Docsity
Docsity
Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity

Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan

Guidelines and tips
Guidelines and tips
Sell on Docsity
Sell on Docsity
Docsity AI
Docsity AI
Log inSign up

Prepare for your exams

Study with the several resources on Docsity

Find documents

Prepare for your exams with the study notes shared by other students like you on Docsity

Search for your university

Find the specific documents for your university's exams

Docsity AINEW

Summarize your documents, ask them questions, convert them into quizzes and concept maps

Explore questions

Clear up your doubts by reading the answers to questions asked by your fellow students

Earn points to download

Earn points by helping other students or get them with a premium plan

Share documents
download point icon20 Points

For each uploaded document

Answer questions
download point icon5 Points

For each given answer (max 1 per day)

All the ways to get free points
Get points immediately

Choose a premium plan with all the points you need

Study Opportunities

Choose your next study program

Get in touch with the best universities in the world. Search through thousands of universities and official partners

Community

Ask the community

Ask the community for help and clear up your study doubts

Free resources

Our save-the-student-ebooks!

Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors

Maternal Exam 2 SLS Notes, Study notes of Obstetrics

Virginia State University (VSU)Obstetrics

Maternal Exam 2 SLS NotesMaternal Exam 2 SLS Notes

Typology: Study notes

2024/2025

Available from 02/14/2025

hesigrader002
hesigrader002 🇺🇸

4.1

(43)

7.7K documents

1 / 19

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
Maternal Exam 2 SLS Notes
Postpartum Hemorrhage
•Risk factors
oUterine atony – leading cause of PPH
oUterine overdistension
oProlonged/difficult labor
oPrevious hx uterine atony/PPH
oTrauma during birth (forceps/vacuum assisted, C section)
oLabor induction
oChorioamnionitis
oHigh parity
oAge (very young or older than 35)
oMacrosomic baby
oRetained placental fragment
oUse of anesthesia that promotes uterine relaxation
•Red flags on assessment
oAlteration in mental status
oTachycardia
oHypotension
oPale in color
oBoggy fundus, above umbilicus and not midline
•What do you do?
oMassage the fundus!
▪Fundus should decrease by 1 cm or 1 finger width every 24 hours
oEmpty the bladder
oFluid bolus to fix low BP
oOxytocic meds:
▪Pitocin (generic name: oxytocin)
▪Methergine (generic name: methylergonovine)
▪Hemabate (generic name: carboprost)
▪Cytotec (generic name: misoprostol)
•Postpartum Assessment: BUBBLEHE
oBreast – engorgement, tissue irritation, milk production
oUterus – firm, boggy, height?
oBowel – Bowel sounds, flatus, BM?
oBladder – empty, able to void?
oLochia – color and amt (will be dark and a lot right after birth, but will
eventually become lighter and decrease in amount)
▪Rubra – red. Occur 1-3 days PP
▪Serosa – pink. Occur 4-10 days PP
▪Alba – white. Non-odorous, looks like mucus, can persist 8 weeks PP
oEpisiotomy – perineum intact, repair, swelling, hematoma, incision?
pf3
pf4
pf5
pf8
pf9
pfa
pfd
pfe
pff
pf12
pf13

Partial preview of the text

Download Maternal Exam 2 SLS Notes and more Study notes Obstetrics in PDF only on Docsity!

Maternal Exam 2 SLS Notes

Postpartum Hemorrhage

  • Risk factors o Uterine atony – leading cause of PPH o Uterine overdistension o Prolonged/difficult labor o Previous hx uterine atony/PPH o Trauma during birth (forceps/vacuum assisted, C section) o Labor induction o Chorioamnionitis o High parity o Age (very young or older than 35) o Macrosomic baby o Retained placental fragment o Use of anesthesia that promotes uterine relaxation
  • Red flags on assessment o Alteration in mental status o Tachycardia o Hypotension o Pale in color o Boggy fundus, above umbilicus and not midline
  • What do you do? o Massage the fundus! ▪ Fundus should decrease by 1 cm or 1 finger width every 24 hours o Empty the bladder o Fluid bolus to fix low BP o Oxytocic meds: ▪ Pitocin (generic name: oxytocin) ▪ Methergine (generic name: methylergonovine) ▪ Hemabate (generic name: carboprost) ▪ Cytotec (generic name: misoprostol)
  • Postpartum Assessment: BUBBLEHE o Breast – engorgement, tissue irritation, milk production o Uterus – firm, boggy, height? o Bowel – Bowel sounds, flatus, BM? o Bladder – empty, able to void? o Lochia – color and amt (will be dark and a lot right after birth, but will eventually become lighter and decrease in amount) ▪ Rubra – red. Occur 1-3 days PP ▪ Serosa – pink. Occur 4-10 days PP ▪ Alba – white. Non-odorous, looks like mucus, can persist 8 weeks PP o Episiotomy – perineum intact, repair, swelling, hematoma, incision?

