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OB Chapter 17, 18

The newborn at risk & Postpartum Complications

Down syndrome one of the most common chromosomal syndromes (extra chromosome), occurring in 1 in 600 to 800 live births; Trisomy 21
instructions for PKU need to limit meat, dairy and most diet drinks
pathologic hyperbilirubinemia major cause is hemolytic disease, in which there is an excessive breakdown of RBC’s of the newborn as a result of maternal antibodies passing through the placenta to the fetus in the uterus
infants more prone to erythroblastosis fetalis when mother has developed a high level of antibodies during a previous pregnancy, abortion, amniocentesis, abruptio placentae, or blood transfusion
direct Coomb’s test at birth the newborn with hemolytic disease caused by Rh incompatibility has a positive direct Coomb’s test, which reveals the presence of antibody-coated Rh-positive RBC’s in the newborn
purpose of phototherapy decrease bilirubin levels by converting unconjugated bilirubin into isomers called photobilirubin, which is transported to the liver, where it combines with bile and is excreted in the feces, and some in the urine
when can an infant be removed from standard high-intensity lights feeding and short parental visits
signs of hypoglycemia in infant poor feeding; jitteriness or tremors; tachypnea; cyanosis; lethargy; hypotonia; irritability; temperature instability; apnea; seizures and coma
nursing care for cleft palate degree of cleft determines care; determine most effective nipple; upright position when feeding; feed slowly; burp frequently; cleanse mouth with water after; support parents; lip surgery and palate repair in stages
what is important to assess on an infant with a mother that has DM? blood glucose level
infants and temperature with infection commonly is low but may also demonstrate temperature instability and fever
initial nursing management of newborns with neonatal abstinence syndrome decrease stimuli such as noise, lights, and handling; be nonjudgmental toward the mother and encourage her in newborn attachment and newborn care
best way to prepare parents for care of a high-risk infant allow the family members to handle equipment and care for their newborn under supervision of the staff
cause of meningomyelocele defect in bony canal causing a protrusion of both meninges and spinal cord
esophageal atresia failure of esophagus to connect with stomach
proper phototherapy treatment green or blue lights above the incubator; a fiberoptic blanket attached to light wrapped around the body, or a fiberoptic mattress attached to a light source placed under the infant; shield the eyes and genitalia, no patterned blankets
4 inborn errors of metabolism phenylketonuria; galactosemia; hypothyroidism; maple syrup urine disease
transient tachypnea of the newborn shortly after birth a transient elevation in respiratory rate occurs in an effort to get rid of amniotic fluid in the newborn’s lungs; expiratory grunting, nasal flaring and mild cyanosis is seen
tetralogy of fallot characteristic defects ventricular septal defect, aorta positioned over the ventricular septal defect, stenosis of the pulmonary valve, and hypertrophy of the left ventricle
phenylketonuria a metabolic disorder caused by an inborn error of metabolism of the amino acid phenylalanine; if PKU remains untreated, mental retardation occurs
galactosemia an increase of galactose in the blood from a congenital inability to metabolize galactose into glucose
hypothyroidism is the result of an inborn error of metabolism caused by a maternal iodine deficiency or the use of antithyroid drugs by the mother
maple syrup urine disease a disorder of amino acid metabolism in which the amino acids leucine, isoleucine, and valine cannot be metabolized because of missing enzymes; body fluids have a sweet odor
most common causes of postpartum hemorrhage uterine atony and laceration; retained placental fragments or subinvolution
nursing care priority in immediate postpartum identify specific cause of hemorrhage; stop the blood loss; start IV fluid; monitor vital signs; provide oxygen and monitor; insert indwelling catheter to assess kidney function and output
uterine atony the inability of the myometrium muscle of the uterus to contract and stay contracted around the open blood vessels
1st intervention for a boggy uterus fundal massage and newborn suckling
hematoma collection of blood within the tissues; may result from injury to blood vessels in the perineum or in the vagina
management of PE raise the head of the bed to facilitate breathing and administer oxygen by mask
endometritis is the most common postpartum infection; it is an infection of the endometrial lining, decidua, and adjacent myometrium of the uterus
treatment of cystitis oral antibiotic therapy, increased fluids, cranberry juice; wipe front to back
patient teaching to prevent mastitis breast hygiene, how to prevent breast engorgement, adequate breast support, proper hand hygiene, and breastfeeding techniques
major concern of postpartum depression untreated women may progress to psychosis and suicide
subinvolution of placental site uterus fails to return to nonpregnant size, it remains enlarged and still has a lochial discharge; may result from placental fragments or mild endometritis, also from excessively vigorous massage of the uterus
women at greatest risk for hemorrhage uterine atony; overdistention; multifetal gestation; hydramnios; fetal macrosomia; oxytocin induction or augmentation; lacerations; bladder distention; disseminated intravascular coagulation; retained placental fragments
signs of puerperal infection fever, tachycardia, chills; uterine tenderness; localized reddened, warm, and tender area; purulent wound drainage; lochia; uterine subinvolution; malaise
necrotizing fasciitis of episiotomy site life-threatening; blue discoloration and numbness or the wound edges; restlessness, disorientation, and hypovolemia, ARDS (acute respiratory distress syndrome), or DIC may develop
mastitis and breastfeeding ensure that the baby is positioned correctly and properly latches onto the nipple and areola, and that the mother is releasing the baby’s grasp on the nipple before removing the baby from the breast; handwashing
symptoms of vaginal or cervical laceration excessive, bright, red, bleeding; uterine fundus is firmly contracted; signs of shock may occur
parametritis infection spread by lymphatics through the uterine wall to the broad ligament or the entire pelvis
placenta accreta placenta adheres to the uterine wall; profuse bleeding may result, and a hysterectomy may be required
subinvolution when the uterus fails to return to its nonpregnant size; instead, it remains enlarged and still has a lochial discharge
embolus a blood clot tears away from where it is attached and moves into the circulation
endometritis an infection of the endometrial lining, decidua, and adjacent myometrium of the uterus
Created by: laotracuata