Exam 2 Flashcards
what causes lactation
- decreasing estrogen and progesterone
* increasing prolactin and oxytocin
PP lochia abnormalities
- constant trickle
- excessive w/ ctx
- foul smelling
REEDA
•episiotomy/incision assessment
- Redness
- Edema
- Ecchymosis
- Discharge
- Approximation
- infection if have pain too
PP s/sx to report
- fever > 100.4
- unilateral breast edema w/ flu s/sx
- abd tenderness/pressure
- perineal pain
- UTI
- DVT
- lochia change
early PP hemorrhage
- w/in 24 hr
- vag: > 500 cc EBL
- C/S: > 1500 cc EBL
s/sx early PP hemorrhage
- excessive lochia
- soft/diff. to locate fundus
- fundus above expected level
PP hemorrhage causes
- uterine atony
- placental complications/retention
- laceration/trauma/hematoma
- uterine inversion
- sub-involution of uterus
- coagulopathies (DIC)
uterine atony causes
- overdistention
- muliparity
- tocolytics
- prolonged/precipitous labor
- C/S
- induction
early PP hemorrhage tx
- fundal massage
- ABCs
- bolus Pit
- new large IV
- admin meds/blood
- elevate legs
meds for early PP hemorrhage
- O2
- oxytocin (Pit)
- methergin
- cytotec
- Hespan
- Hemabate
late PP hemorrhage
- b/t 24 hr and 2 wks PP
* caused by uterine sub-involution
sub-involution causes
- retained placental fragments
* endometritis
s/sx subinvolution
- prolonged, foul lochia
- hemorrhage
- pelvic pain/heaviness
- backache
- malaise/fatigue
- soft/large uterus
subinvolution tx
- methergine
- abx
- D&C (last resort)
endometritis tx
- IV abx
- analgesics (no ASA, ibuprofen)
- high fowlers (drain lochia)
meaty clots indicate…
•uterine atony
thin/shiny clots indicate
•trauma
trauma causes
- macrosomia
- operative vag. delivery
- soft part abnormality
- rapid delivery
trauma tx
•ice
•pressure
•treat shock
*call MD
early signs hypovolumetric shock
•tachycardia •thready pulse •increased RR •BP normal *body trying to compensate
late signs hypovolumetric shock
•falling BP •cool, moist, pale skin •bradycardia •change in mental status *body CANT compensate
hypovolumetric shock tx
- trendelberg/elevate legs
- O2
- multiple IVs (blood, NS, etc)
- admin Hespan
- ABCs
stages of fetal response to Rh incompatibility
- fetal hemolytic anemia
- fetal hyperbilirubinemia
- erythroblastosis fetalis
- hydrops fetalis
when to admin RhoGAM
- 28 wk GA Rh- mom
- post-invasive procedure
- post-abortion
- w/in 72 hrs delivery if baby Rh+
amniocentesis
•measures amnt. bilirubin in amniotic fld. (urine) to determine severity of fetal hemolytic anemia
early abortion
•before 12 wks •r/t abnormalities of: -chromosomes -endocrine -immune -systemic
late abortion
•b/t 12-20 wks •r/t: -AMA -multiparous -infection -drug use
threatened abortion s/sx
- SPOTTING
- BACKACHE
- cramping
- pelvic pressure
threatened abortion tx
•pelvic rest
inevitable abortion
- ROM
- DILATION
- bleeding
- cramping
inevitable abortion tx
- allow nature to work
* if incomplete, D&C
incomplete abortion s/sx
- PROFUSE BLEEDING
- DILATION
- severe cramping
- retained placental pressure
incomplete abortion tx
- < 14 wk, D&C
* > 14 wk, induce
complete abortion s/sx
- CTX STOP
- CERVIX CLOSED
- PG signs/test neg.
