Exam 2 Flashcards
1
Q
What is the normal percentage birth weight loss in the beginning?
A
5- 10% body weight anything more is concerning
2
Q
How many days do newborns return normal birthweight ?
A
10-14 days
3
Q
Vitamin supplements when should the mother take the supplements?
A
Vitamin D and B12 if they lack it on diet
Fluoride after 6 months if they didn’t have fluoridated water
Iron: only late preterm newborns because they have iron storage
Do not introduce newborns to solid food before 6 months can cause Food allergies
4
Q
Why is length a great predictor of how many cm do they grow for newborns?
A
Newborns grow 2.5 cm every month for 6 months and is a great predictor because it doesn’t fluctuate
5
Q
What is the amount weight they grow and how long?
A
Original weight example 7lb
doubled with in the 5months: 14 lb
tippled with in a year : 21lb
6
Q
Why is there no water requirements for newborns ?
A
They should get their fluid requirement from breast milk and formula- milk
7
Q
How long should you breast fed?
A
Women should breastfeed exclusively for 6 months
Then add complementary food with breast milk after 6 months
8
Q
When should they start breastfeeding ? What are the benefits for the mom? What are the mechanism of breast feeding ?
A
- soon as possible within 30 min after during ( Alert Stage)
- Leave the baby cap on the head to maintain heat and provide skin to skin contact
- mom release oxytocin
- promote milk production
- uterus atony and involution
9
Q
What is the mechanism of producing breast milk
A
- Progesterone is secreted during the placenta in which prevents the production of milk even though there is prolactin
- Once the placenta separated Prolactin increased and produce milk
10
Q
Is it breastfeeding painful? Why does it become painful?
A
not the proper latch mechanism and should not painful
11
Q
When do they do the APGAR score
A
At the 1 min mark and later on at the 5 min mark to see how well they transition outer-utero
12
Q
What is Breast feed Assessment tool ?
A
Latching 0 ( not able to latch on at all, sleepy reluctant), 1 ( can hold on to the nipple but needs to keep repeating) 2 ( fully attached) Available Swallowing 0 (none) , 1 ( a few stimulation ), 2 ( completely spontaneous frequently ) Type of nipple 0( inversion), 1 ( flat), 2( everts after stimulation) Comfort 0 ( engorgend no comfort) , 1 (filling red), 2 ( no pain, soft, non-tender Hold 0 ( no hold), 1 ( minimal assistance), 2 ( no assistance) 7-10 normal range
13
Q
How often should the infant feed
A
Feed every 2-3 hrs
Feed on demand
every 3hrs during day, every 4 hrs at night
14
Q
What is the let down reflex ?
A
Warmth at the arm and under the armpit to the breast to signal that milk is being released
Triggered by skin to skin and other newborns crying
Can cause uterus cramping because it release oxytocin
15
Q
Why should clostrum be released alittle bit before breastfeeding?
A
- infants can smell it and prepare them to latch and encourage them to open up their mouth
16
Q
How long to breast feed the baby ?
A
- breastfeed every 15-20 mins per breast - rotate breast
- burp the baby after breastfeeding because babies can swallow air but are mostly formula-fed
- Breast that is not empty can lead to a plugged duct
- Avoid nipple confusion ( do not rotate between feeding with bottle vs breast first couple days can confuse infant and pick bottle)
- Formula fed babies they can swallow but in breastfeeding they have to suck
17
Q
Breastfeeding technique
A
Infant should open their mouth and get the full nipple 1 fingerbreadth around the nipple so it push the pressure on the duct to release the milk
18
Q
Transition of Breast milk
A
Colostrum LIQUID gold ( very a nutritious 1 teaspoon =4oz of formula) milk first 1-2 days have Ig A
Transition milk: Day 3
Mature Milk : Day 14
Engorgement: can happen when the breast is full of milk happen when the mature milk comes in Should continue to nursery because it is the body adjusting, express the milk with hand a little bit so the newborn can latch on
NO breast pump: breast will think they need to produce milk
Leaking: should purchase breast pad wash them with no detergent that has perfume or smell
19
Q
Breast Milk Immunologic Benefits
A
- Nonallergic
- Protects respiratory and GI infection from the Ig A
- colonize infant gut with the right bacteria
20
Q
Nutritional Advantages of Breast MIlk
A
- casein protein ratio helps with digestion and absorption
- high concentration cholesterol creates the myelination and neurodevelopment
- doses of mineral more than the formula
- iron in breast milk more readily available and fully absorbed
- are less obese because they have to suck so they work harder to get their food and helps them not to over eat
- less ear infection
21
Q
Mom and Newborn benefits of breast feeding
A
Mom
- lower risk of breask and ovarion cacer
- uterus innovulate quicker
- prepregnancy weight is quicker loss 500kcal
- less osteoporsis
Baby
- decrease SIDS
- decrease asthma, dm, cancer
- increase O2 sat
- maintain temp regulation
22
Q
How to prevent milk coming in?
