Maternity

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em1277
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241946
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Maternity
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2013-10-23 19:22:59
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Maternity
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  1. Lochia Rubra
    Initial lochia: 1-3 days and is bright red, fleshy odor. Numerous large clots.  Saturation in 1 hour or less.
  2. Lochia Serosa
    Days 4-9. Pinkish brown.  Saturation of pad in 1 hour or less
  3. Lochia Alba
    Day 10 - approx 6 weeks. Creamy white
  4. 4 Stages of maternal role attainment
    • 1. Anticipatory -during pregnancy.  Looks @ role models on how to be a mother.
    • 2. Formal -  birth and on. Still influenced by others
    • 3. Informal -  when mother starts to make her own choices and find own style
    • 4.  Personal - Does what she is comfortable with 3-10 mo after delivery
  5. 2 hormones that stimulate milk production
    • Prolactin
    • Oxytocin (also stimulates uterine contractions)
  6. When is bowel movement expected for mother after delivery?
    Within 3 days
  7. How does a woman remove excess blood volume after birth?
    Diuresis (↑ pee)

    Diaphoresis (↑ sweating)
  8. How long should you leave prepared formula at room temp?
    no more than 2 hours
  9. Only vaccine contraindicated while breastfeeding
    Smallpox
  10. Noisy sucking, clicking sound or dimpling of cheeks indicates what?
    Improper mouth position and requires repositioning
  11. Hindemilk 

    Foremilk
    • Hindemilk - milk produced at the end of feeding. Contains more fat
    • Foremilk -  milk produced at the beginning
  12. How many more calories a day does a breastfeeding mother need?
    500
  13. 5 factors that can slow down involution
    • prolonged labor
    • Incomplete expulsion of placenta
    • Anesthesia
    • Previous labors
    • Full bladder
  14. BUBBLE - HE
    • postpartum check
    • Breasts
    • Uterus
    • Bladder
    • Bowel
    • Lochia
    • Episiotomy
    • Homan's sign
    • Emotional status
  15. 2 infectious diseases absolutely contraindicated for breastfeeding
    • HIV
    • HTLV 1 &2
    • You can breastfeed - Hep A, Hep B (must receive HPV vaccine first) and TB
  16. Storing of breastmilk
    • Can store in glass or hard plastic
    • Do not microwave
    • Store in fridge up to 5 days and freezer 2 weeks
  17. Subinvolution
    Failure of uterus to return to pre-pregnancy size and mostly caused by retained placental fragments
  18. 3 factors that enhance involution
    • Uncomplicated labor
    • Breastfeeding
    • Early, frequent ambulation
  19. Vital signs after delivery
    • Temp may raise to 100.4°
    • Pulse often ↓ to 50-60 bpm for 6-8 days

    BP should remain the same
  20. Signs of a distended bladder
    • Fundus above umbillicus
    • Fundus over to the side
    • Excessive lochia
  21. What in breast milk helps control bacterial growth in GI tract
    Lactoferrin
  22. Assessing lochia flow
    • (In 1 hour)
    • Scant -  < 2" stain
    • Light -  < 4"
    • Moderate - < 6"
    • Large -  > 6" or pad saturated in 2 hours 
    • Excessive -  Saturation w/in 15 min
  23. Diastasis Recti
    Separation of abdominal muscles at midline
  24. Caring for uncircumcised penis
    • Avoid forceful retraction
    • Wash with water only during infancy
    • Whiteish limps (smegma) are normal
  25. Potential consequences of cold stress
    • Hypoxia
    • Acidosis
    • Hypogylcemia
    • ↓ surfactant production
    • Collapse of alveoli
    • Reopening of foramen ovale & ductus arteriosus
  26. Port-wine stain
    • Flat-purple lesion that doesn't blanch
    • Can be assoc. with genetic disorders
  27. Erythema Toxicum
    • Splotchy erythema with firm yellow-white papules
    • No interventions
  28. Brown fat
    • Heat producing tissue
    • Located at the nape of the neck, armpits, between shoulder blades, abd aorta and around kidneys
    • Not rewable
  29. Caput Succedaneum
    • Swelling of soft tissues of the scalp that is caused by pressure on head during labor
    • No intervention needed
  30. Fontanelle's
    • Bulging- can indicate intracranial pressure
    • Depressed -  Late sign of dehydration

