68WM6 Phs 2 Test 10 Postpartum Nursing Care
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| how much blood is lost during a postpartum hemorrhage? | vaginal birth-500ml, C-Section-1000ml. Marked by 10% loss of hematocrit
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| what are two causes of postpartum hemorrhage? | uterine atony and trauma
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| what is uterine atony? | lack of muscle tone that results in failure of uterine muscle fibers to contract firmly around blood vessels when placenta seperates
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| How long is the postpartum period? | begins with delivery of placenta and ends with normal mesus resumption
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| what is involution? | period of rapid healing and returning to pre-pregnant state
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| what would you check during and NSVD? (Normal Spontaneous, Vaginal Delivery | VS, breasts, uterus, bladder, lochia, perineum, lower extremities, other systems
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| what are typical VS that you would find in postpartum assessment? | elevated temp for 48hrs, BP stable, pulse-bradycardia, Resp.-normal
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| during the 1st 24hrs where is the uterus typicall found? | +/- 1-2cm above the umbilicus
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| how much urine is common in postpartum voiding? | up to 3 liters
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| how would you describe the displacement of uterus upon palpation? | upward and laterally
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| If a pt asks you about when she should expect a bowel movement postpartum, what would you tell her. | should have one in 2-3 days
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| lochia | post delivery uterine discharge- note color, odor, amount, presence of clots
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| what are the three types of lochia? | Ruba-bright red-1st couple days, Serosa-pink to brown lasting through 1st week, Alba-yellow to white lasting 10 days-2 weeks
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| r/t lochia, when should you report findings to a provider? | foul smelling, clot larger than fist, saturated pad in less than 1 hr
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| what does REEDA stand for r/t episiotomy? | Redness, Edema, Ecchymosis, Discharge, Approximation
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| what position would you ask mom to lay in to check perineum and episiotomy? | on her side, Sims, with flexed upper leg
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| what comfort measures can you take for an episiotomy? | Ice pack, topical medications, sitz bath, dry heat/heat lamp, oral analgesics
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| true or false: blood clotting factors are higher and postpartum pts are at higher risk for clot formation | True
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| If a new mom asks if her feet will return to prenatal size, what do you tell her? | Sorry momma, your feet are gonna stay that size.
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| If the new mom asks about the chloasma(mask of pregnancy) will fade and is also worried about her hyperpigmentation, what would you tell her? | Yes ma'am, it will fade and disappear
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| how soon after birth is Rhogam given? | within 72 hours
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| What pt teaching and steps would you take r/t a mother that is not Rubella immune? | Give her the immunization immediately in postpartum period and she must consent to avoid pregnancy for 4 weeks
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| what are the three phases of Rubin's psychological changes of puerperium? | phase 1: Taking in, Phs 2: Taking Hold, Phs 3: Letting go
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| what are some things you would teach the new mom r/t psychosocial adaptations? | taking care of herself, good handwashing, breast care, incision/episiotomy care, REST
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| what are some postpartum danger signs? | verbal/nonverbal passive reactions, hostile reactions, disappointment of sex of baby, lack of eye contact, non-supportive interaction between parents
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| r/t family adaption, what concerns for the mother? | primary caregiver to baby, loss of freedom, must be sensitive to concerns
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| r/t family adaption, what concerns for the father? | must involve w/teaching, involve from birth to develop bond, eager to help but not confident
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| what two drugs can be used to augment/induce labor? | prostaglandins, oxytocin
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| what three drugs can be used to ripen the cervix? | prostaglandins, misoprostol, Mag. Sulfate, endocervical gel
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| what is the action of prostaglandins r/t pregnancy? | produces contractions similar to labor, initiates "ripening" of cervix, stimulates smooth muscles
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| what pharmacological measures can be used to control hemorrhage after birth? | oxytocin, methylergonovine, prostaglandin, misoprostol
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| what is the last resort to stop postpartum hemorrhage? | hysterectomy
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| when doing an assessment for uterine atony, do you want the mom to have a full bladder or empty bladder? | empty
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| what is the second most common reason for postpartum hemorrhage and give two examples | trauma - assistive devices (vaccum, forceps)
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| what are three predisposing factors for lacerations r/t birth | rapid labor, forceps, vaccum