A
Ice pack
cold cabbage leaves
Avoid stimulation
Nice tightening bras
23
Q
How do you know if the newborn fed enough?
A
NO dry skin
8-10 times a day
babies should not sleep more then 4 hr
Fontanelles nice flat not depressed (a sign of depression)
Formula-fed should eat 0.5 ounces every feeding and gradually increase over the days
Day 1 1monicuum 1 wet diaper
24
Q
How to store breast milk
A
Fresh milk can be out 4-6 hrs at room temp Can not refrigerator
Last 8 days in the refrigerator
3-4 months in the freezer at the door it has to be held in plastic -if thawed 24hrs in refrigerator - formula do not freeze it -24-48 hrs in the fridge
25
When do you discard breast milk
within an 1hr once the baby begins to feed the bacteria from the baby can infect the milk
- Do not microwave feeding
26
what is the normal weight gain through pregnancy for normal BMI?
Normal BMI 18-24.9
25-35 lbs
2.2-4.4 lbs in the first trimester gain
1 lb per week for the last 2 trimesters
27
What is normal weight gainfor underweight BMI less than 18.5?
-gain 28-40pds
28
What is normal weight gain for over weight BMI 25-29.9?
15-25pds
29
What is the normal weight gain for obese BMI 30?
11-20 pds
30
What is the calories intake between each trimester
- first trimester no calorie change
| - add 300 kcal 2 and 3 rd trimester
31
What is carbohydrate and protein in take
pregnant women is 71 g of protein intake
| carbohydrates intake increase 2and 3 rd trimester
32
What is calcium and phosphorus , sodium?
4servings of calcium a day
- not enough calcium mother bone demineralized bones to give calcium to fetus
- Sodium : do not add sodium
33
What is folate intake ?
important for neurological development
- 600 mg while pregnant
- 500 mg during lactation
34
What is Iron used for ? How to take it ?
- helps with anemia : can, preterm babies, affect fetal brain development cause low birthweight
- it can cause constipation to take it with meals with VitaminC
- milk and caffeine affect absorption
- give stool softener
- daily 30 mcg
35
What is the water intake requirement?
8-12 (8oz) glasses a day
| 4-6 glasses of water a day
36
What some things pregnant women can not consume
-energy drinks: caffeine limit 300 mg a day cause late miscarriages, SGA( small gestation age) , stillbirths
-Mercury : impact cognitive function avoid raw fish or large fish and tuna
Raw foods or undercooked eggs and meat , cookie dough due to the bacteria
soft cheese
Avoid alcohol with in the 1st and 2 nd trimester
37
What helps with nausea?
- dry crackers and toast
- to avoid spice, caffeine, fats, spices, triggers
- Avoid fluids with meals
38
What is PICA
- consumption of unknown objects other than food
- leads to iron deficiency, lead poison, poor or excessive weight gain , fecal impaction,low birth weight, small head cirmcference
39
What PKU diet
- genetic disorder
- resume PKU diet atleast within 3months prior to pregnancy and throughout
- avoid foods with high content of protein
- monitor phenylalanine levels
40
What is normal weight loss for postparturm ?
- 10-12 pdsweight loss
- high fluid intake
- Breast milk feeding mother increase calorie intake by 330 for the first 6months and the last 6 months 4oo calories
no caffiene and alcohol
-increase protein and calcium
Formula feeding no requirements
41
What is Hcg hormone
secretes once ovum is fertilized within 24hrs then maintains the progesterone levels
42
What does the pregnancy test detect ?
The hcg levels can be detected early 7-10 days
43
What are some indication of high hcg levels?
