OB exam 3
How does clamping of cord initiate breathing
DROP in prostaglandin clamp cord
benefit of pacifier cons of pacifier
reduce SIDS nipple confusion *dont discourage pacifier use in a healthy baby who is bresatfeeding*
A baby is just delivered. Which of the following physiological changes is of highest priority?
respirations
what causes subinvolution
retained placental fragments infection
A breastfeeding mother states that she has sore nipples. In response to the complaint, the nurse assists with "latch on" and recommends that the mother do which of the following?
rotate postitions each feed
immunizaitons to give mom upon discharge
rubella varicella Tdap maybe rhogam
time frame for PP blue
start 1-2 days PP --> 1-2 wks PP
list phases of maternal PP adjustment
taking in taking hold letting go
PPH with frank blood indicates
this is bright red - lacerations
how does mastitis rpesent
unilateral flu like symptoms
when does discharge teaching start
upon admission
PPH with dark red blood indicates
uterine atony or prolapse
what is this cause of PPH: nonpalpable uterus with pain
uterine inversion
vaccines given after 1st year of life
varicella and MMR
Immediately after delivery, a woman is shaking uncontrollably. Which of the following nursing actions is most appropriate?
warm blankets
when is Rhogam given
within 72 hrs PP
is HA pp normal?
yes but rule out HNT
Which of the following is the priority nursing action during the immediate postpartum period? 1. Palpate fundus. 2. Check pain level. 3. Perform pericare. 4. Assess breasts.
1. Palpate fundus.
name mechanical stimuli that initiates breathing
-compression of thorax -crying -*positive intrathoracic pressure*
describe dependent-independent taking hold phase
-focus on care of baby and competent mothering -asks Q -desire to take charge -need for nurturing and acceptance -eager to learn
describe dependent taking in phase
-focus on self -rely on others -exicted and talkative -want to talk about birth experience
risk factors of PP depression
-h/o of anxiety/depression -unintended pregnancy (preterm/twins, etc) -lack of social support -unmarried -stressful life events in previous yr -marital probs/violence o thyroid imbalance o DM o Mothers who underwent fertility tx o Complications in pregnancy, birth or breastfeeding o Preterm or ill babies o Multiparity o Low SES o Unintended pregnancy
nonpharm mx for episiotomy/laceration care
-peri bottle w warm water -wash with mild soap and warm water at least 1x per day and wash hands (no gloves) -lie on side -cool compress -shower -clean pad after using bathroom (sitz help w pain)
how long does lochia rubra last
1-3 days (4 is ok)
A client, G1 P0101, postpartum 1 day, is assessed. The nurse notes that the client's lochia rubra is moderate and her fundus is boggy 2 cm above the umbilicus and deviated to the right. Which of the following actions should the nurse take first?
1. MASSAGE 2. bathroom
when do we see lochia alba
10-14
BP when we should call Dr
140/90 on 2+ occassions at least 6 hrs apart --> preeclampsia
PPH if saturate pad within ___
15 min or an hr
how many ml of urine do we expect per void adn total in first few days PP for mom
150 ml/void 3000+ ml per day
when does baby get DTaP
2 months
when does baby get polio
2 months
baby gets MMR when?
2 y/o for rubella
A client who delivered a 3,900-gram baby vaginally over a right mediolateral episiotomy states, "How am I supposed to have a bowel movement? The stitches are right there!" Which of the following is the best response by the nurse? 1. "I will call the doctor to order a stool softener for you." 2. "Your stitches are actually far away from your rectal area." 3. "If you eat high-fiber foods and drink fluids you should have no problems." 4. "If you use your topical anesthetic on your stitches you will feel much less pain."
2. "Your stitches are actually far away from your rectal area."
A maternity nurse knows that obstetric clients are most at high risk for cardiovascular compromise during the one hour immediately following a delivery because of which of the following?
2. Excess blood volume from pregnancy is circulating in the woman's periphery. (high BP bc high volume)
when is dependent-independent taking hold phase
2/3rd day to 10+ days
how long does engorgement last if mom frequently BF
24 h
avg weight of baby
2500-4000
when does baby get Hep b
3 injections in forst 6 mo (1st in first month)
when breastfeeding dont give pacifier for how long?
3-4 weeks
what days do bilirubin normally peak
3-5
A primipara, 2 hours postpartum, requests that the nurse diaper her baby after a feeding because "I am so tired right now. I just want to have something to eat and take a nap." Based on this information, the nurse concludes that the woman is exhibiting signs of which of the following? 1. Social deprivation. 2. Child neglect. 3. Normal postpartum behavior. 4. Postpartum depression.