    • Anterior closed by 18 mo
    • Posterior closed by 2-3 mo
    • 3rd fontanelle may indicate down syndrome
  31. What meds to you administer to newborn?
    • Vitamin K -  newborns cannot synthesize Vit K because they have no bacterial flora, deficient in clotting factors
    • Erythromycin -  prophylaxis against opthalmia neonatorum
    • Hep B
  32. Cord care
    • Check umbilical clamp for tight closure
    • Keep dry and exposed to air
    • Clean around cord with alcohol every diaper change
    • If moist, red or foul odor report immediately
  33. Nevi
    • Stork bites
    • Gradually fade
  34. Nonshivering Thermogenesis
    Heat production without shivering by oxidation of brown fat
  35. Active sleep
    • Easily awakened
    • The best time to test hearing
  36. What is used to determine gestational age of newborn
    Ballard scale
  37. Skin cleansing of newborn
    • Preserve the skins PH
    • Avoid: alkaline soaps, oils, powder, lotions

    For 1-2 weeks, water only
  38. 3 phases of newborn care
    • 1 - Birth - 1 hour (in delivery room)
    • 2 -  1-4 hours
    • 3 - 4 hours - discharge.  Nursing interventions and family teaching
  39. Normal axillary temp
    97.7 - 99.5
  40. Strabismus
    • Failure of the two eyes to direct their gaze at the same object simultaneously.
    • Estropia - when one eye moves toward the other eye
    • Extropia -  turning out of one eye
    • Surgery or eye exercises to treat
  41. Functional Residual Capacity (FRC)
    The amount of air that remains in the lungs after normal expiration
  42. Molngolian spots
    • Bluish pigmentation over lower back and buttocks
    • Common in dark skinned newborns
  43. 3 fetal circulatory shunts
    • Ductus Venosus -  diverts blood away from liver.  Closes when cord is cut
    • Foramen Ovale -  diverts blood from right atrium directly to left atrium. 
    • Ductus Arteriosus -  Diverts blood from pulmonary artery into aorta after birth - closes w/in 15 hours and perm by 3 weeks
  44. Milia
    Small white papules that are harmless
  45. Patent Ductus Arteriosus (PDA)
    • When ductus arteriosus fails to close after birth
    • May lead to CHF if not corrected
    • High occurance in preemies
    • Contributing factors - Congenital rubella
  46. Surfactant
    a substance formed in the lungs that reduces surface tension and helps keep the alveoli expanded and not collapsed
