Chapter 5: Letitia Richford Cord Prolapse and Nonreassuring Fetal Status Flashcards
What are some components of preconception care?
health considerations
- chronic disease mgmt
- medications and herbals
- vaccines
- infectious diseases
- reproductive history (preg, sti, surgery)
- genetic conditions/family hx
- personal hx
what are some components of preconception care?
behavioral considerations
- nutrition (folic acid, diet, exercise)
- contraception
- tobacco, alcohol, substance use
- family structure/personal relationships
- intimate partner violence
- environmental exposures or hazards
inevitable abortion
- YES TO EVERYTHING
- vaginal bleeding and cramping
- cervix dilated
threatened abortion
- vaginal bleeding
- NO cervical dilation
missed abortion
- NO TO EVERYTHING
- preg no longer developing and not viable
- NO bleeding, cramping, cervical dilation
septic abortion
- from intrauterine infection
- fever, chills, abd pain, bleeding, discharge, tachycardia, tachypnea
incomplete abortion
- YES TO EVERYTHING
- vaginal bleeding, cramping, cervical dilation
- stuff remains in cervix or uterus
RhoGam
why, when
- prevent mom’s antibodies from attacking baby
- 28 weeks to all mothers that are Rh-
- Postpartum if baby is Rh+ and mom Rh-
Rhogam 50 ug dosage when
within 72 hr of abortion prior to 13 wks
RhoGam 300 ug dosage when
- abortion after 13 wks
- 28 wks gestation
- within 72 hr of delivery
- within 72 hr of trauma or invasive procedure
RhoGam dosage higher than 300 ug when
if mother’s exposure to Rh+ blood is higher than 15mL
fetal movement kick counts methods
- 10 kicks/2 hr at rest
- 10 kicks/12hr normal activity
- 4 kicks/1 hr at rest
- 10 kicks/25 min if 22-26 wks
- 10 kicks/35 min if 37+ wks
what does a birth plan include?
preferences at birth
* support person
* water breaks by self or assissted
* rest or walk
* intermittent or continuous fetal monitoring
* nonpharm or pharm pain mgmt
* breastfeed or formula
* circumcision or intact
* who cuts cord
what should a client bring to the hospital?
- changes of maternity clothes
- massage stuff
- bluetooth speaker
- nursing bra
- mints
- socks
- travel toiletries
- nightgown
- phone charger
reasurring fetal status
- 2 accelerations over 20 min
- no late/variable decelerations
- mod variability
- HR 110-160
nonreassuring fetal status
- fetal bradycardia
- minimal or absent variability
- prolonged deceleration
- usually from lack of O2, cord prolapse
nonreassuring fetal status interventions
- change maternal position (knee chest or trendelenburg)
- IV fluids increase
- O2
- turn off oxytocin
- sterile vaginal exam (if cord palpated, elevate presenting part off maternal pelvis, call for help)
If C-section delayed:
* keep cord moist
* maybe tocolytic like terbutaline
* fill bladder
postoperative c-section orders (8)
- vitals: q15, q30, q1 hr, q4 hr, q8 hr
- fundus, lochia
- pain and analgesia
- incision care
- IV administration (oxytocin, fluids
- I&O
- activity
- serum testing and injection (kleihauser-belke for Rhogam)
Milia
- little white bumps across face
- normal finding that resolves in few weeks and don’t hurt
late preterm infant gest
34-36^6/7 weeks
late preterm infant risks
- hypoglycemia
- hypothermia
- hyperbilirubinemia
- feeding problems
- respiratory issues (resp distress, tachypnea, pulmonary HTN)
- apnea
late preterm infant assessments
- BG levels (norm 45-80 mg/dL)
- temperature (norm 97.7-99.32 F) and no baths until stable
- transcutaneous bilirubin
- latch and feeding
- resp assessment
hypoglycemia in infants risk factors
- LGA or small for gestational age
- mother w gestational diabetes
- preterm infant
- stress at birth (cold stress, asphyxia)
hypoglycemia signs in infants
- jitteriness
- high pitched cry
- breathing issues
respiratory distress signs in infants
- nasal flaring
- tachypnea
- grunting
- cyanosis
- intercostal and subcostal retractions
- seasaw breathing
- A and B: apnea and bradycardia
risk factors for hyperbilirubinemia
- prematurity
- poor feeding
- excessive breastfeeding
- increased RBC production or breakdown
- cold stress and acidosis
- hemotoma
- jaundice in first 24 hrs after birth
- maternal ingestion diazepam, salicylates, sulfonamides
delivery room newborn assessments (6)
- APGAR at 1 and 5 minutes
- vital signs
- measurements
- sex determination
- muscle tone
- crying and breathing
delivery room newborn interventions (4)
- erythromycin 0.5% ointment
- vit k injection
- breastfeeding attempt
- blood glucose
transitional period newborn assessments in first 4-6 h (6)
- temp 97.7-99.32 F
- HR 120-160 bpm
- pink and acrocyanosis color
- tone
- RR 40-60 breaths/min
- BG 45-80 mg/dL
after transition and until discharge newborn assessments (6)
- vitals q8 h
- head to toe in 24 hrs
- BG (45-80 mg/dL)
- transcutaneous bilirubin or serum
- breastfeeding latch/swallow/duration of feeding 2x/day
- stool and void in first 24 hr
predischarge newborn assessments
- BG after 24 hrs (norm 45-80 mg/dL)
- pulse ox between 24-48 hrs
- min 2 successful feeds
- hearing test
- vitals signs norm for at least 12 hrs
- 1 void and stool within 12 hrs
predischarge newborn interventions
- first hepB vaccine
- follow up with pediatrician scheduled within 48 hr
- car seat challenge test
- educate to feed baby every 3 hours if preterm infant