complete abortion tx
•nothing unless excessive bleeding or complications
missed abortion s/sx
- RED/BROWN spotting
- WEIGHT LOSS
- PG s/sx disappear
miss abortion tx
•wait and then D&C
complications of missed abortion
- sepsis
* DIC
DIC risk factors
- missed Ab
- sepsis
- abruption
- severe PIH
- AFE
s/sx DIC
•bleeding from orafices
•low platelets
•prolonged bleeding time
*DONT give epidural or spinal
risks r/t bicornuate uterus
- poor baby perfusion
* labor issues b/c head doesn’t push on cervix effectively
methotrexate
•antineoplastic ectopic PG tx •N/V •no etoh/sex until no hCG •must be < 8 wks and < 4 cm *preferred tx b/c less scarring risk
placental previa s/sx
- painless bright red bleeding
- uterus soft/nontender
- FHT distress
normal bloody show
- mucous mixed w/ blood
- pink
- small amnt.
pathological bloody show
- dark red
* copious
DONT do vag. exam if bleeding until…
- know where placenta is
* MUST assess for placental previa first
placental abruption
•premature separation of normally implanted placenta •r/t -HTN*** -trauma -nicotine/cocaine
placental abruption s/sx
- abd. pain
- board-like abd
- pathological bloody show
- uterine irritability
- poor rlxn b/t ctx
- FHT distress/absence
grade I abruption
- 10-20% detached
* mom and fetus NOT in distress
grade II abruption
- 20-50% detached
- mom in shock
- fetus in distress
grade III abruption
- > 50% detached
- mom in shock and has DIC
- fetus dead
gestational HTN
- dx after 20 wks
- BP > 140/90
- no proteinuria
mild preeclampsia
- BP > 140/90
- proteinuria 1+
- irritable, edema, abd pain
severe preeclampsia
- BP > 160/110
- proteinuria 3+
- HA, visual distrubances, hyperreflexia, oliguria
severe preeclampsia tx
- MgSO4
- hospitalized bed rest
- induce labor w/ pit
- fld. restriction
MgSO4 uses
- smooth muscle relaxant for SEIZURE PRECAUTIONS
- S/E is lower BP
- given to non HTN mom when baby on steroids to prevent baby cerebral hemorrhage
therapeutic MgSO4 range
•4-8 mg/dL
loss of patellar reflex MgSO4
•9-10 mg/dL
respiratory distress MgSO4
•12-17 mg/dL
cardiac arrest MgSO4
•30-35 mg/dL
signs of MgSO4 toxicity
- absent DTR
- fluid in lungs (dec. RR)
- decreased UOP
r/o uterus rupture
•macrosomia/hydrops
•hx of C/S or uterine surgery
•D&C
*hypervascularized so MAJOR bleeding risk
anemia in PG
- Hgb < 11 g/dl in 1st/3rd trimester
- Hgb < 10.5 g/dl in 2nd trimester
- Hct < 33%
main consequences of anemia
•PREECLAMPSIA and HF b/c less O2 capacity means CO increase
thalassemia
- genetic disorder causing production of short-life span RBC
* DONT give Fe supp. b/c they store Fe in excess
pre-existing diabetes increases r/o…
- abortion
- congenital anomalies (heart)
- macrosomia
- shoulder distocia
- PIH
- C/S
- over distention of uterus
- IUGR
- UPI (perif. vasc. site)
influence of diabetes on newborn
- cardiac anomalies
- rebound hypoglycemia
- RDS b/c late surfactant development
- birth trauma r/t macrosomia
- hypocalcemia
- hyperbilirubinemia (r/t trauma)
why fetus of diabetic mom at risk for macrosomia
- hyperinsulinemia
* lots of sugar from hyperglycemic mom
hyperemesis gravidarum effect on fetus
- IUGR
* preterm birth
toxoplasmosis
•protozoan transmitted thru undercooked meat and cat feces •can cause: -LBW -enlarged spleen/liver -jaundice -anemia
congenital varicella syndrome
- fetal infected by varicella before 20 wks GA
- lib hypoplasia
- cutaneous scars
- microcephaly
zidovudine
- PO med given to HIV+ mom @ 14 to prevent transmission
- IV during labor