  47. Why is it important to keep the infant warm?
    lack of oxygen at the tissue level will depress respirations
  48. Breathing in newborn
    • 30-60 breaths/min
    • Periodic breathing with 5-15 second pauses
    • Breathe through the nose
  49. Cephalohematoma
    • Accumulation of blood under the periosteum of newborns skull
    • Caused by trauma to blood vessels during birth
    • More common in long or difficult labor
    • May take up to 3 weeks to go away
  50. Epstein's Pearls
    • Small, white blebs found on the gums and junction of soft & hard palates
    • You just need to distinguish between them and thrush
  51. Quiet alert
    • Eyes are open, minimal body activity
    • Best time for parent/newborn interaction and to test responses and reflexes
  52. Acrocyanosis
    • bluish discoloration of hands and feet
    • Normal
  53. Circumcision
    • If newborn has phimosis, should be circumcised, otherwise it's elective
    • Preterm infants should not, must be stabilized first
    • A&D or petroleum jelly applied at every diaper change
    • Usually heals in 3-5 days.  Do not remove yellow crust
  54. How long does egg take from Ovum to Uterus?
    5 days
  55. Fimbriae
    Fingerlike projections at the end of fallopian tube
  56. Prostate gland
    • a gland that surrounds the urethra that contributes to semen secretion
    • Adds alkaline fluid to semen
    • Helps neutralize acidity of vagina
  57. Seminal Vesicle
    • 2 saclike structures
    • produces milky secretion that protects sperm
    • empties into urethra
  58. Estrogen
    • Stimulates uterine growth
    • Increases blood flow to uterine vessels
    • Stimulates development of breast ducts
  59. Placental function
    • Protection
    • Nutrition
    • Respiration
    • Excretion
    • Hormone production
  60. Trophoblast
    • The cells on the outer ring of blastocyst
    • Will become placenta
    • The cells secrete enzymes that enable it to implant into uterus
  61. Chorion
    Outer membrane of amniotic sac that is formed from trophoblast
  62. When each cell is reduced to 23 chromosomes
    Haploid # of chromosomes
  63. Spermatogenesis & Oogenesis
    The process of mitosis in the sperm & ovum
  64. Mitosis
    • Type of cell division in which each daughter cell contains the same # of chromosomes as the parent cell
    • The process by which the body grows and cells are replaced
  65. Chromosomes
    • Spiral structures found within nucleus of each cell
    • They control heredity
    • Occur in pairs. One member from mother, one from father.
    • Each cell contains 46 chromosomes
  66. Oligohydramnios
    • Less than 300 mL of amniotic fluid
    • (associated with renal abnormalities)
  67. Hydramnios
    • Excessive amniotic fluid (more than 2L)
    • Assoc w/malformations of CNS and GI tract
  68. Amniotic Fluid
    Fluid that surrounds the fetus and permits fetal movement, absorbs shock and prevents heat loss
  69. Chorionic Villi
    root-like, branching projections of chorion containing capillaries that substances are exchanged between mother and fetus
  70. Progesterone
    • Maintains uterine lining
    • Reduces uterine contractions
    • Prepares glands of breasts for lactation
    • Stimulates testes to produce testosterone (male fetus)
  71. Fetus
    • Undelivered baby after embryonic period
    • 8th week-birth
  72. When can mother feel fetal movement?
    17 weeks
  73. Soma cells
    body cells
  74. Teratogenic Agent
    • agent or substance that causes abnormal development of embryo
    • Most likely to cause damage during first 8 weeks
  75. Embryonic Membranes
    • Amnion - Inner layer that contains amniotic fluid and embryo
    • Chorion -  outer layer that encloses amnion
  76. Genes
    Segments of DNA that control heredity
  77. Gametes
    "sex cells" which determine the sex of the fetus
  78. Signs of a preterm baby
    • Hypoglycemia
    • Respiratory distress
    • Jaundice
    • Lanugo
    • Less body fat
    • Enlarged clitoris
    • Less activity
  79. 46 chromosomes in the body cell are called?
    Diploid number of chromosomes
  80. Meiosis
    Reduction cell division in ova and sperm that halves the # of chromosomes in each cell
  81. When is meiosis completed?
    • in the sperm before traveling to fallopian tube
    • and
    • in ovum after ovulation if fertilized
  82. If only one parent carries a dominant trait...
    50% of offspring will carry that trait
  83. Where does fertilization normally take place?
    the outer third of the fallopian tube
  84. XX
    and 
    XY
    • XX = female
    • XY = male
  85. How long are sperm viable after ejaculation?
    5 days
  86. Ovum can be fertilized for _____ after release from ovary
    6-24 hours
  87. Blastocyst
    • stage that follows morula
    • Outer layer of trophoblast attached to an inner cell mass.  Contains: fluid filled cavity, trophoblast, inner cell blast
  88. Morula
    Stage of zygote where there is solid mass of cells (approx 3 days)
  89. Wharton's jelly
    Thick substance that is physical buffer to prevent kinking of umbilical cord
  90. 4 hormones produced by placenta
    • Progesterone
    • Estrogen
    • HCG
    • HPL
  91. Monozygotic & Dizygotic
    • Mono -  identical twins splitting of one fertilized egg before 15th day. If splitting is incomplete = conjoined twins
    • Dizy -  2 ova, 2 sperm. Each fetus has own amniotic sac and placenta
  92. Pica
    Consumption of substances ordinarily considered inedible.  
