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Mother Baby > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

How do you know when baby is done feeding

A

Breast is soft

Breast produces right amount for growth state infant is in

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2
Q

How to tell if newborn has been sufficiently fed

A

Might nod off, calm, not irritable, will stop crying

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3
Q

How big is newborn’s stomach on day 1

A

5-7 ml

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4
Q

Newborn stomach size on day 3

A

23-27ml

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5
Q

Positive signs of labor

A

Fetal movement by examiner
Fetal heart sounds
Visualization of Fetus by US

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6
Q

Probable signs of labor

A 
Fetal outline by examiner
Breast changes
Positive test
Abdominal and uterine enlargement
Chadwick’s sign - blueish cervix
Goodell’s sign
Ballotement
Braxton Hicks
Skin pigmentation
Hagor’s sign
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7
Q

Presumptive signs of labor (from mom’s perspective)

A 
N/V (morning sickness)
Fatigue
Amenorrhea (absence of period)
Urinary frequency
Quickening (flutter feeling - could be gas)
Breast changes
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8
Q

Chadwick’s sign

A

Blue cervix

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9
Q

Goodell’s sign

A

Softening of the cervix

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10
Q

Hegor sign

A

Softening of the uterus

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11
Q

Ballottement

A

Tap and fetus gets bumped to top of cervix and comes back down

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12
Q

how much weight do newborn’s lose after birth?

A

5-10%

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13
Q

when do newborns regain their weight ?

A

10-14 days after birth

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14
Q

when can babies start having solids

A

6 mons to avoid food allergies

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15
Q

T/F: length is a better measure of growth

A

True - grow 2.5 cm per month in the first 6 months

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16
Q

what does skin to skin do for breastfeeding?

A

mom releases oxytocin faster
promotes milk production
promotes uterine involution
more demand, the more mom supplies

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17
Q

when should breastfeeding start?

A

w/i 30 mins of birth to take advantage of alert stage

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18
Q

LATCH Assessment

A

L - latch - too sleepy, repeated attempts, lips flared/rhythmic sucking
A- audible swallowing - non, a few, spontaneous/intermittent/frequent
T - type of nipple.- inverted, flat, everts after stimulation
C - comfort - engorged/severe pain, filling/red, soft/non tender
H- hold - full assist, minimal assist, no assist

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19
Q

how often should moms feed

A

every 2-3 hours during the day and every 4 hours at night
15-20 mins on each breast
must empty breast to avoid plugged ducts

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20
Q

stages of human milk

A

colostrum = days 1-2
transitional milk - day 3
mature milk by day 14

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21
Q

engorgement

A

when breast is too full - want to make sure breast is emptying to avoid

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22
Q

T/F: preemie milk is fattier

A

True

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23
Q

immunologic advantages of breastmilk

A

IgA antibodies
non allergenic
colonizes infant gut with proper bacteria

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24
Q

nutritional advantages of breastmilk

A 
whey
high concentration of cholesterol and balance of amino acids promote myelination and neuro dev
minerals
iron - more readily absobred
self regulated eating
less ear infections
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25
Q

psychosocial advantages of breastfeeding

A

provides more frequent direct skin contact b/w mother and infant

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26
Q

maternal benefits of breastfeeding

A

lowers risk of breast and ovarian cancer
less osteoporosis
faster involution of uterus and pre pregnancy weight

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27
Q

other newborn benefits of breastfeeding

A

increases o2 saturation
maintains temp regulation
decreases SIDs
reduction in cancer, asthma, dermatitis, type 1 and 2 diabetes

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28
Q

contraindications of breastfeeding

A

fetal galactosemia
mastectomy/breast enlargement
HIV
cytomegalovirus, active TB, varicella, human T cell lymphotropic virus type I and II
maternal medications (chemo, illegal drugs, radiation therapies, antiretrovirals)

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29
Q

common breast feeding positions

A

cradle hold
cross cradle
football hold
side lying hold

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30
Q

steps in breastfeeding

A

massage breast
tap lower lip of baby to open mouth
scoop mouth over nipple

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31
Q

problems in breastfeeding

A 
nipple soreness - check latch/position
cracked nipples - check latch
flat or inverted nipples - address latch
engorgement - pain control, emptying
inadequate/excessive let down
plugged dugs - patience/feeding
mastitis - medical intervention
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32
Q

how to prevent breast milk from coming in

A

ice packs, cabbage leaves, avoid stimulation (tight fitting bra and no hot water)

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33
Q

how to know if newborn baby has had enough

A

weight loss should not exceed 10%
birthweight should return in a few weeks
fontanelles should be flat, skin should not be dry
stools shouldn’t be hard

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34
Q

T/F: you should wake an infant up to feed

A

true

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35
Q

how to store fresh breastmilk

A

4-6 hours at room temp
8 days in the fridge
3-4 months in the freezer
if thawed, good for 24 hrs in the fridge

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36
Q

how to store formula

A

24-48 hours in the fridge

do not freeze

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37
Q

T/F: if the milk is in contact with the baby during the feed, you can reuse

A

False! Finish feed within 1 hour and discard

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38
Q

recommended weight gain for BMI 18.5 - 24.9

A

25-35 pounds
2.2-4.4 in first trimester
1 pound per week in the last trimester

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39
Q

recommended weight gain for BMI less than 18.5

A

28-40 lbs

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40
Q

recommended weight gain for BMI 25-29.9

A

15-25 pounds

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41
Q

recommended weight gain for BMI 30 and above

A

11-20 lbs

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42
Q

calorie requirements during pregnancy

A

no change during first trimester

300 cals extra during 2nd and 3rd trimester

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43
Q

carb requirements for pregnancy

A

increase during 2nd and 3rd timester

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44
Q

protein requirements for pregnancy

A

71 g compared to 46 g for nonpregnant women

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45
Q

how many servings of Ca a day in pregnancy?

A

4 servings

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46
Q

what do you have increased need for when it comes to nutrition

A

Mg, Zn, Selenium
Vit A and C
Thimaine, riboflavin, niacin, folate, B6, B12
iron

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47
Q

risk factors associated with iron deficiency anemia

A

low birth weight, increases risk of preterm birth, inadequate fetal brain development, maternal and infant mortality
daily supplement of iron 30 mg

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48
Q

why is folate important during preg

A

associated with neural tube defects 3-4 weeks after conception
fresh green veggies, liver, peanuts and fortified foods
400 mcg should be taken daily

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49
Q

how much water should a pregnant woman drink per day

A

at least 8-12 glasses of fluid a day

4-6 should be water

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50
Q

what should a pregnant woman not consume

A 
energy drinks
mercury
raw or undercooked eggs
soft cheeses
alcohol
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51
Q

complications of pregnancy

A

nausea
constipation (can come from iron)
PICA
PKU

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52
Q

what to avoid to avoid nausea

A

caffeine, fats, spices, triggers

avoid fluid with meals

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53
Q

PICA

A

craving/consumption of non food substances
associated with iron deficiency, poor or excessive weight gain, fecal impaction, lead poisoning, decreased infant head circumference, low birth weight
impacts 11-16% of women

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54
Q

PKU

A

genetic disease
linked to developmental delays and behavioral problems
should resume PKU diet (low in protein) at least 3 months before pregnancy and continue through

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55
Q

PP nutrition recommendations

A

weight loss of 10-12 pounds

high fluid intake

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56
Q

PP nutrition for breastfeeding moms

A

adequate caloric intake (330 for first 6 mos, 400 for second 6 months)
no caffeine or alcohol
increased protein
calcium

