ob exam three

bronchopulmonary dysplasia prognosis

require oxygen support life long abnormalities increased risk for pulmonary decompensation in severe cases

breast physical assessment postpartum

supportive and properly fitted bra if breastfeeding assess warmth, tenderness, firmness, and redness of breast assess nipples monitoring for engorgement, mastitis, and other infection

neonatal abstinence syndrome treatment

swaddling, pacifier, frequent diaper changes, decreased stimulus, skin to skin, small frequent feeding morphine, methadone, buprenorphine

client self teaching nutrition

calorie recommendations, continue taking prenatal vitamin and/or iron supplement

cervical changes postpartum

can be bruised or have lacerations external os of cervix will close slowly; shape altered permanently

immune complication signs and symptoms

can be subtle and nonspecific

parental feeding

can improve neurodevelopment outcomes, growth and mortality in very low birth weight infants

explanation for night sweats

normal physiologic occurrence that results as body attempts to eliminate excess fluids that were present during pregnancy. may be aggravated by plastic mattress pad

physiologic jaundice def

normal process during transition; appears after 24 hours

postpartum blues client self care teaching

normal psychological changes in postpartum period, signs and symptoms, when to call healthcare provider, involving family/support person during education is crucial

postpartum UTI risk factors

nulliparity assisted childbirth prolonged labor

laceration of genital tract risk factors

nulliparity, epidural, precipitous childbirth, macrosomia, instrument-assisted birth, and oxytocin use

education opportunities postpartum

nutritional counseling breastfeeding assistance maternal exercise newborn/infant care newborn/infant development parenting courses

respiratory distress syndrome assessment

observing for signs and symptoms, blood gases

hypothermia assessment

observing for signs and symptoms, temperature monitoring

late/secondary hemorrhage def

occurs 24hr to 12 weeks postpartum

early/primary hemorrhage def

occurs first 24 hours after childbirth; more common

retained placental fragments def

often occurs when partial separation of placenta from uterus, during fundal massage, before spontaneous placental separation wait to fundal massage until after placental separation

relinquishing mother def

one who chooses to place her newborn for adoption or one who has conceived via traditional or gestation means and is acting as a surrogate mother with the intention of placement of the newborn with another family

preterm cardiovascular complications

patient ductus arteriousus

intraventricular hemorrhage causes

maternal preE, fetal asphyxia, chorio

subinvolution treatment

methedrine 0.2mg Q 3-4 hrs for 24-48 hrs antibiotics curettage

onset of mastitis

3-4 weeks postpartum and with any decrease in nursing frequency

persistent pulmonary hypertension risks

34-37 weeks gestation, SGA, LGA, GDM, AMA, PPROM, RDS, diaphragmic hernia, pneumonia, MAS

small for gestational age/fetal growth restrictions def

<10%

leukocytes in mastitis

>100,000

large for gestational age def

>90% or 4000g

puerperal morbidity

A temperature of 38C or higher for any 2 of the first 10 days postpartum, exclusive of the first 24 hours.

persistent pulmonary hypertension assessment

ECHO, preductal-postductal difference is >10% difference

a recently postpartum client who has heavy vaginal bleeding that does not lessen after a fundal massage says, "I am so thirst. May I have some ginger ale?" which is an appropriate reply by the nurse?

I know this is difficult; however, it's best for you to wait until the bleeding has subsided. I can give you a moisturizer for your lips to relieve the dryness

immune complication causes

IgG is transferred to fetus after 32 weeks poor skin integrity invasive procedures and devices maternal infection increases risk

neonatal encephalopathy assessment

MRI

neonatal pain scales

NIPPS, NPASS

DVT or embolism prevention

SCDs until ambulating regularly dangle legs over side of bed within 12 hours postpartum up with assistance

tobacco use during pregnancy

SGA, increased irritability, hypertonic negative impact on breastfeeding long term: ADHD, asthma, neuro disorders, SIDS

retinopathy of prematurity def

abnormal vascular growth of blood vessels in the retina

fundus indicative of full bladder

above umbilicus and deviated to the right

fundus indicative of excessive bleeding

above umbilicus and/or boggy (not firm)

resumption of sexual activity postpartum

abstain until perineum is healed and lochia flow has stopped vaginal dryness common, water-based lubricant milk ejection may occur during intercourse/orgasms

which additional nursing care is needed for the postpartum client after a cesarean birth that may not be necessary following vaginal birth?

