OBexam#2.pdf NURS 3200
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This 5 page Study Guide was uploaded by Christie Kepler on Sunday February 14, 2016. The Study Guide belongs to NURS 3200 at Western Michigan University taught by Professor Stark in Fall 2015. Since its upload, it has received 23 views. For similar materials see Childbearing 3200 in Nursing and Health Sciences at Western Michigan University.
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Date Created: 02/14/16
Chapter 20 Reproductive system rd Uterus-Involution- begins after expulsion of placenta with contraction of uterine smooth muscle. At 3 stage of labor the Uterus-Midline @ 2cm below the umbilicus. @12h the fundus rises to the level of the umbilicus. Fundus descends 1-2 cm q24h. Subinvolution-failure of uterus to return to non-pregnant state, due to retained placental fragments and infection. Contractions-Oxytocin = strong uterine contractions= promotes homeostasis. 1-2 postpartum contractions decrease and become uncoordinated. Baby after birth + breastfeeding=oxytocin release. Afterpains increased= overdistended uterus + multipara Endometrial regeneration is complete by day 16. Placental site regeneration complete at 6 weeks. Lochia= uterine discharge after childbirth. Lochia Rubra- bright red, goes to Lochia Serosa (old blood) after 3-4 days. Lochia alba (yellow to white) 10 days after childbirth. < lochia = receives oxytocin medication + cesarean births. >Lochia = ambulation + breastfeeding. Lochia serosa + alba + 3to4 weeks= endometritis. Cervix within 10 days becomes regains its form. External Cervical =Fishmouth never regains appearance before pregnancy. <Estrogen = thin vaginal mucosa + no rugae + low lubrication. Hemorrhoids- itching, discomfort, and bright red bleeding with defecation. < in size after six weeks. Pelvic relaxation= the lengthening and weakening of the fascial supports of pelvic structures. < HCSG, Estrogens, cortisol, and the placental enzyme insulinase <BS levels < Estrogen and progesterone levels after placenta delivery, full decrease 1 wk after birth.< Estrogen allow engorgement and diuresis. Breastfeeding wome+ > serum protein levels= suppress ovulation, initial ovulation= 6 months. Ovulation early as 27 days – nonlactating 70-75 days Abdomen- Diastasis Recti Abdominis- the abdominal wall muscles separate ABD regains prepregnancy @ 6 wks. Urinary System- Steroids decrease @birth= < renal function. Return to normal 1 mth @birth. Glycosuria decreases 1 wk @ birth. Lactosuria can occur in lactating women. >BUN due to involution. Ketonuria- uncomplicated and prolonged birth Diuresis occurs 2-3 days after childbirth # 2 – 2.5 loss. Reduced voiding- anesthesia, forces of labor, vaginal lacerations, episiotomy + postpartal diuresis = bladder distension. Adequate voiding is restored 5-7 days @ childbirth. BOWEL- 2-3 days after childbirth < muscle tone in intestines, diarrhea, lack of food or dehydration. Operative vaginal birth and anal sphincter lacterations > risk of anal incontinence BREASTS Colostrum- clear yellow fluid= first 24 hrs(1-2 days). Mature milk= 72-96 hours @birth. Engorgement decreases with discomfort in 24-36 hrs. Pregnancy induced hypervolemia- increase 35% of blood volume. Vaginal Loss- 300-500mL Section- 500-1000mL Protection of blood loss 1) uteroplacental circulation decreases size of maternal vascular 2) loss of placental endocrine stops stimulus for vasodilation 3 ) movement of water stored during pregnancy. Cardiac Output remains increased for 48h @birth because increase stroke volume. WBC during pregnancy 12000, after birth 20-25000 are common. Clotting factors and fibrinogen are increased during pregnancy; causes increase risk of thromboembolism especially after Cesarean. Postpartum HA caused by preeclampsia, stress, leaking CSF, HA duration 1-3 days to weeks. Joints- stabilize 6-8 weeks after birth. Chloasma goes away after pregnancy. Hyperpigmentation don’t regress completely after childbirth. Striae gravidarum fades but doesn’t disappear. Spider nevi persist indefinitely . Fine hair gained decrease after pregnancy. Coarse hair remains. Chapter 21 Women stay in the hospital 1-2 days after vaginal birth. Information communicated to the postpartum nurse: gravidity and parity, age, anesthetic used, medication given, duration of labor and time of rupture of the membranes, whether labor was induced or augmented, type of birth and repair, blood type and Rh status, group strep B streptococci GBS status, status of rubella immunity, HIV , Hep B