Parent and Newborn Nursing Exam 2

post partum hemorrhage

greater than 500 mL

symptoms of post partum hemorrhage

decreased BP

increased pulse

restlessness

decreased urine output

when does early post partum hemorrhage occur

within 24 hours following delivery

what is early (primary) post partum hemorrhage related to?

poor uterine tone (atony)

lacerations

episiotomy

retained placental fragments

hematoma

uterine rupture

problems with placental implantation

coagulation disorders

what can uterine atony be related to?

over distension

prolonged labor

grandmultiparity

medications

prolonged 3rd stage

preeclampsia

operative delivery

retained placental fragments

what is the management for atony related hemorrhage

massage

IV access

infusion of crystalloid

blood products

bimanual massage

meds: pitocin, methergine

D&C

arterial embolization

uterine packing

ligation of the uterine or iliac artery

hysterectomy

risks with lacerations and post partum hemorrhage

nulliparity

epidural

precipitous delivery

macrosomia

operative delivery

pitocin

post partum hemorrhage: retained placental fragments

partial separation of the placenta

may be associated with massaging the fundus prior to separation

placenta should be inspected

uterine exploration

possible D&C

post partum hemorrhage: hematoma

injury to a blood vessel from birth trauma or bleeding of a repair site allows for collection of blood

risks of hematoma in PPH

preeclampsia

first full term delivery

precipitous labor

operative delivery

vulvar varicosities

management for hematomas in PPH

depends on size - may reabsorb or I&D

ice/heat

antibiotics

PPH: uterine rupture risks

prior surgery

fetal malpresentation

grandmultiparity

operative vaginal delivery

pitocin induction

PPH: management of uterine rupture

surgery

fluids

blood replacement

late (secondary) PPH

occurs between 24 hours and 6 weeks post partum

what is late PPH related to?

retained placenta

subinvolution

what is the management of late PPH?

methergine

antibiotics

possible D&C

puerperal infection

infection of the reproductive tract occurring within 6 weeks following delivery

puerperal morbidity

a temperature of 38C or higher for any 2 of the first 10 days PP, after first 24 hours

who is at greater risk for a puerperal infection?

women who deliver via C/S

what are the risk factors for reproductive tract infections

C/S delivery

diabetes

PPROM

chorioamnionitis

multiple vaginal exams

lapses in aseptic technique

compromised health status

internal monitoring

trauma

retained placenta/manual removal

endometritis

inflammation of the endometrial lining

signs/symptoms of endometritis

bloody vaginal discharge

foul smelling vaginal discharge

uterine tenderness

fever

tachycardia

causative agents: GBS, chlamydia, E.coli

what is the management for endometritis

broad spectrum antibiotics

perionitis

reproductive tract infection can spread to the entire peritoneal cavity

potential sites of wound infections

C/S incision

laceration/episiotomy

assessment for a wound infection

redness

foul drainage

warmth

approximation

UTI related to?

postpartum diuresis

increased bladder capacity

decreased bladder sensitivity

catheterization

bacteria

retention

over distention

inability to empty bladder because of trauma

management for over distention

catheterize

encourage patient to empty bladder

cystitis

lower urinary tract infection (bladder)

pyelonephritis

upper urinary tract infection (kidney)