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| what are some s/s of a vaginal hematoma? | bulging, blue-ish or purple-ish mass of the vulva or perineum, not usually visible from outside, severe pain analgesics can not relieve, pressure on vulva, pelvis or rectum
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| what are the predisposing factors of a hematoma? | prolonged or rapid labor, large baby, use of forceps or vaccum
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| what is considered late hemorrhage? | hemorrhage later than 24 hours after delivery or 7-14 days after delivery w/o warning
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| what are the most common causes of late postpartum hemorrhage? | subinvolution, fragments of placenta still in uterus
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| what are predisposing factors for late hemorrhage? | manual removal of placenta, attempt to remove placenta before it seperates from wall, placenta accrete
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| what is subinvolution? | A slower than expected return of the uterus to its non-pregnant size after delivery
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| what are the two common reasons for subinvolution? | retained placenta and pelvic infection
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| what are s/s of subinvolution? | prolonged d/c of lochia, irregular/excessive bleeding, pelvic pain/feeling of heaviness, backache, fatigue
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| what is the progression of lochia? | lochia rubra, lochia serosa, lochia alba
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| what are three causes of Thrombosis? | venous stasis, hypercoagulation, blood vessel injury
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| what is venous stasis? | compression of the large vessels of the legs and pelvis by enlarging uterus, long time in stirrups can also cause this
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| factors that promote clot formation increased and factors that promote clot prevention increased results in what? | hypercoagulation
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| what are predisposing factors for thromboembolitic disorders? | varicose veins, obesity, oral contraceptives, smoking, women older than 35
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| what are s/s of venous thrombosis? | swelling, redness, tenderness, warmth, enlarged cord-like veins, pain while walking
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| how would you tx superficial thrombosis? | analgesics, rest, elevate legs, elastic support, warm packs, avoid standing for long period of times,
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| s/s of DVT | swelling(legs), erythema, pedal edema, + Homan's signs, affected leg - pale&cool, chills
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| what are three ways to diagnose DVT? | ultrasoundography, doppler flow analysis, MRI
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| changes in the shape of the head to allow it to pass through birth canal | molding
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| areas of the head where sutures between the head meet. | fontanelles
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| results in localized edema (fluid) that crosses suture lines in the head | caput succedaneum
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| this is blood between the periosteum and the skull that is on one or both sides of a particular bone and does NOT cross suture lines | cephalohematoma
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| what are Epstein's pearls? | small white dots inside the mouth - normal
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| what is vernix caseosa? | thick white cream cheese-like substance. helps to determine term of baby.
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| white cysts 1-2mm in size that appear on face | milia
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| how often do you assess respirations after birth? | q 30 min
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| normal resp rate for newborn? | 30-60 p/min
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| Tachypnea | >60 resp p/min (r/t newborns)
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| define retractions & 3 examples | using accessory muscles to breath - substernal, intercostal, supraclavicular
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| most breathing "abnormalities" are normal for how long after birth? | about 1 hour
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| differentiate between central cyanosis and acrocyanosis | acrocyanosis is peripheral cyanosis(hands, feet, and mucous membranes of face)
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| one or both nasal passages are blocked or narrowed by bone or membrane? | choanal atresia
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| a newborn should void in the first ? hours | 12
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| rooting | touching side of face with finger, baby turns head, opens mouth
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| moro reflex | infant's arms and legs extend and abduct with fingers forming a "C"
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| palmar grasping reflex | spontaneous grasp of adult finger
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| plantar grasp reflex | toes curl over when foot is touched
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| tonic neck reflex | in supine position, head turns to side and arm extends
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| babinski reflex | stroking the lateral sole of infant's foot from heel forward - toes flare out
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| dance or stepping reflex | hold infant upright and touch feet to solid surface giving appearance of trying to walk
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| what is cytotec used for and what drug classification is it? | cervical ripening and induction of labor. Prostaglandin analog
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| what are contraindications of cytotec? | prior C-section, placenta previa, acute HSV out break, any other contraindication of vaginal delivery