- elixir for baby up to 6 wks
preventing HIV transmission to neonate
- zidovudine
- elective C/S @ 38 wks
- DONT allow ROM
- DONT BF
GBS neonate effects
•sepsis
•pneumonia
•meningitis
*crucial to vag. screen mom @ 36 wks
GBS abx tx if…
- hx of infant w/ GBS
- GBS during current PG
- preterm birth
- maternal fever during labor
- ROM longer than 18 hrs
what conditions can cause IUGR
•diabetes
•hyperemesis gravidarum
*baby thin, pale, loose, dry skin
molar PG basics
- partial- 2 sperm, 1 egg
- complete- 1 sperm, one egg w/o nucleus
- key s/sx hyperemesis gravidarum; grape-like clusters, fundus wrong for GA; scant dark discharge
L/S ratio
- determines fetal pulmonary maturity
- 2+: mature
- 1.5-: r/o RDS
neonate thermoregulations
- flexed position
- constriction of peripheral vessels (acrocyanosis)
- brown fat metabolism
- crying/restless
cold stress
•ineffective thermoregulation leading to hypoxia, acidosis, and hypoglycemia
cold stress s/sx
- drop in temp
- RR increase
- tachy then brady
- mottle skin; acrocyanosis
- if RD, decreased activity
- no RD, increased activity
newborn sucking coordination
- 32-34 wks
* 1500 g
neonate hepatic system fxn
- carb metabolism
- Fe storage
- bilirubin conjugation
- coagulation
hyperbilirubinemia risks
- prematurity
- blood incompatibilities
- cephalhematoma/bruising
- cold stress
- poor intake/BF
- sepsis
physiologic jaundice
•hyperbilirubinemia that appears after 1st 24 hrs •benign •resolves by day 4 •bili < 12 *normal
pathologic jaundice
•hyperbilirubinemia w/in first 24 hrs
•r/t excessive RBC destruction
•bili remains high
*abnormal
kernicterus
- bilirubin encephalopathy
- severe jaundice
- neurological damage and death
- bili > 25
HR apgar scores
- 0: none
- 1: < 100
- 2: > 100
RR apgar scores
- 0: apnea
- 1: irregular/shallow
- 2: crying
muscle tone apgar scores
- 0: flaccid
- 1: some flexion
- 2: well flexed
reflex irritability apgar scores
- 0: none
- 1: grimace/withdraw
- 2: crying
color apgar score
- 0: central cyanosis
- 1: peripheral cyanosis
- 2: pink
classification of gestational age
- preterm: before 37 wks
- term: 38-42 wks
- possterm: after 42 wks
post-mature
- > 3 wks past EDD
- placenta failiing -> less O2/nutrients
- must induce
- LBW, dry, long hair/nails
- r/o meconium aspiration
expected newborn measurements
- length: 45-55 cm
- head: 32-37 cm
- chest: 30-33 cm
expected newborn VS
- 97.7-98.9
- HR: 110-160
- RR: 30-60
- BP: 60-80/40-50
RR indicating RDS
•apnea > 15-20 sec
infant caloric intake
•110 kcal/kg/day
*milk 20 kcal/oz
how to know if neonate receiving enough to eat
- content b/t feeding
- 6-8 wet diapers/day
- gains weight
how should bottle-feeding mom relieve breast engorgement
- wear snug, supportive bra
* DONT pump
healthy neonate blood glucose
•50-60
when are neonate lungs mature?
- 37 wks
* amniocentesis to determine maturity if < 37 wks
avg. cord separation
•10-14 days
pre-eclampsia impact on organs
- decreased fxn of placenta, kidney, liver, brain
* d/t vasospasms that diminish diameter of vessels, impeding flow
most prevalent symptom of abruptio placentae
•intense abdominal pain
- what differentiates it from placenta previa
- both have bleeding, uterine activity, and cramping
s/sx rupture of uterus
- hypotonic activity
- hypovolemia
- no pain
most important factor affecting pregnancy outcome of pre-GDM mom
- glucose control
* no vessel dz
most important cause of perinatal loss in diabetic pregnancy
•congenital malformations, esp. heart