  93. Alpha-fetoprotein test (AFP)
    • usually performed at 16-18 weeks gestation
    • High levels assoc with spina bifida
  94. Chorionic Villus sampling
    • done in 1st trimester 
    • alternative to amniocentesis
    • Higher abortion rate than amnio
    • Checks for chromosome defects
  95. Leopold's Maneuvers
    Used to determine the presentation and position of fetus
  96. Embryonic Period
    • 2nd - 8th week after conception
    • When most basic organ structures are formed
  97. Para
    Number of births after 20 weeks gestation regardless if infants survived
  98. A sudden elevation in BP or excessive weight gain may be a symptom of?
    Gestational hypertension
  99. Positive signs of pregnancy
    • hearing fetal heart sounds
    • palpating fetal movements
    • visualizing the fetus via ultrasound
  100. Supine Hypotensive Syndrome
    Lower BP and pulse in supine position resulting from compression of the inferior vena cava by pressure of the uterus
  101. Cleansing breath
    A deep breath taken at the beginning and end of each labor contraction
  102. Nagele's Rule
    • Method to calculate expected DOB
    • Count back 3 months from first day of last period and add 7 days
  103. Effleurage
    • A slight stroking movement of fingertips over abdomen during labor
    • Used as a distraction for pain relief during contractions
  104. 3 Parts of the Uterus
    • Fundus - upper rounded portion
    • Corpus - middle
    • Cervix - lower potion (known for its elasticity)
  105. Vas Deferens
    • 18" tube that ends at seminal vesicle
    • Carries sperm from testes to urethra
  106. Oxytocin
    Hormone produced by posterior pituitary that stimulates uterine contractions and milk
  107. Epididymis
    • testes open into and becomes vas deferens.
    • Provide reservoir for sperm
    • Can be maintained for up to 3 weeks
  108. False Pelvis
    • Upper portion of pelvis
    • Supports growing uterus and directs head of baby to true pelvis
  109. Lutenizing Hormone (LH)
    Stimulates development of corpus luteum
  110. What maintains acidity in vagina?
    Dorderlein's bacilli
  111. Introitus
    Vaginal opening
  112. 3 layers of fundus and corpus
    • (Outer) Perimetrium
    • (middle) Myometrium
    • (Inner) Endometrium
  113. Follicle stimulating hormone (FSH)
    Stimulates development of graafian follicle
  114. Vulva includes?
    • (external reproductive organs)
    • Mons pubis
    • Labia majora and minora
    • Vestible
    • Fourchette
    • Perineum
    • Clitoris
  115. Phases of menstrual cycle
    • Menstrual
    • Proliferative - post menstrual. Lining repairs
    • Secretary -  Premenstrual. Lots of progesterone. Thick lining
  116. Diagonal conjugate
    Distance between sacral promontory and lower border of symphysis pubis
  117. 4 pelvic types
    • Gynecoid -  female type - Normal/round
    • Android - male type - heart shaped outlet
    • Anthropoid - long anterposterior
    • Platypelloid - wide transverse outlet.  Not favorable for vaginal delivery
  118. Vaginal vestible contains
    • Vaginal opening
    • Urethral meatus
    • Skene's ducts
    • Ducts of Bartholin's glands
  119. Corpus Luteum
    • Solid, yellow body that develops within ruptured follicle
    • Secretes progesterone
  120. HPL
    Increases maternal insulin resistance
  121. Relaxin
    • Relaxes symphysis pubis and other pelvic joints
    • Softens the cervix
  122. Progesterone
    • Inhibits uterine contractions
    • Promotes duct developement
    • Stimulates sodium secretion
    • Reduces smooth muscle tone
  123. 3 types of first-stage breathing
    • Slow Paced breathing -  starts and ends with cleansing breath, then breathes slowly
    • Modified Paced breathing -  begins and ends with cleansing breath, then rapid/shallow breaths
    • Patterned Paced breathing -  during later part of cervical dilation. Cleansing breaths, rapid breaths, pant blow
  124. Cardiac output in pregnancy
    • Doubles
    • 40% increase in blood volume
  125. GTPALM
    • G - gravida (# of pregnancies)
    • T -  # of term pregnancies
    • P -  # of pre-term pregnancies
    • A -  # of abortions
    • L -  # of live births
    • M -  # of multiple births
  126. Where is HCG produced?
    • Chorionic villi of placenta. 
