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Maternal Exam 2
Exam 2
| Term | Definition |
|---|---|
| technique is used to palpate the fundal height on a postpartum client | Placing one hand at the base of the uterus and one on the fundus |
| Why are postpartum women prone to urinary retention | Decreased bladder sensation results from edema because of pressure of birth |
| A nurse is helping her postpartum client up to the bathroom for the first time after delivery. Which finding indicates her lochia is normal or expected | The color of the flow is red |
| According to Erickson’s, which stage of development has the developmental task, trust vs mistrust? | Infancy |
| Lochia initially after delivery | rubra |
| assessment for congenital hip dysphasia findings | click in hip joint, one leg longer than another, one leg appears longer than the other |
| preterm infant with yellow skin color, and rising bilirubin level at risk of | brain damage |
| newborn immunity | newborn has temporary immunity from you for first 3 months |
| postpartum mom nonimmune to rubella | give MMR after delivery but before discharge. |
| Moro reflex | startle reflex, if crib moves suddenly, legs flex and arms fan and then both come back towards midline |
| Adolescent nutrition | boys typically need / require more due to growth spurts |
| soft boggy uterus located above level of umbilicus | massage fundus |
| newborn security | check band # of infant with mom |
| code pink | newborn abduction/ missing infant |
| APGAR : A= | appearance. 0=blue 1=blue extremities 2= pink |
| APGAR: P= | pulse 0=0 1= <100 2=>100 |
| APGAR: G= | grimace 0=0 1=grimace 2= cry & pull away |
| APGAR: A= | Activity 0=limp 1=minor flexion 2=active flexion & extension |
| APGAR: R= | respiratory 0=absent 1=weak cry 2=strong cry |
| adequate newborn feeding | count diapers each day |
| Narcotic Antidote | Narcan/ Nalaxone |
| Notify provider if | No wet diapers in >8 hours |
| RhoGAM | given to Rh - mom and Rh + baby |
| position for post c-section for feeding | football hold |
| 7 month old appropriate toys | hanging mobiles |
| Stage 4 of labor priority | monitor for hemmorrhage |
| normal HR for newborn | 110-160 |
| normal RR for newborn | 30-60 |
| newborn thermoregulation- too hot or too cold due to: | very little subQ fat |
| NPO prior to surgery to prevent | N/V/ Aspiration |
| taking in phase | mom concerned about self, her needs, ID baby, start to bond, wants to discuss birthing experience |
| Taking hold phase | Mom concerned about baby, wants to learn, |
| Letting go phase | Mom comes to terms with being child less, takes on partner role again |
| circumsicion care | wash with warm water, apply diaper loosely, |
| formual feeding teaching | position so nipple full of milk |
| Erickson Toddler stage | Autonomy vs. Shame/ Doubt; negativism due to need for autonomy |
| skin concerns to report | yellowing of skin |
| cephalocaudal | development of head before rest of body. able to lift head before head, neck, shoulders |
| immunizations for 5 year old: if up to date; | MMR |
| breastfeeding post c/section | immediately |
| prevent heat loss/ cold stress for newborn | dry infant immediately |
| supress lactation when formula feeding vs breast | wear supportive bra, cabbage leaves, cold packs |
| umbilical cord care | low diaper for air circulation, warm water sponge bathe, stump will fall off day 10-14. |
| endometritis s/s | temp of 100.4 for 2+ days, foul smelling lochia, abd pain/ tenderness |
| macrosomia places infant at risk of: | hypoglycemia |
| newborn birthweight | up to 10% weight loss. double by 6 months, triple by 1 year. |
| lb : kg | 2.2lb: 1kg |
| caput saccedaneum | swelling of scalp / soft tissue- crosses suture line |
| Cephalohematoma | swelling d/t bleeding; does not cross suture line |
| vitamin K injection site | Vastis lateralis; outer thigh, midway between hip and kneecap |
| mensuration post delivery | formula feeding= 6weeks (2 months) breast feeding= if doing so q2hr, will have absence of flow |
| adolescents' development tasks | defining sense of self |
| 1 hour post-delivery, soaked 3 peds; first task= | check fundus for position and firmness |
| APGAR score documents | how well infant is adjusting to extrauterine life |
| post-partum complication to call provider for | mastitis/ localized pain, redness and swelling in breast |
| magnesium toxcitiy | decreased RR, decreased LOC, decreased. DTR |
| girls' development vs boys | girls have growth spurt 2 years earlier than boys |
| 10 month old infant appropriate toys | push and pull toys, stacking blocks, stuffed animals |
| prevent thrombophlebitis | frequent ambulation |
| lactating and nipple soreness, actions to diminish= | rotate sides, alternate sides when beginning feeding, express milk onto nipple between feeds |