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57
Q

hormones of the repro cycle

A 
GnRH
FSH
LH
estrogen 
progesterone
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58
Q

when does ovulation occur

A

just after decline of estrogen

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59
Q

how long is the follicular phase

A

varies in women

1-14 days

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60
Q

how long is the luteal phase

A

always 14 days - fixed
days 15-28
ovulation to menses

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61
Q

where does fertilization occur

A

outer third of the fallopian tube = ampulla

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62
Q

what happens to the egg if it is fertilized (what does it secrete first)

A

secretes hCG - maintains progesterone levels until the placenta takes over

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63
Q

OTC pregnancy tests detect…

A

hCG

99% accurate

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64
Q

what can high levels of hCG indicate

A

multifetal pregnancy
ectopic pregnancy
hydatidiform mole
genetic abnormality (like Down’s)

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65
Q

what can low levels of hCG indicate

A

miscarriage

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66
Q

stages of lacerations

A

first degree - small tear
second degree - involves underlying muscles
third degree - involves anal sphincter
fourth degree - extends to rectum

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67
Q

t/f: episiotomy is evidenced based

A

false

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68
Q

disadvantages of episitomy

A

blood loss, infection, pain, discomfort, major perineal trauma, sexual dysfunction

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69
Q

does the vagina go back to pre pregnancy state

A

not necessarily

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70
Q

do vaginal secretions increase or decrease during pregnancy

A

increase

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71
Q

what is covered in the first antepartum appt

A 
current pregnancy - how?
past pregnancies
gyno history - abnormal paps, issues/ovaries
current and past medical history
pertinent histories - birth father's
maternal assessment
fetal assessment
education
job/occupation
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72
Q

nagele’s rule

A

add 7 days to LMP and subtract 3 months

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73
Q

is fundal height measurement a good indication of how far along

A

no but b/w 18-32 weeks can be + or - 2 cm

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74
Q

abortion

A

before 20 weeks

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75
Q

stillbirth

A

demise/loss after 20 weeks

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76
Q

preterm

A

after 20 weeks, before 36.6

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77
Q

early term

A

37.0 to 38.6 weeks

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78
Q

full term

A

39.0 to 40.6 weeks

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79
Q

late term

A

41.0 weeks to 41.6

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80
Q

post term

A

more than 42.0 weeks

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81
Q

GTPAL

A 
gravidity = all pregnancies including current
term = births beyond 37.0 weeks
preterm = births b/w 20.0 and 36.6 weeks
abortion = before 20.0 weeks
living = number of living children
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82
Q

gyno history questions

A 
pap smear history
previous infections?
surgery?
infertility or dysmenorrhea?
contraceptives
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83
Q

current medical history questions

A 
immunizations
all medications/drugs
infections/illnesses/chronic diseases
weight and nutrition
activity
eye and dental exams
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84
Q

past and family medical history

A

hospitalizations, accidents
blood transfusion history
presence of chronic illness or diseases in immediate family
history of multiple births, congenital diseases
mental illness
c-sections

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85
Q

pertinent history

A 
genetic
religious/cultural
occupational
birth father
social history
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86
Q

prenatal visit frequency

A

monthly for 7 months
every 2 weeks during 8th month
every week during last month

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87
Q

education during pregnancy

A 
avoid all OTC meds and supplements
avoid alcohol, tobacco, substance use, raw fish, soft cheeses
flu vaccine
genetic testing
exposure to hazardous materials
exercise
avoid hot tubs or saunas
2-3L of water every day
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88
Q

common discomforts of 1st trimester

A 
N/V
breast tenderness
nose bleeds
urinary frequency
UTIs
fatigue
ptylaism - increased saliva
increased vaginal discharge
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89
Q

what labs should you have done during first trimester

A

rubella, CBC, hep B titer, blood type

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90
Q

common discomforts during 2nd trimester

A 
UTIs
heartburn
constipation/hemorrhoids
backaches
varicosities, edema
braxton hicks
supine hypotension
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91
Q

education during 2nd trimester

A 
breastfeeding
lifestyle - sex, rest, relaxation, can lose balance
complications
fetal growth and dev
birth methods/birth plan
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92
Q

3rd trimester education

A

childbirth prep

use back pillows to prop to side

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93
Q

common discomforts of 3rd trimester

A 
UTIs, urinary frequency
fatigue
heartburn
constipation/hemorrhoids
backaches
SOB
leg cramps, edema, varicosities
braxton hicks 
supine hypotension
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94
Q

t/f: pregnant women and close friends/family should get the tdap vaccine

A

true

will reduce cases by 33%, hospitalizations by 38%, deaths by 49%

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95
Q

Antepartum danger signs

A

Abdominal pain
High fever above 38.3 (101F)
Vaginal bleeding
Decreased or absent fetal movement
Epigastric pain (RUQ) —> associated with preeclampsia, associated with liver
Sudden gush of fluid
Persistent vomiting
Blurred vision/dizziness (any visual changes) - sign of HBP/preeclampsia
Painful urination - dysuria
Swelling of hands and face
Severe/persistent headache that doesn’t go away with tylenol

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96
Q

Prenatal Head Assessment

A
  • headache, dizziness, visual changes
  • rhinitis/nose bleeds (d/t increased estrogen)
  • hypertrophy of gingival tissue (d/t increased estrogen)
  • neck nodes (d/t increased estrogen)
  • slight hyperplasia of thyroid by third month (d/t increased estrogen)
  • nutrition
  • increased fluids —> decreased dehydration can cause contractions
  • N/V
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97
Q

Prenatal Psychosocial Assessment

A 
Desire for pregnancy
Fear r/t anticipation of pain
Body image changes
Social support
Sleeping/rest
Mobility/balance - center of balance has changed
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98
Q

Prenatal skin assessment

A 
Consistent with racial/ethnic background
Edema of lower extremities
Spider nevi = common
2nd trimester = striae gravidarum (can be based on heredity), hyperpigmentation (cholasma, Linea Nigra)
Acne
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99
Q

Prenatal chest/lungs assessment

A
  • lungs clear bilaterally
  • heart sounds are regular
  • palpitations d/t to SNS
  • short systolic murmurs
  • breasts: darker pigmentation of nipple and areola, increased in first 20 weeks, nodular, heavy
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100
Q

Prenatal CV assessment

A
  • pulse increases 10-50/min around 20.0 week
  • cardiac hypertrophy
  • respirations increase 1-2/min
  • BP range w/ in pre-pregnancy range during 1st trimester
  • BP decreases 5-10 mm Hg during 2nd trimester
  • BP returns to pre-pregnancy after 20.0 week
  • supine hypotensive syndrome
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101
Q

Pernatal abdomen assessment

A
  • no upper right quadrant pain
  • linea nigra; purple striae
  • decreased gastric mobility
  • N/V from hormonal changes; increased pressure
  • diastasis of rectus muscles
  • fundal measurement
  • fetal HR
  • fetal movement
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102
Q

Prenatal perineum assessment

A
  • odorless discharge; non irritating
  • Goodell’s sign
  • hegar sign
  • Chadwick sign
  • posterior cervix
  • pelvic exam
  • urinary frequency and output stays the same
  • increased filtration rate
  • assess for ketones/proteinuria/UTI
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103
Q

Prenatal extremities assessment

A
  • swelling of feet (and should assess for swelling of hands)
  • pulses, temp, ROM, varicosities, palmar erythema
  • reflexes
  • carpal tunnel syndrome b/c of fluid retention
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104
Q

Muscular skeletal prenatal assessment

A
  • backache: lumbar spinal curve accentuated
  • pelvic joints relax
  • weight increases causes body alteration
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105
Q

Prenatal endocrine assessment

A

Large amounts of hCG, progesterone, estrogen, lactogen, prostaglandins from placenta

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106
Q

Prenatal Lab Tests

A 
Blood type, rh factor
CBC with diff
Hgb electrophoresis
Rubella titer
hep B screen
GBS (35-37 weeks)
Urinalysis
One hour glucose tolerance (24-28 weeks)
Pap test
Vaginal/cervical culture
PPD screen
VDRL (sphyllis)/HIV screen
TORCH screening
MSAFP
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107
Q

Clincial pelvimetry

A

Pelvic type is assessed externally or via sterile vaginal exam

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108
Q

Most common pelvic type?

