Maternal Infant Exam 1 Study Tool x

What is fertility?

a person's ability to reproduce

What can decrease a patient fertility?

- increased age

- elevated or low BMI

- poor diet

- smoking

What can have a positive effect on patient fertility?

- good diet

- exercise

What is birth rate?

babies born in population over a certain period of time

What is morbidity?

having illness/disease

What is mortality?

death rate

What is the current infant mortality trend in the US?

it is increasing

What is the time frame for infant mortality or morbidity?

include postpartum period and up to a year IF condition is related to pregnancy

What are risk factors for infant Morbidity and Mortality?

- gestinatal diabetes

- overweight

- hereditary

- same risk factors for regular diseases

What is the most common cause of fetal + infant mortality?

sudden unexplained infant death syndrome or SUIDS

What causes racial disparities in Maternal Newborn Statistics?

social determinants of health

What is an example of racial disparities in Maternal Newborn Statistics?

black clients have 2-3x increased risk of mortality than non-hispanic white clients

What are the goals of Health people 2030 related to maternal infant nursing?

- healthier pregnancy patients

- decreased maternal and infant mortalities

What is Advocacy?

taking action to influence others to address a health-related concern or to support a health-related belief

What is an example of advocacy with maternal infant nursing?

if a patient has a specific brith plan, do your best to make sure it is possible to the highest extent

What is therapeutic relationship/communication with maternal infant nursing?

- building a rapport with your patient

- it is very important part of a nurse-client relationship

What is the main component of health promotion and injury prevention with maternal infant nursing?

education

What is beneficence ?

to do good

What is autonomy?

allowing patient to make own decisions abut care for themselves and their child

What is moral distress

being aware of your beliefs and making sure thety do not influence the care you provide

What is a Midwife ?

a health professional who is trained or has direct experience with the birth process

What can midwifes NOT do?

perform c-sections

What is postpartum blues?

happens a couple weeks after birth, normal finding as hormones go back to normal

What is postpartum depression?

- intense mood alterations and/or disrupted ability to complete self-care and newborn care

- very prevent, happens to 1 in 8 women

What is postpartum psychosis?

- rapid onset of manifestations that include hallucinations, delusions, bizarre behavior, and confusion

- needs rapid intervention because suicide and infanticide can occur

Family vs Community Centered Care?

- family: used because family is involved with client and newborn after discharge

- community- can be positive to community and help improve maternal + fetal outcomes

When is postpartum depression common and how long can it persist/last?

- most often happens with 6 weeks of birth

- can persist or happen up to a year after birth

What clients are appropriate for home births?

client with low risk of complications with a plan for emergency situations

What are stressors women may face during pregancy?

- social determinants of health

- substance use

- intrapersonal violence

- violence + abuse

What are social determinants of health?

- economic stability

- social + community context

- access to and quality of education

- access to and quality of health care

- neighborhood + built environment

What should you remember when assessing family structures?

they can be complex and look different from what you are used to

What can you do to promote social support systems for a client during pregancy?

assess frequency and provide resources

What should you keep in mind with culture and family roles?

avoid assumptions and sterotypes

What influences childbearing beliefs?

cultural beliefs

What is cultural competence?

to provide appropriate culturally sensitive care related to the clients beliefs and practices.

What is cultural awareness?

An appreciation of the external signs of diversity, such as the arts, music, dress, foods, and physical characteristics

What is a primary level of prevention and an example?

- prevention or delay of occurrence of illness or disease

- example: safe sex, maintance of diet

What is a secondary level of prevention and an example?

- screening

- early detection and treatment of disease

- example: cancer screening, breast-self exam

What is a teritary level of prevention and an example?

- prevention of complication of disease and rehabilitation

- example: pharmacological interventions

What is the quartenary level of prevention and an example?

-prevention aims to prevent overmedicalization

- example: avoiding prescribing antibiotics for a viral cold.

What is done to promote family health?

education on disease prevention

What are the goals for families from health people of 20230?

- Tdap immunity

- smoking cessation

- family planning

What are risk factors of human tracficking?

