🤰🏾- Exam 3 Flashcards

Question

Signs of magnesium toxicity

Answer 1

- RR rate of less than 12 - maternal O2 sat of lower than 95% - absence of DTRs - sweating, flushing - altered sensorium (confused, lethargic, slurred speech, drowsy, disoriented) - hypotension

Answer 2

Hemolysis, elevated liver enzymes and low platelets Liver enzymes ^ when hepatic blood flow is obstructed by fibrin deposits / low platelets occur cuz of vascular damage from vasospasm Deliver vaginally R upper quadrant, epigastric or lower r chest pain Treatment: mag sulfate and hydralazine

Answer 3

Life threatening defect in coagulation Labs: decreased fibrinogen, platelets, increased fibrin degradation and d-dimer is present

Answer 4

Persistent uncontrollable vomiting that can continue throughout pregnancy leading to serious complications Therapeutic management: meds, fluid replacement **eat foods high in K+ and Mg+**

Answer 5

- loss of 5% or more of pregnancy weight - dehydration - acidosis from starvation - elevated levels of blood and urine ketones - alkalosis from loss of hydrochloric acid in gastric fluids (vomiting) - hypokalemia

Answer 6

Low risk- recognize jaundice, family adaptation, adequacy of maternal support High risk- specialized equipment, ensure proper electricity/heat/telephone. Medically fragile: vents, oxygen therapy, apnea monitors, trach care, tube feedings, suctioning and cAre of IV sites

Answer 7

- emergency situation (respiratory difficulty, bleeding) call back in 5 mins to make sure parents seek help - illness (fever, dehydration, change in feeding behavior, unusual rashes) - present problem or remedies aren't working - parents affect seems inappropriate for situation

Answer 8

Infants less than 37 weeks or LBW are placed in car seat and monitored for VS and oxygen level for 90mins

Answer 9

Swaddle Side lying Shushing sound Swinging Suck on pacifier

Answer 10

Prickly heat Develops in infants who are too warmly dressed in any weather / may also occur in infants with fever Appears as red base with papules or clear vesicles in the center Treatment: remove excess clothing or lukewarm bath **avoid ointments

Answer 11

"Spit up" Caused by overfeeding Treat: burp, smaller frequent feed, enlarge nipple hole, upright after feeding

Answer 12

Gains 1oz/day (2lb per month) Grows 1.4inches per month

Answer 13

Focus best within a range of 8-12 inches By 3 months follow objects horizontally Social smile at 1-3months Start "cooing" at 1-4 months Laugh at 3-6 months

Answer 14

1 2 4 6 9 12 months old

Answer 15

Temp > 100.4 Vomiting Watery stools or significant increase in stools Blisters, sores or rashes Listlessness of sleeping more than usual , irritability or crying more than usual Coughing, frequent sneezing, runny nose Pulling or rubbing at ear , drainage from the ear

Answer 16

Dyspnea Rr > 60 Retractions Cyanosis or extreme pallor Difficult to arouse/keep awake

Answer 17

Flattening of the head which was rounded at birth , may result from prolonged lying in the supine position

Answer 18

Abrupt unexplained death of an infant less than 1 year old 3rd leading cause of death in infAnts from birth -1yr Most common cause of death in infants from 1 month-1 yr

Answer 19

- overdistention of the uterus (multiple gestation, large infant, hydraminos) - precipitate labor or delivery - prolonged labor - use of forceps or vacuum extractor - cesarean birth - placenta previa, accreta or low implantation - surgery, oxytocin, tocolytics, mag sulfate

Answer 20

Blood loss of more than 500mL after vaginal birth, 1000mL after cesarean, a decrease in hematocrit of 10% or more since admission or the need for a blood transfusion

Answer 21

Management- Fundal massage, bimanual compression, medicine, fluid, blood replacement, hysterectomy Factors- exhaustion, overexpansion, multi parity, prolonged oxytocin, hyper and hypo uterine contraction, retained placenta

Answer 22

Early- uterine atony, trauma to the birth canal, hematoma, retention of placenta fragments, Late- subinvolution and placental fragments that remain attached

Answer 23

- oxytocin - methylergonovine maleate (methergine) is given IM. Contraindicated in hypertension - carboprost tromethamine (hemabate, prostin/15M) is given IM. Contraindicated in asthma and causes diarrhea. Keep refrigerated - cytotec

Answer 24

Attempts to deliver placenta before it separates from the uterine wall, manual removal of the placenta, placenta accreta, previous cesarean and uterine leiomyomas

Answer 25

Oxytocin , methylergonovine , dilation and curettage , antibiotics

Answer 26

Delayed return of uterus to non-pregnant state Causes- retained placental fragments and pelvic infection Management- methergine PO and antibiotics Nursing considerations- education about warning signs, excessive bleeding and possible infection. Pelvic or fundal pain, backache and pelvic pressure or fullness