A

Gynecoid (50%)

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109
Q

Prior to tests, what should you teach?

A
  • assess whether the woman knows the reason for the test
  • provide an opportunity for questions
  • explain the test procedure
  • validate the woman’s understanding of the prep
  • answer any questions
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110
Q

Ultrasound scanning

A

Use of high frequency sound waves

Takes 20 minutes

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111
Q

What does an ultrasound show?

A

allows the observation of fetal movements including breathing, cardiac action, and vessel pulsation

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112
Q

If GBS +, when do you give antibiotics

A

During active labor or ROM

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113
Q

When to give rubella vaccine if non-immune?

A

Vaccine prior to hospital discharge

no pregnancy for 3 months after vaccine

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114
Q

If Rh -, when do you give Rhogam?

A

28 weeks, or after any trauma or exams that could cause mixing of blood
Within 72 hours of birth

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115
Q

If infant direct Coombs is positive why dont we give rhogam?

A

Mom is already alloimmunized so rhogam won’t prevent anything, she is alloimmunized for life

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116
Q

How can you tell if a newborn was born by c section?

A

No conehead/molding

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117
Q

Benefits of spontaneous labor

A

Provides natural pain relief
Helps calm woman
Facilitates normal detachment of placenta
Enhance breastfeeding
Warm the mother’s skin
Clear fetal lung fluid
Ensure transfer of maternal antibodies to the fetus

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118
Q

Vaginal seeding

A

Babies born through vaginal canal have stronger immune system to bacteria they encounter after
May be d/t traveling vaginal canal and exposure to flora in canal

Seeding = swab canal/flora and swab infant’s mouth if baby is born by C-section

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119
Q

Why 39 weeks for bishop scoring?

A

Estimated Date of birth - someone at 39 weeks is going to be b/w 38-40 weeks.

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120
Q

How can pitocin be delivered?

A

IV or IM

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121
Q

Interventions or medications for blood loss postpartum

A
  • fundal massage, IV fluids, empty bladder, balkri balloon

- methergine, hemabate, pitocin, cytotec

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122
Q

When is methergine contraindicated?

A

Hypertension

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123
Q

external abdominal ultrasound - when is it useful?

A

noninvasive

more useful after first trimester

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124
Q

internal transvaginal US

A

first trimester
invasive
detects ectopic pregnancy
establishes gestational age

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125
Q

doppler ultrasound blood flow analysis

A

noninvasive

IUGR evaluation

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126
Q

Level I US characteristics

A

assess number of fetuses, presentations, lie, viability, location of placental site, and amniotic fluid volume

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127
Q

Level II US characteristics

A

more comprehensive

evaluates fetal anatomy along with level I parameters

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128
Q

when can a US show the gestational sac?

A

4-5 weeks

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129
Q

when can US show fetal heart mvmts?

A

7 weeks

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130
Q

when can US show fetal breathing mvmts?

A

11 weeks

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131
Q

when can US measure crown rump length?

A

before 12 weeks

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132
Q

what can a US do in the second trimester?

A

measure fetal biparietal diameter, femur length, abdominal and head circumferences to estimate gestational age and weight

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133
Q

Quadruple check

A
  • MSAFP
  • uE3 conjugated estriol
  • hCG
  • inhibin A

**screening not diagnostic

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134
Q

indications of Downs from MSAFP

A

MSAFP = low
uE3 = low
hCG = high
inhibin A = high

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135
Q

AFP

A

alpha fetoprotein - produced by fetus and can be detected in maternal serum by 7th week
most accurate b/w weeks 16-18

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136
Q

what can impact MSAFP levels that is not abnormalities?

A

diabetes, smoking and multiples

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137
Q

what does amniocentesis measure?

A

Chromosomal and biochemical determinations
-measures AFP for neural tube defects and L/S ratio for fetal lung maturity (later in pregnancy), blood typing
Can validate abnormalities detected by US

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138
Q

how and when is amniocentesis performed?

A

aspiration though a needle of amniotic fluid (through abdominal wall or intravaginally)
15-16 weeks gestation

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139
Q

what does a pregnant women have to do before amniocentesis?

A

empty bladder

sign consent form

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140
Q

post amniocentesis and CVS responsibilities

A

monitor UCs at start and then 1-2 hours post procedure

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141
Q

how and when is chorionic villi sampling performed

A

aspiration through a thin catheter or syringe of chorionic villi (through abdominal wall or intravaginally)
9-12 weeks gestation

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142
Q

what does the mom need to do before CVS?

A

drink plenty of fluid to fill bladder so fetus can’t move around as much
provide consent

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143
Q

risks of CVS

A

spontaneous abortion
infection of amniotic fluid
break amniotic fluid

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144
Q

PUBS (percutaneous umbilical blood sampling)

A

most common method to sample fetal blood during amniocentesis.. can use that blood for:

  • Kleihauer Betke test (fetal blood)
  • CBC count with diff
  • indirect coombs
  • visualization of chromosomes
  • blood gases
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145
Q

risks of PUBS

A
  • cord laceration
  • cord infection
  • hemorrhage
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146
Q

fetal movement assessment low tech intervention

A

kick count

helps woman become aware of fetal activity

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147
Q

what is normal for a fetal movement assessment

A

3 or more mvmts in 1 hour

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148
Q

when should you call your HCP regarding fetal movement

A

no fetal movement in 8 hours
less than 10 fetal movements in 12 hours (really 2)
violent fetal movement followed by decreased activity

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149
Q

when should fetal movement assessments happen

A

when you can feel the fetus
same time every day that the fetus is active
count kicks and document once you reach 10
can drink water to wake baby up

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150
Q

When do you do the non stress test?

A

3rd trimester

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151
Q

How do you conduct a non stress test

A

Place on EFM for 20 minutes

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152
Q

What does a reactive stress test mean?

A

2 or more accelerations of at least 15bpm, each lasting at least 15 seconds, during the 20 mins
No decels
Moderate variability

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153
Q

What does a non reactive stress test mean?

A

Criteria wasn’t met

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154
Q

What do you do for non reactive stress test result?

A

Give baby more time
Snack for mom
More detailed test

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155
Q

How often do AMA get non stress test?

A

Weekly in third trimester

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156
Q

How often do diabetics and high BP patients get a non stress test?

A

1-2x per week during last trimester

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157
Q

How to perform contraction stress test?

A

Nipple stimulation (for 2 minutes, rest 5 minutes and repeat)
Pitocin stimulation
Terbutaline to stop contractions

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158
Q

What is a normal result for a contraction stress test

A 
Negative = normal, no fetal heart rate decels
3 contractions (40 seconds)  within 10 minute periods
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159
Q

What does a positive contraction stress test mean?