management of UTI

urine C&S

antibiotics

pyridium

mastitis

inflammation of lobular connective tissue in breast

generally unilateral

more frequent among nursing mothers

may progress to an abscess

S/Sx of mastitis

red, painful, swollen breast

causes of mastitis

milk stasis

bacterial invasion

trauma

obstruction of ducts

failure to empty breasts

treatment of mastitis

frequent breastfeeding

supportive bra

ice packs

meds: antibiotics/analgesics

venous thrombosis

formation of a blood clot

thrombophlebitis

inflammation, leading to formation of a clot

causes of thrombophlebitis

hypercoagulability

venous stasis

vessel injury

thromboembolic disease factors in PP period

increased clotting factors

release of thromboplastin

increased fibrinolysis inhibitors

risk factors for thromboembolic disease

C/S

immobility

smoking

prior thrombus

varicose veins

diabetes mellitus

AMA

multiparity

anemia

inherited disorders

superficial thrombophlebitis signs/sx

tenderness

localized warmth and redness

normal temp or low grade fever

management of superficial thrombophlebitis

heat

elevation

analgesics

bed rest

elastic compression stockings

deep vein thrombosis (DVT) signs/sx

edema

tenderness

pale limb color

low grade fever, followed by spike in temp

chills

management of DVT

often requires heparin therapy

in addition to superficial thrombophlebitis management

PP MMD: post partum depression sx

sadness

crying

sleep pattern disturbances

changes in appetite

difficulty concentrating and making decisions

feelings of worthlessness and inadequacy

lacks interest in pleasurable activities

lack of interest in appearance

risk factors of post partum depression

primiparity

ambivalence about pregnancy

PP blues

prior hx of PP depression

lack of social support/family relationships

complications

loss of newborn

domestic violence

management of PP depression

antidepressants

psychotherapy

educate patients about PPD prior to discharge

PP psychosis sx

irrational thinking

delusions

hallucinations

confusion

agitation

confusion

agitation

hyperactivity

insomnia

PP psychosis risk factors

previous PP psychosis

hx of bipolar disorder

obsessive personality

social factors

management of PP psychosis

safety is the priority!

often hospitalized

meds

psychotherapy and cognitive behavioral therapy

assistance with newborn

perinatal loss

death of a fetus or infant from conception through 28 days following birth

fetal death

loss after 20 weeks

causes of fetal death

could be unknown

asphyxia

congenital malformations

placental abruption/ previa

cord accidents

growth restriction

alloimmunization

preeclampsia

diabetes

lupus

thyroid disorders

renal problems

risk factors for fetal death

nullipara

multiple gestation

obesity

infection

clotting disorder

maternal physiologic implications

infection DIC (disseminated intravascular coagulation)

what is disseminated intravascular coagulation (DIC)

thromboplastin is released from fetal tissues, activating the clotting system

how is DIC managed?

address underlying condition

blood transfusions

anticoagulation

post birth evaluation

postmortem studies may give cause of demise

autopsy

chromosomal studies

cultures

visual examination

blood tests

x-ray/MRI

bereavement

to suffer loss

grief

reaction to loss

mourning

process of incorporating the loss

reactions to loss

shock

numbness

confusion

denial

anger

protest

guilt

loneliness

dual process model

loss and restoration

need to address the loss

regain balance in light of loss

attachment theory

the intensity of grief can be assessed by considering attachment to the anticipated baby

frameworks for attachment theory

planning pregnancy

confirming pregnancy

accepting pregnancy

fetal movement

accepting fetus as an individual

giving birth

seeing baby

touching baby

caring for baby

meaning reconstruction

redefining life after a loss

search for meaning

the caring theory

knowing- understanding the loss as it pertains to the parents

being with- ability to give of yourself to the family

doing for- do for the family as you would want others to do for you

enabling- help the family through events surrounding loss

maintaining belief- believing that the parents can get through this loss

caring for grieving family: RESPONDING acronym

R = recognition and validation of loss

E = emotional availability

S = spiritual and cultural accommodation

P = physical presence

O = open communication

N = normalization of grief reactions

D = decision making assistance

I = interdisciplinary involvement

N = nonjudgmental attitude

G = genuine caring

considerations for grieving family

room placement

acknowledge loss

continuity of care

encourage questions

if desired, allow time with infant

remove tubes/wires

bathe and dress

pictures

footprints/handprints, lock of hair

memory box

risk factors associated with greater neonatal morbidity and mortality

low socioeconomic status

no prenatal care

exposure to teratogens

preexisting maternal conditions

age and parity

pregnancy complications

IUGR: symmetrical (proportional)