- ectopic pregnancy
- multiple pregnancy
- molar pregnancy
- genetic abnormality
44
What are the degree of lacerations
First degree: small tear doesn't involve the perineal
second degree: tear down the facia / muscles
third degree: involves the anal sphincter
4th degree: extends to the anal and the rectum needs surgery to fix it
45
What are the epistomies
- midline or mediolateral
- not evidenced-based lead to blood loss, discomfort, more tearing after birth
- usually done to shoulder dystocia
46
What is Nageles Rule ?
ESDB first day of your menstrual period + 7 days - 3months
47
What is the fundal height measurement
- Tape measure and from symphis pubis and estimate fetal gestation from 18-32 weeks
- Not reliable
48
Presumptive changes of Pregnancy Women is seeing and stating
- Nausea ( morning sickness)
- Amenorrhea
- urine frequency
- breast tenderness
- quickening ( the mother perception of the fetus movement occurs 18-20 weeks ) abdominal cramping
49
Probable Changes objective data that the provider noticed
- Goodells sign the softening of the cervix
- Chadwick signs the bluish purple sign of cervix due to vasocongestation
- Hegar signs softening of the uterus occurs 6to 8 weeks of pregnancy
- braxton hicks contraction
- Mc donalds sign
- enlargement of stomach
- Mcdonalds sign: sign of pregnancy characterized by an ease in flexing the body of the uterus against the cervix
- changes of pigmentation : straie , chloasma
- uterine souffle
- pregnancy test positive
- ballottement: when the fetal movement pushing against the cervix with two fingers cause the fetus to rebound
50
Positive signs of pregnancy
- FHR
- Fetal movement after 20 weeks
- visualization of fetus with ultrasound
51
What is GTPAL
```
Gravida : the amount of pregnancy
Term : after 37 weeks
Preterm : between 20 -37 week
Abortion : before 20 weeks
Live: Live births and children
```
52
How many prenatal visits?
- monthly for 7 months
- every 2 weeks on the 8month
- every week on the last month
53
What we seeing for first and ongoing visit
Initial visit: EDB, history, physical assessment, lab test, self-care, expectation education
Ongoing visit: weight, nutrition, urine, edema, fetal development, self-care
54
A woman has been unable to complete three pregnancies with fetal losses at 8 weeks. This is most likely due to low levels of which hormone?
Hcg
55
A woman's first day of her last menstrual period is April 2. When is her EDB?
January 9th
56
During a prenatal visit Jane learns that she is 8 weeks pregnant. Last year she miscarried at 7 weeks and is concerned about this pregnancy. What is her Gravida and Para?
G2 P 0010
57
A nurse is assessing an infant’s breastfeeding. The maternal nipple is soft and non-tender, but flat. It takes the infant repeated attempts to latch, but with full assistance from the nurse, the infant is able to hold the nipple in the mouth. Spontaneous, frequent audible swallowing is heard once the infant latches. When using the LATCH scale to assess the couplet, what score would the nurse assign?
Score 6
58
```
Ms. K arrives at 6am for a 7:30 am
scheduled cesarean at 36.6 weeks.
She has had two fetal losses at 22 weeks in
2006 and 14 weeks in 2012.
In 2016 had a vaginal birth at
41 weeks of a little boy who is outside
waiting with his mom.
What is her GTPAL on admission?
```
G4, T1, P1, A1, L1
59
Signs of headache visual changes and dizziness in prgnancy and delivery
High bp and preclampsia
cold compress to relieve heat
NPO diet
60
Skin ASSESSMENT throughout pregnancy
Prenatal : acne , hyperpigmentation
Labor and delivery: diaphoresis. edema and lower extremities
Postpartum: lost 6.6 lbs in 1st week, itching when the epidural wears off
61
Chest / Lungs Prenatal, Labor and Delivery, Postpartum
- short systolic murmur due to increased CO
- breast is darker, particularly nipple
- avid stimulation of nipple during delivery to prevent contraction
62
Cardiovascular prenatal, Labor and delivery , Postpartum
- RR increased, Pulse increased, BP increased
- Aware of Supine hypotensive syndrome position patient in lateral or semi fowler
- Postpartum orthostatic hypotension BP and pulse goes back after 10 weeks
63
When do you check GBS
35-37 weeks
64
When do you take the glucose tolerance
24-28 weeks
65
Different types of pelvis types ?
