NUR113 Exam 2 Study Guide

NUR 113 Exam 2 Study Guide


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