A

Abnormal

Late decels

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160
Q

When would you recommend a biophysical profile

A

Negative non stress test = non reactive

Positive contraction test

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161
Q

How do you score BPP

A

Score of 10 with 2 points for each:

  • FHR reactivity
  • fetal breathing movements
  • fetal body movements
  • fetal tone
  • amniotic fluid volume

Fetal asphyxia = 0
7/10 or below = induce

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162
Q

Hyperemesis gravidarum

A

N/V post first trimester
Women at risk for weight loss, dehydration, electrolyte imbalances, ketonuria, acidosis
Can cause IUGR

163
Q

Cause of hyperemesis gravidarum

A

High hCG/estradiol
H. Pylori infection
History of migraines or asthma

164
Q

How to diagnoses hyperemesis gravidarum

A

Weight loss > 5% pre pregnancy weight
Dehydration
Ketonuria
History of intractable vomiting

165
Q

How to treat hyperemesis gravidarum

A 
Avoid odors
Frequent small meals
Vitamin b6
Phenergan / reglan / Zofran
Ginger
Acupressure/ acupuncture 
IV fluids
166
Q

If rh- mom is exposed to rh+ fetus…

A

Mom Will create IgG antibodies against RBC of fetus = alloimmunization
Will impact second rh + baby that mom has

167
Q

If an indirect Coombs test is negative…

A

Mom is not alloimmunized
Give rhogam at 28 weeks, after any trauma or procedure, and within 72 hours after birth (after another negative indirect Coombs at birth)

168
Q

If indirect Coombs is positive at birth…

A

Run Coombs on infant , run KB test

If positive = no rhogam —> mom is already alloimmunized. Need to frequently monitor and observe

169
Q

Oligohydramnios

A

Too little amniotic fluid, a 5cm or less pocket of amniotic fluid
Seen with post maturity, IUGR, renal malformations

170
Q

How to treat oligohydraminos

A

Amnioinfusion

171
Q

Polyhydramnios

A

Too much fluid
>20 cm pocket
Seen with congenital anomalies

172
Q

How to treat polyhydramnios

A

Indocin (indomethacin)

173
Q

PROM

A

Premature rupture of membranes anytime after 37 weeks before onset of labor

174
Q

PPROM

A

Preterm premature rupture of membranes anytime before 37 weeks

175
Q

Prolonged rupture

A

More than 24 hours before birth

176
Q

How to manage PROM

A

Birth within 24-48 hours (unless PPROM - birth can be delayed with close mgmt)
Treat for infection (chorioamnionitis)

Risk for decels and cord prolapse

177
Q

How to treat prolapse cord

A

priority: get pressure off of cord
Keep hand in vagina and push presenting part away from cord but don’t push cord in!
-Place mom in trendelenburg or chest prone down/kneeling position, buttocks up
-Type and cross match blood, large bore IV
-monitor FHR
-Prepare for emergency c section
-cover with gauze and saline

178
Q

Placenta previa

A

Placenta abnormally implants in lower segment of uterus near or over cervical os (2% incidence)
Can result in bleeding in first trimester

179
Q

Placenta previa grade 1 or 2

A

Low lying placenta

180
Q

Grade 3 partial previa

A

Partial previa

Usually cannot have vaginal birth

181
Q

Grade 4 placenta previa

A

Total
Most complicated - c section
Can’t efface or dilate

182
Q

Factors that may contribute to previa

A 
Precious hx of placenta previa
Uterine scarring
Maternal age greater than 35-40 years
Multifetal gestation 
Smoking and/or cocaine use
Large placenta
Placenta accreta
183
Q

Previa assessment

A
  • painless bright red vaginal bleeding in 2nd or 3rd trimester
  • fetus position
  • reassuring FHR
  • normal VS
  • h/h, CBC, blood type and rh, coag profile, kleihauer-betke
  • transabdominal or transvaginal US
  • refrain from SVE to avoid bleeding
  • BRP (bed rest) if no bleeding
184
Q

Placenta accreta

A

Abnormally deep attachment into uterine wall

1 in 2000 pregnancies

185
Q

Accreta

A

Attach to myometrium (75% of cases)

186
Q

Increta

A

Invades myometrium (17%)

187
Q

Percreta

A

Penetrates myometrium (5-7%)

188
Q

How do estrogen and progesterone impact insulin?

A

Stimulate insulin production

Increase tissue response to insulin to make insulin more easily stored

189
Q

T/f: Insulin needs during first trimester are decreased

A

True

190
Q

Can insulin cross the placenta?

A

No

191
Q

Can glucose cross the placenta?

A

Yes

192
Q

Do insulin requirements increase or decrease at birth?

A

Decrease because placenta separation causes decrease in hormones which causes decrease in insulin requirements at the tissue level

193
Q

What happens to insulin requirements post partum

A

Decrease

Decrease further with breastfeeding

194
Q

What causes hypoglycemia in neonates

A

Lack of glucose supply, but production of excessive insulin
Blood sugar drops when cord is clamped
Glucose comes from food/milk in 2-4 hours- babies also get sleepy

195
Q

Gestational diabetes mellitus

A

Glucose intolerance

Gestational is controlled with diet and education

196
Q

Risks associated with diabetes

A 
Hydraminos 
Preeclampsia (treat w/ low dose aspirin)
Ketoadidosis
Fetal macrosomia and IUGR
UTI/vaginitis 
Retinopathies 
Congenital abnormalities
Sacral agenesis
Respiratory distress syndrome
197
Q

What should you watch for during 1st prenatal visit r/t diabetes

A

HbAic >= 6.5%
Fasting glucose >= 126
2 hour glucose >= 200

198
Q

How do you monitor glucose during l&d and postpartum

A

Glucose levels every 1-2 hours during active labor
Discontinue insulin at end of 3rd stage of labor
Monitor s/s postpartum
Reassess 4-12 weeks postpartum

199
Q

What is the hemoglobin level considered anemic?

A

Less than 11 g/dl

200
Q

Risk factors for anemia

A 
Race
Altitude
Smoking
Nutrition
Medications
201
Q

When is the greatest need for iron?

A

Second half of pregnancy

202
Q

Nursing interventions for anemia

A
  • education on iron supplementation
  • monitor h/h every 2 weeks
  • take vitamin c but avoid with caffeine or milk
  • recognize signs and symptoms - fatigue, headache, pallor, tachycardia, hgb < 11
  • advocate for pain month in cases of sickle cell anemia
203
Q

Impact of marijuana during pregnancy

A

Lower birth weight

204
Q

Impact of cocaine/crack during pregnancy

A

Placental vasoconstriction
SAB, abruption, IUGR, preterm birth, stillbirth
Microcephaly, anomalies, SIDS
No breastfeeding!

205
Q

Impact of opioids during pregnancy

A

Abnormal placental implantation, abruption, PTL, PROM, meconium
IUGR, LBw, preterm birth, fetal distress

206
Q

Impact of heroin

A

Anemia
Preeclampsia/eclampsia
STI
preterm birth, IUGR

207
Q

Can psych drugs cross the placenta

A

Yes
No psychotropic drugs are approved by FDA
Need to balance risk associated with parental exposure

208
Q

What congenital heart defects, if repaired, can proceed as normal?