- STI

- Violence

- Malnourishment

What is the benefits of homecare services?

people do not have to leave home

What is the roles of the nurse regarding the childbearing family?

- advocacy

- therapeutic relationships / communications

- health promotion

- injury prevention

- support, counseling, and collaboration

- legal and ethical practice

What is Healthy People 2030 goals trying to INCREASE within the childbearing family?

- abstinence from cigarette smoking, alcohol, illicit drugs, and opioids

- proportion of women with enough folic acid, early/adequate prenatal care, and healthy weight before pregnancy

- proportion of women screened for postpartum depression

What is Healthy People 2030 goals trying to DECREASE within the childbearing family?

- maternal and infant mortality

- severe maternal complications during delivery hospitalizations

- c-section births among low-risk women w/o prior births

- preterm births

What does the BUBBLEHED acronym stand for?

B- breast

U- Uterus

B- Bladder

B- bowels

L- Lochia

E- epistomy/laceration (perineal)

H- Homen''s sign

E- Emotional staus

D- Diastasis Recti

What is colostrum?

1st milk production, really thick

What is primary engorgement?

normal finding as breast fills with milk

What is secondary engorgement?

enlargement in breast due to too much milk

What are some possible causes of secondary engorgement?

- baby not latching

- breast not being emptied

- mother pumping while baby in nursery

Why is breastfeeding important for the MOTHER?

breastfeeding is important for the mother because it released oxytocin causing uterus to contract, preventing hemorrhage

What are some tips you should give a NON-LACTATING client?

- minimize palpation of breast to avoid stimulation of milk

- place ICE/COLD pack on breast (NO WARMTH)

- wear supportive bra

What are you checking for on the inspection of a mothers nipples?

- if they are everted/ flat/ inverted

- cracks

- redness

- soreness

- fissures

What should you observe the mother do with her baby when checking the mother nipples?

observe the baby breastfeeding and make sure they latch on properly

What is an expect finding of the fundal assessment postpartum?

- firm and well-contracted

- at or below maternal umbilicus

- non-tender (does NOT me NO pain)

What are abnormal finding of the fundal assessment postpartum?

- not firm

- right or left of umbilicus

What interventions can be taken for abnormal fundal assessment findings?

- fundal massage

- emptying bladder

What is lochia rubria?

- dark

- 3-4 days postpartum

- mostly in hospital

What is lochia serosa?

- pink to brown

- 4-10 days postpartum

What is lochia alba?

- white or yellow

- 10-14 days postpartum

- assess odor for possible sign of infection

What should NOT be seen on your assessment of the amount of lochia because what does it indicate?

- perineal pad should NOT be saturated in less than 1 hour

- clots should not be bigger than a chicken egg/ golf ball

Indicates: postpartum hemorrhage

How is lochia amount documented?

documented as amount on pad after 1 hour

- scant: < 2.5 cm

- light:

What is a normal finding on elimination assessment postpartum?

- first void taken place within SIX HOURS or earlier

- post- void residual should be < 150mL

What should the nurse do for the patient first few urination attempts postpartum?

accompany/assisit for 1st 2 void, more if voiding

What abnormal signs should the nurse look for when assessment elimination of postpartum client?

- infrequent voiding

- urinary retention

- frequent voiding

- painful voiding

- burning

- foul-smelling urine

What issues can cause voiding problems in postpartum clients?

- fatigue

- perineal swelling

- long, difficult L + D

What can too much proteinuria indicate?

preeclampsia

Why is a full bladder postpartum concerning?

a full bladder can displace the uterus which will impair the uterus ability to contract which will increase the risk of postpartum hemorrhage

What should you do if you assess your postpartum client had a deviated fundus?

try to get the client to empty their bladder

How is the placement of the uterus document and what can changes be a sign of?

- X/u: above umbilicus

- U/U: at umbilicus (should be HERE and MIDLINE)

- U/X: below umbilicus

"X" is measured using centimeter (finger widths)

changes could be a sign of hemorrhage

When in a normal time for a postpartum client to have first bowel movement?

on or after 2nd day postpartum

What should you assess for when doing a bowel assessment on a postpartum client?

