics Skin ; Lanugo Plantar surface Eyes and ears Genitals Chest
Verbalize Large for gestational age (LGA) Weighing 4000 g (~ 8.8 lbs) or more at birth
Treatment for meconium aspiration Suction of head? No Suctioning? (debatable) Direct tracheal suctioning if infant is not vigorous (HR>100)Amnioinfusion-infused normal saline or ringer's lactate. Warmed, humidified oxygen,, or extensive respiratory support with mechanical ventilation. NO
What Makes a Newborn ‘At-Risk?’ Minority Maternal SES Limited access Environ dangers Neighborhoods Preexisting mat problems Mat factors (age/ parity) Medical conditions r/t pregnancy Pregnancy complications
Nipple Problems Nipples Inverted, Flat, Everted Causes the infant difficulty in latching
Etiology of a boggy fundus: Most common reasons Atony, clot, full bladder, retained placental tissue fragments Subinvolution of uterus Hemmorage
Bilirubin and Jaundice: Patient teaching UV light, more frequent feedings
Methods of heat loss in the newborn Four methods: -Conduction -Convection -Evaporation -Radiation *hypothermia can lead to death
Immunities in the NB IgG (G=Given) crosses the placenta -Passive acquired immunity IgM (M=mine,all mine) infant develops on his own -Active immunity occuring- 18 mos IgA (A=also a gift) immunity transferred through breastmilk
Reflexes of the newborn Reflexes: indicate neurological integrity -Rooting -Sucking -Palmar grasp -Plantar grasp -Tonic neck -Moro -Stepping -Babinski's
Cephalohematoma vs. Caput Caput crosses suture line; covers everything. Cephalohematoma stops at suture line; its under the periostium
When to call for help Signs/symptoms of concern, Fever, Localized pain, redness in a breast. Persistent abdominal tenderness. Frequency/urgency/ burning on urination. Redness/drainage/foul odor or separation of incision
When to call for help continued Abnormal changes in lochia Increased amt Sudden bright red blood Passage of large clots Foul odor Tenderness/warmth in legs
Discharge instructions Topics Involution Hand washing Breast care Suppressing lactation Care of the incision Perineal care Don’t touch the perineal side of the pad with hands
Discharge instructions continued Kegel exercises Rest & sleep Feeding schedules Nutrition Exercise Sexual activity F/u appointments
Normal RR? Abnormal RR? -30-60 -below 30 above 70 tachy- 60-70
PP hemorrhage: Who’s at risk? Uterine atony Overdistention of uterus Multifetal births Macrosomic infant Polyhydramnios Trauma Prolonged labor Assisted birth Previous hemorrhage
PP hemorrhage: When to call for help Bright red blood Foul smelling discharge Fever
Vaccines that mom’s receive after giving birth Rhogam Blood product Rubella, if mom is not immune
Care Post Cesarean Birth – 1st 24 Major abdominal surgery Pain relief 1st 24 Respirations Pulse ox – 1st 24 Q15 x 1st hr Q 30 x 3-6 hr Qh x 24 hrs ≤12-14 bpm – notify Lung sounds? Bowel sounds
Care Post Cesarean Birth – 1st 24 cont Surgical dressing REEDA I&O 1st 24 Pain management Anesthesiology Turn, cough Q2, while awake Flex feet, knees
Cesarean Care – After 24 hours IV/Foley are d/c Dressing is removed Clear liquids - soft/regular diet Provide help w/ambulation Assist with feedings B’feeding may be v. painful Pillow on the lap Side lying position Abdominal distention Watch fizzy drinks
Cesarean Care – After 24 hours cont Ambulation Simethicone (order) Suppositories (order)
Blood vessels in eye are damaged usu r/t O2 use. May result in visual impairment or blindness in preterm infants. Occurs more often in premature infants weighing 1500g or less. Retinopathy Of Prematurity ROP:
Serious; inflammatory; gut. A serious inflammatory condition of the intestinal tract that may lead to cellular death of areas of intestinal mucosa. Necrotizing enterocolitis NEC
Thought to be caused by immaturity of the intestines. Signs include increased abdominal girth caused by distention, increased gastric residual, decreased or absent bowel sounds, respiratory difficulty, apnea, bradycardia, hypotension. Necrotizing enterocolitis NEC
Early unlimited contact between parents and infants Assist the parents in unwrapping the baby to inspect their body. Inspection fosters identification and allows the parents to become acquainted with the “real” baby. Promoting attachment and bonding
Position the infant in an en face position and discuss the infant’s ability to see the parent’s face. Point out the reciprocal bonding activities of the infant: “Look how she holds your finger” Promoting attachment and bonding continued
Assist mom in putting infant to breast if she plans to breastfeed. Reassure that many infants do not latch onto breast at 1st. If formula feeding, assist in positioning reassure her that holding and cuddling the infant provide comfort and security. Promoting attachment and bonding continued
Model behavior by holding the infant close, making eye contact with infant, and speak in high pitched, soothing tones. Encourage the parents to take as much time as they wish with the infant Promoting attachment and bonding continued
Point out the characteristics of the infant in a positive way: “She has such pretty little hands” Promoting attachment and bonding continued
Provide comfort and ample time for rest because mother must replenish her energy and be relatively free of discomfort before she can progress to initiating care of her infant. Promoting attachment and bonding continued