A

Tetralogy of fallot, atrial septal defect, ventricular septal defect, patent ductus arteriosus

209
Q

What congenital heart defects make pregnancy contraindicated

A 
Eisenmenger syndrome
Pulmonary HTN
Uncorrected coarctation of the aorta
Aortic stenosis
Marfan syndrome 
All cause persistent cyanosis
210
Q

What congenital heart defect tolerates pregnancy well

A

Mitral valve prolapse

211
Q

What is peripartum cardiomyopathy and what are the s/s (cow dep)

A

serious dysfunction of left ventricle that occurs toward end of pregnancy or in first 5 months postpartum
No previous history
Chest pain, Dyspnea, orthopnea, palpitations, weakness, edema

212
Q

WHO risk classes for CVD: no contraindications

A

Class I and II

213
Q

WHO risk classes for CVD: contraindicated pregnancy

A

Schedule IV

214
Q

Heart disease in pregnancy assessments

A 
Frequent prenatal appts
Assessment b/w 28-32 weeks
Oxygen and diuretics during labor
Pain mgmt to decrease pain
Assisted birth to decrease pushing 
Critical period of 48 hours postpartum
215
Q

T/f: bleeding during pregnancy is normal

A

False - abnormal. Always has to be investigated

216
Q

Causes of bleeding in pregnancy: before 20 weeks

A

Abortion
Ectopic pregnancy
Gestational trophoblastic disease
Trauma

217
Q

Causes of bleeding during pregnancy: second half of pregnancy

A 
Trauma
Placenta previa
Abruptio placentae
Labor
Preterm labor
218
Q

Nurses role in bleeding during pregnancy

A
  • assess history
  • monitor VS and bleeding ant
  • assess gestational age and fetal heart tones
  • insert IV, collect GTs, H&H
  • prepare for US and/ or vaginal exam
  • rh status
  • psychological support
  • assess signs of shock, phlebitis, ectopic pregnancy
219
Q

Spontaneous abortion

A

Expulsion of products of conception before age of viability (20 weeks or 500g)

220
Q

Causes of SAB

A 
Chromosomal abnormalities
Teratogenic drugs
Structural abnormalities
Placental abnormalities
Maternal disease
Cervical insufficiency
Endocrine imbalances
221
Q

SAB procedures

A

US
cervical exam
D&C
Dilation and evacuation - to evacuate uterine contents after 16 weeks
Prostaglandins into amniotic sac or as a vaginal suppository and oxytocin

222
Q

Dilation and curettage

A
  • empty bladder
  • assist woman to relax
  • watch for vasovagal reaction
  • observe for signs of uterine perforation afterwards
  • may be given prophylactic antibiotics
  • monitor vital signs
  • give rhogam if woman is Rh negative
223
Q

SAB discharge instructions

A

contact provider if:
Heavy bright red bleeding
Elevated temp
Foul smelling discharge

Small amount of discharge normal for 1-2 weeks
Pelvic rest for 2 weeks
Avoid pregnancy for 2 months
Antibiotics
Support groups
224
Q

Ectopic pregnancy

A

Implantation of a fertilized ovum in a site other than the endometrial lining of the uterus

225
Q

Cause of ectopic pregnancy

A 
PID, endometriosis, previous ectopic pregnancy
IUD 
Pelvic or tubal surgery 
AMA
Ovulation inducing drugs
226
Q

S/s of ectopic pregnancy

A

One sided lower abdominal pain or diffuse lower abdominal pain
Fainting/dizziness
Referred right shoulder pain —> ask if appendix has been removed

227
Q

Ectopic pregnancy interventions

A 
IV access
Labs
Pelvic exam
US
Emotional support
228
Q

treatment for ectopic pregnancy

A

methotrexate IM, saplingostomy/salpingectomy

229
Q

Gestational trophoblastic disease (molar pregnancies)

A
  • a group of rare tumors that develop during the early stages of pregnancy
  • hydatidiform mole
230
Q

hydatidiform mole

A
  • growth of an abnormal fertilized egg or an overgrowth of tissue from the placenta and produce HcG
  • will show a positive pregnancy test result
  • complete (empty egg) and partial (69 chromosomes instead of 46)
  • risk of choriocarcinoma (cancer)
231
Q

symptoms of gestational trophoblastic disease

A 
vaginal bleeding
anemia
N/V
elevated HCG
low levels of AFP
hyperemesis
HTN before 24th week (due to rapid growing, causing pressure vascularly)
absent fetal heart tones
uterus enlarges at a rapid rate
232
Q

interventions of gestational trophoblastic disease

A
  • baseline chest X ray
  • serum HCG weekly until negative and then monthly
  • avoid pregnancy for a year
233
Q

trauma

A
  • assessing for placental detachment, mixing of fetal and maternal blood
  • EFM; vital signs, KB test, hemoglobin F
234
Q

KB test

A

measures amount of fetal hemoglobin transferred to maternal bloodstream
diagnoses fetomaternal hemorrhage, quantification, risk for PTL
low sensitivity and tendency to over estimate volume of hemorrhage

235
Q

hemoglobin F

A

quantification more reliable test for quantifying fetomaternal hemorrhage

236
Q

placenta previa

A

placenta abnormally implants in lower segment of the uterus near or over the cervical os (2% incidence)

237
Q

abruptio placentae (abruption)

A

premature separation of a normally implanted placenta (1% incidence)

238
Q

factors that may contribute to abruption

A
  • maternal HTN
  • blunt external abdominal trauma
  • cocacine use resulting in vasoconstriction
  • hx of abruption
  • smoking
  • PROM
  • multifetal pregnancy
239
Q

assessment of abruption

A
  • dark red bleeding, port wine amniotic fluid
  • acute abdominal pain, sudden onset
  • board like abdomen, increase in uterine size
  • contractions with hypertonicity
  • fetal distress
  • woman is at risk DIC
  • H/H, coag factors, KB test, clotting factors
  • urine output less than 30 cc per hour
240
Q

what values would you see in DIC

A

fibrinogen and platelet decreased

PT and PTT prolonged

241
Q

risk factors for preterm labor

A
  • infections
  • hx of PTB, abortions
  • multifetal pregnancy
  • hydraminos
  • age below 17 or above 35
  • low SES
  • smoking, substance abuse
  • domestic violence
  • diabetes or HTN
  • lack of prenatal care
  • placenta previa/abruption
  • short pregnancy interval (short time b/w last and current birth)
  • uterine abnormalities
  • recurrent premature cervical dilation
242
Q

assessment of PTL (mother’s perspective)

A
  • persistent low backache
  • pelvic pressure and cramping
  • GI cramping, with or without diarrhea
  • urinary urgency, frequency
  • vaginal discharge
  • cervical change, bleeding
  • contractions, with or without pain
  • PROM
243
Q

what does a positive fetal fibronectin mean?

A

determines risk of preterm birth in the next 7 days
related to inflammation of placenta
swab of vaginal secretions b/w 24 and 34 weeks

244
Q

what other assessments would you do for PTL?

A
  • endocervical length measurement with US - if less than 30mm –> risk of PTL
  • home uterine activity monitoring
  • cervical culture
  • BPP, NST
245
Q

how to prevent PTL

A

hydration
cerclage
infection screening

246
Q

how to treat PTL

A

focus is to stop uterine contractions
activity restriction
hydration
treat infections (tachycardia, elevated temp, fetal tachycardia)

247
Q

medications for PTL

A
  • progesterone (prophylactic)
  • nifedipine (procardia, adalat)
  • mag sulfate (prophylactic)
  • indomethacin (indocin)
  • betamethasone (celestone) - helps surfactant develop
  • terbutaline (brethine)
248
Q

when to use terbutaline?