- bowel sounds every shift

- palpate abdomen for distention

What can help a postpartum client pass bowels?

- stool softeners

- drinking fluids

- fiber

- movement

When should you avoid the use of enemas/suppositories to aid a postpartum client to pass bowels?

when they have a 3rd or 4th degree laceration

What tool do you use when assessing epistomy /lacerations ?

"REEDA"

R- redness

E- ecchymosis

E- edema

D- discharge

A- approximation of skin edges

What can you do for a client with edema or discomfort in 1st 12-24 hours post delivery?

less than or equal to 20 MINUTES at a time

- cooling pack

- sitz bath (warm water- increased circulationH and prevents infection)

How should you assess a postpartum client for hemorrhoids?

watch for active bleeding

What causes hemorrhoids in postpartum clients, and what can hemorrhoids cause?

cause of hemorrhoids: during deliver, due to prolonged pushing, or use of forceps/ vacuum

can cause: anal sphincter injury leading to anal incontinence

Why dont we perform the homans sign anymore, but what would it check for?

checks for DVT, but is not done anymore since it can dislodge a clot

What are signs of a DVT in postpartum client?

- edema

- redness

- swelling

- warmth

- difference in calf size > 2cm

- varicosities

- discolorations

- peripheral pulses

What should a nurse do in relation to a postpartum clients emotional status?

- teach self care, eating well, sleeping when the baby sleep and accepting help

- assess for postpartum blues (normal) and postpartum depression

How do you assess for diastasis recti?

- have patient lay supine while they lift their head up and place chin on chest

What is a positive sign for diastasis recti?

tent-like lower abdominal protrusion is visible (2cm x 8cm)

- palpate at level of umbilicus for seperation in the muscle

What is the patient education with diastasis recti?

- exercise to regain muscle tone and for strong abdominal support for future pregnancies

CONDITION RESPONDS WELL TO EXERCISE

How should pericare be done?

- using peri-bottle with warm water after each void/BM to rinse stitches/perineum

- wipe front to back, patting gently

- spray area with anesthetic spray after wiping

How should peripad be changed?

- change peripad after each void

- apply 1-2 tucks pad to peripad w/ each pad change

What aren't the Rubella/MMR and Varicella vaccines given during pregnancy ?

due to risk to the fetus from giving a live vaccine

When should the Rubella vaccine be given?

should be given ASAP when patient is no longer pregnant or 28 days before next pregnancy

When should varicella vaccine given?

1st dose- after birth before discharge

2nd dose- 4-8 weeks postpartum

When is the Tdap vaccine given if not given during preganacy, why, and who else should get it ?

give to maternal client immediately postpartum because baby can not get it until 2 months of age

else: people close to newborn

What is the significance of Abo/RH?

Rh- client need Rh immune globulins to prevent antibody formation

When should Rh immune globulins be given to a Rh- client?

- 28 weeks gestation, then again within 72 hours of Rh+ newborn birth

- during every pregnancy as well as postpartum after every birth of Rh+ infant

What is the purpose of giving a Rh- negative client Rh immune globulins?

prevent the development of antibodies in birthing client that could harm future Rh+ fetuses

Can the Rh immune globulins be given earlier than 28 week gestation?

yes, they can be given earlier if it is suspected Rh- pregnant patient blood is mixed with fetus blood

What is postpartum hemmorhage?

- cumulative blood loss >1000ml with manifestations of hypovolemia within 24 hours of birth (primary)

- if within 24 hr - 12 weeks (secondary)

What are the causes of postpartum hemmorhage?

- uterine atony

- retained placenta

- inversion

- sub-involution

- genital tract lacerations

- hematomas

What is the acronym for postpartum hemorrhage management ?

"E- MOTIVE"

-E: early detection

- M: massage

- O: oxytocic medicaiton

- T: tranexamic acid

- IV: IV fluids

- E: examination

What is uterine atony?

failure of myometrium to contract leading to bleeding