Answer 27

Control bleeding , check VS q3-5 mins , give 8-10L of oxygen and draw labs for H&H, clotting studies and type and cross

Answer 28

``` Inactivity Prolonged bed rest Obesity Cesarean birth Sepsis Smoking Hx of thrombosis DM Trauma Prolonged labor Age > 35 Dehydration ```

Answer 29

Endothelial injury Causes: increased clotting factor, venous stasis, vessel injury= prolonged in stirrups/constriction/flexion

Answer 30

Signs- swelling of the extremity, redness, tenderness and warmth to CALF OR IV SITE management- analgesics, rest and elastic support. Elevation improves venous return, warm packs *avoid standing for long periods

Answer 31

Pain in leg, groin, lower back or right lower quadrant. Swelling of the leg (>2cm larger than the other), erythema, heat and tenderness No homans sign -not reliable test Pain on ambulation, chills, general malaise and stiffness of affected leg

Answer 32

``` Elevation Anticoagulants (lovenox, heparin) Analgesics Antibiotics Moist heat Gradual ambulation ``` **no Coumadin during pregnancy

Answer 33

Amniotic fluid embolism

Answer 34

Signs- dyspnea, chest pain, tachycardia , tachypnea, crackles, hemoptysis, decreased O2 sat Management- VS, elevate HB, give O2, meds (heparin, thrombolytics)

Answer 35

Temperature of 100.4 or higher AFTER the first 24hrs and occurring on at least 2 of the first 10 days following childbirth Types: endometritis, wound infection, uti, mastitis and septic pelvic thrombophlebitis

Answer 36

- hx of uti, mastitis, thrombophlebitis - cesarean birth - trauma - prolonged ROM , labor - excessive number of vaginal exams - retained placenta - poor general health, nutrition, hygiene - DM

Answer 37

Bacterial infection of endometrium Signs- temp > 100.4 within 36hrs of birth, chills, malaise, anorexia, abd pain, uterine tenderness and purulent fouk smelling lochia, tachycardia and subinvolution Management- IV antibiotics to prevent spread to tubes and ovaries Nursing considerations- fowlers position to promote drainage of lochia, foods high in vitamin C and protein to aid healing and PO fluids

Answer 38

Signs- edema, warmth, redness, tenderness and pain Management- analgesics and warm compress or sitz baths, good hand washing technique

Answer 39

Signs- dysuria, urgency, frequency and suprapubic pain. Hematuria. Low-grade fever **begin on first or second postpartum day** Day3-4 may develop pyelonephritis (chills, spiking fever, cva tenderness, flank pain and n/v) Nursing considerations- increase fluid intake (2500-3000mL), acidic juice (apricot,plum, prune and cranberry) 🚨no carbonated drinks/grapefruit = increase alkalinity

Answer 40

Causes- constriction , decreased immune system, engorgement Signs- flu like symptoms (fatigue, achy muscles) temp > 102.2, chills, malaise and headache .. localized lump or wedge shaped area of pain, redness, heat, inflammation and enlarged axillary lymph nodes Management- antibiotics and continued breastfeeding or pumping from both breasts **untreated may result in abscess Nursing considerations- breastfeed q 2-3hrs, warm press, start BF on unaffected side 1st, massage

Answer 41

100-115 kcal/day Breastfed: 39-45 kcal per pound Formula: 45-50 kcal per pound

Answer 42

27 to 45mL/lb (60-100mL/kg) for the first 3 to 5 days of life Gradually increasing to 68 to 80mL/lb (150-175mL/kg)

Answer 43

I- begins at 16wks gestation to day 2-3 of birth. Colostrum is rich immunoglobulin A which helps in GI tract protection II- from day 2-3 to day 10. Transitional milk. Lactose, fat and calories increase III- mature milk. Contains 20 kcal/oz

Answer 44

Protein: less amount than cows milk Carbohydrate: lactose Fat: 50% of calories in breast milk Vitamins: no vitamin d - supplement 400 IU is recommended (via present in formula) Minerals: iron in breast milk, not formula Enzymes: pancreatic amylase, lipase for fat digestion

Answer 45

Infant - allergies less likely to develop, helps prevent infection and disease, easier digestion, nutritional content, decreased incidence of overfeeding, constipation less likely Mom - oxytocin release enhances involution, less blood loss, delayed ovulation, reduction in incidence of some cancers, bonding, convenience and economical

Answer 46

Soy formulas may be given to infants with galactosemia or lactase deficiency and to those whose families are vegetarians