3. Normal postpartum behavior. (taking in phase)
nurse should ntofy HCP if Hct drops below
30%
NORMAL Hct for PP woman
35-45 (ANYTHING BELOW 30 IS A CONCERN)
when do we see lochia serosa
4-10
It has just been discovered that a newborn is missing from the maternity unit. The nursing staff should be watchful for which of the following individuals? 1. A middle-aged male. 2. An underweight female. 3. Pro-life advocate. 4. Visitor of the same race.
4. Visitor of the same race.
do we suction nose or mouth first
mouth!
when can pt exercise
6 wk
time frame for PP depression
6-12 months PP (can start wk 4)
normal pulse ox for baby
95+
should mom take supplements when BF
no
food restrictions when breast feeding
none
drugs that will cause PPH
oxytocin magnesium sulfate
S/S of DVT
pain warmth redness edema
when to do physical portion of ballard
ASAP (NM is not ASAP just within 24h)
CI of methargine
HTN & heart conditions & preeclampsia
how much drop in Hct and Hgb is expected to be seen after birth
Hct: 2% Hgb: 0.5
you CAN breastfeed if you have which virus
Hepatitis (HIV is CI)
IS PP BLUES A RISK FACTOR FOR PP DEPREESION
NOOOO!!!!
benefits of BF for mom (6)
PP depression PP blood loss DM heart disease obesity *reproductive cancers*
how to prevent evaporation when baby warm
WDS
sensory stimuli that initiates breathing
WDS lights temp change noise nose and mouth suctioning
can baby come out of phototherapy?
YES for like 30 min to feed & mom to hold
when does baby get varicella
after 1 y/o
caution of prostaglandin R2 (dinoprostone) if hx of
asthma HTN/hypotension
hemabate CI if
asthma (or HTN) hx
what to tell mom after getting MMR
avoid pregnancy for 28 days
BUBBLE-E
breast uterus bladder bowel lochia episiotomy emotional state
best non-hormonal BC
breast feeding
how to manage/prevent engorgement
breastfeed Q2-3h warm compress before ice pack/cabbage after
which type of birth increases risk of DVT
c section
checmical stimuli to initiate breathing
cessation of placental BF
what is suspected if continuous bleeding w/o cause
coagulopathy --> give factor VIII
air draft is what kind of heat loss
convection
The nurse should warn a client who is about to receive Methergine (ergonovine) of which of the following side effects?
cramping (BC IT CONTRACTS UTERUS)
which position for BF uses pillow
cross cradle
when do we normally see engorgement
day 3-5
if mom had anesthesia encourage
deep breathing
tachycardia indicates
dehydration infection PPH
what phase is mom dealing with physical and emotional change
dependent-independent taking hold phase
what phase is mom in during PP blues
dependent-independent taking hold phase
what is baby wearing in phototherapy
diaper adn eye shield
SE of misoprostol
diarrhea --> increase fluids
what is indicative of PPH
drop of 10% in hct (MAKE SURE TO CALCULATE 10% NOT SUBTRACT 10)
what causes hematoma
episiotomy or forceps birth
what is expected in active alert state of baby
expressing hunger and frustration
when is dependent taking in phase
first 24-48 hrs
when is fundus at level fo umbilicus
first 24h
births putting mom at risk for PPH
forceps c-section
focus of interdependent letting-go-phase
forward movement of family as a unit -mom allows family involvement -reassure relationship and sex w partner
The nurse informs a postpartum woman that which of the following is the reason ibuprofen (Advil) is especially effective for afterbirth pains?
has anti-prostaglandin effects
what is this cause of PPH: "my butt is hurting"
hematoma
smacking, lickign lips and opening & closing mouth indicates
hunger
where is bulb syringe kept
in crib always
cephalohematoma puts baby at risk for
jaundice
what is this cause of PPH: Uterus is firm and well contracted but constant trickle or frank (bright red blood) bleeding
laceration
causes of genital tract laceration
large baby operative birth fast birth abnormal presentation
body surface in baby vs adult
larger in baby (little skin exposed is a lot for a baby)
what is it called when milk flow starts
let down reflex
what to give to pt if subinvolution of uterus
methargine
temp indicating infection in mom baby?
mom: >100.4º+ baby: >100º
