OB exam 4

Card Set Information

Author:
servinggod247
ID:
312313
Filename:
OB exam 4
Updated:
2015-12-01 01:14:29
Tags:
OB
Folders:
OB
Description:
OB
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user servinggod247 on FreezingBlue Flashcards. What would you like to do?


  1. purpose of attachment
    • make the child feel safe, secure and protected 
    • NOT play with and entertain child
  2. holding, comforting child during painful medication procedures is
    essential
  3. You can/cant spoil a baby by holding them to much
    cant
  4. If you pick up a crying baby, it will
    • cry less
    • learn to self-soothe
    • respond more appropriately to caregiver
  5. Mutual regulation (mutuality)
    • infants behavior call- corresponds with behaviors from parents
    • Crying- parents attend to infant
    • Delayed: temperament, social capabilities, appearance, gender
  6. Acquaintence
    Baby gives clear behavioral cues -- caretakers response predictable -- mother will feel effective & confident

    • Infant behavioral cues (smiles, breasfeeds eagerly, grasps finger, consoles easy, like cuddlin)
    • Claiming process--likeness--differences--unique
  7. Assessment
    • Feeding = excellent time to observe
    • Fantasy about “ideal” baby – birth, fantasy becomes real
    • Do they reach for infant? Call infant by name? ID special things?
    • Body contact? Talk to baby? Make eye contact? Comfortable w/ providing care?
    • Express concerns/disgust? Show affection? Use comforting techniques?
  8. Mexicans
    no sustained eye contact, evil eye
  9. entrainment
    • babies move in time with structure of adult speech
    • culture determines rhythms- ingrained long before first words
  10. Biorhythmicity
    • baby's heart beats in tune with moms
    • lay baby on chest
    • record heart beat
  11. Reciprocity
    • body movement/behavior that provides the observer with cues
    • caregiver interpretes and responds
  12. Dependent phase of attachment
    • taking in
    • 1st 24-48hrs – mom’s needs predominant
    • She needs mothering
    • Relies on others to fulfill needs for comfort, rest, food, closeness to family
    • Mom talks about birth story – excited, talkative
  13. Dependent-Independent phase of attachment
    • Taking hold
    • 2-10days after Focus on baby & competent mothering
    • Desire to take charge
    • Eager to learn/practice
    • Handles discomfort & emotional changes
    • Possible “baby blues” – r/t hormones
    • Desire for nurturing & acceptance from others
    • Uncertain, trapped, overwhelmed –1st time moms
  14. Interdependent phase of attachement
    • Letting go
    • Focus on family unit
    • Reassert partner relationship and physcial intimacy
    • Resolve individual roles
    • Homemaking, career, marital relationship
  15. Paternal Attachemtn
    • Stage 1: expectations
    • Stage 2: REality-Sadness (ambivalence. Jealous. Frustration. Overwhelming desire to be involved.)
    • Stage 3: Transition to Mastery (conscious decision to take control and be more active)
    • 1st few weeks: uncertain. Increased responsibility. Disruption of sleep. Can't control time needed for infant care. Re-established marital dyad
  16. Paternal interacction characterized by
    play
  17. Teen parents
    • Knowledge deficit, inexperience, immaturity, difficulty recognizing problems/resources, unmeet developmental needs of teens
    • Feel different from peers
    • Excluded from “fun” activities
    • Prematurely forced into adult role
    • Conflict b/w own desires & baby’s demands
    • Relationship w/ father beneficial
    • Less verbal, less attentive Less knowledge of child G&D
    • Assume maternal role that they experienced
    • Encourage family to be involved
  18. Teen fathers
    • Crisis mode – teen tasks, transitioning in parenthood, & adapting to marriage/cohabitation
    • Encourage dad to go w/ mom to PP & well-baby check ups
    • Support – finances, child care, parenting skills, reproduction, birth control, safe sex
  19. positive sibling responses
    • showing interest
    • maintaining their interpendence
  20. negative sibling responses
    • regression
    • aggression
    • attention seeking beahviors
    • whining
    • usually passes quickly
  21. Siblings
    • Parents attitude sets the stage
    • Jealousy after interest worn off
    • Actively involve them in prep for new baby
    • Take 1st born to hospital – compare to his/her birth
    • Have small gift from baby to sibling – or sibling to baby
    • Arrange sib to be the 1st one to hold baby
    • Plan time for each child
    • If preschoolers/early school age – give them a “baby” to care for
    • “I’m a big brother t-shirt”
    • Give photo of baby for sib to take to school
    • Supervise interaction b/w siblings
    • Initial behaviors – looking & touching
    • Let kids interact @ own pace
  22. Grandparents
    • Respond to adult kids depending on their view of childbirth, childrearing, & roles
    • Life-transition
    • Maternal grandparents – higher expectations for themselves – may be self-critical
    • Sometimes adult kids may not want help
    • Involvement depends on: willingness to help, proximity, & ethnicity/culture
    • GP: respect autonomy, parents wishes & remain available 4 million
    • GP had primary responsibility for grandkids (2010)
  23. readiness for enhanced family coping r/t
    • positive attitudes and realistic expectations
    • nurturing behaviors
    • verbalizing plus factors in lifestyle change
  24. Risk for impaired parenting r/t
    • lack of knowledge of infant care
    • feelings of incompetence
    • unrealistic expectations
    • fatigue from interrupted sleep
  25. Parental conflict
    • role transition
    • unwanted pregnancy
    • lack of support
  26. Risk for impaired attachement
    • difficult birth
    • postpartum complications
    • neonatal complications
  27. Interventions
    • Home visits ideal
    • Anticipatory guidance on transition to home
    • Written info
    • List available resources
    • Classes
    • Disposable diapers Preparing frozen meals before birth
    • Time discharge to provide adequate time to “settle in” before feedings
    • Provide ready-to-feed bottles for 24-48hrs
    • Assert need to limit visitors
    • Signal partner w/ mom needs rest
    • Let family know how they can help
    • Keep mom in robe
    • Mom should limit activity
    • Rest when baby rests – environment conducive to rest & family plan
    • Adequate nutrition
  28. All infants lose weight
    • meconium, extracellular fluid, low fluid intake
    • >10% loss is concerning but no dehydration
    • 7-10 days-regain birth weight
    • gain 35g/day
    • formula babies regain quicker
  29. adequat hydration
    140-160 mg/kg/day

