Exam 10: Review
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| How long is the puerperium and what happens during that time? | 6-8 weeks. During this time the woman’s body makes rapid physiological adaptations reversing the physiological changes that occurred during pregnancy, while at the same time trying to adjust to the new family members.
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| What is involution? | Involution is the process that results in the rapid healing of the birth canal and the return of the uterus and all systems to (or almost to) the prepregnant state.
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| When is a temperature considered abnormal postpartum? | If Temp > or equal to 100.4 for two out of the first ten days or if it is elevated during the first day and accompanied by sx such as calf pain, foul smelling lochia, or dysuria it may be due to infection and need to be reported to the hcp.
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| What hormone is responsible for stimulating milk production postpartum? | Prolactin
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| What is the hormone that causes milk ejection? | Oxytocin
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| How long does it take for lactation to be suppressed? | 5 days
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| Nipple trauma should suggest what nursing intervention? | Instruct mom on proper positioning with latch.
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| Where is the fundus located during the first 24 hours after delivery? | + or – 1-2 cm above or below the umbilicus and then it descends below the umbilicus approx 1 cm/day.
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| What is the first nursing intervention for a boggy uterus? | massage the fundus until firm
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| What is the next nursing intervention if massage alone cannot maintain contraction of the uterus? | plan to administer pitocin and call the hcp
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| Why does a full bladder increase vaginal bleeding? | Full bladder pushes the uterus up and to the side impeding contraction.
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| Why do we always support the uterus with one hand above the symphysis pubis when we massage the uterus? | to prevent accidental uterine inversion and a subsequent hemorrhage.
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| How do you tell the difference between septic shock, anaphylactic shock and hypovolemic shock? | septic is often flushed and feverish, in anaphylactic usually immediately follows an exposure to a new drug or food, in hypovolemic Pt is pale, diaphoretic with a narrow pulse pressure, falling systolic pressure, tachycardia and decreased urine output
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| Name 3 nursing interventions for uterine cramping. | motrin or tylenol, hot pack, uterine massage-
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| Name 4 nursing interventions to help relaxation of the perineal muscles and stimulate the sensation of needing to void. | medicate for pain, run water in the sink or shower, pouring water over the vulva, encouraging urination in the shower or sitz bath, providing hot tea or fluids of choice, asking the mother to blow bubbles through a straw.
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| Name 3 signs of UTI to teach postpartum patients. | urgency, frequency or dysuria
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| What is the difference between postpartum blues, postpartum depression and postpartum psychosis? | postpartum blues are mild and self-limiting.
depression lasts longer than 3 weeks and includes physical and psychological signs of clinical depression.
postpartum psychosis is rare and involves loss of contact with reality, delusions and/or hallucinatio
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| When is the best time to begin bonding between mom and baby? | as soon as possible after birth
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| List ACOG’s discharge criteria. | mother is without complications and all assessments are wnl, lab data has been reviewed and Rhogam or rubella vaccines have been given if indicated, the mother has received discharge instructions on caring for herself & baby.
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| What is the most common cause of early postpartum hemorrhage? | uterine atony
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| What is the most common cause of late postpartum hemorrhage? | retained placental fragments
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| When should the postpartum uterus be down below the symphysis pubis? | Day 10
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| Name 3 signs of uterine sub-involution? | prolonged discharge of lochia, excessive uterine bleeding, sometimes profuse hemorrhage, pelvic pain or heaviness, bachache, fatigue and persistant malaise
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| What is the difference between superficial and deep venous thrombosis? | superficial thrombosis is unlikely to be life threatening and can be managed with rest, analgesis, elevation of the extremies, compression hose and warm moist heat.
DVT can lead to pulmonary embolism and acute onset CP, SOB and hemoptysis.
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| When should a woman put on her support hose? | before getting out of bed in the morning.
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| What is cholasma? Does it go away? | AKA “the mask of pregnancy” -- usually resolves.
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| What positions are commonly used for breastfeeding? | side lying, or sitting up with a cradle hold or foot ball hold.
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| Name 5 signs of a good latch. | side lying, or sitting up with a cradle hold or foot ball hold.
Mouth covers most of areola, not just on nipple. Cheeks stay round during suckling. Mom denies pain or pinching during feedings after the first 15-20 seconds.
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| What is a sitz bath? | a sitz bath is a soak in warm water to clean the perineal area and encourage resolution of swelling from pushing around episiotomies/lacerations or due to hemorrhoids.