status, infection identified during pregnancy(STD), infusion of fluids, lochia, bladder, and perineum, sex and weight of infant, time of birth, chosen method of feeding, abnormalities noted, assessment of parent- infant interaction. INFANT information: Apgar scores, weight, voiding, stooling, feeding since birth, name of pediatric care provider. Interventions (Vitamin K, eye prophylaxis) and identification procedures (footprints and armbands) Discharge- depends on physical condition of the mother and the newborn, mental and emotional status of the mother , social support at home, client education for self and infant care and financial constraints. Birthing Centers release after 24-36 h after vaginal. Laws for Discharge- Mothers’ health protection act 1996- plans are required48 hours with Vaginal birth, 96 hours after Cesarean. High risk for discharge- Jaundice, feeding difficulties, infection, unrecognized respiratory and cardiac issues Follow-up in 72 hours after discharge < infant readmission. HgB & Hct are reevaluated to assess blood loss during childbirth> after cesarean. Nursing interventions- Sitz baths in first 24 h with cold water <edema & warm after to increase circulation. Encourage voiding, running water over perineum and in the sink, assess anxiety-potential sources. Prevention of infection- maintain clean environment, bed linens changed as needed, disposable pads, hand hygiene and standard precaution, teaching wipe from front to back. Prevention of excessive bleeding- good uterine tone and preventing bladder distention. Uterine Atony- failure of uterine muscles to contract firmly, excessive bleeding is the result. Alleviate atony by massaging the fundus until firm. Teaching massage of fundus can alleviate anxiety. > fluids and oxytocin. Blood loss defined as scant, light, moderate, or heavy. Time is a factor - changing of a perineal pad. Bladder distention > epidural anesthesia, vaginal and perineal lacerations, instrument-assisted birth, prolonged labor. Promotion of comfort- use non-pharmacological interventions- laying on side, ice packs, topical application, dry heat, shower-tub bath or sitz. Sore Nipples- lanolin or hydrogel pads Sore Breasts- ice packs and cabbage leaves Pharmacological intervention- NSAIDS, PCA pumps, epidural analgesia. REST_ Postpartum Fatigue (PPF)- complex phenomenon of fatigue. Fatigue- long labors, cesarean, breastfeeding, anemia, infection, thyroid dysfunction, anxiety, depression . Ambulation- Early movement < (VTE) venous thromboembolism, RISK FACTORs- staying in bed after giving birth Intervention- TED hoses, SCDS, exercise HOMANS SIGN- pain in the calf muscle-Confined to bed, elevated affected limb. Exercise- begin right after birth, 4 wks after Cesarean birth. Kegels- very important – inappropriately increases risk of incontinence. Nutrition- Prenatal vitamins & iron supplements continued 6 wks after birth. Recommended intake 1800-2000 kcal/day Breastfeeding- 2700 kcal/day Bladder Function- void 6-8 hours after birth. Output should be measured at 150 mL Bowel Function-Constipation, dehydration, immobility, episiotomy, perineal lacerations or hemorrhoids- encourage adequate fluid intake and SE of medications- stool softeners or laxatives can be used early ambulation and rocking chair stimulates passage. Breast feeding promotion- 1-2 hours after birth, first hour is the most important after birth for basic knowledge. Lactation suppression- well fitted bra in first 72 hours is important. Ice packs-15 min and 45 min off Rubella- Varicella-Tdap- Rh – 72 hrs after birth , 300 mcg prevents maternal sensitization, suppresses immune system and should be retested in 3 months= 28 weeks of gestation in Rh (-). Psychosocial Needs : Birth Experience: Birth experience was different than their birth plan. Self Image:Women’s Self concept, body image, and sexuality. Parenthood to parent infant interactions: observe maternal and parental reactions to the newborn and their interactions with the infant. Family Structure and Functioning: mother is affected greatly by her relationships with her partner, her mother and other relatives and any other children. Effects of Cultural Diversity : Psychosocial assessment is woman’s cultural beliefs, values, and practices. Sexual Activity and Contraception: Risk of hemorrhage and infection is min by 2 wks postpartum. Ovulation occurs 1 month after birth-bottle feeding. Medication: Breastfeeding- prenatal medications Hgb: Supplement Iron Episiotomy: stool softener NSAIDS- Cesarean. Follow-UP: Vaginal Births- 6 