administering the prescribed pain medication in scheduled intervals

general principles of postpartum assessment

ask woman to void before assessment always do vital signs before assessment pre-medicate if applicable incorporate teaching breasts, uterus, bladder, bowel, lochia, episiotomy, homans, emotional

hypoglycemia treatment

assess at risk groups 30-60 min after birth carefully monitor feeding check blood glucose levels maintain a warm environment monitoring blood glucose Dgel, D10

persistent lochia rubra nursing action

assess location and firmness of fundus assess activity pattern assess for signs of infection record and report findings

presence of clots nursing action

assess location and firmness of fundus, assess voiding pattern, record and report findings

prevention with early ambulation

assist with postpartum ambulation first few times dizziness not uncommon should ensure client is steady, without dizziness, and able to sit without assistance before first shower signs/symptoms of DVT

therapeutic hypothermia

at least 36 wk start with 6 hours lasting 72 keep infant core temp 33-35 degrees C gradual rewarming

urinary tract postpartum

at risk of distention and difficulty voiding- anesthesia even higher risk puerperal diuresis causes rapid filling of bladder urinary stasis increases risk of infection and hemorrhage

where should fundal position be 6-12 hours postpartum?

at umbillicus

sga/fgr signs and symptoms

average sized head with long skinny body, thin umbilical cord, separated sutures

mutual regulation phase

balance is sought between needs of mother and baby

preE postpartum implications

blood pressure increased CNS irritability= increased risk for seizure increased need for bedrest= increased risk for thrombophlebitis

non pharmacological pain management

breastfeeding, nonnutritive sucking, swallowing, skin to skin, oral sucrose

necrotizing entercolitis treatment

broad spectrum antibiotics, surgery, bowel rest

perineal changes postpartum

bruising, swelling, check approximation for any lacerations or episiotomies completely healed by 4-6 months

integumentary birth injuries

brusing lacerations

postpartum thromboembolic risk factors

c/s, prolonged immobility, obesity, smoker, trauma to extremity, diabetes, anemia

postpartum endometritis risk factors

c/s, prom, prolonged labor preceding cesarean birth, multiple vaginal examinations during labor, compromised health status, use of fetal scalp electrode or intrauterine pressure catheter for internal monitoring during labor

pph nursing care management

call for help, initiate rapid response team massage to firm fundus and remove clots initiate or verify IV access weigh pads to accurately monitor blood loss vital signs Q15 oxygen if client desat void or catheterize to eliminate overdistention replace volume with saline or LR elevate legs 30 degrees to promote circulation and venous return

nonnutritive sucking

calming effect, may improve digestion

apnea assessment

continuous monitoring

pulmonary infection prevention

cough/deep breathe and incentive spirometer

postpartum hemorrhage defined

cumulative blood loss greater than or equal to 1000 ml or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process regardless of route of delivery

anemia causes

decrease in erythropoiesis increase need for blood testing short abc life span

thromboembolic disease assessment

edema of leg or ankle, low-grade fever with subsequent chills and high grade fever, tenderness or pain in leg, inguinal area, or abdomen, palpable cord, color changes to affected limb, humans sign, limb pale/cool to touch

full bladder fundal intervention

empty bladder and reassess fundus

ptsd symptoms

feeling numb seeming dazed and unaware of environment irritable intrusive thoughts and flashbacks difficulty thinking and sleeping avoidance of anything remind her of event

taking in period

first several days passive, somewhat dependent, follows suggestions, hesitates with decisions, preoccupied with own needs, food and sleep major

fourth stage of labor

first two hours after birth immediate recovery maternal organs undergo initial change frequent assessments required

venous thrombosis def

formation of blood clot at an area of impeded blood flow in a superficial or deep vein

postpartum endometritis assessment

foul-smelling lochia, fever, uterine tenderness on palpation, lower abdominal pain

sub involution symptoms

fundal height greater than anticipated lochia not progressing normally package, leukorrhea, and foul smelling lochia

acquaintance phase

getting to know baby first day or two

HIV

goal is to reduce transmission

intraventricular hemorrhage assessment

head circumferences, ultrasounds

patient ductus arteriosus treatment

ibuprofen and indomethacin

persistent lochia rubra possible problem

inadequate uterine contractions, retained placental fragments, infection, undetected cervical laceration

hypothermia prognosis

increase risk for hypoglycemia, IHV, acidosis

neonatal abstinence syndrome prognosis

increased risk for mental and behavioral issues decreased IQ

retained placenta postpartum implications

increased risk of hemorrhage increased risk of infection

precipitous labor postpartum implications

increased risk of laceraction to birth canal= hemorrhage

extended period of time in stirrups at birth postpartum implications

increased risk of thrombophlebitis

overdistention of uterus postpartum implications

increased risk of thrombophlebitis increased risk of problems breastfeeding increased risk of hemorrhage increased risk of anemia increased stretching of abdominal muscles increased incidence and severity of afterpains

necrotizing enterocolitis signs and symptoms

increased stomach girth, bowel loops, feeding intolerance, hypotension, temperature instability, respiratory distress

diuresis postpartum

increases postpartum failure to diurese increases risk for pulmonary edema and cardiac issues

temperature postpartum

increases up to 38 C first 24 hours related to exertion, dehydration, and mother's milk coming in

neonatal encephalopathy def

infants >35 weeks who demonstrate neurological dysfunction

peritonitis

infection involving the peritoneal cavity

perperal infection

infection of the reproductive tract associated with childbirth that occurs up to 6 weeks postpartum

which component of nursing care is most important for a newborn with respiratory distress syndrome?