A

48-72 hours use to gain time in order to administer 2 doses of betamethasone

long term use is questionable –> associated with maternal deaths

249
Q

cervical insufficiency: assessment

A
  • cervical length surveillance b/w 16 and 24 weeks
  • assessment for funneling/thinning of cervix
  • cerclage
    • serial US of cervix throughout pregnancy to make sure its closed
    • no sex until 34 weeks and then remove it before dilation
250
Q

what are hypertensive disorders associated with

A 
associated with abruption
kidney failure
hepatic rupture
PTB
fetal and maternal death
251
Q

chronic hypertension

A

HTN before 20 weeks
140/90 prior to pregnancy
no proteinuria

252
Q

gestational HTN

A

after 20th week of pregnancy
elevated BP (140/90) at least twice, 4-6 hours apart, within 1 week
no proteinuria
BP returns to baseline 6 weeks PP

253
Q

what is the treatment for preeclampsia

A

birth

exclusively a disease of pregnancy

254
Q

cause of preeclampsia/eclampsia

A
  • immune response against pregnancy
  • presence of widespread arteriolar vasospasm
  • injury of endothelial lining of blood vessels
  • intravascular fluid moves to extravascular space
255
Q

mild preeclampsia

A

gestational HTN with proteinuria of greater than 1+
24 hour protein test > 300mg

may or may not have transient headaches and/or edema

256
Q

severe preeclampsia

A 
blood pressure 160/100 or greater
proteinuria 2+ or more - greater than 500 mg in 24 hour test
elevated serum creatinine (>1.2 mg/dL)
oliguria
visual disturbances
hyperreflexia with possible clonus
edema hands and face
right upper quadrant epigastric pain
thrombocytopenia
257
Q

eclampsia

A

severe preeclampsia with onset of seizure activity or coma
-preceded by headache, severe epigastric pain, hyperreflexia, and hemo-concentrations (warning signs of probably convulsions)

258
Q

HELLP syndrome

A

variant of gestational HTN in which hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction
H: hemolysis
EL: elevated liver enzymes, epigastric pain, N/V
LP: low platelets, abnormal bleeding and clotting time and possible DIC

259
Q

cause of HELLP

A
  • platelets accumulate at lesion sites (thrombocytopenia) and a fibrin network forms (elevated liver enzymes)
  • RBCs are forced through fibrin network under high BP, resulting in hemolysis with damaged erythrocytes (hyperbilirubinemia; jaundice)
  • maternal liver damage from microemboli in hepatic vasculature, which causes ischemia/tissue damage within liver
  • obstruction of hepatic blood flow and continual deposit of fibrin causes hepatic distension (can palpate liver)
260
Q

risk factors for HTN disorders

A
  • younger than 20, older than 40
  • morbid obesity
  • chronic renal disease
  • chronic HTN
  • hx of preeclampsia, gestational HTN
  • diabetes
  • molar pregnancy
261
Q

nursing care: preeclampsia

A
  • assess LOC
  • pulse oximetry
  • daily weights
  • vital signs
  • NST, BPP, AFI
  • assess for proteinuria
  • s/s
  • frequent rest
262
Q

medications for mild preeclampsia

A 
low dose aspirin
methyldopa (aldomet)
nifedipine (adalat, procardia)
hydralazine (apresoline, neopresol)
labetalol PO
263
Q

medications for severe preeclampsia

A

mag sulfate –> to prevent seizures and keep BP normal

labetalol/hydralazine IV bolus

264
Q

low dose aspirin

A

81mg daily after 12 weeks gestation
reduced premature birth by 14%
reduced IUGR by 20%
does not increase risk of excessive bleeding at birth

265
Q

nursing care: severe preeclampsia

A 
nursing care for preeclampsia
hourly VS, urine output (>30 cc), reflexes, lung sounds, visual assessment, clonus, edema and epigastric pain eval
continuous fetal monitoring
strict I/O (IV fluid max 125)
expect mag sulfate
dim, quiet room
266
Q

MgSO4 dose

A

loading dose of 4-6g - 20-30 min via pump, with maintenance of 2-3 g/hr via pump

continue for 24 hours postpartum

267
Q

MgSO4 toxicity signs

A 
absence of reflexes
decreased urine output  (less than 30/hr)
decreased respirations (<12 / min)
decreased LOC
cardiac dysrhytmias
268
Q

MgSO4 antidote

A

calcium gluconate (1 g of 10% solution IV push over 3 mins)

269
Q

MgSO4 fetal effects

A

hypotonia
observe infant for delayed effect after birth
NICU

270
Q

PP management

A

BP may rise 3-6 days postpartum
antihypertensive meds for 4-6 wks PP (potentially)
late PP eclampsia (more than 48 hours but less than 4 weeks PP)
past 4 weeks = chronic HTN

271
Q

labor dystocia

A 
interference in 5Ps
psychosocial
passenger
power
passageway
position
272
Q

hypertonic uterus (dystocia of power)

A
  • frequent, intense, painful UCs
  • tachysystole (terbuatline short term to space out contractions)
  • rest with short term opioid/sedative
273
Q

hypotonic uterus (dystocia of power)

A

contractions are infrequent or not strong enough to cause labor
either prolonged labor less than 1cm per hour or arrest of progress: no cervical change for 2 hours

274
Q

how to treat hypotonic uterus

A

augment with pitocin

amniotomy to rupture membranes

275
Q

amniotomy

A

artificial rupture of membranes with amniohook
form of augmentation of labor
should only happen when fetus is engaged
nurse should note TACO

276
Q

chorioamnionitis

A

infection that can occur with rupture of membranes

277
Q

risks associated with ROM

A

risk for variable decels d/t lack of fluid d/t cord compression
risk for cord prolapse

278
Q

amnioinfusion

A

0.9% sodium chloride or LR through IUPC to supplement amniotic fluid amt

279
Q

oligohydramnios

A

too little amniotic fluid

280
Q

RN’s role in dystocia of power

A 
manage pitocin
position changes
LOCK
assist with amniotomy
assist with IUPC
281
Q

dystocia: position (4 things)

A

use or misuse of gravity
shoulder dystocia
inadequate maternal expulsion power from lying on back for too long
affected psychological response

282
Q

what happens during a shoulder dystocia

A

inferior shoulder gets stuck by pelvic bone

can lead to brachial nerve injury

283
Q

RN role during shoulder dystocia

A 
subrapubic pressure
stool
timer --> need to know when it starts and for how long
team - get team assembled - NICU
McRobert's position
284
Q

how to anticipate shoulder dystocia

A

leopold’s
turtling effect
read chart first - big baby, post date, diabetic mom, no previous birth or failed vaginal birth

285
Q

how to avoid shoulder dystocia

A

w/ squatting

286
Q

episiotomy

A

can be used in shoulder dystocia to create more space

happens at pelvic bone level

287
Q

treatment for episiotomy

A

ice then heat
stitches dissolve on their own
no baths

288
Q

dystocia: passenger

A
  • persistent occiput posterior position
  • brow, face, shoulder, compound presentation
  • transverse
  • breech
289
Q

moxibustion complementary therapy

A

burn incense - thought to help turn baby

290
Q

external cephalic version

A

an attempt to turn the fetus so that he or she is head down (from breech)

291
Q

when can you perform ECV

A

after 37 weeks

292
Q

risks w/ ECV

A

ROM
prolapse
uterus rupture
decels

293
Q

RN role during ECV

A 
IV
assist with sonogram
rhogam/KB if indicated
tocolytics
OR team
NST
294
Q

macrosomnia

A

> 4000 grams - can lead to fetus not being engaged and can lead to shoulder dystocia

295
Q

what to expect with dystocia (passenger)

A 
position changes
pelvic rocking
counterpressure on lower back for pain
instrumental delivery
C-section
296
Q

cephalopelvic disproportion (CPD)