Gynecoid : most common
| Platyllepoid new born can not engage at all
66
What is ultrasound
- takes 20 min
- can see the visual fetal movements including the breathing ,cardiac action, and vessel pulsation
- high frequency sound wave
67
When is the external abdominal ultrasound used
- in the first trimester , non invasive
68
When is the internal abdominal ultrasound used?
- in the first trimester
- invasive
- establish the gestational age
- ectopic pregnancy detection
69
Why use a doppler ultrasound
- to detect IUGR ( inuterogrowth restriction)
| - noninvasive
70
Different types of ultrasound
Basic 1 : assess the number of fetuses, fetus presentation, fetus lie, viability, amount of amniotic fluid , location of the placenta
Basic 2: in-depth evaluation of fetal anatomy 16 weeks gestation among 2nd trimester
71
Ultrasound Scan
- gestational sac: 4-5 weeks
- fetal heart movements: 7 weeks
- fetal breathing movements : 11 weeks
- measurement of the crown - rump length: before 12 weeks
- second trimester : measure fetal biparietal diameter , femur length , and abdominal and head circumferences to estimate gestational age and fetus weight
72
What is AFP? alpha fetoprotein Quadruple check
-multiple screening second trimester
-MSAFP: high levels sign of neuro tube defect , open abdominal
low levels downs syndrome
- UE3 unconjugated estriol: low levels of Downs syndrome
- HCG
-Inhibin A
73
When do you check AFP
- check by 7 week gestation
| more accurate of 16 to 18 weeks
74
What is CVS ?
Chronic villi sampling
- goes through the vagina
- drink plenty fluids NEEDS A FULL BLADDER
- monitor mom vital signs
- -monitor FHR
- monitor UC AT START AND THEN 1-2 HRS AFTER
- Give Rhogam if the Mom Rh neg
- HIGHEST RISK OF SPONTANEOUS ABORTION
75
What is amniocentesis
- happens 15-16 weeks
- NEED AN EMPTY BLADDER
measure AFP and fetal lung maturity less than 37 weeks checked the L:S ratio
make sure to know mom RH test and give RHogam if it is negative
76
WHAT is PUBS
most commo fetal blood test during amniocentosis
| - aspirate blood of the umbilical vein
77
What is the fetal movement Asessment? What too look for ?
- NO fetal movement at 8 hrs , less than 10 at 12 hrs, and violent fetal movement followed by decreased activity call HCP
- 3 or more movement in an Hr GOOD sign
- Try to wake up the fetus by eating something or drink something
78
What is Non-Stress Test
- done in the third trimester
- continuous monitor
- reactive is 2 or more accelerations at least 15 sec of 15mph
- need moderate variability
- No decelarations
Premature : 10 by 10
79
What is Contraction Stress Test
- use contraction to check fetal reaction
- use nipple stimulation for 2 min , 5 min rest , repeat release endo oxytocin and cause contraction see how newborn contract
- Pitocin Stimulation 3contractions 40 secs long with in the 10 min period evulate FHR
- Negative stress test means FETUS IS NORMAL AND NO DECELERATIONS
- POSITIVE : ABNORMAL : LATE DECELARATIONS noted with UCS
- HAVE terbutaline AVAILABLE
- NEED TO BE DONE ON FULL TERM
80
WHAT is BPP ( Biophysical Profile )
- Negative on non-stress test : the baby was not reactive and a positive contraction stress test ( abnormal decelerations)
Score of 10
- FHR reactivity
- FETAL BREATHING MOVEMENT
- FETAL BODY MOVEMENTS
- FETAL TONE
- AMNIOTIC FLUID VOLUME (CHECKS KIDNEY)
- less than 8/ 10 need the fetus to be induced
0/10 fetal aphyxia ( died)
81
What is hyperemesis Gravidarum
- vomiting and nausea weight loss greater than 5% pre-pregnancy weight , dehydration, history of intractable vomiting
Etiology : high HCG/ estradiol, H.pylori GI infection, history of migraines
Women at risk for weight loss, IUGR, dehydration, ketone acidosis, electrolyte imbalances
82
Treatment of hyperemesis gravidaram
- aviod odor, frequent small meals that are dense. vitamin B6 , Phenergan/ Reglan, Zofran, ginger tea, acupressure, acupuncture , IV fluids
83
What is Oligohydraminos
- too alittle amniotic fluid a 5cm or less pocket of amniotic fluid
- detected by the sonogram count the 4 quadrants
- seen with post maturity, IUGR, renal malformation
Treated with amnioinfusion
84
What is Polyhydramnios
- too much amniotic fluid greater than 20
seen in congenital anomalies
- Treated with Indocin ( Prostagladin synthesis Inhibitor)
85
What is PROM VS PPROM, Prolonged Rupture, what is the treatment
PROM : premature rupture membrane happens after 37 completed weeks , before onset of labor leads to oligohydraminos
PPROM : preterm premature rupture of membran, anytime before 37 weeks
Prolonged Rupture: more than 24hrs before birth
Management: - deliver within 24-48 hrs to prevent infection
- chrorioamnionitis
- if PPROM : delivery may be delayed with clsoed management
- risk for decelerations, cord prolapse
86
What is Cord prolapsed and how to manage it ?