    DO NOT NEED EXTRA WATER

    Increased surface area to body ratio, hgih water content, low kidney function
  30. sufficent calores
    100-115 kcal/kg/day
  31. fats
    • 15% of calories
    • Long chain polyunsaturated FA
    • DHA & ARA
    • Fat content ­ increased in PM, decreased in AM
    • BM tailored to baby – preterm or term
  32. cards
    • main energy source (40-50%)
    • Lactose primarily (enhances absorption of Ca, Mg, zinc)
    • Oligosaccharides promote growht of lactobacillus bifidus
  33. Protein
    • BM-predominanly Whey
    • Need 2.25-4g/kg/day
    • Easily digested and broken down
    • Reason BF babies feed more ofetn

    • Cows milk > casein
    • Bigger curds when broken down
  34. Vitamins
    • BM low in Vit D (recommend: 400 if/day for babies getting <32 oz/day)
    • Vit k=small quantities
    • B12- only if mom vegan/vegetarian diet
    • VIt A- rich in BM, helps prevent blindness
    • Vit. E- essential, esp. preterm (In BM and formula)
  35. Minerals
    • BM and formula adequate
    • Dont recommend low-iron formula
    • IRON DOES NOT CAUSE CONSTIPATION IN INFANTS
    • Constipaton- caused by casein in formula- firm rubbery curds
  36. feeding intolerance
    • dont assume baby lactose intolerant
    • babies are not allergic to BM, may be allergic to antigen in cows milk from mothers diet
  37. Milk production
    15-20 lobes with lobules where milk secreted
  38. Progesterone inhibits
    milk flow
  39. Prolactin
    • hey hormone in breast feeding, sucking stimulates release
    • if 3hrs lapse between sucking, prolactin rapidly decreases
    • nurse every 1.5-2 hrs during day