weeks post partum. Cesarean- 2 wks after hospital discharge. Warm lines_ telephone link between family and concerned caregivers or experienced parent volunteers Chapter 22 Attachment_ the process by which a parent comes to love and accept a child and the child comes to love and accept the parent. Bonding – first few minutes or hours after birth when mothers and fathers are in close contact with their infants to optimize later development. Mutuality- infants behaviors and characteristics elicit a corresponding set of parental behaviors and characteristics. Signaling- crying, cooing, smiling. Executive- rooting, grasping, and postural adjustments. Acquaintance- use eye contact, touching, talking, and exploring. Claiming process- “Likeness “ to other family members & “uniqueness”. Assessment of Attachment is mainly important with the mother. Parent-Infant Contact: Early Contact : facilitate the attachment process- Skin-to-Skin contact with cap for heat loss. Extended Contact : Rooming- in family Centered care: keeping the infant close to the parents. Communication between Parent & infant: Touch: Mother use fingers (most sensitive part) stroking soothes and quiet infant. Eye Contact: Infants looking at mother feel closer to them. En Face : A position the parents and infants faces are 20 cm apart and on the same plane.- Diming lights help promote infant to open their eyes and delayed eye prophylaxis. Voice: Crying reassures to the parent babies health. Infant responds to parents high pitched voice and distinguish mother’s voice. Odor: Mother’s comment on babies distinct odor and Infants distinct odor of Mother’s breast milk. Entrainment: Newborn move in time with the structure of adult speech “dancing in tune” to parent’s voice. Bio Rhythmicity: infant being in tune with mother’s natural rhythm- Mother’s HB and soothes the crying infant. Reciprocity: type of body movement or behavior that provides the observer with cues. Synchrony: “fit” the infant’s cues and the parent’s response. Transition to Parenthood: the decision to conceive to the first months of having a child. As parents work through the transition they find personal strength and resourcefulness. Parental Tasks and Responsibilities: The parent copes with child’s appearance, sex, innate temperament, and physical status. Becoming a mother: Dependent, dependent-independent, independent behavior. Four Stages of becoming a Mother: 1) Commitment/Attachment 2) Acquaintance/attachment 3) Moving to new normal 4) Reincorporated Maternal Identity. Maternal Sensitivity/Maternal Responsiveness: important to Maternal-infant relationship. Mothers Sensitive behaviors based on awareness, perception, responsiveness to infant cues and behaviors| TWO social processes: Engagement/Acknowledging Motherhood. “Pink” period- 1-2 days after birth heightened joy and feelings of well-being. “Blue” period 50-80% postpartum blues “baby blues”- emotionally liable and often cry for no reason, cause is unknown. PPD-Postpartum Depression 10-15 % experience severe symptoms/ Fathers experience PPD. Fathers have 3 phases 1) expectations/intentions 2) confronting reality 3) creating the role 4) reaping rewards. Engrossment: used for father’s absorption, preoccupation, and interest in the infant. Resuming Sexual Intimacy: 2-4 week after the baby is born. Infant-parent interactions 1) modulation of rhythm 2) modification of behavioral repertories 3) mutual responsivity Rhythm- Both parent and infant must be able to interact. Behavioral Repertoires: Infants- gazing, vocalizing, and facial expressions. Infants focus on parents emotions through facial expressions. Responsivity: responses that occur within a specific time and are similar in form to stimulus behavior. Adolescent Mother_ egocentric and concrete thinking interfere with the ability to parent effectively. Inexperience, lack of knowledge, and immaturity, Interventions: community-based programs for pregnant adolescents, increase access to healthcare, education, and other support services. Adolescent Father: Feelings of guilt, powerlessness, or bravado because negative consequences to parent and the child. Maternal Age Older than 35 y.o.- Sandwich generation-taking on care of parents while parenting younger children. Child care is a major factor in causing stress in work. Perimenopausal – difficulty distinguishing fatigue, loss of sleep, decreased libido, or other physiologic symptoms that cause changes to their sex lives. Paternal Age older than 35 y.o.