    • Present as early as 1 week after conception
  127. Gravida
    Any pregnancy, including present one
  128. Exercise in pregnancy
    • Used to maintain fitness, not improve
    • Mild to moderate is beneficial
    • Strenuous or prolonged may cause hypoxia in baby
  129. Normal fetal heart rate
    110 - 160 bpm
  130. Vertex presentation
    When fetal head is flexed
  131. Decelerations
    • Decreases in fetal heart rate
    • Indicate an interruption of oxygen transfer to fetus
  132. Mentum
    Face
  133. Frequency of contraction
    • time from beginning of contraction until the beginning of the next
    • Contractions more than every 2 min may decrease fetal O2 supply
  134. 3 Phases of contractions
    • Increment -  period of increasing strength
    • Acme -  peak - period of greatest strength
    • Decrement - period of decreasing strength
  135. Fetal Position
    Relation of presenting fetal part to the front, sides and back of maternal pelvis
  136. Anterior fontanelle formed by which sutures?
    • Sagittal
    • Frontal
    • Coronal
  137. Nursing care during active phase of labor
    • Vital signs every 30 minutes
    • Provide support
    • Assess membrane status
    • Dilation
    • Position changes
  138. Variable Decelerations
    • Decrease in fetal HR before, during and after contraction
    • r/t compression of umbilical cord
    • Change mothers position
  139. First stage of labor
    • Latent phase -  when regular contractions start up to dilated 4 cm
    • Active phase -  dilation from 4-7 cm
    • Transition phase -  dilation completes to 10 cm
    • 1st stage ends when fetal head can be seen
  140. Flexion
    Fetus is flexed with head on chest, arms and legs folded and legs drawn up onto abdomen
  141. 4 variables of labor (4 P's)
    • Passageway (Pelvis size and shape)
    • Passenger ( fetus size and position)
    • Powers (effectiveness of contractions)
    • Psyche (preparation and previous experience)
  142. Station
    • Relation of presenting fetal part to the pelvic ischial spines of the birth canal
    • How far fetal presenting part has descended into mothers pelvis
    • Measured in cm above or below ischial spine
    • Above = minus 1-5
    • At 0 = head is engaged
  143. What's included in Apgar (5)
    • HR
    • Respiratory effort
    • Muscle tone
    • Reflex irritability
    • Color
  144. Chloasma
    • Increased pigmentation of the face during pregnancy
    • aka - "mask of pregnancy" or melasma
  145. Admission data needed
    • ID bracelet
    • Vitals
    • Fetal HR
    • SROM?
    • Assess contractions
    • Allergies
    • Last food intake?
    • Recent illness or meds?
    • Consent sigs
    • Review lab tests and document
    • RH status
    • Orient to unit
    • Care preferences
  146. Assess what after rupture of membranes?
    Fetal HR because prolapse of umbilical cord is most likely to occur at that time
  147. Early Decelerations
    • Slowing of FHR caused by head compression
    • Mirrors contraction
    • No interventions
  148. Late Decelerations
    • Begin at peak of contraction and end after contraction ends
    • Assoc with uteroplacental insufficiency
    • Repetitive decelerations are bad
  149. Signs of imminent delivery of placenta
    • Lengthening of umbilical cord
    • Gush of blood from vagina
    • Elevation of fundus
  150. Fetal Attitude
    • The relation of the fetal parts to one another
    • Normal attitude is flexion
  151. Maternal response to transition
    • Irritability
    • Restlessness
    • Amnesia
    • Cramps in legs
    • Belching/hiccups
    • nausea
    • Sweating
    • Wants meds
    • Feels out of control
  152. Why do you assess bladder every 2 hours?
    • Can displace uterus and inhibit uterine contraction
    • Woman may not be able to sense the need to void
  153. Suction newborn in what order?
    Mouth then nose
  154. How often to assess mom after delivery
    Every 15 min for at least 1 hour
  155. First priorities for newborn after birth
    • Maintain thermoregulation
    • Maintain cardiorespiratory function
    • ID
    • Look for anomalies
    • Meconium & Urine
    • Bonding
  156. Fetal Lie
    • Relational longitudinal axis of the fetus to the longitudinal axis of the mother
    • Ideal is parallel with eachother
  157. Fetal Presentation
    • Body part that is lowest in the mother's pelvis
    • Cephalic is most common
  158. Occiput
    Back part of the head
  159. 6 mechanisms of labor
    • Descent
    • Flexion
    • Internal rotation
    • Extension (when crowning occurs)
    • External rotation - after head is delivered
    • Expulsion - when baby is delivered (end of 2nd stage of labor)
