Exam 2 study guide for NUR 113 (fall semester). Study guide has all relevant exam content and topics with detailed information pertaining to each topic.
Postpartum Depression
Risk Factors:
Hormonal changes with rapid decline in estrogen/progesterone levels
Individual socioeconomic factors
Decreased social support system
Anxiety about new parent role
Unintended pregnancy
Hx of previous depressive disorder
Low self-esteem
Hx of partner violence
Medical conditions (thyroid imbalance, diabetes, infertility)
Breastfeeding complications
Parent of multiples
Young age of mother
First pregnancy
Prevention:
Prioritize daily tasks
Maintain outside interests
Healthy diet
Adequate sleep
Allow for overwhelmed feelings
Pharmacological Therapy:
Postpartum Blues: does not require treatment
Postpartum Depression: antidepressants
Postpartum Psychosis:
o Lithium
o Antipsychotics
o ECT
o Removal of infant
Nursing Care:
Assess pt for risk of harm to self or others
Assess pt for signs of depression
Educate pt/partner about possibility of postpartum blues
Describe S/S to pt and partner
Encourage pt to have plan regarding how they will manage at home
Postpartum Depression: occurs during or in first 4 weeks following birth; characterized by persistent feelings
of sadness and intense mood swings; thoughts of suicide common
Expected Findings:
Feelings of guilt/inadequacies
Irritability
Anxiety
Fatigue persisting beyond reasonable amount of time
Feeling of loss
Loss of appetite
Persistent sadness
Intense mood swings
Loss of sleep
Flat affect
Weigh loss
, Rejection of infant
Postpartum Blues: occurs during first few days after birth for up to 10 days; typically resolves in 10 days
without intervention; key feature is episodic tearfulness; contributing factors include emotional letdown and
physical discomfort; feelings of worry, unhappiness, exhaustion
Expected Findings:
Feelings of sadness
Lack of appetite
Loss of sleep
Feelings of inadequacy
Crying easily for no reason
Restlessness, insomnia, fatigue
H/A
Anxiety, anger, sadness, hostility
Postpartum Psychosis: develops within first 2-3 wk postpartum period; history of bipolar disorder increases
risk; medical emergency due to risk of suicide/infanticide
Symptoms:
Agitation/irrational
Hyperactivity
Insomnia
Delusions/hallucinations
Paranoia
Confusion
Severe mood swings
Suicidal thoughts
Postpartum Care
Prematurity
Preterm newborn birth occurs after 20 wks and before completion of 37 wks
Late preterm newborn birth occurs from 34-36 ½ wks
Risk of variety of complications: immature organ systems
Goals for premature newborn: growth/development needs
Main priority in treatment: support of cardiac/respiratory systems
Premature weights:
Low birth weight (LBW): 2500 g (5 lb 8 oz)
Very low birth weight: < 1500 g (3 lb 5 oz)
Extremely low birth weight: < 1000 g (2 lb 3 oz)
Risk factors:
Multiple gestations: twins/triplets
PROM (premature rupture of membranes
Incompetent cervix: premature dilation of cervix
Maternal infection
No/lack of prenatal care
Adolescent pregnancy (<19 y/o)
Maternal substance abuse (ETOH/drugs)
Expected findings (physical assessment):
Flaccid tone
Thin/translucent skin
Head large compared to body
Lanugo is plentiful
, Poor gag/sucking reflexes
Soft nails
Testes not distended
Weak cry
Complications (Most common):
Respiratory distress syndrome
o inadequate surfactant; poor gas exchange/ventilation failure
o signs of distress:
tachypnea
expiratory grunting
nasal flaring
chest retractions
Anemia (decreased iron stores)
Apnea (cessation of breathing 20 sec or longer)
Intraventricular hemorrhage
o Most rapid brain growth/development occurs during 3rd trimester
o Most common in neonates (particularly those weighing <1500g and <34 wk gestation)
o Hypoxic events (respiratory distress, birth trauma, birth asphyxia)
Patent ductus arteriosus (PDA) (failure to close)
Cardiac Alterations:
Persistent murmurs beyond day 2 of life
Cyanosis
Tachy/bradycardia
PDA
Thermoregulation:
Major problem in prematurity; limited by 2 factors
o Glycogen in liver
o Amount of brown fat available
Heat loss increased by:
o Increased O2 need
o Decreased ability to vasoconstrict
o Ratio of body surface > body weight
o Small amount of SUBQ fat (body’s insulation)
o Thinner, permeable skin
o Posture (extension of extremities)
Potential GI Alterations:
Marked danger of aspiration
Feeding intolerance
Small stomach (difficulty meeting caloric needs)
Ca+ deficiency (weak bones)
Necrotizing enterocolitis
o Inflammatory disease of GI mucosa caused by ischemia (reduced blood loss) or hypoxia
o Complications: failure to thrive
o Physical assessment:
Abdominal
Bloody stools
Lethargy
Potential Abdomen Alterations:
Umbilical hernia
Two-vessel cord
Distension, absent bowel sounds
Abdominal mass
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