- increased love and commitment between two parents, reinforcement of marriage of why one married in the first place a feeling of being completed, financial stability, more freedom to focus on parenting than on career Lesbian Couples- Birth mothers have a greater role in parenting because they consider themselves primary. Social Support – multidimensional and includes the number of members in a person’s social network, types of support, perceived general support, actual support received, and satisfaction with support available and received. Sibling rivalry: common once initial excitement of having a new baby at home is over. Grandparent Adaptation: Primary role is support, nurture, and empower their children in their parenting role. Chapter 23 Transition to extrauterine life-during first 6-8 hours of life THE three stages of newborn. 1) First period of reactivity ( lasts 30 min)- HR 160-180 drops to 100-120. Respirations 60-80 breaths/min Auscultation- crackles and grunting. 2) Period of decreased responsiveness ( 60-100 min) SKIN is pink respirations are shallow and rapid. Bowel sounds are audible and peristalsis is noted. 3) Second period of reactivity (2-8 hr) after birth and lasts 10 minutes to several hours, tachycardia and tachypnea occur. Increased muscle tone, change in skin color, mucous production, and meconium is produced now. Physiologic Adaptations- Clamping umbilical cord increases BP= increases circulation and lung perfusion. Chemical- Decreased 02 and increased CO2 cause stimulate medulla causing resp. Mechanical- the chest is compressed during vaginal birth. Crying increases the distribution of air in the lungs and promotes expansion of alveoli. Thermal- environmental temperature stimulates the skin = stimulation in the medulla. Sensory- lights, sounds, smell of new environment stimulates the medulla. Surfactant- a protein manufactured to lower surface tension and reduces the pressure to keep the alveoli open at respiration and prevents collapse on exhalation. Respiratory Distress Signs- nasal flaring intercostal or subcostal retractions or grunting on respirations <30 & >60 breaths/min –evaluated- Tachypnea – inadequate clearance of lung fluid. Acrocyanosis is common in first 24 hours after birth in hands and feet. Central cyanosis is abnormal- lips and mucous membranes- inadequate 02 to alveoli, poor perfusion to the lungs & cardiac dysfunction. Cardiovascular System- First few days of life, crying can reverse the flow through the foramen ovale temporarily and lead to mild cyanosis. The ductus arteriosus can open in response to low oxygen levels= hypoxia + asphyxia + prematurity. Auscultation of the chest a patent ductus arteriosus can be detected as a heart murmur. HR = 100-160 HR/MIN. Murmur + poor feeding + apnea + cyanosis + pallor= abnormal and should be investigated BP Systolic 60-80 & Diastolic 40-50 Blood Vol 80-85 mL/Kg. Total blood avg 300 mL| Delayed cord clamping improves hematocrit and iron status and decreasing anemia and benefits last 6 months.| Tachycardia= Sepsis, anemia, hypovolemia. Bradycardia= congenital heart defect and hypoxemia. RBC 4.8-7.1 HgB 14-24 WBC @ Birth 18000. WBC on 1 day of Birth 23000-24000 Increased WBC is caused by crying , maternal hypertension, asymptomatic, hypoglycemia, hemolytic disease, meconium, aspiration syndrome, labor induction with oxytocin, surgery, difficult labor, high altitude, and maternal fever. Platelets=150000-130000. Newborns cant synthesize Vitamin K. Thermoregulation- maintenance of balance between heat loss and heat production. Neutral Thermal Environment- heat balanced is maintained for neonate. Heat loss in the newborn four modes: Convection: body surface to cooler ambient air. Radiation- Loss of heat from the body surface to a cooler solid surface not in direct contact but in relative proximity Evaporation- loss of heat when liquid is converted to vapor Conduction- loss of heat from the body surface to cooler surfaces in direct contact Thermogenesis- neonate attempts to generate heat by increasing muscle activity= increase in 02 consumption + glucose consumption NON-shivering thermogenesis = brown fat richer fat and nerve supply. Cold Stress- imposes metabolic and physiologic demands on all infants= respiratory increases + increase need for 02 + BMR increases leads to hyperbilirubinemia HYPERthermia- excess heat production= sepsis + decrease in heat loss. Feet are warm to touch and infant posture of extension RENAL system- needs to void in 48 hours to decline renal impairment. 