Answer 47

Personal knowledge and past experiences Support/education from others Culture Employment/school

Answer 48

L- latch A- audible swallowing T- type of nipple C- comfort (breast or nipple) H- hold (positioning)

Answer 49

licking or sucking movements Lip smacking Rooting Hand to mouth movements Sucking on the hands Increased activity Crying (a late sign)

Answer 50

Foremilk- watery first milk that quenches the infants thirst Hindmilk- comes at the end of the feeding. Richer in fat, more satisfying and leads to weight gain

Answer 51

- falling asleep after feeding for less than 5 minutes - refusing to feed - smacking or clicking sounds while on breast - lower lip turned in - failure to open the mouth widely at latch-on - dimpling of the cheeks - short choppy motions of the jaw

Answer 52

Avoids pressure against an abdominal incision

Answer 53

Preterm or have a fractured clavicle

Answer 54

Avoids pressure on episiotomy or abdominal incisions

Answer 55

Drug abuse , active untreated TB, HIV, galactosemia band maternal chemotherapy **moms on methadone or buprenorphine, hepatitis A/B/C are allowed to breastfeed

Answer 56

5hrs at room temp 5 days in fridge 5 months in freezer

Answer 57

Polydipsia- increase thirst Polyuria- excessive urination Polyphagia- excessive hunger

Answer 58

Early pregnancy - metabolic rates and energy needs change little. Increased insulin release. HYPOGLYCEMIA may occur Late pregnancy - increased placental hormones create insulin resistance. HYPERGLYCEMIA may occur Birth- maintenance of normal maternal glucose levels is essential to reduce neonatal hypoglycemia Postpartum - the need for additional insulin falls

Answer 59

Type 1- insulin deficient Type 2- insulin resistant GDM A1- diet controlled GDM A2- diet and insulin controlled

Answer 60

- increased incidence of spontaneous abortion - fetal malformations - preeclampsia - development of ketoacidosis - increased UTI - hydramnios - premature ROM - macrosomia increased likelihood of cesarean and risk of PPH

Answer 61

- congenital defects (neural tube defects, caudal regression syndrome, cardiac defects) - macrosomia increases risk of cesarean or shoulder dystocia - sga - IUGR - oligohydramnios

Answer 62

Hypoglycemia , hypocalcemia , hyperbilirubinemia and respiratory distress syndrome

Answer 63

``` Overweight Maternal age > 25 years Previous GDM hx of diabetes in a close relative Member of high risk group ```

Answer 64

1st- decreased insulin need 2nd and 3rd- increase During labor- maintenance of tight maternal glucose control during birth is desirable to reduce neonatal hypoglycemia Postpartum period- insulin needs should decline rapidly after the delivery of the placenta and abrupt cessation of the placental hormones

Answer 65

Administered between 24 and 28 weeks of gestation. Mom ingests 50g of oral glucose solution A blood sample is taken 1 hour later - > 140mg/dL

Answer 66

Gold standard for diagnosing diabetes Mom must fast from midnight on the day of the test, then ingest 100g of glucose solution. positive GDM if fasting is abnormal or 2 or more values occur Fasting > 95 1 hour > 180 2 hours > 155 3 hours > 140

Answer 67

``` Shakiness (tremors) Sweating Pallor, cold clammy skin Disorientation; irritability Headache Hunger Blurred vision ```