    Delayed: c section- first kid, long 1/2 stage, PP hemorrhage, stress, DM1, obesity, hx breas surgery
  40. Formilk
    • water
    • increase lactose and protein
    • decrease fat
  41. Hindmilk
    • rich in fat and calores
    • more often breasts are empty, faster milk is produced
  42. Colostrums
    • intial milk, small volume
    • thick, creamy, yellow
    • concentrated: protein vitamins and minerals
    • low fat and lactose
    • lots of IgA
    • Laxative effect- passage of meconium
  43. Transitional milk
    • 32-96 hrs
    • "coming in" milk
    • yellowish, copious amounts
    • more fat, lactose and calories
    • by day 5, produces 16 ml/day
  44. Mature milk
    • by 2 weeks
    • white or blue tinged
    • looks thin but very nutritious
    • by 6 months- 800 ml/day
  45. Contraindications for BF
    • HIV pos
    • Active TB
    • Varicella
    • Cnacer drugs
    • Galactosemia
    • Illicit drug use
    • Smoking
  46. Advantages of breat feeding
    • rich in lactose
    • iron more easily absorbed
    • decrease risk of: DM2, obseity, cancer, asthma
    • Antibacterial, antiviral
    • Still need vaccines
    • Increased self esteem, enhanced bonding
    • Mother: decreased PP hemorrhage, breast/ovarian cancer, DM2, RA, HTN
  47. Disadvantages of BF
    • Pain (nipple tenderness)
    • Improper latch, position; engorgement, infection
    • Leaking milk
    • Embarrassment
    • Stress
    • Father is left out
    • Diet restrictions – no alcohol or caffeine
    • Limited birth control Progestin-only pills, depo shots ok if BF established
    • Vaginal dryness – use water based lubricant; temporary
  48. Medications in BF
    • no long acting meds
    • Take after BF
    • use alternatives if available
    • Use single symtpom drugs
    • Potential AE
  49. Herbs in BF
    • raglan
    • Fenugreek- increase milk supply in 1-3 days
    • Not recommended- ask DR before
  50. Establighin a pattern BF
    • Initial in st 2 hrs after birth
    • dont force
    • helps oxytocin release
    • helps mother learn cues
    • promotes bonding
    • facilitates meconium passage
    • stimulates more milk
  51. feeding cues
    • hands to mouth
    • sucking, rooting, mouthing
    • regurgitation "wet burps"
    • hiccups common
    • after sleep, infant will want to feed
  52. Feeding patterns
    • BF every 1.5-3 hrs
    • 8-12 feedings/day
  53. How to know when baby has had enough to eat
    • longer pauses between sucking
    • total body relaxation
    • release of nipple
    • fall asleep
  54. never put _________ on pacifer
    • honey
    • cornsyrup