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| What are hemorrhoids? | hemorrhoids are dilated veins in the anus that can be very painful and often appear during pregnancy or after prolonged or forceful pushing in stage II.
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| Name 3 signs of mastitis | temp > 100.3, hot, red tender area on breast usually the upper outer quadrant often accompanied by a flu like malaise.
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| What is endometritis? | infection of the uterine lining postpartum s/sx include fever, abd tenderness, uterine sub-involution and foul smelling lochia. Often associated with prolonged ROM or multiple vaginal exams during labor after ROM.
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| What is lanugo? | fetal hair
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| What is vernix? | cheesy substance that protects the skin of the fetus.
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| What is acrocyanosis? | bluish discoloration in hands and feet due to poor peripheral circulation in the newborn.
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| What is “Doll’s eyes” | Doll’s eyes is the rolling motion of the eyes to the midline when the baby is turned on its side.
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| What is the rooting reflex? | baby turns head to that side if the mouth or cheek is touched (usually with nipple. This is a breastfeeding reflex to help the baby latch on)
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| Describe the startle reflex? | The baby opens the arms wide and brings them back partially to the midline with the hands in the “c” position in response to a sudden stimuli like a loud noise or being unwrapped.
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| Describe the normal VS in a newborn.i.e. HR, RR and temp. | HR= 110-160
RR=30-60
Temp. Report <97.4 or >100.3 98-99 is ideal.
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| Describe common interventions to warm a baby with a low temperature. | place under warmer until temp rises, then dress warmly with two blankets and a hat and recheck temp in about 30-60 minutes to see if baby can maintain body temperature.
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| What is the best way to monitor temperature in a baby with a low temp? | Monitor temperature with a skin probe while infant is under the warmer.
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| Name 3 early signs of an infected newborn. | RR > 60, low temp, low tone/poor feeding.
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| What should you teach parents about phototherapy for jaundice? | the baby’s liver is immature and cannot break down the bilirubin, a produce of RBC breakdown, fast enough. The bilirubin is depositied in skin to decrease blood levels and makes it look yellow.
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| What are “milia?” | small white bumps ,usually on the nose and face. No intervention is needed. They will resolve on their own. Don’t squeeze them.
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| What does newborn rash look like? | Newborn rash looks like blotchy flat red spots with a tiny pimple in the center. May last days to weeks but will clear on its own without treatment.
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| Describe cord care. | practice varies between institutions and you may use, antibiotic ointments, soap and water or alcohol to clean area. Goal is to keep it clean and dry so it will fall off.
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| What is a circumcision? | circumcision is removal of the foreskin and has the AAP that data re potential benefits is insufficent to warrant routine circumcision for medical reasons.
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| When should the plastibell fall off? | in 5-8 days
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| In the first 6-8 hours of life what are your priority assessments? | bleeding and time of first void (baby should void within 6-8 hours after procedure.
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| Why do premies have problems with hypoglycemia? | premies lack glycogen (stored glucose) and fat stores which increases their risk for low blood sugar.
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| BPD (bronchopulmonary dysplasia) and ROP (retinopathy of prematurity) are both results of what treatment? | high levels of oxygen therapy
--thinner skin and higher skin surface to core area increase heat loss.
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| Name 3 differences from term babies that predispose premature infants to complications | immature gut predisposes to risk of NEC
immature lungs lack surfactant increase risk for RDs
immature liver increases risk for jaundice
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| What is necrotizing enterocolitis? | life threatening inflammatory bowel condition associated with prematurity that may lead to cellular death of areas of intestinal mucosa.
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| How does breastfeeding affect the risk for NEC? | breastmilk decreases the risk of developing NEC probably due to IgAs, WBC and other anti-bacterial agents in breast milk.
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| Why are premies often gavage fed? | nippling consumes a great deal of energy. Some premies have difficulty coordinating sucking, swallowoing and breathing and are unable to consume sufficient calories before they become fatigued and may be at risk for aspiration.
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| How often should you check gastric residuals on gavage fed infants? | before every feeding.
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| If the SOP at your facility is to replace gastric aspirate instead of discarding it, what should you do next before initiating a feeding? | reduce the amount of the feeding by the amount of aspirate.
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| Why should we give the premie a pacifier during tube feeding? | It stimulates the sucking reflex, helps prepare the infant for nippling, is comforting and helps the infant associate sucking with feeding.
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| Why do postdates infants also have problems with hypoglycemia? | postdates infants also lack glycogen stores due to poor nutrition reserves due to decreased placental function late in the pregnancy.