A 
head doesn't fit
could be d/t 
-contracture/narrowing of pelvis
-fetus is too large for size of pelvis (doesn't mean fetus is too large)
-android and platypelloid pelvis at risk
297
Q

trial of labor

A

might try to see if vaginal birth can happen

298
Q

why does sitting or squatting help with dystocia of passage

A

can increase outer diameters

299
Q

when might you need cervical ripening

A

post dates
preeclampsia
water broke but no labor
gestational DM

300
Q

what is the bishop scale used for

A

used to determine maternal readiness for labor by evaluating cervix

301
Q

what is the bishop scale composed of

A 
dilation
effacement
station
consistency
position
302
Q

what score do you want for multiparous

A

> 8

303
Q

what score do you want for nulliparous

A

> 10

304
Q

what does cervical ripening do

A

-promotes cervical softening, dilating, effacement, and a more successful induction of labor

305
Q

cervical ripening: mechanical and physical methods

A 
foley bulb catheter (w/o urine bag) - pump up 50 cc --> puts pressure on cervix
membrane stripping
amniotomy
laminaria
lamicel
306
Q

cervical ripening: chemical methods

A

misoprostol (cytotec tablets orally or vaginally)

dinoprostone (cervidil, prepidil)

307
Q

what are the benefits of dinoprostone vs. misoprostol

A

dinoprostone can be removed - wrapped around cervix and dissolves to help efface and dilate. can remove string and stop
can’t take back misoprostol –> can cause labor

308
Q

what do you do if there is fetal distress caused by cervical ripening, induction, augmentation?

A

stop medication

LOCK - position, oxygen, fluids, notification, possibly terbutaline

309
Q

what is induction of labor

A
  • initiation of uterine contractions to stimulate labor before spontaneous onset
  • mechanical or chemical cervical ripening
310
Q

pharmacological methods of induction

A

IV oxytocin, endogenous oxytocin (nipple stimulation)

311
Q

nonpharm methods of induction

A 
membrane stripping
castor oil (GI irritation that can cause induction)
312
Q

contraindications of induction of labor

A

vertical incision on uterus, placenta previa or suspected abruption, multiple gestation other than twins, abnormal fetal lie

313
Q

when do you augment labor

A

stimulation of hypotonic contractions once labor has spontaneously begun but progress is inadequate

314
Q

vacuum assisted birth

A

cuplike suction device attached to fetal head

traction applied DURING contraction to apply the pressure before the next contraction

315
Q

when could you have a vacuum assisted birth

A

vertex (head down) presentation
no CPD
ruptured membranes

316
Q

risks of vacuum assisted birth

A

lacerations
subdural hematoma
cephalohematoma (must monitor bump where suction was placed)

317
Q

caput succedaneum

A

normal occurrence with vacuum

resolves within 24 hours

318
Q

how many times can you try a vacuum assisted birth

A

can only pop off 3 times

nurse should record how many tries

319
Q

forceps assisted birth

A

two curved spoon like blades applied during contraction

put on hard parts of cranium, turn head or help with traction

320
Q

when can you use forceps

A

abnormal presentation
arrest of rotation
no CPD
ruptured

321
Q

risks associated with forceps

A

lacerations
bladder or urethral injuries to mom
facial nerve palsy
bruising

322
Q

when is C-section indicated

A 
failed vaginal birth
CPD
failure to progress
shoulder dystocia
placenta previa
transverse
shouldn't be elective
323
Q

factors influencing rate of c sections

A 
changing philosophies regarding best method for delivering breech
interpretation of EFM tracings
changing practice related to VBACs
increased use of epidural anesthesia
convenience
324
Q

RN role: c section preop

A
  • bring support person in
  • assessment data
  • consents, identification, lab data, blood type, Rh
  • anti embolism stockings and sequential compression device
  • admin preop medications
  • assist in epidural placement
  • urine catheter placement
  • positioning in PACU
  • prepare surgical site
  • bovie pad, straps
  • warm blankets
  • TIME OUT
  • oversee sterility and OR conduct
  • counts
325
Q

what’s included in a time out

A

right patient, time, procedure and provider

326
Q

RN role: c section post op

A

REEDA
fundal tenderness
lochia
post surgical assessments

327
Q

what could indicate endometritis

A

foul smelling lochia

328
Q

things for RN to note post c section

A

baby bonding / breast feeding may be impacted
increased risk of constipation
C/S limits number of children (no more than 3-4)
risk of adhesions (chronic pain, infertility, GI problems) which increase with each subsequent c section

329
Q

when would VBACs not be possible

A
  • evidence of uterine ruptures
  • vertical incision from previous c section
  • uterus shape changes
  • non-reassuring fetal HR
  • trial of labor
  • myocmectomies - surgery to remove uterine fibroids
  • active Herpes outbreak
  • 3 or more cesareans
330
Q

when do VBACs have the best outcome

A

1 C/S w/ horizontal incision and previous successful vaginal birth

331
Q

complete uterine rupture

A

uterus splits open

332
Q

incomplete uterine rupture

A

layers separate along previous incisions or surgery

333
Q

risks for uterine rupture

A 
congenital uterine anomaly
uterine trauma
LGA
multiples
polyhydramnios
hyperstimulation
versions
multigravida

*would want to put in IUPC to know contraction pressure

334
Q

signs of uterine rupture (assessment)

A 
sensation of ripping or tearing
sharp abdominal pain
uterine tenderness
contractions "that don't go away"
nonreassuring FHR
change in uterine shape
cessation of contractions
335
Q

recommendation for uterine rupture

A

alert provider while IV fluids
be ready for possible blood transfusion
stat C/S

336
Q

precipitous labor

A

3 hours or less from onset of contractions to time of birth

337
Q

risks with precipitous labor

A 
tearing 
fetal distress (not enough time to transition)
hemorrhage
mom panicking
placenta retention
338
Q

RN role during precipitous labor

A 
DO NOT leave unattended
call for help
globes
do not breakdown bed
stay calm
pant with an open mouth
light pressure on fetal head
eye contact
to buy time and stop pushing
encourage her to stay calm
339
Q

PP hemorrhage

A

cumulative blood loss >= 1000ml within 24 hour after birth process regardless of route of birth
*might be over 500 for vaginal births and over 1000 for CS

340
Q

early (primary) hemorrhage

A

within 24 hours

341
Q

late (secondary) hemorrhage

A

up to 12 weeks PP

342
Q

what can cause early PP hemorrhage

A
  • uterine atony (relaxation of the uterus)
  • lacerations of the gential tract
  • retained placenta
  • vulvar, vaginal, pelvic hematomas
  • uterine inversion
  • coag disorders (DIC)
343
Q

risk factors for uterine atony

A 
macrosomia
polydramnios
multiple gestation
prolonged or precipitous birth
oxytocin augmentation/induction
retained placenta
placenta previa/accrete
abruption
magnesium
344
Q

4 Ts of uterine atony

A

tone
trauma
tissue
thombin time

345
Q

what can cause late PP hemorrhage

A

result of subinvolution (failure to return to normal size of uterus) or retention of placental tissue

346
Q

signs of late PP hemorrhage

A

scant brown lochia
irregular heavy bleeding - bright red, more than 1 pad/ hour
boggy fundus that doesn’t respond to massage
abnormal clots
high temp
unusual pelvic discomfort or backache
persistent bleeding, firm fundus
rise in fundal height
increased pulse, decreased BP - sign of shock
hematoma formation

347
Q

late PP hemorrhage: nursing assessment

A

monitor fundus, lochia, bladder
perineal pain
weighing of perineal pads (1 ml = 1g)

348
Q

PP hemorrhage treatment (in order of less invasive to more)

