Week 13 Review for Last Maternity Exam PDF

1. Postpartum physiological assessments and nursing care and High-risk PP care a. Assessments and frequency i. 15 minutes x 1 hour, 30 minutes x 1 hour, 4 hours x 22 hours, then q shift. ii. Assessing for hemorrhage (complications DIC, AFE, PE),...

1. Postpartum physiological assessments and nursing care and High-risk PP care a. Assessments and frequency i. 15 minutes x 1 hour, 30 minutes x 1 hour, 4 hours x 22 hours, then q shift. ii. Assessing for hemorrhage (complications DIC, AFE, PE), HELLP/Eclampsia 1. Vital signs a. Temp. BP. HR. RR. SpO2. Pain 2. Lochia b. Color, amount, odor 3. Fundus c. Void, supine for best assessment d. Height (U), Tone (firm, boggy), Location (midline, displaced) iii. Shift head-to-toe add-ons 4. BUBBLE-HE 5. REEDA (posterior) b. Critical findings iv. Purulent discharge (infection) 6. Odor 7. Fever, tachycardia, tachypnea, pain v. Bleeding \>500 ml vaginal birth (\>1000 ml c/s) 8. Quantitative blood loss (weigh/measure) 9. Hypotension, tachycardia, tachypnea, dizziness, pale, cool, clammy vi. Boggy and deviated fundus (s/s of hemorrhage) 10. Void 11. Massage until firm 12. Oxytocin (IV or IM) 13. Reassess q 30 minutes vii. Preeclampsia/eclampsia, HELLP (DIC) 14. Hypertension (above 160/100) 15. HA, nausea, AMS/Sz, blurred vision, RUQ pain, edema 16. Bleeding (everywhere), petechiae, purpura viii. Sudden drop in O2 Sat 17. Anaphylaxis 18. PE 19. Hypotension (hemorrhage) c. Hemorrhage ix. Fundus should be firm and midline, involution x. Primary PPH (Early) (1^st^ 24 hours) 20. Uterine atony- urinary retention e. Fundus is boggy, elevated, deviated f. Void (straight cath for PVR) (Foley for retention) 21. Uterus normal (midline, firm) g. Laceration (red bleeding with normal fundus) h. Hematoma (normal fundus, ecchymosis, swelling, severe pain) xi. Secondary PPH (Late) (after 24 hours) 22. Retained placental fragments/tissue i. Subinvolution, rubra/odor/changes in color, metritis (septic, DIC) d. Infection xii. Breast (mastitis with/without abscess) (3-4 weeks post delivery) 23. Redness (localized), pain, warmth, fever, HA, flu-like s/s 24. Encourage BF, chin toward red area, pumping afterwards j. Only dump Breast-milk with pus present 25. Plugged duct (warm showers/compresses, massage toward nipple) 26. Keep area clean, dry, hand-washing. 27. Keflex (antibiotics), Tylenol for pain. xiii. Metritis (\>24 hours) 28. Retained tissue, stillborn, intercourse/objects, STI, wiping 29. Odor, pain, fever, s/s of infection xiv. Incision/laceration (wound) 30. C/section, lacerations, improper wound care, DM, immunocompromised, obesity, chronic hypertension xv. UTI 31. Anesthesia, Foley, Straight cath, operative vaginal birth, urinary retention, peri/hygiene, urethral trauma, dehydration, pads too long 32. Pyelonephritis (kidney)- flank pain e. Other complications xvi. DIC xvii. Anaphylaxis xviii. VTE/DVT and PE f. Psychological disorders xix. Baby blues (postpartum blues) 33. First 2 weeks, few days 34. ABLE to perform all ADLs xx. Postpartum Depression (MDD) 35. First year 36. UNABLE to perform ADLs k. Changes in sleep, appetite, weight, self-care 37. Psychosis may be present, self-harm, baby-harm 38. Immediate appointment or ED xxi. Postpartum psychosis (manic Bipolar-I) 39. Early as day 3 40. UNABLE to perform ADLs 41. SI/HI, never leave with baby