keeping the infant in a warm environment

neonatal encephalopathy causes

largely unknown but linked to perinatal asphyxia

acute bilirubin encephalopathy clinical presentation

lethargy fever irritability jitteriness hypotonia apnea poor feeding seizures high-pitched cry

musculoskeletal birth injuries

nasal septal dislocation fractions, CLAVICLE most common

preterm nutrition complications

necrotizing enterocolitis

diabetes postpartum implications

need for insulin regulation episodes of hypoglycemia or hyperglycemia decreased healing

jaundice/hyperbilirubinemia prognosis

neurotoxin= can cause death levels >25mg/dL= risk for bilirubin0induced neurologic disfunction

lochia odor

non offensive and never foul

respiratory distress syndrome prognosis

o2 levels outside 90-95% are associated with worse outcomes risk for pneumothorax

intraventricular hemorrhage prevalence

occurs in 45% of extreme low birthweight infants

neurological birth injuries

ocular, intracranial hemorrhage (increased risk with assistive deliveries), brachial plexus injuries (usually unilateral paralysis of arm), facial nerve trauma (forceps)

meconium aspiration syndrome def

passage of meconium in utero typically due to intrauterine stress. leads to physical obstructions, chemical irritation, infections, and decreased surfactant production

factors that slow involution

prolonged labor, anesthesia, full bladder, retained placaenta

bronchopulmonary dysplasia signs and symptoms

pulmonary edema, narrowing of the airway, airway scarring, wheezing, decreased lung compliance, severe retractions

risks with c/s immobility

pulmonary infection abdominal distention DVT or embolism

persistent pulmonary hypertension etiology

pulmonary resistance remains high right to left shunting in heart -> blood bypasses lungs and fails to get oxygenated self perpetuating and difficult to interrupt

involution of uterus def

rapid reduction in size of the uterus and its return to the pre-pregnant state excess tissue that involved placenta and no longer needed sloughs off

syphilis

rash on posterior and soles of feet fetal hydros, meningitis

cytotec route postpartum

rectal

reeda scale

redness, edema, ecchymosis/brusing, discharge, drainage, and approximation

prevention of mastitis

regular drainage of both breasts

uterine atony definition

relaxation of the uterus; accounts for 80% of PPH

respiratory distress syndrome treatment

respiratory support, surfactant, temperature control, intake and output

necrotizing enterocolitis prognosis

sepsis, DIC, hypoglycemia, metabolic acidosis

intraventricular hemorrhage treatment

supportive care avoid triggers

chlamydia

swelling and discharge vision problems pneumonia

apnea treatment

tactile stimulation CPAP caffeine

a woman who gave birth to a second child 3 weeks ago is depressed, crying, and having extreme difficulty caring for her children. which approach would the nurse take when the husband calls the women's health clinical and asks what he should do?

telling him that his wife may be suffering from depression and needs emergency care

explanation for large stomach after birth and failure to lose all weight gained during pregnancy

the baby, amniotic fluids, and placenta account for only a portion of the weight gained during pregnancy. the remainder takes approximately six weeks to lose. abdomen also appears large because of decrease muscle tone. postpartum exercises will help

explanation for gush of blood that sometimes occurs when she first arrises

there is a normal pooling of blood in the vagina when the woman lies down to rest or sleep. gravity causes blood to flow out when she stands

T pneumonic for bleeding

tone, trauma, tissue, and thrombin

respiratory distress syndrome causes

too little surfactant causes alveoli to collapse= decreased lung compliance

pharmacological pain management

topicals, acetaminophen, opioids, nerve block, deep sedation

hematoma risk factors

trauma to area, primiparity, macrosomia, prolonged second stage, preE, clotting disorder, history of vulvar varicosities

discharge assessment and follow up postpartum

up to date on immunization access to and filled prescriptions for analgesics ensure client has access to follow-up care discuss family planning and contraception before discharge home visit or follow-up phone call 3-4 days after discharge

intraventricular hemorrhage signs and symptoms

usually occur in first 5 days, diagnosed with ultrasound

apnea prognosis

usually resolve by 44 weeks for very preterm

retinopathy of prematurity treatment

usually resolves itself more severe cases require intervention

uterine atony risk factors

uterine distention, prolonged labor, oxytocin in labor, grand-multiparty, anesthesia, magnesium sulfate, Procardia, terbutaline, prolonged 3rd stage of labor, pre eclampsia, retained placental fragments

abdomen postpartum

uterine ligaments stretched and takes postpartum period to recover; also responds to exercises diastatic recti abdominis straie/stretch marks generally fade with time