- when the amniotic fluid is ruptured allowing the cord to go ahead of the fetus
Treatment:
- keep the hand in the vagina push the fetus presentation part away from the cord
- DONOT PUSH THE CORD IN CAN CAUSE AN INFECTION
- Place in trendelenburg or chest prone down/ kneeling position , buttocks up
- monitor FHR
- Emergency C-section
87
What is Placenta Previa ?
Placenta is implant in the lower segments of uterus
| -Result to bleeding on the third trimester due to cervical dilation and the placenta is stretched
88
What are the different grades of placenta previa?
Grade 1 or 2 : Low lying placenta
Grade 3: Partial ( Can not have vaginal birth)
Grade 4: Total ( Can not have vagina birth and the cervix should not dilate)
89
What is History of placenta previa
- history of placenta previa
- uterine scarring
- maternal age greater than 35-40
- Multifetal gestation
- smoking or cocaine usage
- large placenta
- placenta acreta
90
What is the assessment of Placenta Previa
- painless BRIGHT RED VAGINAL BLEEDING 2 or 3 rd trimester
- ASK about the history of bleeding
- Transabdominal ultrasound
- DONOT PERFORM STERILE VAGINAL EXAM CAN CAUSE BLEEDING
- PALPATE INTERNAL CERVIX O'S LAST RESORT
- ASSES FETUS POSTION , FHR, VS, BLOOD LEVELS
- NEED to be on bed rest and TREATMENT: c-section is required
91
What is Placenta Accreta?
the difficulty of placenta separating cause PP HEMOHRAGE DUE TO FUNDUS NOT CONTRACTING
Accreta: attached to the myometrium
Increta: attaches more deeply inside the myometrium
Percreta: penetrates myometrium
92
What is Antibody Screen TEST ? When should give Rogham
- within 28 weeks or when they are doing an procedure that requires mixture of blood
- within 72 hrs of birth ( after)
Indirect combs test : based on the mother's blood test
- Negative mother did not form the RH antibodies and should give the RHOGAM
- Positive ( abnormal ) did form the antibodies and attacked the baby it is too late and does not need the RHOGAM
93
What is direct Combs test
Test the umbilical cord and the fetus blood
94
It is Monday, March 30th. Ms. P arrives for an NST accompanied by her husband. She is sent to room 4 and assigned to you. The charge nurse informs you that she is a patient of Dr. X’s, that this is her first baby, and that she is scheduled for an NST for postdates. The first day of her last menstrual period was June 23rd, 2019.
You enter Ms. P's room, introduce yourself and proceed to prep her for the NST. You confirm her identity. Using bullet points, describe what you would do next in order of priority, including how you explain an NST to Ms. P and the reasons why she is receiving one. Make sure to use therapeutic language (the words you would use if you were truly speaking to Ms. P and her husband).
- Nonstress test to see if the fetus is adequately oxygenated. Non-reactive result is a sign of uteroplacental insufficiency and leads to lack of oxygen in the fetus
- 2 or more acceleration in 20 min by 15 bpm and 15 sec ( Reactive baby)
- (Non reactive): deceleration and no acceleration after 40 min
Before the test
- Mom should eat and not smoke 2 hrs before the test
- Mom should void and empty her bladder before the test
- place mom in semi-fowler position and pillow under the right hip to displace the uterus on the left side
- ASSESS FETAL MOVEMENT, FHR, MOM VS,
- If fetus sleeping wake the fetus up by allowing mom to drink some juice or water
-
95
Ms. P has been pregnant 3 times. One loss at 14 weeks and one loss at 23. What is her GTPAL and why?