  160. What position would this be?
    Breech felt in fundus, fetal back on right side of woman's abdomen, directed anteriorly, with fetal head firmly fixed in pelvis
    ROA - Right occiput anterior, engaged
  161. Effacement
    Thinning and shortening of cervix before and during labor
  162. Lightening
    • Movement of the fetus and uterus downward into the pelvic cavity
    • Physical changes in mother are: easier breathing, increased urination, leg cramps, edema
  163. Correct sequence in the development of the fertilized Ovum
    • Zygote
    • Morula
    • Blastocysts
    • Embryo
    • Fetus
  164. Circulation of the umbilical cord
    • Umbilical arteries carry deoxygenated blood to placenta
    • Umbilical vein carries oxygenated blood from the placenta
  165. Foramen Ovale closes after birth because?
    Increased pressure in the left atrium
  166. When are the beginnings of all major organs present?
    By the end of the seventh week
  167. Age of viability
    20 weeks
  168. For a recessive trait to show up in children
    Each parent must contribute an abnormal gene
  169. Presumptive signs of pregnancy
    • Amenorrhea
    • Nausea
    • ↑ urination

    • Fatigue
    • Quickening
    • Breast tenderness
  170. Probable signs of pregnancy
    • Uterine enlargement
    • Hegar's sign
    • Positive pregnancy test
  171. Changes in GI system during prenancy
    Increased saliva production
  172. Fetal Distinction
    When woman feels quickening, the fetus becomes distinct and separate. Daydreams and speaks of baby
  173. One purpose of ultrasound
    Rule out fetal abnormalities
  174. Diagnostic test to determine fetal lung maturity
    L/S ratio
  175. Elevated AFP test can indicate what
    Neural tube defects
  176. A Nonstress test (NST) assesses
    Fetal oxygenation and autonomic functions
  177. Nipple stimulation
    Woman brushes palm across nipple for 2-3 minutes
  178. How to care for leg cramps in pregnancy
    Stand with feet flat on the floor
  179. Why do you suction the mouth first in a newborn?
    To prevent aspiration
    • #1: Urinary Bladder
    • #2: Vas Deferens
    • #1: Pectoralis major muscle
    • #2: Alveoli
    • #3: Areola
    • #4: Nipple
    • #1: Fallopian tube
    • #2: Ovary
    • #3: External Illiac Vessels
    • #4: Infundibulopelvic Ligament
    • #1: Seminal Vesicle
    • #2: Ejaculatory Duct
    • #3: Prostate Gland
    • #1: Round Ligament
    • #2: Corpus of Uterus
    • #3: Bladder
    • #4: Symphysis Pubis
    • #1: Mons Pubis
    • #2: Clitorus
    • #3: Prepuce
    • #4: Labia Minora
    • #1: Orifice of Urethra
    • #2: Labia Majora
    • #3: Opening of Bartholin's Gland
    • #4: Perineal Body
    • #1: Hymen
    • #2: Orifice of Vagina
    • #3: Vistibule
    • #4: Fourchette
    • #5: Anus
    • #1: Vaginal Orifice
    • #2: Urogenital Diaphram
    • #3: Vagina
    • #4: Anus
    • #1: Epididymis
    • #2: Testes
    • #3: Scrotum
    • #1: Urogenital Diaphram
    • #2: Glans of Clitoris
    • #3: Urethra
    • #4: Labium Minus
    • #5: Labium Majus
    • #1: Bulbourethral Gland
    • #2: Anus
    • #1: Urethra
    • #2: Penis
    • #3: Glans Penis
    • #4: Foreskin
    • #1: Ureter
    • #2: Sacral Promontory
    • #3: Uterosacral Ligament
    • #4: Posterior cul-de-sac of Dougles
    • #1: External Anal Sphincter
    • #2: Lavator Ani Muscle
    • #3: Fornix of Vagina
    • #4: Rectum
    • #5: Cervix

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