o Homans sign – any signs of DVT? o Emotional status – maternal/infant bond, feeling about delivery, anxiety? Infection

  • Most common site of infection PP is the repro tract Room in – always a good option when child is in hospital Postpartum preeclampsia
  • S/S: headache, SOB, blurry vision, n/v, edema, seizure, epigastric pain
  • Treatment: BP meds, bed rest, mag sulfate o Strict I/O o Daily weights Breastfeeding
  • Colostrum contains a lot of immunity for baby o Watery yellow fluid that contains protein, sugar, fat, vitamins, minerals and maternal antibodies o Replaced by transitional breast milk 2-4 days PP
  • Engorgement – enlargement of breasts due to increase milk o If nursing, do not use ice before feeding because it decreases the amt released o If nursing and they are painful, can use ice after feeding o Warm compresses are ok
  • Mature breast milk produced 10 days PP
  • Nipple care – make sure nipples are not cracked, this is a good entry for bacteria
  • How do I know they are getting enough? o Weight gain o Diaper count (should be wetting at least 6-8 diaper per day) o Breastfed baby have more BM than bottle fed baby
  • If mom is breastfeeding, and needs antibiotics, should she continue breast feeding? o Yes!! o Just keep an eye on baby – they may have thrush or GI upset
  • Benefits breastfeeding: o Helps uterus go back to normal size o Protective fxn against breast/ovarian cancer o Return to pre-pregnancy weight quicker o Decrease cost of feeding o Decrease risk osteoporosis Mastitis
  • Unilateral and develop after flow of milk has been established
  • Most common organism is Staph aureus – introduced into nipple thru a crack
  • Infection involves ductal system, causing edema, enlarged axillary lymph nodes and breast engorgement w/ milk flow obstruction

▪ Mongolian spot ▪ Vernix caseosa – skin is dry and there is not a lot of vernix, baby is postterm ▪ Lanugo ▪ Milia – baby acne ▪ Telangiectatic Nevi “stork bite” ▪ Post-term baby (40+ Weeks) have leathery skin o Head ▪ Circumference ▪ Fontanels ▪ Shape

  • Hydrocephalus: excessive cerebral fluid in brain cavity
  • Microcephaly: abnormally small head
  • Caput succedaneum: localized swelling of soft tissues of scalp d/t pressure on head during labor – resolve on own
  • Cephalohematoma: collection of blood b/w periosteum and bone of scalp d/t trauma of birth process – resolves on own o Crosses suture line o Eyes ▪ Symmetry, spacing, shape ▪ Subconjunctival hemorrhage is common after birth ▪ Eyesight minimal o Ears ▪ Should be even with the eyes – lower set can indicate a chromosomal abnormality ▪ Cartilage should be firm o Anogenital ▪ Anus patent ▪ Meconium passed within 24-48 hrs after birth ▪ Newborn boy DO NOT retract the foreskin
  • Assessing to see where the urethra is – it should be midline o Epispadias: urethra is on top of penis o Hypospadias: urethra is below the penis
  • Assess to see if the testes are descended into the scrotal sac ▪ If they are not, could cause infertility later on ▪ Female genitals are usually swollen after birth ▪ First urination within 24 hrs o Extremities/spine ▪ Assess for ROM, spine is straight/midline
  • If baby has spina bifida/myelomeningocele – cover it with a wet, sterile dressing, lay the baby on their stomach ▪ Sacral dimples ▪ Symmetrical movement ▪ Equal gluteal fold ▪ No click with hip abduction