PPH treatments

uterine tamponade uterine artery embolization surgical management

retained placental fragments treatment

uterotonic agents or curettage

fundal massage

utilized if uterus not firm and contracted may expel clotsand correct cause consider pain medication if additional massage/interventions needed

immune complication prevalence

very common- 43%

treatment for afterpains

warm pack to abdomen, analgesics, ambulation, and prone position with pillow

cleft lip and palate special considerations

watch feedings monitor for respiratory issues

uterine inversions causes

weak muscle, relaxed uterus from anesthesia or drugs, abnormal placental adherence to uterus, manual removal of placenta, or cord tugging

thrombophlebitis def

when clot forms as a response to inflammation in the vein wall

pulmonary embolism def

when clot, formed in deep leg veins, is carried to pulmonary artery

how does phototherapy work

when exposed to blue light bilirubin is converted to lumirubin which does not need to be conjugated in the liver

persistent pulmonary hypertension signs and symptoms

within 24 hours cyanosis and respiratory distress split S2 or systolic murmur

the nurse has received the end-of-shift report on the postpartum unit. which client should the nurse see first?

woman day of delivery, fundus firm 2 cm above umbilicus

prostaglandin contraindications

women with cardiovascular, renal, liver disease, or asthma

jaundice/hyperbilirubinemia symptoms

yellowing that starts in face and moves down yellowing of eyes

persistant pulmonary hypertension prognosis

10% mortality rate risk for developmental delay, CP

weight loss postpartum

10-12 lbs after delivery of neonate and placenta 5lbs from puerperal diuresis return to pre pregnancy by 6-8 weeks postpartum

average blood loss cesarean delivery

1000 mL

corrected age used until when

2 years of life

target weight gain

20-30g/kg/day

average blood loss vaginal delivery

200-500 mL

twelve hours after a spontaneous birth a clients temperature is 100.4 F. which condition would the nurse suspect as the cause of this increase temperature?

dehydration

phototherapy monitoring

dehydration, closely monitor intake and output obtain and monitor vital signs weight loss reassess bilirubin level per providers orders (TURN OFF LIGHT WHILE DRAWING BLOOD AND NO TCB)

what is jaundice/hyperbilirubinemia

difficulties conjugating bilirubin and removing it from body

postpartum UTI clinical therapy

straight catheter x1 bladder scanner to evaluate volume of urine in bladder reoccurrence of distention indwelling catheter for 24 hrs often indicated

alcohol use during pregnancy

structural defects, vision and hearing problems 1st cause of preventable birth defects long term: substance abuse, risk taking behaviors, cognitive impairments

sepsis symptoms

subtle temperature instability, irritability, lethargy, respiratory symptoms, poor feeding, tachycardia, poor perfusion, hypotension

bronchopulmonary dysplasia treatment

supportive may need tracheostomy for long term oxygen delivery increased calorie needs and fluid restrictions

persistent pulmonary hypertension treatment

supportive care first ECMO treat underlying cause

cleft lip and palate treatment

surgical repair at 3 months for lip and 6 months for palate

bright red blood with

suspect lacerations

treatment for laceration

suture/repair

immune complication treatment

antibiotics

DVT and PE treatment

anticoags strict bedrest elevation of affected limn compression stockings analgescs closely monitor for bleeding

preterm respiratory complications

apnea of prematurity respiratory distress syndrome bronchopulmonary dysplasia

postterm

birth at 42wk gestation or later

cleft lip and palate causes

due to genetic syndromes or exposure to teratogens

methergine contraindications

hypertension preE

anemia signs and symptoms

poor weight gain, increased oxygen needs, braydcardia, and apnea

enteral tube feeds

for infants who can't suck, swallow, or breath often started small and gradually increased

cardiac disease postpartum implications

increased maternal exhaustion

clinical therapy for postpartum psychosis and ptsd

psychiatric meds (lithium for psychosis), support groups, electroconvulsive therapy, removal of baby (for psychosis)

hypothermia causes

decrease in subq and brown fat lack of muscle tone immature brain

postpartum/puerperium period

after competition of the third stage of labor; period during which the woman readjusts, physically and psychologically, from pregnancy and birth. it begins immediately after birth and continues for approximately six weeks or until the body has returned to a near non pregnant state

third stage of labor

after delivery of fetus and until delivery of placenta shortest stage of labor placenta and amniotic membranes examined for intactness cord blood obtained

which clinical manifestation would the nurse assess for in a client a few hours into alcohol withdrawal?