    can cause botulism
  55. how many wet diapers by day 5?
    6-8
  56. No soap on
    nipple
  57. breast milk can last
    • 8 hr in very clean conditions at room temp
    • up to 8 days in fridge
    • 6 months frozen
    • Thaw in fridge for 24 hrs
  58. Do not shake or rotate
    BM
  59. bottle feed every
    • 3-4 hrs
    • 6-8 feedings/day
    • larger volumes
  60. Powder
    • least expensive
    • not sterile
    • 1:2 ratio
  61. Concentration
    • more expensive 
    • 1:1 with sterile water
  62. Ready to feed
    • most expensive
    • sterile
    • good if no clear water available
  63. Preparing forumla
    • Wash lid before opening
    • Shake bottle after mixed
    • Run tap water 1min before use, use cold water (b/c lead)
    • Use only the scoop that comes w/formula
    • Warm bottle by placing in warm water   ~15min
    • Don’t let sit >2hrs
    • Use 1 bottle/feeding
    • Hold infant -- don’t prop bottle
  64. Water
    • Distilled: acceptable, no Flouride
    • Filtered Tap: acceptable
    • Spring water: avoid!
    • Tap water: safe
    • Well water: not recommended, can be used if thoroughly tested
    • Fluoride supplement >6mos.
  65. Burb when
    • after 15 ml in first day of life
    • then after 30
  66. Involution
    • rapid decrease in uterus size after birth
    • healing of uterus
  67. Involution delayed by
    • prolonged labor
    • anesthesia- muscle relaxation
    • difficult birth and excessive manipulation
    • grandmultipartiy
    • full bladder- if they pee just a little= bladder overdistended
    • retained placenta
    • infection
  68. Immediately after bith, fundus where?
    1/2 way between symphasis and umbilicus
  69. Each day, fundus goes down ______ below umbilicus
    1 cm
  70. Placental insertion site heals by
    • exfolation so no fibrous scar
    • scar limits future implantation sites
  71. cervix permanently changed from
    round to slit
  72. after birth cervix will be
    • spongy
    • flabby
    • bruised
  73. 2-3 days post baby, cervix dilated
    2 fingers