unattended, supervise all interactions and care 42. ADMITTED xxii. Paternal postnatal depression (low Testosterone) 43. Provider visit, therapy or replacement/meds g. Discharge teaching xxiii. Normal resolution of pregnancy vs abnormal findings 44. Lochia (rubra, alba, serosa) 45. Involution and afterpains (increase with multiparity, breast feeding, oxytocin) 46. RhoGAM for Rh- mom to prevent problems with future pregnancies xxiv. Recognition of s/s of PP depression xxv. **PPH remains a leading cause of morbidity and mortality** xxvi. Infection xxvii. Preeclampsia, HELLP, Eclamptic seizures xxviii. Diet, exercise, sleep/activity, smoking cessation xxix. Resuming sexual activity, contraception (ovulation prior to menses) 2. Transition to parenthood h. Teaching xxx. Needs are met prior to teaching (pain, position, toilet, etc) xxxi. Evaluate for understanding xxxii. Infant communication i. Support xxxiii. Observe and promote bonding xxxiv. Communication of expectations j. Loss xxxv. Promoting successful grief (DABDA) xxxvi. Support, avoid retraumatization 3. The neonate k. Transition to extrauterine life xxxvii. Normal assessment 47. Tone: flexed 48. Head: fontanels flat, symmetrical, eyes/ears, nares patent l. Cephalohematomas (injury from vacuum) m. Caput Succedaneum (serous crosses sutures) 49. Chest: crackles (amniotic fluid) n. Resp 30-60, patterned- count for full minute o. Apical pulse 110-160, slightly irregular (respirations) 50. Abdomen: soft, round, belly breathing, cord (AVA) 51. Genitalia: p. Female- spotting vaginal discharge, swollen labia q. Male- palpate both testes, swelling scrotum 52. Back: skin is closed (no sacral dimples or tufts of hair) 53. Limbs: Gluteal folds symmetrical, no clicks hip movement, symmetrical movement of all extremities. r. Acrocyanosis- mottling or cyanosis on extremities 54. Skin: Core should be normal coloration s. Document: lanugo and vernix, slate gray patches (hyperpigmentation), birth marks, injuries, vascular spots 55. Reflexes t. Observe for any missing or asymmetrical findings xxxviii. Critical findings 56. Jaundice (1^st^ 24 hours- pathologic) 57. Pallor, dusky, cyanosis 58. Hypotonia, Seizure 59. Fontanel bulging, sunken. Clefts. Low set ears 60. See-saw or paradoxical breathing, Tachycardia/Tachypnea, Bradycardia/Bradypnea, Resp distress (grunting), accessory muscle use 61. Distension, decreased bowel sounds. No meconium \>48 hours, No urine \>24 hours. Bright green or bloody stool. 62. Vital signs: u. Temp under 36.5/97.7 or over 100.4 v. HR under 100 (under 60 start compressions) or over 180 w. RR under 30, apnea for more than 15 seconds, or over 60 x. SpO2 under 94 (initially 65%, rapidly increases to 90s in about 10 minutes) 63. Glucose \15 seconds is critical xlii. RDS/BPD 73. RDS: tachypnea with retractions 74. BPD: Preterm (not fully matured lungs/surfactant) a. Ventilation, O2 lead to fibrosis and alveolar collapse 75. Oscillatory ventilation is decreasing rates of BPD 76. Bronchodilators, steroids, diuretics -- prevent FVO/HF xliii. PDA 77. Heart failure (increases blood flow through pulmonary vessels) pulmonary HTN 78. NPO/fluid restrictions (IV maintenance rate only), diuretics -- treat FVO/HF xliv. ROP 79. Retinal detachment, related O2 xlv. Infections/Sepsis 80. GBS- Group B strep- meningitis or pneumonia- sepsis b. Vaginal culture 35-37 weeks c. IV maternal antibiotics prior to delivery d. Hospitalization: Abx: 24 hours i. Not tested, or no abx: 48 hours e. Monitor for s/s of infection (fever, tachypnea, tachycardia, hypoglycemia) 81. Erythromycin eyes- blindness xlvi. Jaundice 82. 