```
G3T0P1A1L0
Gravida: the amount she pregnant 3 types
t: term is 37 weeks and more
P: preterm is 20-37 weeks
A: less than 20 weeks
L: alive babies
```
96
What cause gestational diabetes
- In the first trimester: insulin was created more inside estrogen and progesterone creates insulin breaks down glucose
- In the second trimester: Placenta produce prolactin and lactogen that are resistant to insulin, more glucose in the blood and cross the placenta cause the fetus to utilize and gain weight which becomes GDM insulin can not cross over the placenta so more glucose in the utero placenta
Accelerated starvation formed ketones in the urine cause preeclampsia and Hyperemesis
97
What are the requirement of insulin in labor and delivery?
- turn of insulin drip after pregnancy because there is a little requirement of insulin because the placenta is separated
98
What is postpartum care of GDM?
- insulin drops significantly and breastfeeding drops insulin
At the risk of hypoglycemia: because way more insulin than glucose because of lack of food or feeding way and placenta is cutoff so infant is not receiving glucose IN neonates check glucose for 2-4 hrs
99
What is the assessment for GDM on the prenatal visit
- ASSESS RISK factors, LGA,
| - HbAic> 6.5% and fasting glucose >126 , 2 hr PP> 200 visit twice a month and weekly on the last trimester
100
Continuous Prenatal GDM test What are the Assessment?
- 24-28 weeks glucose tolerance test 1and 2 hr fasting
- check Aibc levels
- nutirition: 300 kcal
Glucose monitor
< 95 fasting
< 120 1-2 hr After Eating PP
NST twice a week after 32 weeks
Sono : 24,28,32,36 weeks
101
How to assess GDM on labor and delivering ?
- glucose level every 1-2 hr during active labor
- Discontinue insulin at the end of 3rd stage
- monitor s/s PP baby and mom
- there is need of pre-snacks of breastfeeding
- reassess 4-12 weeks PP to see if there glucose in controlled and temporary
102
What are the Assessment of Anemia during Pregnancy?
- hemo less than 11
greatest need of iron during 2nd half of pregnancy
Always provide vitamin C and stool softener with iron supplements
Required to take 30 mg of iron
103
What are the interventions of Anemia?
- monitor Hand H every 2 weeks
| - take iron supplements avoid caffeine and milk
104
What is Alcoholic teratogens ?
- chronic abuse: lead to malnutrition
- FASD: lead microencephaly, intellectual disabilities, cardiac anomalies, IUGR
Breastfeeding not contradiction
105
What is marijuana cause on fetus
- low birth weight
106
What cocaine cause on the fetus
- placenta vasoconstriction
| - SAB , Abruption, IUGR , preterm birth
107
Is breastfeeding contradiction to opioids?
- YES
| cause abnormal placental implantation, abruption, PTL, PROM, meconium
108
What are the cardiac disease that are contradicted to pregnancy and why?
- Eisenmenger Syndrome
- Marfan syndrome
- pulmonary hypertension
- aorta stenosis
- uncorrected coarctation of aorta
Persistant Cyanosis lack of O2 in Mom means baby can be fatal
109
What is Peripartum Cardiomyopathy?
- no previous history of cardiac disease
| Signs: chest pain , dyspnea, orthopnea, palpitation, weakness, edema
110
what is WHO CVD classification? to determine pregnancy classification
- Class 1 or Class 2: no contradiction of pregnancy
- Class 3 : dependent on symptoms
- Class 4 : pregnancy contradiction
111
What is the assessment of CVD ?
- Frequent appointment
- Essential between 28-32 weeks
- oxygen and diuretics during labor
- Pain management
- Decrease pushing too much work on the heart
- critical period 48hrs PP
112
Why is there bleeding before 20 weeks in pregnancy
- abortion
- ectopic pregnancy
- trauma
- gestational trophoblastic disease
113
What is bleeding in pregnancy of the second half?
- trauma
- placenta previa
- placenta abruption
- labor
- preterm labor
114
What is nursing role in Bleeding in Pregnancy?
- ask about the history of bleeding
monitor and check the bleeding amount count and weight the amount the pads and tissues
-look at fetal heart tones
- Prepare for Ultra sound then do vagina exam
- Insert IV, GTS, H/H
- Check RH status
115
What is assessment SAB ( spontaneous abortion) and the procedure?