    1 wk- will admit fingertip
  74. Vagina healed by
    3 weeks
  75. labor may increase
    labia size
  76. vaginal size doesnt or does return to delivery state
    doesnt
  77. menstrual cycle
    • returns in nonBF mothers in 6 weeks (40%) and 24 weeks (90%)
    • In BF mothers returns in 12 weeks (45%)
  78. Abdominal tone will return
    in 2-3 months with exercise
  79. if exercising too mcuh
    increased bright red lochia
  80. assess perineum when
    • woman on side
    • lift butt cheek
  81. Care for perineum
    • Ice pack for 20min on 20min off
    • Pericare w/ squirt bottle
    • Sitz bath (105o)
    • Topical anesthetic
    • Avoid direct contact
  82. lochia 2-3 days
    • lochia rubra
    • Dark red, w/ epithelia cells, RBCs, WBCs, deciduas, fetal waste
    • NO large clots (quarter size)
  83. lochia 3-10 days
    • lochia serosa
    • Brownish pink w/ serous exudates, deciduas, RBCs, WBCs, mucus, microorganisms
  84. lochia 10 days-3 weeks
    • lochia alba
    • yellowish white with WBC, fat, mucus
  85. lochia has ______odor
    musty
  86. total lochia volume
    8-9 oz
  87. more lochia in
    AM, because pooling at night
  88. Rubella titer
    • if <1:10= rubella vaccine
    • must avoid pregnancy for 3 months
  89. Rhogram
    • rh- mom
    • rh pos baby
    • give within 72 hrs of delivery
    • should have gotten a dose at 28 weeks and if trauma
  90. baby blues
    1-2 days
  91. taking in
    • mom focus on herself
    • body functions
    • decreased interest in education
  92. Taking hold
    • concerns about being good parent
    • receptive to teaching
  93. Call docter if
    • Persistent/spike in fever
    • Change in lochia to earlier state or foul smell
    • Mastitis
    • Thrombophlebitis
    • UTI
    • Pelvic pain
  94. asses breath sounds especially in
    • c sections and smokers
    • increased risk pneumonia
  95. breat nipple assessment
    • Pain r/t inflammation 2nd to breast milk suppression                                    Engorgement       To help – tight, supportive bra (24hrs/day); ice;decrease nipple stimulation; cabbage leaves                 
    • For BF: decrease pain during latch on by 1st doing hand expression to provide cusion
  96. Elimination
    • void every 2-4 hours
    • If no void for 8 hrs- straight cath
    • After cath removal, should pee within 1-3 hrs
    • Have BM when she feels need to- DO NOT WAIT
    • should have BM after 48 hrs
  97. Signs of full bladder
    boggy and displaced uterus
  98. Hemorrhoids
    • sitz bath
    • anesthetic ointment
    • lay on side
    • adequate fluid
    • colace
  99. Fundus
    • check q15 x4 then q30 x2 then q4hrs and PRN
    • Should be midline and firm
    • If above umbilicus= clots
    • If tipped to side= full bladder
    • RF for boggy-multipara, full bladder, general anesthesia, not ambulating, lots of pain meds
    • If boggy= empter bladder ambulate and massage
    • Massage not routinely done b/c painful
    • Massage if clots
    • The more they pee- less risk of boggy and UTI
    • Pain r/t afterpains
    • Lie prone with pillowunder abd; sitz baths;ambuulation;  analgesic(motrin)
  100. Lower extremeties
    • Homan's sign
    • if seen, measure both calfs
  101. teens are
    defensive
  102. postpartum hemorrhage
    blood loss over 500 ml
  103. Early PPH
    • within 24 hrs of delivery
    • Causes: uterine atony, laceration, retained placenta, blood coagulation
    • RF: over distention of uterus, multiparity, anesthetic agents, trauma, prolonged labor, rapid deliver, use of Pitocin, uterine infection, malnutrition, anemia, PIH
    • S/S: Slow/quick gush of blood from uterus or pool under uturus. Change in VS
  104. Management of early PPH
    • Prevent w/ adequate nutrition, good prenatal care, early dx of complications
    • Avoid traumatic procedures, type & cross all pts.
    • Fundal massage prn Methergine: for hemorrhage, causes smooth msucle contraction, oral
    • If bleeding: bimanual massage, Pitocin rate increase, o2
    • If bleeding continues: inspect genital tract by Dr, D&C, Prostin IM, blood transfusion, Coag profile, hysterectomy
  105. Late PPH
    • after 24 hrs
    • Most common cause= retained placenta
    • Presentation: few hrs after deliver up to 2-4 days
    • Prvention: careful exam of placenta
    • S/S: bogy uterus and bleeding
    • Mgmt: IV pitocin, methergin, ATB, volume expanders, blood, D&C, estimate blood loss by weighing pads (1 ml=1g)
  106. Postpartum infection
    • Hx of malnutrition, anemia, debilitated condition
    • RF: episiotomy, endometriosis
  107. Baby blues
    • 75% of mom’s have
    • 3-7 days after delivery
    • Mild depression, goes away itself – no tx needed
  108. Postpartum depression
    • 10-15% women
    • Greater emotional distress, distorted thinking, debilitation
    • Develops slowly over days – weeks
    • s/s: crying, insomnia, appetite changes, feels worthless, little concern for appearance, irritable, loss of control
  109. Postpartum psychosis
    • 1-2% women
    • Serious w/ potential for woman to kill herself &/or baby
    • Delusional & hallucinations
  110. Stillbirth, Miscarriage & Infant Death: Understanding Grief
    • Normal INTENSE grieving – up/downs, for 18mos-2yrs.
    • Crying acceptable & healthy expression of grief
    • Bizarre delusions (phantom crying & aching arms) = normal
    • Put off all major decisions for @ least 1yr.
    • Give yourself sufficient time to mourn & recover (~1yr) before getting pregnant again
    • For new pregnancy, choose new names –each child is unique
    • Fathers should expect mother to have more intense feelings for longer time b/c bonding started before birth
    • Let others know how you feel & how your working out your grief
    • w/in 3mos, try to become involved in a support group
    • The anniversary of birth & death can be stressful – be good to yourself & allow yourself some emotional space & time for grieving
    • Have patients w/ yourself – make time for family, love your mate

What would you like to do?

Home > Flashcards > Print Preview