ATI Maternal Newborn Flashcards
When to be refitted for a diaphragm
every two years, 20% of weight change after pregnancy
Diaphragm education
should remain in place for 6 hours after sex but not more than 24 hours
reapply spermacide for each act of intercourse
oral contraceptions common side effects
nausea, breast tenderness, fluid, retention, breakthrough bleeding, headache
contraindications for oral contraceptives
smokers and a history of blood clot, stroke, CVD, hypertension
signs from thromboembolic events
DVT (leg pain, swelling), PE (chest pain, SOB), stroke (vision issues, weakness, numbness, slurred speech), MI (chest pain, sweating, GI upset)
Medroxyprogesterone side effects
decrease in bone density, thromboembolic events
medroxyprogesterone key teaching
patients should increase intake of calcium and vitamin D
Side effects of an IUD
increased risk of ectopic pregnancy, pelvic inflammatory disease, uterine perforation
IUDs key teaching
Patient should report foul smelling discharge, change in IUD string length, fever, chills, pain with intervourse
what is transcervical sterilization
flexible agents inserted into the fallopian tubes, resulting in scarring
effectiveness is delayed for 3 months
alternative contraceptives needed until confirmation of a blocked fallopian tube
not for post partum
Risks with transcervical sterlization
perforation, increased risk of ectopic pregnancy
What is tubal ligation
Severance burning of fallopian tubes can be done postpartum
risks with tubal litigation
risks associated with surgery, increase risk of ectopic pregnancy
what is a vasecetomy
severance of vas deferens
vasectomy education
alternate form of BC needed for 20 ejaculations, follow up testing for sperm count important, reversal is possible
infertility definition
inability to conceive for a long period of time, at least 12 months
diagnostic procedure for infertility
semen analysis - FIRST
hysterosalpingography - checks for the patency of fallopian tubes using contrast dye - NO SHELLFISH/IODINE ALLERGY
laparoscopy - observation and assessment of internal organs under general anesthesia
presumptive signs of pregnancy
can be explained by OTHER conditions
amenorrhea, n/v, urinary frequency, breast changes, quickening, uterine enlargment
probable signs of pregnancy
Hegars sign, Chadwick sign, Goodells sign, ballottement, Braxton hicks, a positive test
positive signs of pregnancy
fetal heart sounds, fetal movement felt by provider, visualization of fetus on ultrasound
calculating due date
add 9 months plus 1 week from last menstrual period
fundal height
measured from the symphysis pubis to the top of the fundus
fundal height = gestational age
GTPAL
gravidity - # of times pregnant
term birth - # births carried to term
preterm births - # of births before
abortion - number of abortions and miscarriages
living = living children
cardiovascular changes during pregnancy
increase in cardiac output (30-50) and HR
respiratory changes during pregnancy
oxygen needs increase, lung capacity decreases, RR increases
cervical changes during pregnancy
becomes softer, blue purple color
breast changes during pregnancy
larger breast
skin changes during pregnancy
chloasma - brown patches on the face
linea nigra - a line that runs from the navel to the pubic bone
striae gravidarum- stretch marks
supine vena cava syndrome
maternal hypotension due to weight of the uterus on the vena cava
supine vena cava syndrome prevention
Teach the patient to lay on the left side in semi fowlers position or place wedge under one hip when supine
Rh Factor
The indirect Coombs test determines if the mother is Rh negative or Rh positive
for Rh negative patients repeated 24-28 weeks administer RhoGAM at 28 weeks
group B streptococcus
vaginal, anal culture was taken at 35-37 weeks
one hour glucose tolerance test
taken at 24-28 weeks
no fasting required
result should be less than 140 mg/dl
3 hour glucose tolerance test
if the first test was over 140
fasting is required
maternal serum alpha-fetoprotein
taken at 15-22 weeks to screen for down syndrome (low) and for neural tube defects (high)
weight gain during pregnancy
total weight gain should be 25-35 lbs for total pregnancy
1st trimester - 2.2. lbs - 4.4 lbs
2nd and 3rd 1 lb per week
overweight - 15 - 25 lbs
underweight - 28-40 lbs
additional calories needed during pregnancy
no additional calories during 1st semester
340 extra cals during 2nd trimester
462 extra cals during 3rd trimester
breastfeeding 450-500 extra caks
Maternal phenylketonuria
Genetic disease that causes the amino acid phenylalanine to build up in the body, posing a risk of birth defects in the fetus
PKU patient teaching
adhere to PKU diet 3 months prior to pregnancy and through pregnancy
monitor blood levels during pregnancy
PKU diet
avoid foods high in protein
meat
fish
poultry
nuts
eggs
dairy
preparation for ultrasound
Drink 1 quart of water prior to the procedure, better reflects sound waves
biophysical profile
uses real-time ultrasound technology to assess fetal well being
score from 8-10 is normal
lowe than 8 can mean asphyxia
scoring of a biophysical profile
reactive FHR - +2 non-reactive - 0
fetal breathing movement - 1 or more eps for 30+ secs = +2
gross body movements - 3 or more body/limb extensions with the return to flexion +2, 3 or less = 0
fetal tone - 1 or more episodes of extension with a return to flexion +2
amniotic fluid volume - 1 pocket greater than 2 cm in 2 perpendicular planes +2, less = 0
nonstress test
a noninvasive test that measures FHR response to fetal movement performed during the 3rd trimester. acoustic vibration device may be used to awaken a sleeping fetus. mom pushes button when she feels fetal movement
indications for nonstress test
decreased fetal movement, diabetes, gestational HTN, post maturity
interpretation of results for nonstress test
Reactive - NORMAL FHR has a normal rate, moderate variability, and accelerates more than 2 times in a 20 min time period
non-reactive - ABNORMAL FHR does not accelerate sufficiently with fetal movements
contraction stress test
more invasive test used to measure FHR response to contractions, nipple stimulations or pitocin use to induce contractions
can lead to preterm labor
indications for a contraction stress test
nonreactive stress test, high risk pregnancies
interpretation of results contraction stress test
Negative - normal finding. no late decelerations of FHR with three contractions in 10 mins
positive - abnormal finding, late decelerations present in 50% or more contractions, may mean uteroplacental insufficiency
amniocentesis
amniotic fluid is aspirated under ultrasound guidance
performed after 14 weeks
alpha-fetoprotein
high levels associated with neural tube defects, low levels associated with the chromosomal disorder
empty bladder prior
risks - amniotic fluid emboli, hemorrhage, infection, leakage of amniotic fluid, premature rupture of membranes, miscarriage
chorionic villus sampling
the portion of the placenta is aspirated through catheter to assess for chromosome abnormalities
10-13 weeks gestation
provides earlier diagnosis
can cause chorioamnionitis, premature rupture of membranes, miscarriage