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| how long should a woman remain in the supine position after an endocervical gel is applied? | 15-30 min
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| what meds would you expect every baby to get upon birth? | Vit K, antiinfectives(erythromycin, tetracycline), Vaccines - Hep B
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| what does a meconium stool look like? | tarry, black, sticky-icky, odorless
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| what are 4 drugs used to tx postpartum hemorrhage? | pitocin, hemabate, cytotec, methergine
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| where are hematomas r/t birth trauma usually located? | on the vulva or inside the vagina
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| tachycardia, increased resp rate, decreased bp, pale cold clammy skin, confusion, and decreased urinary output are all s/s of | hypovolemic shock
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| what are s/s of subinvolution? | prolonged discharge of lochia, irregular or excessive uterine bleeding, pelvic pain, pelvic heaviness, backache, fatigue, malaise
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| bacterial infection after birth | puerperal infection
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| what are some postpartum depression risk factors? | marital dysfunction, anger about pregnancy, medical problems during preg, financial worries, lack of support, birth of infant with anomalies/illness, multifetal preg
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| what does a meconium stool look like? | tarry, black, sticky-icky, odorless
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| what 4 things do you measure on a newborn? | weight, avg length, head circumference, chest avg
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| what is the avg length of a newborn? | 19-21 inches 48-53cm
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| what is the normal weight range for a newborn? | 5 lb 8oz - 8 lb 13oz - AVG: 7.5 lb
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| what is the normal range for head circumference? | 33-35.5cm
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| what are the avg temp ranges for axillary and rectal? | 97.7-99.5 - 97.7-99.7 axilla preferred
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| within the first hour or so, what meds would you expect the Doc to order for a newborn? | Vit K, erythromycin
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| what do you clean the umbilical cord with? | alcohol or triple dye
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| how many ID bands are made upon birth of baby? | 4 total - 2 for baby, 1 for mom, 1 for significant other
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| 110-120 calories/kg/day is what? | Daily need for a newborn
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| what is the avg requirement of milk p/day for a newborn? | 10-21 ounces
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| A thick yellow substance high in protein, minerals, fat soluble vitamins and immunoglobulins, which transfers some immunity to the infant | colostrum
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| Appears as the milk changes from colostrums to mature milk; Immunoglobulins and protein decrease, whereas lactose, fat, and calories increase | transitional milk
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| Established by two weeks after delivery. Bluish in color and not as thick as colostrum | mature milk
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| How long should you either use breast milk or modified cow's milk(formula)? | 12 months
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| newborn characteristics that predispose them to heat loss | skin is thin and blood is close to surface, little subcutaneous/white fat, low % of subq fat, more surface area than body mass
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| what are the two types of jaundice? | physiologic and pathologic
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| when would you expect to see physiologic jaundice? | two to three days old
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| when would you expect to see pathologic jaundice? | first 24 hours
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| what is a significant level of bilirubin in a newborn? | 1.5-2 mg/dl
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| bilirubin/jaundice that crosses the blood brain barrier that causes cerebral palsy, mental retardation, hearing loss, and more subtle long-term neurologic problems | kernicterus
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| as the nurse, what risk factors are you looking for r/t hyperbilirubinemia | delayed or poor intake, cold stress, prematurity, asphyxia, infection, breastfeeding, sepsis, Rh/ABO in capability
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| s/s are benign rash of unknown cause in newborns, blotchy red areas that may have white or yellow papules or vesicles in the center; "fleabite rash" | ERYTHEMA TOXICUM
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| bluish black marks that resemble bruises, usually in the sacral area, frequent in newborns with dark skin | mongolian spots
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| pinpoint bruises that resemble a rash, increased intravascular pressure, may indicate infection or low platelet count | petechiae
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| flat, pink, or reddish discoloration, usually on face or neck, color blanches, disappear by 2 years of age | nevus simplex
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| known as port wine stain, permanent, flat, dark, reddish-purple mark, varies in size and location, can be removed by laser surgery | nevus flammeus
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| known as strawberry hemangioma, enlarged capillaries in the outer layer of skin, dark red and raised w/rough surface | nevus vasculosus
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| lacelike red or blue pattern, cold stress, overstimulation, hypovolemia, or sepsis, may indicate chromosomal abnormality | cutis marmorata