▪ 10 finger/toes

  • If baby is premature, they will have less creases in their foot. If baby is full term, 2/3 of foot should be covered in creases o Esophageal Atresia – malformation of esophagus in utero, esophagus doesn’t connect to stomach properly ▪ Worry about nutrition
  • APGAR Scores o Remember that when the baby is crying really hard, the whole face is grimacing – even if grimace isn’t specifically mentioned in the prompt ▪ Be able to read a prompt and then score a baby based on the prompt

Baby reflexes: have a good idea of how to test these Caloric demands of baby

  • Infant up to 2 months old requires 100-120 cal/kg body weight every 24 hours
  • 1 year – 100 cal/kg
  • 5-10% weight loss is expected after birth o should rebound in first 2 weeks after birth o ideal weight gain 100-200 g/week first 3 months
  • 24 calorie formula used for preterm baby
  • 20 calorie formula used for term baby
  • Nonbreastfed baby needs 70-90 ml per day of 20 cal formula for each pound of the baby o Ex: baby weigh 8 pounds, need 70 ml ▪ 8 x 70 = 560 ml -> oz -> 19 oz / 6-8 feedings -3 ml per feeding ▪ Do the same thing for 90 ml Newborn vaccination
  • Vit K: give in thigh IM o Vit K usually begins being excreted once breast milk introduced into GI tract
  • Hep B: give in thigh, IM
  • If baby needs both – give in different legs **Newborn complications
  • Newborn s/s hip dysplasia** o Limited ROM o One limb looks longer than the other o “clicking” noise when you move their legs o Uneven skin folds – extra gluteal folds are uneven - Newborn hyperbilirubinemia o Causes: ▪ Prematurity ▪ Rh Isoimmunization ▪ ABO incompatibility (mom/baby have different blood types) ▪ Biliary atresia – blocked biliary tree, everything builds up o Treatment: ▪ Bili-lights
  • Cover the baby’s eyes
  • Only the diaper on
  • No lotion
  • Reposition baby frequently so that the light hits all over the skin
  • Make sure they are in a stable environment – not too hot/not too cold ▪ Feedings
  • Feed often!! Q2hr – more food helps the bile break down
  • Urine will be very dark – this is normal from the bilirubin
  • Poop – make sure they have it, will look like Dijon mustard o Complication: ▪ Acute bilirubin encephalopathy (Kernicterus)
  • Destruction of brain cells by invasion of bilirubin
  • Results from high concentration bilirubin that form in bloodstream and excessive destruction RBC at birth - Neonatal abstinence syndrome (NAS) o S/s: high pitched cry, tremor, sneezing, hiccups ▪ Everything is over-reacting – increase HR, increase RR, diarrhea, not eating o Swaddle baby tightly, keep a calm and quiet environment o Try to cluster care - Hypoglycemia o Common to see a drop in glucose immediately after birth o Monitor and assess glucose o Preterm baby at increased risk o Babies of GDM moms

o n t h s Knows primary caregiver Squeals aloud to show pleasure Moves arms and legs simultaneously Can hold a rattle e Mirror 6 M o n t h s Apprehensive of strangers Babbles and coos Observes environment Rolls from side to side well Sits with assistance Transfers objects from hand to hand Rolls from back to abdomen Holds bottle Sits in highchair Rattle Soft toys Bright colors 9 M o n t h s Waves “bye-bye” Mama, Dada indiscriminately Stranger anxiety Exhibits objects permanency Sits well without assistance Uses pincer grasp Creeps on hands and knees Stands with assistance Rattle Soft toys Bright colors 1 2 M o n t h s Imitates behaviors Cooperates with dressing Mama, Dada has meaning Shows jealousy Birth weight tripled Walks with assistance Turns page in a book Stands without assistance Attempts to stack blocks Push and pull Cloth books Surpri se toys Ball ****Issues Related to Hospitalization:**

  • Interrupted routine
  • Lack of stimulation
  • Parental separation
  • Delayed response to cry/needs

Nursing Interventions :

  • Encourage caregiver to room in
  • Primary nursing
  • Hold for feedings
  • Promote home routines
  • Respond promptly to cry and other

needs

Nutrition

Food Introduction:

  • Breast milk/iron fortified formula for 1 st year
  • Grains: 4 – 6 months
  • Fruits/vegetables
  • Meat/eggs Instructions for Feeding: - Feed all solids with spoon - Introduce at 3 – 4 day intervals - Common reaction: eczema - Do not dilute formula

Feeding is one of the major activities for infancy Play Infant play is characterized as onlooker and solitary. The infant actively watches others. When he/she participates in play activities it is usually of the solitary type with minimal interaction with other persons. The infant uses the hands and mouth as exploring organs. Play develops gross and fine motor skills and spatial relationships. Anticipatory Guidance/Health Promotion Safety in vehicle, crib, bath falls, nutrition and feeding, colic teething, thumb/pacifier sucking, temperament, immunizations, stimulation, DO NOT sleep with parents in bed Safety

  • Infants up to 20lb (9kg) should be restrained in a rear-facing car seat in the middle of the back seat of a car.
  • Crib side rails up.
  • Never leave infant unattended on bed, changing table or bathtub.
  • Check temperature of bath water, foods, and formula.
  • Teach injury prevention: aspiration of foreign objects, suffocation, falls, poisonings and burns. Toddler: 1 year – 3 years *Maternal attachment is firmly in place. Ritualistic behavior is exhibited during the toddler period: ritualism is the toddler’s need to maintain sameness and reliability; provides a sense of comfort. He/she has a short attention span (< 15 min.) and still takes naps. The toddler has poorly developed body boundaries, and any intrusion (even a painless one) produces anxiety. ****Erikson : Autonomy vs. Shame and Doubt – the toddler develops a sense of independence through exploration of the world around him/her and encouragement from the primary caregiver. The child learns to tolerate frustration through socialization and toilet training. Failure to achieve autonomy may leave the child feeling doubtful about his/her abilities. Developmental Milestones:
  • Birth weight quadruples by 2 years
  • Anterior fontanel close by 18 months
  • Sphincter control begins around age 2 years
  • Potbelly appearance
  • Head circumference = chest circumference Psychosocial Motor Toys 15 Uses 4-6 words Walks without assistance Push and

training, sibling rivalry, negativism, fears, and separation anxiety.

Safety

  • Continue to use car seat properly: children greater than 20 lbs. (9 kg) should be in a forward- facing position in the back seat of the car.
  • Supervise indoor play and outdoor activities – swimming
  • Teach use of syrup of ipecac for accidental ingestions
  • Teach injury prevention: childproof home, suffocation (plastic bags, pacifier, toys), burns (ovens, heaters, stoves, sunburns, check water and food temperature)
  • Aspiration related to latex balloons Toilet Training The child’s bladder and bowel muscles and innervations must be physically mature and the bladder large enough to hold urine for several hours at a time. The child should be able to remove pants and underwear independently, sit quietly for short periods, imitate behaviors, and want to please parents. Success should be praised, and accidents cleaned up without comment. If the child is not interested, it is best to stop and wait a month. Discipline Suddenly, the compliant infants have now turned into a negative toddler. Discipline becomes a major issue. Parents should set simple rules and apply them consistently to acquire socially acceptable behaviors. Temper Tantrums Temper tantrums are a normal behavior occurring because of a toddler’s inability to control his/her feelings when frustrated. Since they cannot use language to express feelings, they use their body. Do not give in to their demands; it rewards them to try again. Sibling Rivalry The next baby is often born when the first child is in the toddler years. The toddler may perceive the baby as a rival for the mother’s affections and time and may verbally and sometimes physically attempt to harm the infant. Allow the toddler to assist in the preparation for the new infant. Schedule times during the day for just the toddler. Preschool: 3 – 6 years Erikson : Initiative vs. Guilt – the child develops a sense of self-esteem through task accomplishment. There is less need for direct supervision. The child asks many questions and begins to take responsibility for his/her own actions. There is beginning conscience development and regard for others. The preschooler wants to conform to others. Conflicts will arise when the child overstep the limits of his/her abilities and will acquire a sense of guilt for not behaving appropriately. Developmental Milestones :
  • Growth is slow and steady; 4 – 5 lb/year
  • Height increases 2 – 3 inches/year
  • Body systems mature