agitation, tremulousness

lochia day 10-21

alba

postpartum endomedtritis

an inflammation of endometrium portion of the uterine lining

preterm hematologic complications

anemia

postpartum endometritis treatment

antibiotics (IV for metritis) wound with pus/drainage or infected stitch will have be opened and drained

treatment for mastitis

antibiotics, frequent and complete emptying of breast, rest and increased fluids, supportive bra, heat/ice, nsaids, monitor for access formation, probiotics to promote health flora and decrease risk for candida albicans

A neonate born at 35 weeks' gestation has Apgar scores of 8 and 9. At 4 hours of age the newborn begins to experience respiratory distress, has a below-normal temperature in a warm environment, and has a low blood glucose level. What problem does the nurse suspect?

bacterial sepsis

mastitis diagnosis

based on presenting signs and symptoms culture and sensitivity of breast milk if client does not respond to antibiotics or has reoccurring mastitis

postpartum exercises

begin keels right after birth to help with vaginal tone and prevent urinary leakage short walks abdominal exercises retone muscles reassess exercises if increased lochia or pain vigorous exercise only after cleared at 6 wk postpartum visit

very preterm

birth from 28 to 31 6/7 wk gestation

moderate-to-late preterm

birth from 32 to 36 6/7 wk gestation

late preterm

birth from 34 to 36 6/7 wk gestation

early term

birth from 37 to 38 6/7 wk gestation

full term

birth from 39 to 40 6/7 wk gestation

late term

birth from 41 to 41 6/7wk gestation

extremely preterm

birth prior to 28wk gestation

preterm

birth prior to 37wk gestation

intraventricular hemorrhage def

bleeding into the later ventricle of the brain

immune complications assessment

blood cultures, lumbar puncture, C-reactive protein

sepsis assessment

blood cultures, lumbar puncture, CPC, CRP, chest xray

hypoglycemia def

blood glucose <45 mg/dL (<40 in first four hours)

explanation for passing clots

blood pools at the top of then vagina and forms clots that are passed upon rising or sitting on the toilet

afterpains postpartum

caused by intermittent uterine contractions more common in multiparas oxytocic agents and breastfeeding makes afterpains worse

headache postpartum

causes include cerebrospinal fluid leakage or stress

apnea causes

central, obstructive, or mixed

at 20 hours of age, a newborn is found to have a bilirubin concentration of 13mg/dL. which finding most likely contributed to this bilirubin level?

cephalhematoma

kernicterus clinical presentation

cerebral palsy sensorineural hearing loss gaze abnormalities dental enamel dysplasia (permanent irreversible effects)

meconium aspiration syndrome assessment

chest x-ray, arterial blood gasses

sepsis risk factors

chorioamnioitis, maternal intrapartum temperature of 100.4 F or greater, delivery prior to 37 wk gestation, maternal GBS colonization, prolonged rupture of membranes of 18 hrs or more, fetal tachycardia, meconium-stained fluid, use of a fetal scalp electrode, use of forceps, apgar score of 6 or less

superficial vein disease def

clot involves saphenous vein; more common in women with pre-existing varicose veins and seen 3-4 days postpartum

phototherapy parent education

cluster care and feed newborn at least every 2-3 hours avoid lotions or ointment; can cause skin burns AQUAPHOR ONLY adverse effects are few

preterm temperature instability complications

cold stress

the nurse plans to delegate some of the tasks for the discharge of a postpartum client to an unlicensed health care worked. which activity must be performed by the nurse?

comparing identification bands of the mother and infant

fundus still boggy after massage

concern for postpartum hemorrhage

common complications of infant of diabetic mother

congenital abnormalities stillbirth hypoglycemia hyperbilirubinemia polycythemia delayed lung maturity

meconium aspiration syndrome treatment

deep suctioning is no longer supported focus on maintenance of ventilation and perfusion surfactant therapy ECMO

nursing assessment for mastitis

daily assessment of breast including skin color, surface temperature, nipple condition, and presence of pain if infection present, assess for cracked nipples, poor hygiene, engorgement, supplemental feedings, change in routine or feeding pattern, abrupt weaning, or lack of breast support

necrotizing enterocolitis causes

delayed transit time, increased permeability of GI tract, failure of colonization of good bacteria, breast milk has decreased risk

neonatal encephalopathy prognosis

depends on severity

posttraumatic stress disorder def

development of characteristic symptoms following exposure to one or more traumatic events... examples labor and delivery, loss of baby

hemoglobin and hematocrit postpartum

difficult to interpret because of changing blood volume postpartum 2-3 point drop hematocrit for every 500mL blood loss

which education would the nurse provide to a mother of a newborn regarding the safe use of breast milk?

