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Puerperium?
1st 6 weeks after birth of an infant
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When should the uterus no longer be palpable after birth?
10th day
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Where should uterus be within 24 hrs of birth?
Umbilicus - should feel firm
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How many finger breaths per day should the uterus decrease after birth?
1 finger breath per day
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Postpartum chill?
Shaking from nervousness - give them a warm blanket
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What should you do if someones uterus isn't firm?
Massage & should become firm
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What should you do if you have a boggy uterus?
Notify MD - assess for clots & hemorrhage - Administer oxytocin
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Seperation of the longitudinal muscles of the abdomen during pregnancy
Diastasis Recti
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Normal blood loss for vaginal birth?
500 ml
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Normal blood loss of C-section?
1000 ml
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What is a warning sign for lochia & bleeding?
If lochia returns to previous state (Ex. Serosa to Rubra or Alba to Serosa)
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Rubra, Serosa or Alba?
Red, day 1-3 blood
Rubra
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Rubra, Serosa or Alba?
Pinkish/Brownish, day 3-10, blood, mucus, leukocytes
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Serosa
Pinkish or brownish, day 3-10 blood, mucus, leukocytes
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Rubra, Serosa or Alba?
Whitish , day 10-14, largely mucus & leukocytes
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If lochia flow increases what should you do?
Woman should rest more
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T/F: Constant trickling of blood or soaking pad every 60 min is more than normal.
True
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1 gm = how many ml of blood?
1 ml
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What is considered a moderate amount of Lochia?
4-8 partially/saturated pads/day
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How long should you wait before inserting anything into the vagina after birth?
6 weeks
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To inspect the perineum how should the patient lie?
Sim's position - lift upper buttock and assess
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What stage of Lochia is sex considered to be ok?
Alba
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Reva Rubin:
Mom wants to talk about her experience of labor & birth, preoccupied with her own needs
Taking in
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Reva Rubin:
More ready to resume control of her body, baby & taking on mothering role. Needs reassurance if inexperienced.
Taking hold
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Reva Rubin:
by 5th week, total abandon to NB - mother is worried aboutbaby rather than her own needs
Letting-go
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Reva Rubin:
en face position, engrossement. Encourage through early interaction & breastfeeding
Bonding
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Transient depression in first few days after having a baby?
Postpartum Blues - weepiness, mood swings, anorexia, difficulty sleeping, feeling of letdown
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Depression persisting >2 weeks after having a baby?
Postpartum Depression - sad feelings, hopeless, worthless, trouble sleeping, unable to concentrate
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Postpartum Psychosis?
Woman may act on harming herself so be aware
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Treatment for Superficial Leg Vein Disease?
- Local heat
- Elevate limb
- Bed rest
- Analgesia
- Elastic support hose
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S/S: tenderness in portion of vein, local heat & redness, normal temperature or low grade fever
Superficial Leg Vein Disease
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S/S: edema of ankle, leg, initial low grade fever then high temp & chills, tenderness & pain, changes in limb color & difference
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Treatment of DVT?
- IV heparin
- Bed rest
- Elevation of leg
- Analgesics
- warm moist heat
- antibiotics
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When should you suspect infection of a postpartum woman?
temp > 100.4
Slight elevation is normal in first 24 hrs due to dehydration
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Postpartum - rapid of thready pulse could be a sign of what?
Hemorrhage
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Postpartum women may have orthostatic hypotension r/t blood loss so what should you do ?
Assist to first trip to bath room
Instruct pt. to dangle legs and sit first before rising
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Breast Assessment:
- Soft: Day 1-2
- Filling: Firmer & warmth - day 3
- Engorged: Firmer, warm and have milk
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Mastitis?
It's unilateral infection of the breast - one tit will be reddened and warm
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Breastfeeding or Non-breastfeeding?
Warm compress & warm shower
Breastfeeding
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Breastfeeding or Non-breastfeeding?
Cold compress, ice packs, snug bra
Non-breast feeding
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Postpartum Breast care?
- Wash daily - NO SOAP!
- Wear 1-2 sizes larger bra with absorbant pads
- Avoid underwires
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5 signs of respiratory distress?
- Tachypnea
- Cyanosis
- Nasal flaring
- Expiratory grunting
- Retractions
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Normal weight loss for a newborn?
5-10% of origanal weight
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Normal Head & Chest circumference of a newborn?
32 - 35 cm
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How is first temparature always taken?
Rectally
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How much larger should the head be than the chest?
2-3 inches
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Losing/gaining heat by air?
Convection
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Laying a baby onto a cold table and the baby loses heat is known what type of heat loss?
Conduction
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Gaining heat by light?
Radiation
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Losing heat after taking a bath is what type of heat loss?
Evaporation
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How should the baby sleep to decrease the chance for SIDS?
Supine position
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When can you start adding cereal to an infants diet?
4-6 months
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T/F: Infants should never sleep with parents
True
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How many hours/day will an infant sleep?
16 out of 24
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What color stool will an infant have if they are recieving phototherapy?
Light green
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Toes fan reflex
Babinski reflex
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Normal, immature circulatory system. Dependent side red, upper side pale.
Harlequin sign
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Edema on scalp that CROSSES SUTURE LINE?
Caput Succedaneum
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Blood between periosteum of skull bone and bone itself. DOES NOT CROSS SUTURE LINE.
Cephalhematoma
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When does posterior fontanelle close on an infant?
2 months
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When does anterior fontanelle close on an infant?
12 - 18 months
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Normal APGAR at 1 minute?
7-10
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What does the APGAR measure?
- HR
- Respiratory effort
- Muscle tone
- Reflex irritability
- Color
(done at 1, 5 & 10 min)
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What type of blood is incompatible with A or B?
Type O
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When is a Direct Combs test advised?
mom Rh- or Type O
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When should you give a rhogam shot?
if mother is Rh- & father is Rh+
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S/S of Endometritis?
- foul smelling, bloody discharge
- fever (day 3-4)
- Uterine tenderness
- tachycardia
- chills
- (elevated temp in 1st 24 hrs & WBCs are normal)
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if BS < 40 in an infant what should you do?
FEED IMMEDIATELY
(S/S: jittery, lethargy & seizures)
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