A
  • fundal or uterine massage
  • elevate legs 20-30 degrees
  • fluid replacement
  • meds
  • prepare for blood transfusion
  • uterine tamponade - bakri balloon catheter
  • uterine artery embolization
  • laparoscopy: compression/ligation of arteries
  • hysterectomy = last resort
349
Q

meds for PP hemorrhage

A

pitocin
methergine
cytotec (800-1000 mg rectally)
hemabate

350
Q

what can prevent a uterus from contracting

A

retained placenta

351
Q

risk factors for retained placenta

A

excessive traction on cord
partial separation
abnormal adherence
preterm births (20-24 wks)

352
Q

retained placenta assessment

A 
monitor uterus (atony)
monitor lochia
monitor VS (increased temp)
maintain or initiate IV fluids
oxygen
353
Q

retained placenta: recommendations

A

H & H

alert provider for manual separation or D&C

354
Q

uterine inversion

A

turning inside out of uterus

emergency situation

355
Q

risk factors for uterine inversion

A 
retained placenta
uterine atony
excessive fundal pressure
multiparity
fundal implantation
extreme traction on cord
356
Q

uterine inversion assessment

A 
pain in lower abdomen
large red mass protrusion
dizziness
hypotension
pallor
assess introitus
stop oxytocin
357
Q

introitus

A

any type of entrance or opening

assess/visualize lochia

358
Q

uterine inversion recommendations

A

alert provider stat
be ready with terbutaline, antibiotics
C-section for future births!

359
Q

hematomas assessment

A

250-500 ml of clotted blood within tissues
pain rather than noticeable bleeding
monitor size and note time
icepacks for first 24 hours

360
Q

hematomas recommendation

A

notify provider

evacuation/ligation

361
Q

venous thromboembolism

A

thrombopheblitis: thrombus associated with inflammation
pulmonary embolism
DVT

362
Q

VTE assessment

A 
leg pain and tenderness
unilateral area of swelling
warmth
calf tenderness
redness
363
Q

how to prevent VTE

A

antiembolism stockings
early and frequent ambulation
avoid prolonged periods of immobility
fluid intake

364
Q

VTE recommendation

A
  • facilitate bedrest
  • elevate extremity above heart avoiding pillow under knees
  • intermittent or continuous warm moist compresses as prescribed
  • do not massage affected area
  • thigh high antiembolism stockings
  • anticoags
  • monitor aPTT, PT
  • avoid pregnancy, aspirin, ibuprofen, alcohol
365
Q

pulmonary embolism

A

fragments of entire clot dislodges and moves into circulation
complications of DVT

366
Q

when fatalities occur within PE?

A

within 30-60 mins

367
Q

PE assessments

A 
apprehension
pleuritic chest pain
peripheral edema
dyspnea
tachypnea
hypotension
hypoxia
368
Q

PE recommendations

A

scans and angiograms of lungs
embolectomy
meds - alteplase, streptokinase

369
Q

amniotic fluid embolism

A

infiltration of amniotic fluid into maternal circulation
amniotic fluid can obstruct pulmonary vessels
can be d/t sac or veins rupturing d/t pressure

370
Q

amniotic fluid embolism assessment

A 
sudden chest pain
resp. distress
bleeding from incisions / IV sites
uterine atony
circulatory collapse
371
Q

amniotic fluid embolism recommendation

A 
alert provider
oxygen
IV fluids
be ready to assist with ventilation and intubation
position on side with tilted pelvis
foley
C/S
372
Q

ITP (idiopathic thombocytopenic purpura)

A

autoimmune disorder

platelet life span is decreased resulting in severe hemorrhage following a C/S or lacerations

373
Q

disseminated intravascular coag (DIC)

A

clotting and anticlotting mechanism occur at same time

374
Q

risk factors for DIC

A

abruption, fetal demise, severe preeclampsia or eclampsia, hemorrhage, molar pregnancy, amniotic fluid embolism

375
Q

ITP & DIC assessment

A 
epistaxis
petechiae
ecchymoses
excessive bleeding
hypotension
tachycardia
oliguria
376
Q

ITP & DIC recommendation

A

CBC with diff
clotting factors (platelets, fibrinogen, PT increased)
platelet transfusion
possible splenectomy

377
Q

puerperal infection

A
  • infection of repro tract associated w/ childbirth that occurs at any time up to 6 weeks following childbirth or abortion
  • temp of 100.4 or higher for 2 consecutive days during first 10 days after birth
378
Q

s/s of puerperal infection

A
  • body aches
  • chills
  • fever
  • malaise
  • tachycardia
  • sites includes uterus, wounds, bladder or breast
379
Q

endometritis

A

infection of uterine lining

usually begins on 2-5th day PP

380
Q

risk factors for endometritis

A 
C/S
retained placenta
PROM/chrioamniotis
multiple vaginal exams
prolonged labor
infections (i.e. chlamydia)
381
Q

endometritis assessments

A 
uterine tenderness and enlargement
lower abdominal pain
tachycardia
chills
fatigue
loss of appetite
dark profuse lochia that is malodorous
382
Q

endometritis recommendations

A

notify provider for labs and medications (i.e. antibiotics)

383
Q

What can lead to wounds from the birthing process

A

Cesarean, episiotomies, lacerations, trauma to birth canal

384
Q

how to assess wounds

A 
REEDA
redness
edema
ecchymosis
discharge
approximation
385
Q

UTI

A

can be secondary to bladder trauma during birth or a break in aseptic technique during foley placement

386
Q

UTI assessments

A 
urgency, frequency
dysuria
pelvic discomfort
fever
chills
malaise
387
Q

what should you encourage for UTI

A

voiding
sitz bath, warm water, running water, in and out cath
avoid bladder distension!

388
Q

UTI recommendations: nursing

A

urinalysis
blood work
antibiotics

389
Q

Is mastitis always bacterial and is it 1 or 2 breasts?

A

inflammation of breast with or without bacteria infection
usually cause by staph
usually unilateral

390
Q

when does mastitis usually occur

A

usually 2-4 weeks in breastfeeding women

391
Q

risk factors for mastitis (4)

A

milk stasis from blocked duct
nipple trauma
poor breastfeeding technique, including decreased frequency
poor hygiene

392
Q

what can cause burning nipple pain

A

candida

393
Q

mastitis assessments

A

painful or tender localized hard mass
reddened area
chills
fatigue

394
Q

mastitis recommendations

A

continue breastfeeding at least every 2-4 hours

contact the provider for antibiotics to get rid of infection

395
Q

What does high levels of AFP indicate

A

Open neural tube defects, spina bfida, anencephaly

OR could indicate incorrect gestational age, more than one fetus, gastroschisis (hole in abdominal wall) or fetal death

396
Q

When can you perform quadruple check

A

Second trimester

*more accurate when combined with ultrasound

397
Q

What is a quadruple check used to screen

A

NTD, trisomy 21, and trisomy 18

398
Q

indications for amniocentesis

A

AMA
couples who already had a cild with a birth defect or family history of chromosomal birth defects
pregnant women with other abnormal screening or genetic test results

399
Q

what does chorionic villi sampling test for

A

genetic, metabolic and DNA abnormalities

usually completed 10-12 weeks gestation

400
Q

priority after amniocentesis

A

monitor fetus

401
Q

bishop score: what is it used for?

A

a scale used by medical professionals to assess how ready your cervix is for labor

402
Q

arrest of progress

A

no cervical change for 2 hours

403
Q

prolonged labor

A

less than 1 cm per hour

Mother Baby (3 decks)

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