- S/S: backache and abdominal tenderness
Procedure: ultrasound, cervical exam
D/C : scrape all the content
D/E ( dilation /evacuation) : evacuate uterine contents after 16
weeks
- Prostaglandins ( into the amniotic sac or as a vagina suppository) and oxytocin: helps complete abortion
116
D/C care
- empty bladder
- assist woman to relax
- watch the vasovagal reaction
- observe for signs of uterine perforation afterward given prophylactic antibiotics
- monitor vital signs
- if RH negative give Rhogam within 72 hrs
117
What is the discharge instructions and signs of SAB
-HEAVY BRIGHT RED BLEEDING and ELEVATED TEMP, FOUL SMELL VAGINA DISCHARGE is a sign to return
- a small amount of discharge normal of 1-2 weeks
- Pelvic Rest for 2 weeks ( No tampons, no sex)
- Avoid Pregnancy for 2 months
- Antibiotics
- Support groups
118
What is Ectopic Pregnancy ? Intervention and Treatment
- implantation of the egg outside of the uterus
- Sand S : one-side lower abdominal pain, faint, dizzy, referred right shoulder pain
- Intervention: IV access, labs, Pelvic exam, Ultrasound, emotional support
Treatment: Methotrexate, Salpingostomy ( fallopian tubes removed)
119
What is gestational trophoblastic disease? Interventions and Disease
- complete molar
- complete empty egg with no genetic content and partial ( 69 chromosomes) might have some fetus part can show positive on the pregnancy part
- Risk of Choriocarcinoma
-S/S: vagina bleeding, anemia, elevated hCG, nausea, vomit, low levels AFP, hyperemesis, HTN before 24 weeks, absent FHR tones, UTERUS ENLARGES AT A RAPID RATE
Intervention: Baseline chest x-ray , check HCG weekly until neg and then monthly ( 6-12 months)
- AVOID PREGNANCY FOR ONE YEAR
120
What are you assessing for trauma in bleeding?
- assess placenta detachment, mixing fetal and maternal blood
- Test EFM, VITAL SIGNS, KB TEST, Hemoglobin F
-KB test: measures amount of fetal hemoglobin transferred to maternal bloodstream
- Diagnosis Fetomaternal hemorrhage, quantification, risk PTL
Hemoglobin F is more reliable 23 hrs of observation to make sure they are good
121
What is Placenta Abrupto and total bleeding ?
```
- Premature separation of the placenta
Assess VS
S/S: DARK RED BLEEDING
( PORT WINE AMNIOTIC FLUID)
- acute abdominal pain, sudden onset
-board-like abdomen, increase the uterine size
-Contractions with hypertonicity
-Fetal DISTRESS
```
122
What is DIC AND ASSESSMENT?
LAB TEST: fibrinogen and platelet decreased, PT and PTT prolonged
ASSESSMENT:
-Urine output ( watch less than 30 cc per hr)
-UP TO DATE GTS
123
What is Preterm LABOR ASSESSMENT?
more than 20 weeks less than 37 weeks
S/S: persistent Low backache, Pelvic pressure, and cramping, GI cramping with or without diarrhea, Uterine Urgency, Vaginal discharge, cervical change, contractions, PROM
ASSESSMENT: Fetal fibronectin swab of vagina secretion between 24-34 weeks Picks up inflammation markers of placenta picks up the substance that placenta release
A positive test is a sign they will have preterm labor in the next 7 days
- Endocervical Length measurement dependent on Ultrasound less than 30mmm at risk of preterm labor
- Home Uterine Activity monitor, Cervical Cultures, NST/BPP
124
What are the prevention and Treatment of Preterm labor?
- Prevention: Hydration, Cerclage, infection screening
- Treatment: STOP UTERUS CONTRACTION Activity restriction, hydration, treat infection, medication
Medication: .
-Progesterone, Nifedipine, Magnesium Sulfate, Indomethacin( Indocin), Betamethasone ( steriod helo develop babies surfactant levels), Terbutaline
Long-term: 48-72 hrs use to gain time in order to administer 2 doses of BETMEAHASONE
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What was cervical insufficiency ?ASSESSMENT
- painless dilation of the cervix without contraction because the structure or function cervix
- Cervical length surveillance between 16 and 24 weeks
- -ASSESSMENT FOR FUNNELING ( THINING OF CERVIX).