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| deep red color over half of body with pallor on the other half, usually seen w/ infants that are placed on side | harlequin color change
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| hands and feet may appear slightly blue | acrocyanosis
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| pearly white pinpoint papules on face and nose newborn due to clogged sweat and oil glands not functioning properly | milia - teach parents NOT to squeeze out
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| what are the two main types of methods for circumcision? | gomco clamp, plastibell
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| what are some therapeutic management steps you can take r/t DVT | ROM exercises w/in 8 hrs after childbirth, ambulate asap, antiembolism stockings, or SCD's, teach mom about tight pants and prolonged sitting (no good)
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| what would be the initial tx for a mom with DVT? | bedrest, elevate leg, gradual ambulation, anticoagulant therapy, analgesics, moist heat for pain
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| what are s/s of a PE | sudden chest pain, cough, dyspnea, depressed consciousness & signs of heart failure
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| what is an infection after childbirth - (episiotomy site, lacerations, uterus, urinary tract, breasts) | puerperal infection
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| what are s/s of a puerperal infection? | temp >100.4 or higher, localized redness, edema, pain, fever, malaise, loss of appetite
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| an infection of the uterine lining often at the site of the placenta | endometritis
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| s/s of endometritis | fever, chills, uterine tenderness, abd pain, foul-smelling lochia, leukocytosis after 1st day
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| what IV antibiotics would be administered to tx endometritis? | clindamycin and gentamicin
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| suprapubic pain, low-grade fever, dysuria, polyuria, chills, and spiking fever are all s/s of what? | UTI
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| prenatal age of a baby (measured in weeks) | gestational age
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| how many weeks is considered pre-term | < 38 wks
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| how many weeks is "term" | 38-42 wks
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| what is "postterm" | > 42 wks
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| what is the name of the scoring system used to assess gestational age? | Ballard Scoring System
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| what is the range of scoring on the Ballard Scoring System? lowest score to highest score | -10 to 50, -10 lowest, 50 highest
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| SGA | Small for Gestational Age
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| AGA | Appropriate Gestational Age
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| LGA | Large for Gestational Age
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| ELBW - how many grams? | extremely low birth weight - 1000g or less
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| VLBW - how many grams? | very low birth weight - 1500g or less
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| LBW - how many grams? | low birth weight - 2500g or less
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| what are three classifications for gestational age? | preterm, term, postterm
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| If the baby is showing experiencing respiratory distress and insufficient surfactant, what would you expect? | Respiratory Distress Syndrome
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| IV antibiotics, meticulous handwashing, warmth maintenance, and nutrition are steps to prevent what? | Sepsis
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| infants less than 28 weeks 1500g or less that have optical impairment is know as? | Retinopathy of prematurity
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| blood diverting from the GI tract caused by an infection in an infant is called? | Necrotizing enterocolitis
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| what are s/s of necrotizing enterocolitis? | abd distention, decreased bowel signs, vomiting, bile-stained emesis, bloody stools, abd tenderness, s/s of infection
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| what are some treatments of necrotizing enterocolitis? | antibiotics, NPO, gastric suction, parenteral nutrition, possibly surgery(ostomy)
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| what are two nursing interventions for a baby with necrotizing enterocolitis? | measure abd girth, and position baby on side so minimize pressure on diaphram
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| High levels of oxygen, oxygen-free radicals, and high positive-pressure ventilation that damage bronchial epithelium and interfere with alveolar development is what? | Bronchopulmonary Dysplasia
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| what is the result of Bronchopulmonary Dysplasia? | inflammation, atelectasis, edema, airway hyperreactivity with loss of cilia
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| what are some s/s of Bronchopulmonary Dysplasia? | Tachycardia. Tachypnea. Retractions. Rales. Wheezing. Respiratory acidosis. Increased secretions. Bronchospasm. Characteristic changes in the lungs on chest X-ray
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| what are 4 tx for BPD? | use of steriods, minimize o2, avoid fluid overload, increased nutrition, bronchodialators, diuretics, increased calories and proteins
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| what are 5 handicaps for newborn preterm babies? | inadequate respiratory function, sepsis, poor temp control, ROP, NEC, BPD, hypoglycemia, hypocalcemia
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| at what gestational age does an infant have the ability to suck and swallow? | 34 wks