Safety Car seat belt can provide safety when child reaches either 40 lb. or 4 years. Injury prevention: Traffic safety, strangers, and fire prevention/safety, water safety. Sex Education Preschoolers are curious about everything and ask sex related questions along with their other questions. Always determine why they are asking the question before answering. Sex education should also include sexual abuse education. The child should understand who may touch private parts and who needs to be reported to a trusted adult. Masturbation Occasional masturbation is normal and an expression of sexual development. Imaginary Friends Sometimes used as companions when other playmates are not available. As long as the child is interacting with the real world, imaginary friends should be tolerated as an example of the child’s vivid imagination. Fears A vivid imagination also brings fears. They may be real or unreal. Fears should not be dismissed and should be dealt with appropriately. School Age : 6 – 12 years Erikson : Industry vs. Inferiority – this is the age of self-concept development. The child achieves a sense of personal and interpersonal competence by acquisition of technologic and social skills. They have a variety interests, learn rules and how to win/lose. Peer group activities encourage cooperation and competitiveness. Inability to acquire a sense of accomplishment will result in a sense of inferiority. Developmental Milestones :

  • Weight: steady, slow growth; gains approximately 5 lbs/year
  • Height: increases 1 – 2 in/year; boys differ little at first, but by end of this period girls will gain more weight and height compared to boys
  • Reaches one half of adult height by age 3 years
  • Doubles strength and physical capabilities
  • Deciduous teeth are replaced by permanent teeth Psychosocial Motor Toys 6 – 12 years Same sex friends Loves school Interactive play Collects things Physical skills maximized Cursive writing Rides a 2- wheeler Runs, swims, and dances Board games Card games Video games Team activities Computer games

Issues Related to Hospitalization :

Separation from family, friends,

and

Nursing Interventions :

Frequent visits by family

school

Fear of bodily injury

Nutrition

Telephone calls

Communication with

school Explain all

procedures Child to

participate in care Provide

for privacy

Reassure illness is not a punishment

  • There is a risk of obesity in this age group and a tendency to eat “junk” food.
  • Secondary sex characteristics begin at 8-9 years in girls; 12 years in boys.
  • Requirement is 85 kcal/kg/day.
  • Irregular family meals.
  • Schedule of working parents. Play
  • Play is primarily Group oriented, especially with the same sex.
  • Rules and rituals
  • Formalized groups/clubs
  • Becomes sensitive to social norms and pressures of peer groups Safety The incidence of accident/injuries is less likely. Proper use of sports equipment should be stressed. Discourage risk-taking behaviors (smoking, alcohol, drugs, sex). Teach injury protection concerning bicycle safety, firearms. Sex Education Should be introduced. Television TV rarely depicts reality. The violence appears to desensitize children. Imitation of TV role models increases aggressiveness in play and life situations unless an adult points out inappropriate TV behavior. Adolescent : 12 – 18 years Erikson : Identity vs. Role Confusion – the adolescence focuses on independence from the family and uses the peer group as a bridge between dependence on the family and complete independent behavior. Peer group and peer acceptance is extremely important. It is a time of trying on different roles to see how they fit and making comparisons with the peer group. He/she has wide mood swings, and fantasizes and daydreams. There may be conflict with parents over independence and control. He/she feels invulnerable. If the adolescent is unable to acquire a stable sense of self, direction and place, identity diffusion may result. Developmental Milestones :
  • Weight: rapid period of growth causes anxiety; girls gain 15 – 55 lbs. (7-25 kg) boys gain 15 – 65 lbs. (7-29 kg).
  • Height: attain final 20% of mature height; girl’s increases approximately 3 in/year, slows at menarche, stops at 16 years; boys: increases 4 in/year, growth spurt approximately at 13 years, slows in late teens
  • Primary and secondary sex characteristics develop
  • Puberty occurs 2 years earlier in girls than boys
  • Adult body type

Areas of stress :

  • Body image
  • Sexuality conflicts
  • School pressures
  • Finances
  • Competitive pressures
  • Decisions about future rules Limit setting and discipline : Teens need firm but reasonable limitation to protect them