- Cerclage: tie the cervix remove cerclage before the dilation to prevent tearing
- serial ultrasound of the cervix , NO SEX UNTIL 34 WEEKS
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What is chronic HTN
-before 20 weeks 140/90 no proteinuria
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What is gestational HTN
- after 20 weeks elevated BP 140/90 at least 2 times 4-6 hrs apart within a week
- NO proteinuria
- BP returns baseline after 6weeks in postpartum
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What is treatment of Preeclampsia and eclampsia
-delivery separation of the placenta
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Preclampsia
- immune response against pregnancy ( placenta involved)
- arteriolar vasospasm
- urine collection: within 24 hrs greater 300 cc
- swollen face and hands
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Signs of Mild Preclampsia
- gestational HTN with proteinuria of greater than 1 +
- may or may not have transient headaches
- EDEMA
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SIGNS OF SEVERE PREECLAMPSIA
- BP 160/100
- proteinuria 3+
- elevated serum creatinine greater than 1.2
- Oliguria
- visual disturbances
- Hypereflexia with possible Clonus
- Edema
- Right Upper quadrant epigastric pain
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ECLAMPSIA and what is the sign
-severe preclampsia with seizure or COMA
-preceded by headache, SEVERE EPIGASTRIC PAIN, HYPERREFLEXIA
HEMO-CONCENTRATION ( WARNING SIGNS OF PROBABLE CONVULSIONS)
H: hemolysis ( anemia,jaundice)
EL: Elevated liver enzyme (alt,ast, epigastric pain,n/v)
LP: low platelet , abnormal bleeding , clotting tike and possible DIC
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Nursing CARE of HELLP
- ASSESS LOC ( LEFTLATERAL POSITION, OXYGEN Correct contribution factor) Pulse oximetry , VS, Daily weights
Assess Proteinuria
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What is medication for mild preclampsia
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low dose aspirin ( 81 mg after 12 weeks gestation reduce premature and IUGR)
methyldopa
Nifedipine
Hydralazine
Labetol
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What is severe Preeclampsia Medication
- Magnesium SULFATE : 4-6 loading dose , 20-30 min via pump, with maintence of 2-3/hr via
Evaluate for toxicity: absence of reflexes decreased urine output, decreased RR( <12) decreased LOC , cardiac dysrhythmias
Antidote : calcium gluconate IV push over 3min
Fetal effects: Hypotonia, NICU, observe infant for delayed effect after delivery , continue infusion for 24 hrs PP
-LABETOL/ HYDRALOZINE
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What is Postpartum Managment for BP
- BP pressure may rise 3-6 days PP
- Anti HTN meds for 4-6 weeks PP may rise
- Late postpartum eclampsia ( more than 48 hrs but less than 4 weeks PP )
- HTN remain past 48 days in Chronic HTN
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What is the first sign of Shoulder dystocia
- turtling : when the head goes inside and outside
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What is BISHOP TEST ?
- sterile vaginal exam, check how your cervix is progressing toward readiness for labor by scoring how softening cervix, dilation to be ready for labor
- The score is 8 if they had previous pregnancy
- The score 10 if they had no previous pregnancy
- TAKE THE TEST WITHIN 39 weeks
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What are some methods of
Foley bulb catheter
Membrane stripping: put two fingers inside cervix and rotate around the amniotic sac cause the release prostaglandins labor begins 24-48 hrs
-Oxytocin IV infusion: if caused tachysytole more than 5 contractions in the 10 min
Amniotomy: purposely rupture the amniotic sacs
Laminaria
Lamicel
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What is induced Labor?
- starting the contraction before the onset of the spontaneous onset
Based on Bishop Score
- Contradiction: vertical incision of c-section, multiple fetus besides twins, fetal decelerations, abnormal fetal lie
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What is Amniotic Embolism? What at risk?
- Advanced maternal age
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What are the symptoms of Uterine Rupture
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Sensation of ripping or tearing, sharp
abdominal pain, uterine tenderness,
contractions that “don’t go away”, NRFHR,
change in uterine shape, cessation of
contractions
```
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What is Treatment of Uterine Rupture
alert provider WHILE IV fluids, be
| ready for transfusion, stat cesarean
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What is Precipitous Labor