do not thaw the breast milk in the microwave breast milk can be stored for up to 6 months in the freezer

neonatal abstinence syndrome def

drug withdrawal in infants from mothers that use drugs while pregnant usually seen in first 48-72 hours

post term infants assessment

dry, cracked skin no vernix, lanugo meconium staining

retinopathy of prematurity signs and symptoms

edema, hemorrhage, detachment of the retina

vaginal changes postpartum

edematous and bruising evident, rugae no longer present vagina returns to near normal size and regale returns

white blood cells postpartum

elevated postpartum (20-25k) returns to normal by end of 1st week

postpartum diaphoresis

elimination of excess fluid and waste perspiration at night common offer fresh, dry gowns/linens and shower/sponge bath encourage increased fluid intake

lung physical assessment postpartum

encourage cough and deep breathing; incentive spirometer with c/s, monitoring for pulmonary edema (preterm and preE women at higher risk)

nursing interventions to assist mother in process

encourage skin to skin instruct about newborn caregiving building awareness of and responsiveness to infant interactive capabilities promoting maternal newborn attachment preparing the woman for maternal social role

seizures post partum

epileptics at higher risk postpartum ensure they are taking antiepileptics

large hematoma treatment

evacuation via incision and drainage, ligation of blood vessel, sometimes vaginal packing, antibiotics often ordered

prolonged labor postpartum implications

exhaustion increased risk of hemorrhage nutritional and fluid depletion increased bladder atony and/or trauma increased pain and bruising from prolonged time in stirrups

difficult birth postpartum implications

exhaustion increased risk of perineal lacerations increased risk of hemorrhage anemia

nursing considerations for phototherapy

expose as much skin as possible to light position light and/or pad in line with bank of lights; position height appropriately remove all the baby's clothing except diaper apply eye covering

toxoplasmosis

eye and neuro issues

gonorrhea

eye lid swelling and discharge, leads to eye damage

subinvolution def

failure of a part to return to its normal size after functional enlargement, such as failure of uterus to return to normal size after pregnancy

platelets postpartum

falls as a result of placental separation returns to normal by six weeks postpartum

maternal newborn initial attachment behavior

familiarizes self with baby, touching activities, face to face and eye to eye contact, greets newborn and talks in high pitched voice, responds verbally to noises newborn makes

mother/baby (couplet) care def

family-centered approach for maternal-child nursing where both the mother and her baby are cared for by the same nurse, with the baby remaining at the mothers bedside

mastitis signs and symptoms

flu-like symptoms, warm-reddened painful area of breast

critical postpartum teaching concepts

headache, leg pain, abnormal vaginal bleeding, swelling of face or extremities, chest pain or shortness of breath, thoughts of harming self or baby, oral temperature of 100.4 F or higher, excessive incisional pain or discharge

uterine stimulatns

help contract the atonic uterine muscles oxytocin, cytotec, methergine, and hematate/prostaglandin prophylactic IV/IM oxytocin most effective right after cord clamping

pathologic jaundice def

hemolytic diseases causing total bilirubin to be higher; appear first 24 hours ABO/Rh incompatibility increase RBC breakdown

abruptio placentae, placenta previa postpartum implications

hemorrhage anemia decreased uterine contractility after birth= increased risk of infections

postpartum psychosis risk factors

history of bipolar disorder and postpartum psychosis

ptsd risk factors

history of prior trauma and/or psychiatric history and women who undergo emergency c/s

sibling reaction to postpartum

hospital visitation encouraged, opportunity to see mother and meet baby before discharge need reassurance that they are still special to the parents regression of sibling not uncommon

gi system postpartum

hunger and thirst immediate postpartum period common sluggish bowels delayed elimination and constipaition for fear related pain with bearing down increased gas pain

risk factors for postpartum depression

hx of depression, ppd, or bipolar illness stressful life events primiparity ambivalence about maintaining the pregnancy lack of social support dissatisfaction with herself complication of delivery loss of newborn age

causes of postpartum thromboembolic disease

hyper coagulability of blood, increased blood clotting factors, postpartum thrombocytosis, release of thromboplastin substances from decider, placenta, and fetal membranes with delivery, increase in fibrinolysis inhibitors venous status injury to epithelium of vessel

postterm and LGA complications

hypoglycemia meconium aspiration syndrome birth trauma infection cephalopelvic disproportion polycythemia