restriction of growth in size of organs, body length, and head circumference

d/t long term conditions

IUGR: asymmetrical (disproportional)

birth weight is below 10th%

head and/or body length remain normal

often d/t impaired uteroplacental blood flow

complications of the SGA/IUGR newborn

hypoxia

aspiration syndrome

hypothermia

hypoglycemia

polycythemia

large for gestational age (LGA)

weighs more then the 90th%

correlations: diabetes, genes, multiparity, male infants

complications of the LGA

birth trauma r/t cephalopelvic disproportion

induction of labor

cesarean section

hypoglycemia

polycythemia

hyperviscosity

a newborn of a diabetic mother may be…

SGA or LGA

complications of the newborn of the diabetic mother

hypoglycemia

hypocalcemia

hyperbilirubinemia

birth trauma

polycythemia

respiratory distress syndrome (RDS)

congenital malformations

hypoglycemia in a baby

less than 40-45 mg/dl

signs/sx of hypoglycemia

tremors/seizures

apnea

cyanosis

temperature instability

poor feeding

hypotonia/lethargy

hypoglycemia frequency for baby

blood sugar checks done with every feed (2-3 hours) and want a few stable measurements before discontinued

prematurity

preterm: newborn delivered prior to 38 weeks

incidence: 12%

concern: prematurity of all systems

complications of prematurity

cardiovascular and respiratory

at risk for RDS

inadequate amounts of surfactant

pulmonary vessels not fully developed

at risk for PDA

prematurity: thermoregulation

great body surface area

little subcutaneous faat

thin skin

less flexion

prematurity complication: GI/GU

poor sucking

poor swallowing

poor gag reflex

small stomach capacity

difficulty absorbing fat

calcium and phosphorus deficiency

increased BMR and oxygen needs

at risk for necrotizing enterocolitis

immature kidneys

decreased GFR

limited ability to concentrate urine

prematurity complication: hepatic and hematologic

at risk for hypoglycemia

low iron stores

at risk for hyperbilirubinemia

prematurity complications: neuro

rapid brain development during the 3rd trimester

at risk for: intraventricular hemorrhage, intracranial hemorrhage, apnea (cessation of breathing for at least 20 secs - may be r/t bradycardia)

prematurity: possible long term complications

SIDS

respiratory infections

neurologic problems

auditory problems

speech problems

retinopathy of prematurity

prematurity expected care

cardio/respiratory monitoring and function

meet growth and development needs

nutrition

maintain fluid and electrolyte balance

thermoregulation

infection prevention

promote bonding

postmaturity

born after 42 completed weeks gestation

postmaturity complications

hypoglycemia

meconium aspiration

seizures

polycythemia

congenital anomalies

cold stress

newborn of the substance-abusing mother

born to a mother who is dependent on drugs or ETOH

complications include congenital anomalies and/or developmental problems

fetal alcohol syndrome

exposure to ETOH can cause physical, behavioral, and cognitive problems

appearance: short stature, microcephaly, thin

long term complications of fetal alcohol syndrome

impulsive behavior, cognitive involvement, speech problems, learning disabilities

drug abuse

may be legal or illegal drugs

risks to baby: asphyxia, infection, LGA or SGA, low APGAR scores, respiratory distress, congenital anomalies, behavioral problems. withdrawal

long term problems with newborns of substance-abusing mother

developmental, cognitive, social, behavioral, GI, and respiratory problems

care given for newborn of substance-abusing mother

promote postnatal care

newborn drug screen

social service consult

medication administration

reduce withdrawal symptoms

abstinence scoring

small, frequent feedings

monitor GI status

swaddle, pacifier, calm infant

skin protection

decrease stimulation

phenylketonuria (PKU)

phenylalanine amino acid disorder - unable to convert excess phenylalanine to tyrosine

leads to cognitive disabilities

galactosemia

carbohydrate metabolism problem

homocystinurea

deficiency of cystathionine beta synthase