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| what are heat loss factors of an infant? | think skin, lack of brown fat, larger head-greater body surface, temp control center of brain is immature, limp extended body posture, complication from heat loss
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| what are signs of heat loss in an infant? | decreased skin temp, s/s of respiratory difficulty, signs of hypoglycemia, mottled skin, lathargy, decreased muscle tone
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| what nursing interventions would you take for an infant with heat loss? | place baby in warmer, monitor skin temp, avoid cold surfaces, warmed o2, weaning to open crib
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| what are physical characteristics of a postterm baby? | thin w/loose skin, unusually alert and wide-eyed, little vernix, skin wrinkles, long nails
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| what are some problems you could expect with a postterm baby? | Asphyxia, Meconium aspiration,Poor nutrition status, higher perinatal mortality rate, Risk for low temperature, Polycythemia
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| what are 4 tx for BPD? | use of steriods, minimize o2, avoid fluid overload, increased nutrition, bronchodialators, diuretics, increased calories and proteins
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| what are 5 handicaps for newborn preterm babies? | inadequate respiratory function, sepsis, poor temp control, ROP, NEC, BPD, hypoglycemia, hypocalcemia
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| at what gestational age does an infant have the ability to suck and swallow? | 34 wks
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| what are heat loss factors of an infant? | think skin, lack of brown fat, larger head-greater body surface, temp control center of brain is immature, limp extended body posture, complication from heat loss
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| what are signs of heat loss in an infant? | decreased skin temp, s/s of respiratory difficulty, signs of hypoglycemia, mottled skin, lathargy, decreased muscle tone
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| what nursing interventions would you take for an infant with heat loss? | place baby in warmer, monitor skin temp, avoid cold surfaces, warmed o2, weaning to open crib
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| what are physical characteristics of a postterm baby? | thin w/loose skin, unusually alert and wide-eyed, little vernix, skin wrinkles, long nails
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| what are some problems you could expect with a postterm baby? | Asphyxia, Meconium aspiration,Poor nutrition status, higher perinatal mortality rate, Risk for low temperature, Polycythemia
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| when assessing the postterm infant, what will you look for? | Resp distress, hypoglycemia, hypothermia, jaundice
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| what is hydrocephalus? | Condition caused by an imbalance in the production and absorption of CSF in the ventricles of the brain
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| hydrocephalus can be a result of preexisting defects such as? | Arnold-Chiari malformation and Dandy-Walker Syndrome
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| what is Arnold-Chiari malformation? | the cerebellum and medulla extend down through foramen magnum
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| describe the Dandy-Walker syndrome | When the enlarged head involves a prominent occiput, the condition usually involves an atresia of the foramen of Lushka and Magendie
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| what would you expect to find in your assessment of a baby with hydrocephalus? | fontanel is full or bulging, head is enlarged, setting-sun is apparent
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| in infants, what is the predominant sign of hydrocephalus? | head enlargement
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| what primary methods are used to diagnose hypocephalus? | CT & MRI
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| what is the name of the shunt placed to tx hypocephalus? | Ventriculoperitoneal Shunt
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| what are the two classifications of hydrocephalus? | communicating and noncommunicating
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| define spina bifida and give the two types; | Midline defect involving failure of the bony spine to close; Spina Bifida Occulta. Spina Bifida Cystica
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| which type of spina bifida is NOT seen externally? | Spina Bifida Occulta
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| where would spina bifida occulta usually present and what can you identify externally that would clue you in? | lumbosacral area, a dimple on the back with possible tuft of hair over it
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| what are two major forms of spina bifida cystica? | meningocele(meninges and spinal fluid), meningomyelocele(contains meninges, nerve roots, spinal cord, and spinal fluid)
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| how can you diagnose neural tube defects? | MRI, Ultrasound, CT, myelography, elevated AFP, chorionic villus sampling
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| what are some nursing considerations r/t neural tube defects? | diapering, skin care, post-op care, latex-free environment, family support
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| what are some nursing interventions for a CL/CP infant? | Breck feeder(large syringe w/soft rubber tubing), feed in upright postion b/c milk will enter nasal passage=aspiration, feed slowly to burp frequently, wash away milk curds with water
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| what is PKU? | phenylketonuria- genetic disorder that causes central nervous system damage from toxic levels of amino acid phenylalanine in the blood
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| s/s of PKU: | feeding difficulties, vomiting, hypertonia, irritability, eczema and musty odor of urine