6-8 voiding’s per day. Infants body is 75% of weight is water. Fluid requirement of a full-term infant is 60-80 mL/days | Gastrointestinal- infant can swallow, digest, metabolize, absorb proteins, simiple carbohydrates and emulsifying fats. Hydrated infants- Mouth : pink, moist Palates : intact + mucus. Meconium fills lower intestines at birth. Meconium is greenish black + viscous + occult blood= pass in 12-24 hours. Time and color of first stool= recorded. Fullness of the abdomen above the umbilicus= hepatomegaly, duodenal atresia or distention. Fullness of the abdomen below the umbilicus= distended bladder. Passage of meconium from vagina or urinary meatus is a sign of a possible fistulous tract from the rectum. Fetal Liver =HgB production- storages lasts 4-6 months. Unconjugated Bilirubin- is insoluble and almost entirely bound to albumin, a plasma protein. Bilirubin free from albumin and easily cross the BBB and cause neurotoxicity. Only the conjugated bilirubin can be excreted from liver cells in the form of bile. Feeding helps assist is the removal of bilirubin by increasing meconium. Pathologic jaundice if it appears within 24 hours of birth. Kernicterus – irreversible, long term consequences of bilirubin toxicity such as hypotonia, delayed motor skills, hearing loss, cerebal palsy, and gaze abnormalities. Breastfeeding Jaundice- @ 2-4 days of age. Breast Milk Jaundice- 4-6 days| IgG antibodies that were transferred across the placenta from the maternal circulation. – provides sufficient antimicrobial protection during first 3 mths. IgA comes from breast milk and acts in the intestines. Risk for infection- Temperature instability- lethargy irritability, poor feeding, vomiting or diarrhea ,decreased reflexes, pale or mottled skin. Vernix Caseosa- white substance @ 35 wks gestation covering the body. Acrocyanosis- hands and feet are slightly cyanotic. Milia- Small white sebaceous glands. Desquamation- peeling of the infant skin occurs a few days after birth. Mongolian Spots- bluish, black areas of pigmentation i.e. at back and buttocks, common in dark skinned. NEVI- stork bites on upper eyelids . Erythema Toxicum- flea bite dermatitis found in first 3 weeks of life. Skeletal System- Growth is Cephalocaudal. Head is one fourth of the total body length. Caput Succedaneum – edematous area of the scalp found on the occiput. Cephalhematoma – Collection of blood between a skull bone and its periosteum. HIP integrity is tested w/ Barlow test. Newborn Reflex- Palmar- infants grips examiners finger Plantar- toes curl downward. Moro-abduction and extension of arm are seen. Two sleep states deep and light, Four wake states- drowsy, quiet alert, active alert, and crying. Infants clearest distance is 17-20 cm. @ 6 mths vision is good as adults. Habituation – protective mechanism that allows the infant to decrease response to repetitive stimulus. Chapter 24 Apgar score 1) HR 2)Respiratory 3)Muscle tone 4)reflex irritability 5) generalized skin color 0=low 2=good Generated scores at 1 & 5 minutes. 7-10 means little to no difficulty adjusting to extrauterine life. Temperature 97.7- 99.5 F BP 73/55 Normal HR 140-160 B/min Head circumference 32-36.8 cm. Dubowitz Scales- measure gestational age of infants between 35-42 weeks, assessing six external physical and six neuromuscular signs. New ballard Score Newborns – 20 wks of gestation. Eye Prophylaxis- Erythromycin for those with chlamydia and gonorrhea . givin within 1-2 hours. Vitamin K for clotting factors child makes their own in 7 days. Cord is perfect for bacteria and infection and use of sterile water for 2 weeks till separation. Hypoglycemia less than 40 mg S&S jittering, lethargy, poor feeding, hypotonia, temperature instability, respiratory distress and apnea, and seizures. Hypocalemia less than 7.8- 8 mg/dl occurs in infants whos mother with diabetes, trauma, asphyxia. S&S same as hypoglycemia. Physiologic Jaundice ,Risk Factors- Gestational age < 38 wks, breastfeeding, previous sibling with jaundice, jaundice before discharge. Maternal blood type, Rh status Hep B is for all infants get 0.5 mL per shot HBsAG- provides protection against infection of infants born of HBsAG – positive mothers Cord clamp is removed after 24 hours and the cord falls off in 10-14 days Chp 25 Breastfeeding is 8-12 times in 24 hours/ 30-40 min at 15-20 min per breast. Breast milk can be stored at room temperature for eight hours and refrigerated for up to 8 days. Feeding pattersn 24-48 hours drink 15-30 mL of formula. Newborns 90-150 mL by end of second week or sooner.
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