24 hours- pathological jaundice -- neuro damage 83. Treat: Bili lights (cover eyes), Feed xlvii. PKU 84. Neuro damage 85. Screen: heel stick (2-5 days of feeding), check prior to d/c return for follow up. xlviii. NEC 86. Necrotic bowel- surgically removed (NG/OG tube, NPO), IV fluids, Abx. 87. Risk: premature. Reduce risk: breast milk (pump, tube feed in nursery) xlix. Meconium aspiration 88. Risk: Stress (hypoxic event) and postdates 89. Presentation: amniotic fluid is green at time of rupture 90. Aspiration syndrome: low APGAR scores, floppy, poor air entry 91. Treatment: SUCTION, assist provider with tracheal intubation with suction, prepare for resuscitation (BVM, O2, Suction, warmer) m. Teaching l. Abusive head trauma 92. Put baby down in safe place and walk away (10 minutes) cry it out. 93. Talk: friend, family, Parent stress line li. Circumcision and cord care 94. Circumcision: infection, cleaning, pain, bleeding, swelling (urinating) 95. Cord: avoid direct pressure, cleaning lii. SIDS prevention 96. Crib safety, back to sleep, no swaddling for sleep (sleep sacs) 97. Avoid overheating, exposure to smoke/tobacco 98. Breastfeeding, pacifier liii. Bathing, diapering 99. Spot cleaning, never leave alone near water, dry well after bathing 100. Cleaning with diaper changes, fold to avoid cord liv. Feeding 101. Breast feeding f. Engorgement, nipple care, pumping and storage 102. Bottle feeding g. Preparation and storage 4. Women's health n. LGBTQIA lv. Ask, do not assume. Use correct pronouns and body part terms. Support and provide safety. Alter care as needed to avoid re-traumatization o. STIs lvi. Barrier devices do not protect against all STIs. Can transmit without symptoms. lvii. Gonorrhea and chlamydia- PID, infertility 103. Reportable DOH, contact tracing lviii. HPV- warts/cancer 104. Warts are flesh colored, cauliflower growths 105. Vaccine, slow growing (PAP smear) p. Vaginitis lix. Bacterial- Fishy odor, grey discharge, Metronidazole (Flagyl) lx. Yeast- Candidiasis, cottage cheese, sour, itching, Miconazole (Monistat) q. Cancer screening lxi. Cervical- PAP 106. No intercourse 48 hours prior lxii. Breast- Mammogram- annual provider breast exam 107. No deodorant, powders, or lotions lxiii. Endometrial- bleeding after menopause, endometrial biopsy 108. No prep needed r. Surgery lxiv. Fibroids 109. Removal of benign tumors can increase fertility lxv. Hysterectomy 110. Major abdominal surgery 111. Hemorrhage, Infection (wound, UTI), DVT, internal injuries, paralytic ileus 112. NPO (gag), Ambulate (after anesthesia wears off) 113. Remove foley once they can ambulate, monitor for first void lxvi. Fistulas 114. Pain, constipation, stay with patient for first bowel movement 115. Education about avoiding constipation s. PCOS lxvii. Complications (diseases/disorders can result) lxviii. Fertility (metformin, clomid, exercise/weight loss) t. Menopause lxix. Perimenopausal- symptoms lxx. Menopause 12 months with no menses lxxi. Postmenopausal- increased risk of stroke, heart attack, osteoporosis (DEXA) u. IPV lxxii. Increased with pregnancy. Preterm birth. Low birth weight. Neonatal Death.