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| Describe the typical postdates newborn. | Postdates babies have dry cracked (or peeling) skin and may look long and skinny due to weight loss. Little vernix or lanugo. May have lots of hair on head.
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| Name four causes of heat loss in newborns. | Conduction, convection, evaporation and radiation.
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| What is hydrocephalus? | ”water on the brain” a excessive amount of CSF due to over production or blockage in the drainage system. Treatment usually requires placement of a ventriculo-peritoneal shunt.
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| What is a “pavlik harness” and what condition is it used to treat? | a harness that maintains the hip joints in external rotation and flexion to encourage pressure of the femur head against the acetabulum. It is used to treat congenital hip dysplasia.
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| At what age does the risk of having a baby with Down’s syndrome increase? | Age 35, but most baby’s with Down’s syndrome are born to women in their twenties because this population has the most babies, even though their overall risk is lower.
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| What is intraventricular hemorrhage in the newborn? What are some signs to watch for? | bleeding in the ventricles of the brain, common with delivery of premature infants and in infants with hemorrhage disease of the newborn; Stages I-II are mild; Stages III-IV may have longer term defects.
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| What two complications are common in infants born to diabetic mothers? | these infants are prone to hypoglycemia and jaundice as well as muscle and nerve injuries related to traumatic deliveries due to macrosomia.
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| Name three signs of a baby with Down’s syndrome. | slanting eyes, large protruding tongue, low set ears, simian crease, inward curve of fourth and fifth fingers.
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| What is the Ballard scale? | the ballard scale uses neuromuscular and physical characteristics of the newborn to estimate gestational age after delivery if dates are unsure or baby appears to be older or younger than expected by the EDD.
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| What is physiologic jaundice? | 50% of newborns experience some degree of mild (non-toxic) jaundice related to elevated bili-rubins from RBC breakdown and an immature liver in the first few days after delivery. No Treatment.
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| What is pathologic jaundice? | often occurs within the first 24 hours after birth and is related to pathologic processes resulting in dangerously elevated levels of bili-rubin that can result in kernicterus.
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| What are the two most common treatments for pathologic jaundice? | common treatments are phototherapy and in severe cases exchange transfusions.
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| What is erythroblastosis fetalis? | hemolytic red cell breakdown in the fetus in response to blood incompatibilities between baby and mother. Severe cases can cause fetal kernicterus, CHF, asiites and death.
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| What is spina bifida? | an open neural tube defect where the bony spine does not close around the spinal cord and nerve tissue and neural membranes protrude outside the spine.
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| What are two signs of occult spina bifida? | Two signs of occult spina bifida are coarse hair along the spinal column and lipomas on the spinal column on the baby’s back.
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| What is the vitamin supplement that can prevent 75% of open neural tube defects? | folic acid 0.4-0.6 mg/day. 0.8 recommended for twin pregnancies
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| Describe nursing care for the baby with a cleft palate. | feed in an upright position., feed slowly with frequent stops to burp, wash away milk curds with water after feeding. Many babies with unilateral cleft lip or palate can breastfeed.
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| Nevus Simplex | stork bite flat pink or red discoloration due to dilated capillaries—usually gone by age 2-3.
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| Nevus Flammeus | port wine stain Permanent flat dark reddish purple birthmark
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| Nevus Vasculosus | strawberry hemangioma, dark red raised lesion grows in size up until about 5-6 months –usually regresses until gone by early school age.
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| Cutis Marmorata | mottling
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| What are café au-lait spots? | permanent light brown or tan birth marks that may occur anywhere on the body. >5 are associated with an increased risk for neurofibromatosis.
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| What are mongolian spots? | flat blue/black pigmentation patches usually on the back or buttock in darker skinned babies. May be in extremities or shoulders. Usually disappears in childhood. Occasionally persists to adulthood. Benign.
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| Varus | foot is inverted or bent forward
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| Valgus | foot is everted or bent outward
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| Equines | Foot is in plantar flexion with the toes lower than the heel
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| Calcaneus | Foot is dorsifelxes and the toes are higher than the heel
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| What is hip dysplasia? | Hip dysplasia is a congenital defect where shallow hip sockets cause the femur to dislocate from the hip easily.
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| What is PKU? | congenital error of metabolism in which the body cannot breakdown toxic by products associated with metabolism of pheny alanine which is an amno acid.
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| What does LGA stand for? | Large for gestational age
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| What does SGA stand for? | Small for gestational age.
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