care of family during pregnancy & labor ch 14, 17, 19 Flashcards
1st trimester
1-13 wks
2nd trimester
14-26 wks
third trimester
27-40 wks
Naegele rule
first day of LMP
subtract 3 months
add 7 days
maybe add a year (depends)
most accurate method to date pregnancy
ultrasound at approx 8 wks gestation
development process for mother
phase 1: accepts biologic fact; thoughts center on herself, child is viewed as part of her, not separate
phase 2: accepts growing fetus as distinct from her (usually accomplished by 5th month) beginning of mom-child relationship
phase 3: prepares realistically for the birth and parenting of the child, “I am going to be a mother”
father’s stages
announcement phase: accept biologic fact of pregnancy; ambivalence common in early stages of pregnancy
moratorium phase: accept reality of pregnancy; become introspective, engage in deep convos, particularly with their father
focusing phase: negotiate with partner the role he is to play in labor & in preparing for parenthood
prenatal visit schedule
first visit with the first trimester
monthly visits following first prenatal visit
every 2 wks from wks 29-36
weekly visits week 36-birth
initial prenatal visit
longest visit prenatal interview current pregnancy childbearing and repro system hx health hx (medical & surgery) physical exam (review of systems) lab tests
prenatal interview
nutritional hx hx of medication/herbal prepartation use family hx social, experiential and occupational hx mental health screening hx or risk of IPV
every prenatal appt following initial will always do these things:
VS weight urine dipstick fundal height fetal heart tones
vaccine received during every pregnancy
Tdap between 27-36 weeks
provides pertussis immunity to newborn
Live vaccines are contraindicated during pregnancy
varicella
MMR
oral polio
FluMist
RhoGAM
- given to Rh- mothers at 26-30 weeks gestation
- if baby Rh+, will receive again within 72 hrs of birth
- will also receive if there’s any risk of mixing of blood ie amniocentesis, CVS, spontaneous or therapeutic abortion, ectopic pregnancy, abdominal trauma, or external cephalic version
rubella titer
< or = 1:8 Non immune
> or = 1:10 Immune
Rubella vaccine is live and tetragenic to fetus; if given, must wait 28 days to attempt pregnancy and given in PP period if not immune
Hgb normal value during pregnancy
non-pregnant - 12 - 15.5
1st trimester - 10.8 - 14.0
2nd trimester - 10.0 - 13.2
Hct normal values during pregancy
non-pregnant - 36 - 44
1st trimester - 31.2 - 41.2
2nd trimester - 30.1 - 38.5
platelets < 100,000 could prevent use of what
epidural
recommended weight gain for pregnancy
underweight <18.5 28-40lbs
normal wt. 18.5-24.9 25-35
overweight 25-29.9 15-25
obese >30.0 11-20
how to calculate BMI
kg/m2
Leopold’s first maneuver
- first - fundus
- palpate fundus to determine if head or breech is present
- head feels harder and bottom will feel soft, less round, harder to outline and feel
Leopold’s second maneuver
- second - sides
- palms are placed on either side of mother’s abd to determine presence of fetal back versus arms and legs
Leopold’s third maneuver
- third - top
- palpating the top of the symphysis pubis to determine head or bottom
Leopold’s fourth maneuver
- face to feet (examiner)
- only maneuver examiner faces mom’s feet
- checking for engagement
urinalysis in pregnancy screens for:
- glucose
- protein (assoc. w/ preeclamsia, kidney disease)
- nitrites (UTI)
- leukocytes
- blood
- specific gravity (hydration status)
contraindications for epidural or spinal
- use caution with platelets < 100,000
- maternal hypotension
- coagulopathy
- allergies to numerous anesthetic agents
- maternal inability/refusal to cooperate
- infection at insertion site
SE of epidural/spinal
- maternal hypotension
- increased ICP
- slows down labor (epidural)
- bladder distension (late complication)
- increased risk of C-section
nursing care with epidural/spinal
- assess labs (platelets, fibrinogen)
- IV hydration (500 mL bolus often given before receiving to decrease effects of hypotension)
- frequent VS monitoring (BP esp.)
- FHR monitoring
- labor progress
- frequent repositioning is critical to help baby with cardinal movements of labor
- spinal: keep supine 12-24 hours
cardinal movements of labor
Every Engagement
Damn Descent
Fool Flexion
In Internal Rotation
Egypt Extension
Eats Raw External Rotation
Eggs Expulsion
risks of epidural and spinal
- epidural vein: watch for tachycardia, numbness of tongue, metallic taste, increased BP or tinnitus w/in 2-3 minutes
- subarachnoid space: immediate upper thoracic sensory loss, severe lower extremity blockade, possible resp. arrest
- spinal headache
stages of labor
- stage one: onset of labor to 10 cm dilated
- latent: onset of labor to 5 cm
- active: 6-10 cm
- stage two: full dilation to delivery of baby
- stage three: delivery of baby to delivery of placenta (shouldn’t last longer than 30 min)
- stage four: delivery of placenta to first 2-4 hrs PP
how to test for amniotic fluid
- Amnisure (most accurate)
- nitrazine paper (tests for alkilinity)
- fern test (not highly sensitive)
palpating for intensity of contractions
- mild: slightly tense fundus (nose)
- moderate: firm fundus (chin)
- strong: rigid fundus (forehead)
encourage mom to void every ____ hours
two
prevents distended bladder which can compromise labor progression
ambulating and positioning during labor
- change position q 30-60 min
- side lying preferred
- sitting on a birthing ball
- squatting
- use of peanut ball
danger sign in labor
- intrauterine contraction strength > 80 mmHg
- resting tone > 20 mmHg
- contractions lasting > or = 90 seconds
- contractions occurring more frequently than q 2 min
- foul smelling vaginal discharge
- relaxation b/t contractions < 30 seconds
- fetal brady/tachycardia or minimal/absent variability not assoc with sleep
- meconium stained amniotic fluid
- maternal temp > 100.4
- persistent bright/dark red bleeding