late preterm infants at risk for

hypothermia, hypoglycemia, respiratory distress, jaundice, feeding difficulties

low or decreasing blood pressure a sign of

hypovolemia and/or hemorrhage

small hematoma treatment

ice first 24 hrs and then heat

postpartum women with psychiatric disorder assessment

identify risk factors obtain personal/prenatal/family health history provide screening tools observe for objective signs of depression recognize risk for suicide

presence of clots possible problem

inadequate uterine contractions that allow bleeding from vessels at the placental site

immune complications prognosis

increase risk of mortality and longer hospital stay

postpartum UTI causes

increased diuresis increased bladder capacity decreased bladder sensitivity from stretching or trauma bacterial shedding with urinary stasis contamination from catheterization inhibited neural control of bladder following anesthesia

cesarean birth postpartum implications

increased healing needs increased pain from incision increased risk of infection increased length of hospitalization exacerbation of carpal tunnel syndrome

mastitis definition

inflammation of the breast with or without bacterial infection, that occurs primarily in lactating women

contraception postpartum

information made available to couple before discharge from hospital stress that pregnancy can occur before first menstrual period returns

vulvar, vaginal, and pelvic hematomas caused by

injury to blood vessel from birth trauma soft tissue opportunistic for large and rapid hematoma development

retained placental fragments diagnosis

inspect delivered placenta for intactness and for any missing fragments uterine exploration sonography

postpartum chills

intense tremors that resemble shivering immediately after birth caused by hormones, anesthesia, and release of pressure on the pelvic nerves

lactation post partum

interplay of hormones lead to established milk production

preterm neurological complications

intraventricular hemorrhage periventricular leukomalacia

anemia treatment

iron supplementation, blood transfusions

neonatal abstinence syndrome signs and symptoms

irritability, high-pitched cry, sleep/wake disturbance, failure to thrive, hypertonia, hyperactive reflexes, tremors, skin excoriation, disorganized feeding, vomiting, frequent loose stool, swelling, sneezing, mottled skin, fever, nasal stuffiness, yawning

which finding would the nurse report to the health care provider after assessing a 12-hour old newborn?

jaundice

apnea prevention

keep at stable temperature airway in neutral position

jaundice exchange transfusions

most effective way, but more risk, more expensive reserved for very high levels or neonate with neurologic symptoms very effective in ABO/Rh incompatibility blood is removed and replaced 10% at a time

postpartum psychosis def

most serious of psychiatric disorders but rare a medical emergency because of suicide and infanticide risk

hypothermia signs and symptoms

mottled, cyanotic, cool to touch

hypoglycemia signs and symptoms

lethargy, sleepiness, limpness, poor feeding, hypothermia, temperature instability, pallor, cyanosis, respiratory distress, hypotonia, tremors, high-pitched cry, exaggerated Moro reflex

maternal newborn attachment factors

level of trust and self esteem, capacity for enjoying herself, adequacy of knowledge about childbearing and childrearing, prevailing mood or usual feeling ton, and reactions to the present pregnancy

oral feeds

limit feeding attempt to 15-20 min limit number of attempts per day stop with signs of distress

retinopathy of prematurity risk factors

low gestational age and weight artificial ventilation surfactant therapy

fetal alcohol syndrome signs and symtpoms

low nasal bridge minor ear abnormalities indistinct philtrum micrognathia epicanthal folds short palpebral fissures flat mid face and short nose thin upper lip

phototherapy goals

lower bilirubin

neonatal encephalopathy treatment

maintain physiologic hemostasis seizure control fluid restriction therapeutic hypothermia

uterine inversions treatment

manual repositioning of uterus in pelvis by doctor

lochia def

maternal discharge of blood, mucus, and tissue from the uterus

patient ductus arteriosus screening

measure spo2 on right hand (pre-ductal) then on other extremity (post-ductal) greater than 3% deviations indicate follow up, repeat results indicate heart defect

anemia assessment

monitor for signs and symptoms, cbc

postpartum blues symptoms

mood swings, anger, weepiness, anorexia, difficulty sleeping, and a feeling of letdown... when asked why she's crying responds IDK

explanation for afterpains

more common in multipara. caused by contraction and relaxation of uterus. increased by oxytocin, breastfeeding. received with mild analgesics and time

intraventricular hemorrhage prognosis

mortality rate is 40% at grade IV bleed cerebral palsy post hemorrhagic hydrocephalus

reciprocity

mutual regulation achieved and mother/baby interaction mutually gratifying

respiratory distress syndrome signs and symptoms

pale, cyanotic, decreased lung sounds/crackles, retractions, nasal flaring, tachypnea, grunting chest x-ray show ground glass appearance

fundus is not firm

perform fundal massage and should firm up with massage

postpartum blues def

period of depression that can occur postpartum

cytomegalovirus

petechiae, jaundice, neuro issues, hearing loss

on the third postpartum day after a cesarean birth a client tells the nurse that her breasts feel warm, firm, and tender. the skin is shiny and taut. which condition would the nurse suspect as the cause of the client's breast discomfort?

