Maternity Ch 9-10-11 CCC PN105
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| 3 different characteristics of lochia | lochia rubra, lochia serosa, lochia alba
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| lochia rubra | red, mostly blood, for 3 days post birth
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| lochia serosa | pinkish, blood and mucous, 3-10 days post birth
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| lochia alba | mucous, clear and colorless or white, 10-21 days post birth
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| Why should discharge teaching include if change to lochia from pink to bright red? | possible postpartum hemorrhage, infection, thrombosis
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| 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
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| 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
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| What if abscess forms in mastitis? | may need incision and drainage of infected area, IV antibiotics
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| 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
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| How should uterus feel after delivery? | should feel firm and size of grapefruit
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| What are indications of soft, boggy uterus? | soft not firm, higher than umbilicus
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| 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)
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| Location of uterus after delivery? | felt at midline, at or below umbilicus, descending 1cm/day
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| What indication if uterus is felt 2-3 fingers above unbilicus and to the side? | uterine atony with full bladder
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| 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
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| Diet of lactating mother | 500 additional calories; follow food pyramid; no caffiene/alcohol/drugs
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| Menstrual cycle after childbirth during breastfeeding | may be delayed past 6-8wks but may occur at any time with or without bleeding
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| Menstrual cycle after childbirth, not breastfeeding | normal cycle resumes in 6-8wks
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| When should a woman who is not immune to rubella receive the vaccine? | Immediately postpartum and not get pregnant for at least one month
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| 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
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| What are afterpains? | intermittend uterine contractions similar to cramps
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| Afterpains occur more commonly in which pregnancy? | multipara
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| 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)
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| What phase of Rubin's psychological change to puerperium is ideal for teaching? | Phase 2 - Taking Hold
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| 4 ways heat is lost | evaporation, conduction, convection, radiation
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| heat loss by evaporation | liquid on skin evaporates
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| heat loss by conduction | direct skin contact with cold surface
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| heat loss by convection | heat is drawn away by drafts
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| heat loss by radiation | near (but not touching) cold surfaces
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| How do newborns lose heat right after birth? | amniotic fluid evaporates quickly, drafts move heat away, may contact cold surfaces
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| 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
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| When should woman receive RhoGAM after delivery? | within 72 hours after giving birth
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| 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
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| 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
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| Hypoglycemic blood glucose level in newborn | <40mg/dL
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| Signs of hypoglycemia in newborn | jitteriness, poor muscle tone, sweating, respiratory difficulty, low tempterature, poor suck, high pitched cry, lethargy, seizures
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| Interventions for hypoglycemia in newborm | nurse or give formula to prevent fall in blood glucose level
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| 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
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| 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
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| What is oxytocin and its uses? | IV medication that causes uterine contraction to firm uterus after placental detachment postpartum
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| Postpartum discharge instructions | self-care teaching, written materials, emphasize importance of follow-up appts, report any complications ASAP
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| 3 types of thromboembolic disorders | SVT superficial; DVT deep; PE pulmonary embolism
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| 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
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| 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
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| PE pulmonary embolism | sudden chest pain, cough, dyspnea, decreased consciousness, heart failure; treat in ICU and notify physician immediately
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| What is Homans sign? | pain when foot is dorsiflexed
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| 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
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| 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
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| How does oral contraceptive prevent pregnancy? | Prevents ovulation, makes cervical mucous thick and resistant to sperm
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| Side effects to oral contraception | nausea, headaches, breast tenderness, weight gain, spotting, amenorrhea
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| 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
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| Signs of ovulation | rise in basal temperature; change in cervical mucous consistence; date of last period
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| 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
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| What is Clomid (clomiphene)? | therapy for infertility to induce ovulation; can be used with hcG; continued for 6-9 cycles for optimum outcome
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| 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
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| Prevention of osteoporosis | clacium intake from dairy, dark green leafy vegetables, soybeans, wheat breat, and calcium supplements as child and throughout adulthood
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| 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
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| TSS symptoms | sudden spiking fever, flulike symptoms, hypotension, generalized rash that resembes sunburn, skim peeling on palms and soles 1-2 wks after illness
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| What is a vasectomy? | Cut made in each side of scrotum and cut each vas deferens to stop sperm ; outpatient surgery
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| 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
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| Diagnosis of ovarian cyst | transvaginal ultrasound and laproscopy to view ovaries
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| What is candidiasis? | yeast infection; itching and burning on urination; inflammation of vulva and vagina, cottage cheese discharge
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| 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
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| Types of formula preparations | ready to feed; concentrated liquid; powder
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| 4 types of shock after delivery | cardiogenic, hypovolemic, anaphylactic, septic; body compensation can mask until condition becomes life threatening
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| Cardiogenic shock | PE, anemia, HTN, cardiac disorders
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| Hypovolemic shock | hemorrhage or blood clotting disorders
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| Anaphylactic shock | allergic response to drugs given
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| Septic shock | puerperal infection
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| Contraindication of breastfeeding | maternal medications passed to milk; true galactosemia; untreated active TB, HIV, active herpes zoster; drug or alcohol abuse
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| What is prolactin? | hormone from anterior pituitary gland causing production of breast milk
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| What is cystocele? | anterior vaginal wall becomes too weak to support bladder containing urine; may lead to stress incontinence
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| What causes stress incontinence? | cystocele, genital trauma, antidepressants, diuretics, caffiene, anticholinergenics, alcohol, beta blockers, ACE inhibitors
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| What is stress incontinence? | urine leakage caused by sudden increase in intraabdominal pressure like coughing or sneezing
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| Ways to help pelvic floor dysfunction | surgical correction is most definitive relief; can use pessary in vagina for those contraindicated to surgery
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| Pessary device | device to support pelvic structures, used for pelvic floor dysfunction when surgery is contraindicated
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