SGA/LGA infants: Special needs-793 -SGA-hypoglycemia, early and more frequent feedings, temp regulation and respiratory support, observe for jaundice in infants with polycythemia -LGA-assess for injuries, hypoglycemia, polycthemia
Factors that help establish neonatal circulation (Areas where pressure increases vs. decreases to begin newborn respirations) ___PO2 levels;___ pulmonary resistance;___ pressure in R. atrium; ___ pressure in L. atrium; ____ systemic vascular resistance Increased PO2 levels Decreased pulmonary resistance Decreased pressure in R. atrium Increased pressure in L. atrium Increased systemic vascular resistance
If dura is unint. punctured with the needle used to introduce the epidural catheter, leakage of CSF can occur, which may result in postdural puncture (“spinal”) headache. (postural spinal HA). Postdural punctures
It is worse when a woman is upright and may disappear when she is lying flat. Postdural pucture headaches
Treatmeant for postural puncture headaches (4) Treatments- 1.Bed rest with oral or IV hydration. 2. Caffeine is another oral therapy. 3.A blood patch. 4. Epidural injections of dextran, sterile saline, or fibrin glue created from pooled human plasma
Patient care postural puncture Patient care-assess mother’s VS and FHR
Name method of heat loss? Can occur during birth or bathing from moisture on skin, as a result of wet linens or clothes, and from insensible water loss Evaporation
Name method of heat loss? Wet diaper, regurgitated milk on shirt, hair wet from bath, insensible water loss from lungs Evaporation
Name method of heat loss? Occurs when the infant comes in contact with cold objects or surfaces such as a scale, a circumcision restraint board, cold hands, or a stethoscope Conduction
Name method of heat loss? Cold hands, metal scale with thin paper liner Conduction
Name method of heat loss? Occurs when drafts come from open doors, air condition, or even air currents created by people moving about Convection
Name method of heat loss? Open door to hall Blanket loss or off Air condition Convection
Name method of heat loss? Heat is lost by this method when infant is near cold surface. Thus, heat is lost from the infant's body to the sides of the crib or incubator and to the outside walls and windows Radiation
*Hormone; ant pituitary; promotes milk production Prolactin:
Secreted during pregnancy; days 7-10 after birth Colostrum:
Swelling of the breasts from stasis Engorgement:
First breast milk received in a feeding Foremilk:
Last breast milk received; contains highest fat Hindmilk:
*Hormone; post pituitary; stimulates milk let-down Oxytocin:
Infection of the breast Mastitis:
Appears ~ 2 weeks of lactation Mature milk:
> 90 percentile @ birth LGA:
Breathing stops > 20 secs AND cyanosis or bradycardia Apneic spells:
Requires O2; chronic Bronchopulmonary dysplasia (BPD):
Elasticity of lungs and thorax Corrected age: Chronologic age – Wks premature Compliance:
Failure to grow appropriately Intrauterine growth restriction (IUGR):
Serious; inflammatory; gut Necrotizing enterocolitis:
Surfactant resulting in atelectasis, hypoxia, hypercapnia Resp distress syndrome (RDS):
Weighing <2500 g (5.8 lbs at birth) LBW:
Birth wt >90 percentile Macrosomia:
Resistance of lungs/thorax to expansion Noncompliance:
Bleeding around/into ventricles of brain IVH:
Born >42 weeks; Posterm:
born <38 weeks, GA Preterm:
Blood vessels in eye are damaged usu r/t O2 use Retinopathy Of Prematurity ROP:
<10th percentile SGA:
Cessation last 5-10 seconds and then 10-15 seconds of rapid resp. NO change in HR or color Periodic breathing:
Problems common to multiparous women during the postpartum period After pains are more severe. The uterus may take longer to return to normal size due to multiple pregnancies.
Problems common to multiparous women during the postpartum period continued.. Caesarian deliveries may have more complications due to repeated C-sections and scar tissue and adhesions. Multiparous women are at greater risk for hemorrhage due to boggy uterus.
How respirations are initiated at birth Normal RR? Normal RR?First 30 minutes: Time of reactivity, Tachypnea (60-70 bpm), Cyanosis/Acrocyano sis, Crackles. Once established: 30-60 bpm, irregular and shallow, symmetric.
How respirations are initiated at birth Abnormal RR? Abnormal RR? Respirations <30 or >70 per minute at rest, dyspnea, cyanosis, nasal flaring/grunting. (Occurs after respiratory transition)
D/C instructions for new parents 1. S/S of infection-for mom 2. When to call the physician-for mom o 1/2 Fever, Localized pain/redness in a breast (mastitis),Persistent abnormal tenderness, Frequ/urgency/burning on urination (UTI),Redness/drainage/foul odor or separation of incision (infection),
D/C instructions for new parents continued 1. S/S of infection-for mom 2. When to call the physician-for mom 1/2 Abnormal changes in lochia (increased amount, sudden bright red blood, large clots, odor) (hemorrhage),Tenderness/warmth in legs
D/C instructions for new parents continued 3. Accepted weight loss in the NB- 4.# of kcal/day needed in the newborn- 5.Getting rid of excess fluid in the mouth- 3. Accepted weight loss in the NB- <10% of birth weight 4. # of kcal/day needed in the newborn- 110-120 kcal/kg daily (FT) 5. Getting rid of excess fluid in the mouth-Use a bulb syringe
Created by: lalad13