physiologic engorgement

the nurse in the postpartum unit is teaching self-care to a group of new mothers. which color would the nurse teach them that the lochial discharge will be on the fourth postpartum day?

pinkish brown

taking hold period

postpartum day 2 or 3 ready to resume control of mothering and life; critical judges own ability to care for abby; nurse should reassure client and encourage

sga/fgr complications

prematurity, FETAL HYPOXIA, mas, hypothermia, hypoglycemia, polycythemia

migraines postpartum

prevalence returns to pre-pregnancy baseline postpartum

exfoliation part of healing process

prevents uterine scarring that can affect future pregnancies and implantation

postpartum blues risks

primipara, hormones, unsupportive environment/insecurity, fatigue, and pain

uterine inversion def

prolapse of the uterine fundus to or through the cervix so that the uterus is in effect, turned inside out after birth

bronchopulmonary dysplasia causes

results from oxygen adminsitration and mechanical ventilation

cardiac output postpartum

return to predelivery levels 1hr post delivery return to prepregancy level 6-12 weeks postpartum

reoccurrence of ovulation and menstruation postpartum

returns 7-12 weeks for non lactating women and 3 months to as late as 3 years for lactating women

hypothermia treatment

rewarming

siblings and others

rooming-in and visiting hours encourages participation of attachment for other family members/siblings

lochia day 2-4

rubra

skin infections

scalded skin syndrome- staph aureus

transient tachypnea of the newborn signs and symptoms

seen within 2 hours of birth, clear breath sounds, typically resolve in 24-48 hours

neonatal encephalopathy signs and symptoms

seizures, poor tone, diminished reflexes, feeding difficulties, weak cry 5 and 10 min APGAR below 5 acidemia

transient tachypnea of newborn treatment

self limiting, monitor closely some may need supplemental oxygen and NG feeds

transient tachypnea of the newborn causes

self-limiting, delayed clearance of alveolar fluid increased risk for c-sections, preterm, diabetic mothers

GBS

sepsis, pneumonia, meningitis

lochia day 7-10

serosa

lochia amount

should never exceed moderate, average 6 partially saturated peri pads/day normal

meconium aspiration syndrome signs and symptoms

signs of respiratory distress within 15 min increased anterior posterior diameter rale and rhonchi

abdominal distention prevention

simethicone ambulate when able general anesthesia client at higher risk lie on left side; promotes gas expulsion

father newborn interactions

similar to mothers attachment engrossment: sense of absorption, preoccupation, and interest in baby

postion to assess perineum

sims postion/buttocks lifted

postpartum psychosis symptoms

sleep disturbances depersonalization confusion hallucinations psychomotor imbalances

client self teaching for sleep

sleep when baby sleeps, utilize family and friends for support/assistance, delegate/postpone unnecessary tasks

lochia presence of clots

small clots not unusual because of pooling blood in vagina; large clots abnormal

which clinical manifestations of withdrawal would the nurse anticipate in a newborn exposed to opioids prenatally?

sneezing, hyperactivity, high-pitched cry, exaggerated Moro reflex

a newborn has an Apgar score of 3 at 1 minute after birth. which is the immediate nursing action response to this Apgar score?

start resuscitation

perineum client teaching

stitches will dissolve in a few weeks cleanse perineum with peribottle after elimination when wiping change peri pads frequently perineal ice packs for first 24hrs sitz bath after 24 hrs witch hazel, benzocaine spray, dibucaine analgesics for pain, stool softeners NO SUBMERGED BATHS

goal for postpartum hemorrhage

stop hemorrhage correct hypovolemia treat the underlying cause

apnea signs and symptoms

stopping breathing for 20 seconds or more or stopping in breathing associated with bradycardia (70-80bpm) or hypoxemia (80-85%)

blood pressure postpartum

transient rise immediate postpartum common then return to pre-pregnancy baseline within couple days orthostatic hypotension

becoming a mother (BAM)

transition process of becoming mother and change in mother-child relationship commitment, attachment, and preparation (pregnancy) acquaintance, learning, and physical restoration (first 2-6 weeks after birth) moving toward a new normal (2 weeks to 4 months) achievement of the maternal identity

which conditions increase the risk for postpartum hemorrhage?

twin birth, over distended bladder, retained placental fragments