Answer 68

``` Fatigue Flushed, hot skin Dry mouth; excessive thirst Frequent urination Rapid, deep breaths, door of acetone on breath Drowsiness; headache Depressed reflexes ```

Answer 69

Complication that follows strep throat Causes scarring of the ❤️ valves , resulting in stenosis (narrowing) of the openings between the chambers of the heart. Leads to pulmonary hypertension , pulmonary edema , chf

Answer 70

- Careful I/O - Position: on side, with head and shoulders elevated - O2 - monitor - vaginal delivery

Answer 71

- may experience cardiac decompensation - observe closely for signs of infection, hemorrhage and thromboembolism - observe for signs of chf - observe for decreased urine output

Answer 72

Cough (frequent, productive, hemoptysis) Progressive dyspnea with exertion Orthopnea Putting edema of legs and feet or generalized edema of face, hands or sacral area Heart palpitations Progressive fatigue or syncope with exertion Moist rales in lower lobes, indicating pulmonary edema

Answer 73

- assessment - telemetry - VS - educate on no weight gain , anemia - 2200 cal diet - rest - avoid extreme temps

Answer 74

10.5 or 11 g/dL

Answer 75

Meat, fish, chicken, liver and green leafy vegetables

Answer 76

(Most common type) Pallor, fatigue, lethargy and headache Inflammation of lips and tongue and Pica

Answer 77

Meals and vitamin C

Answer 78

Genetic disorder that involves abnormal synthesis of alpha or beta chains of hemoglobin Leads to decreased lifespan of RBC

Answer 79

Women of childbearing age consume 400mcg daily 600mcg daily when pregnancy is confirmed Foods- fortified greens, beans (black and lentil), peanuts and fresh green leafy vegetables

Answer 80

Autoimmune condition that produces antiphospholipid antibodies - body rejects pregnancy Low-dose aspirin and prophylactic heparin are recommended

Answer 81

Sudden unilateral neuropathy of the 7th cranial (facial) nerve that causes facial paralysis with weakness of the forehead and lower face

Answer 82

1 hepatitis B - infectious liver infection, transmitted by blood & body fluids 2 rubella - transmitted through droplets or contact with nasopharyngeal secretions , common congenital disorders include developmental delay, hearing loss, cardiac defects, cataracts, IUGR, microcephaly 3 varicella zoster - transmitted by direct contact or through respiratory tract, immune prior to pregnancy, VZIG ** chicken pox in preg=pneumonia 4 cytomegalovirus - spread through contact with body fluids, primary prevention is hand washing 5 parvovirus b19 (5ths disease) - transmitted through respiratory secretions or blood, "slapped checks" rash, fever, malaise, maybe fatal to baby

Answer 83

1 taxoplasmosis - transmitted via raw or undercooked organisms (handling a litter box), treated with sulfonamides/combination therapy, NEONATAL EFFECTS: abortions or other serious complications 2 group b streptococci - bacterium in vagina/rectum/cervix/urethra , often asymptomatic- cultures @35-37 weeks, treated with PCN/cephazolin/clindamycin, NEONATAL EFFECTS: sepsis, pneumonia, meningitis 3 tuberculosis - transmitted to neonate from amniotic fluid ingestion or respiratory droplet inhalation , NEONATAL EFFECTS: failure to thrive/rds, treated with isoniazid and rifampin

Answer 84

Visceral- dull, can't pin point, 1st stage Uterus contracting Somatic- more specified, sharp, quick, end of 1st and 2nd stage , fetus puts pressure on maternal tissue

Answer 85

- tissue ischemia - cervical dilation - pressure and pulling on pelvic structures - distention of the vagina and perineum

Answer 86

Labor intensity Cervical readiness Fetal position: occiput posterior Pelvic readiness: size and shape Fatigue and hunger Caregiver interventions **anxiety and fear = ^ muscle tension**

Answer 87

Relaxation Cutaneous stimulation Hydrotherapy Mental stimulation Breathing techniques

Answer 88

Given in epidural space Adjust amount of anesthetic with opioid for motor function Wait until at least 5cm dilated No pain felt , but can still feel pressure

Answer 89

Bleeding disorders, uncorrected hypovolemia, infection, allergy, scoliosis

Answer 90

-maternal hypotension (give bolus of fluid, change position, ephedrine and O2) - bladder distention - prolonged second stage - catheter migration - can feel brief shock in leg

Answer 91

IV fluids Bed rest Caffeine infusion Blood patch- uses patients blood to patch up CSF leak

Answer 92

- uses 25 or 27g needle to go deeper into the subarachnoid space (L4 and L5) - rapid onset, single dose - lose sensory and motor functions - used in c-section, forcep delivery or other high risk - bolus to prevent hypotension

Answer 93

Meperidine (Demerol) Morphine sulfate (duramorph) Fentanyl (sublimaze)

Answer 94

Butorphanol (stadol) Nalbuphine (Nubian) - mixed agonist and antagonist drugs-

Answer 95

Naloxone (narcan)

Answer 96

A sedative that has prolonged depressant effects on the baby Small dose maybe given to promote rest if mom is fatigued from false labor or a prolonged latent phase

Answer 97

Medicate at the beginning of a contraction for limited transfer to fetus

Answer 98

Nonreassuring fetal hear tones and respiratory distress

Answer 99

Or Sellick's maneuver Used to prevent vomit from entering the woman's trachea while she is being intubated for general anesthesia - obstructs esophagus

Answer 100

Numbs the perineum for episiotomy or laceration repair Not for labor pain No effect on the baby 👶🏾

Answer 101

Anesthetize the lower vagina and part of the perineum to provide anesthesia for an episiotomy and vaginal birth using low forceps Given transvaginally with a 6in needle

Answer 102

Postpartum laxatives

Answer 103

No - take with food because it causes gastric irritation

Answer 104

Vicodin, lortab, norco

Answer 105

Numbing spray

Answer 106

Witch hazel (tucks) *also for episiotomy Dibucaine ointment (nupercaine) Hydrocortisone acetate

🤰🏾- Exam 3 Flashcards

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