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| what type of diet would you expect to be ordered for a child w/ PKU? | fruits, veges, starches a w/phenylalanine-free protein supplement
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| when would you screen for PKU? | 24-48 hrs post birth
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| what are ways to diagnose Down Syndrome? | AFP screening, multiple marker screening, chorionic villus sampling, amniocentesis, nuchal translucency
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| what are some physical signs of Down Syndrome? | brachycephaly, small rounded skull, flat face profile, upward/outward slant of eyes, small depressed nasal bridge, high arched palate, downward curve of mouth, mouth kept open
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| how would you describe the hands, feet, chest, abd of a child w/ Down Syndrome? | hands:short/stubby, incurved fingers, feet:wide space between big toe and second toe, Chest:shortened rib cage, Abd:protruding, muscles lax and flabby, diastasis recti
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| what other problems could a child with Down Syndrome also be at risk for? | congenital heart malformation, resp tract infection, dysfunction of immune system, hypothyroidism, leukemia
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| bleeding around and into the ventricles of the brain | Periventricular-Intraventricular Hemorrhage
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| what grading scale is used with PIVH? | 1-4 with 4 being most serious
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| what are s/s of PIVH? | lethargy, poor muscle tone, decreased resp status with cyanosis or apnea, drop in Hct level, decreased reflexes
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| what nursing interventions would you take for a PIVH pt? | minimal handling, reduce environment stressors, parental support
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| what are some complications a newborn will have whose mother is diabetic? | cardiac, urinary tract, GI, neural tube defects, cardiomegaly
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| what would you expect to find in an assessment of a newborn of a diabetic mother? | resp problems, hypoglycemia, rapid resp w/ low temp and poor muscle tone
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| describe postop care for a Cleft lip baby | arm restraints, prevent from sucking or crying, prevent infection, elbow restraints, pain relief/sedation
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| describe post-op care for a cleft palate baby | lie on abd, may resume feeding, oral packing, clear to full liquids
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| what is a complex deformity of the ankle and foot; forefoot adduction, midfoot supination, hindfoot varus, and ankle equinus? | congenital clubfoot
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| there are 4 types of clubfoot. name them | Talipes varus, talipes valgus, talipes equines, talipes calcaneus
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| plantar flexion in which the toes are lower than the heel | talipes equines
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| an inversion or bending inward or the foot | talipes varus
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| an eversion or bending outward | talipes valgus
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| dorsiflexion, in which the toes are higher than the heel | talipes calcaneus
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| this is the most common occuring clubfoot type - the foot is pointed downward and inward in varying degress of severity | talipes equinovarus (TEV)
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| heel | talus
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| pes | foot
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| equinus | extension
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| varus | bent inward
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| what are the three stages in management of clubfoot? | correction, maintenance, follow-up
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| what are the three stages DDH? (Developmental His Dysplasia | acetabular dysplasia, subluxation, dislocation
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| r/t DDH, what is Galeazzi sign? | shortening of the limb on the affected side
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| what are two other tests that are used to identify DDH? | Barlow's test and Ortolani's Sign
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| what is the harnes called that you would expect to see a child with DDH wear and how long will they 'usually' wear it? | Pavlik harness - 3-5 months
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| how is the hop joint maintained in splinting? (think position of joint and bones) | proximal femur centered in the acetabulum in an attitude of flexion
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| what are s/s of PKU in older children? | eczema, hypertonia, hyperactive behavior, mental retardation, seizures, hypopigmentation of the hair, skin, and irises.
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| what 4 drugs are most commonly used for postpartum hemorrhage? | Oxytocin, Methergine, hemabate, cytotec
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| what are nursing interventions for late postpartum hemorrhage? | assess frequently, allow rest periods, encourage intake of foods high in iron, assess for dizziness/low BP
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| s/s of postpartum depression | lack of enjoyment in life and food, disinterest in newborn and others, inability to make decisions, constant fatigue, feeling of unworthiness, suicidal feelings
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| s/s of postpartum psychosis | sleep disturbances, confusion, agitation, irritability, hallucinations, tearfulness, preoccupation with guilt, lack of appetite, excessive concern w/ baby's health
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|
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