| folate purpose | prevents neural tube defects |
| pain presentations | clenched fists, facial grimacing, elevated BP |
| active labor care plan | risk for injury related to hemmorrhage |
| white spots on baby face and nose | milia; leave alone and will disappear |
| Source of Ca | Milk, milk products |
| Sources of Iron | green leafy, broccoli, red meat |
| engorgement | breasts feel heavy and swollen. Apply ice packs and cabbage leaves to relieve |
| breastfeeding with mastitis | continue to feed at normal times |
| post partum depression | monitor for worthless, guilty feelings, encourage to get outside |
| preventing SIDS | (ABC) - alone, on back, in crib w/ firm mattress |
| 4 year old toys | modeling clay |
| soft, boggy uterus wih deviation | assist pt to void |
| hypoglycemia in infants | <40 |
| perineal self care | warm water in peri bottle, pat to dry, sitz baths, ice packs for 1st 24 hours |
| rooting reflex | stroke baby cheek/ corner of mouth- suckling movements |
| involution | uterus returns to pre-pregnancy state in pelvis |
| fundus findings | expected to be at BB by 1 hour post delivery. declines 1cm per day, by day 10- not palpable |
| lacerations immediately after delivery teaching/ care | cold packs to perineum |
| stepping relfex | hold newborn upright with feet touching flat surface |
| postpartum reports fullness, tenderness on outer side of breast. with light palpation, small lump with engorgement- dx as | plugged milk duct |
| 8lb baby shoudl eat | 20-24oz |
| myelomeningocele- | place a sterile mosit dressing over |
| A Postpartum patient has moderate, red colored lochia after delivery | Lochia rubra |
| palpate fundus | place one hand on top of uterus and one at supporting base of uterus |
| Rubella vaccine for baby | Baby cannot get this vaccine until they are 1 y/o |
| Your patient is 24 hours postop from her C-Section has a boggy uterus and large vaginal bleeding. Which medication would be appropriate to give? | Carboprost |
| vitamin K for baby why? | Babies do not actively synthesize the Vitamin K. This medication helps with blood clotting |
| advantage of breastfeeding | easy to digest, contains antibodies, decrease in illness, immunity, wt loss for mom |
| newborn stool | normal= Yellow, soft, and seedy |
| 3 yo toddler sharing toys? | no- they will become angry and may have a physcial response |
| Rooming in | allows increased maternal newborn contact |
| action by mom showing that she is accepting baby | mom turns face to meet newborn eyes when she hold baby. (En Face) |
| jaundice baby receiving phototherapy | cover eyes, leave undressed, reposition, monitor temp |
| newborn with dry, cracked skin and absence of vernix, lack of subQ fat= | post term baby |
| engrossment | stare at newborn for extended period of time |
| acrocyanosis | bluish color of hands/ feet due to immature peripheral circulation- 24/24 hours post birth- normal finding |
| respiratory distress in newborn s/s= | tachypnea, dyspnea, grunting, nasal flaring, intercostal retractions, cyanosis |
| Piaget Stage 0-2 yr | Sensorimotor- development thru senses |
| Piaget 2-7yr | preoperational- increased ability to communicate and reason but still egocentric |
| Piaget 7-11yr | concrete operations- logic, cause and effect |
| Piaget 11-16yr | formal operations- ability to think abstract and problem solve |
| adolescents are at most risk of what safety hazard | Accidents- Motor vehicle accidents |
| 3-6yr olds play with= | small puzzles, toys with buttons, moving parts, play pretend, can copy a circle, can turn doorhandle, can screw a jar lid on and off |
| toddlers play toys | crayons, understand common objects (spoons) , can point to body areas |
| Preeclampsia post partum | – Monitored for level of consciousness, decline in respiratory rate, and absent deep tendon reflexes . |
| What is rubella vaccine | Rubella is a viral infection that can cause sickness for several days or weeks often has rash with it. Extremely rare with less then 1,000 cases per year in U.S |
| Cradle cap / Seborrheic Dermatitis | caused by excess sebum at the roots of the hair. It’s harmless. Simply wash your baby’s head with mild shampoo and remove flakes gently using a baby comb. |
| Sources of Protein | lean meats, beans, greens |
| 1st month motor skills: | Grasp Reflex is present , Can lift head during this time for brief periods that get more steady and stronger with time. |
| 4th month motor skills | Can grab objects, roll from back to front |
| 9th month motor skills | Crawling and starting to pull themselves up to stand |
| 12 month motor skills | walking holding onto hand or can sit to stand, can turn pages in a book |
| toddler stage mobility | Walks independently, Drinks from a cup, Eats with a spoon, Able to use pull toys when walking |
Created by:
kmccaustlin
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