exam 2: OB + Newborn Flashcards
GTPAL
Gravida: # of pregnancies
Term: # born at term
Preterm: # born preterm
Abortions/Miscarriages
Living: # of living children
Naegele’s Rule
LMP + 7 days + 9 months
discomforts during pregnancy
- n/v
- syncope
- urinary frequency/urgency
- increased vaginal discharge
- SOB
- fatigue
- heartburn
- edema
- varicose veins
- hemorrhoids
- leg cramps
- back pain
- constipation
antepartum diagnostic tests
- H&H: may decrease d/t increased plasma volume
- Rh factor/blood type and cross
- ultrasound
- genetic testing
- amniocentesis (rule out genetic disorders, risk for infection)
gestational diabetes
- if mom has fasting glucose >126 or random higher than 200
- glucose tolerance test (50g glucose): after 1 hour >140, after 3 hours >130-140= positive
impact of chlamydia and gonorrhea on fetus/newborn
- eye infections
- blindness
impact of trichomoniasis on fetus/newborn
- premature ROM
- infection
impact of syphilis on fetus/newborn
- deafness
- congenital abnormalities
- death
impact of HSV on fetus/newborn
- neonatal infections
- encephalopathy
- death
impact of HPV on fetus/newborn
- transmission to newborn
placenta previa
placenta forms in lower portion of uterus and blocks birth canal
may require c-section for delivery
signs of placenta previa
- painless
- bright red vaginal bleeding
- vital signs and FHR normal
interventions for placenta previa
- assess for bleeding
- no vaginal exams (makes bleeding worse)
- leave pulse ox on
placental abruption
premature separation of the placenta
signs of placental abruption
- painful
- dark red vaginal bleeding
- fetal distress
- shock
interventions for placental abruption
- immediate delivery
- continuous fetal monitoring
- oxygen for mom
abortion
loss of pregnancy before 20 weeks
fetal death
loss of pregnancy after 20 weeks
preeclampsia
BP disorder diagnosed after 20 weeks
BP >140/90
risk factors for preeclampsia
- HTN
- diabetes
- obesity
- aging
assessment findings for preeclampsia
- weight gain
- swelling
- vision changes
- protein in urine
interventions for preeclampsia
- bed rest
- reduce stimuli
5 P’s of labor
- passenger
- passage
- powers
- psyche
- positioning
impending signs of labor
- lightening/dropping
- Braxton Hicks contractions increase
- cervical changes
- nesting
- weight loss
- spontaneous ROM
false labor
- contractions go away with activity
- contractions are irregular with no progression
true labor
- strong, regular, close contractions
- fetus becomes engages
- cervix begins to dilate and efface
baseline for fetal HR
110-160
FHR patterns
- accelerations
- variable decelerations
- early decelerations
- late decelerations
accelerations
- an increase of FHR by 15 bpm with fetal movement
- normal :)
variable decelerations
- cord compression
- irregular shape, duration, and decline
- interventions: d/c oxytocin, turn on left side, give o2
early decelerations
- head compression
- uniform shape, mirrors contractions
- no interventions needed
late decelerations
- placental insufficiency
- occurs after peak of contraction
- emergent intervention required
first stage of labor
latent: cervical dilation 1-4 cm, mild contractions, 15-30 min apart, duration is 30 seconds
active: 4-7cm, moderate contractions, 3-5 min apart, duration is 30-45 sec
transition: 8-10 cm, severe contractions, 2-3 min apart, duration is 45-90 sec
interventions for first stage of labor
- encouragement
- discuss birth plan
- keep comfortable
- encourage void
- breathing techniques
- music therapy
- rest
second stage of labor
latent: laboring down
active: pushing
- cervical dilation is complete, mom feels like she could push or needs to poo
interventions for second stage of labor
- positioning
- be ready for baby
- goal is safe delivery
third stage of labor
- expulsion of placenta
- typically occurs 5-30 min after baby delivery
interventions for third stage of labor
-ensure placenta is intact
- monitor for signs of PPH
- promote bonding
- assess fundus
OB procedures during labor
- induction –> meds such as oxytocin
- amniotomy –> AROM
- episiotomy
- external version
- forceps delivery
- vacuum extraction
- c-section
complications of labor
- premature ROM –> infection risk
- prolapsed umbilical cord (MED EMERGENCY)
- vena cava syndrome –> baby and uterus push up against the heart, causing hypotension when laying down
- preterm: 22 weeks-37 weeks –> bedrest, tocolytics
- precipitous labor –> lasts less than 3 hours, higher risk of PPH
- dystocia: prolonged, difficult labor
- uterine inversion: can happen 10-30 min after delivery
postpartum period
starts immediately after birth up until 6 weeks after delivery
expected changes during postpartum
- fundal height decreases 1 cm per day, not palpable at 10 days PP
- lochia decreases
- distention and engorgement of breasts (milk production)
- changes in urinary patterns (loss of elasticity and tone)
- return of menses 3-6 months
- return of normal stools, hemorrhoids common
types of lochia
rubra: bright red, day 1-3
serosa: brownish pink, day 4-10
alba: white day 11-14
how long after delivery should breastfeeding be initiated?
1 hour
benefits of colostrum
- dense in nutrients
- provides passive immunity to baby
BUBBLEE
Breast
Uterus
Bowels
Bladder
Lochia
Episiotomy
Emotions
PPH
more than 500 mL blood loss after vaginal birth or more than 1000 mL blood loss after c-section
usually happens within 4 hours after delivery
risk factors for PPH
- assistive birth
- large birth weight
- placenta previa/abruption
- multiple pregnancies
- hx PPH
assessment findings in PPH
- SOB
- heavy bleeding (bright red blood, clots)
- hypotension
- tachycardia
- restlessness/anxiety
- boggy uterus on fundal massage
PPH treatment
- fundal massage (stimulates uterus to contract)
- give blood
- oxygen
- oxytocin (helps firm uterus by causing it to contract)
gestational age
-preterm: less than 37 weeks
late preterm: 34-37 weeks
term: 37-41 weeks, 6 days
postterm: more than 42 weeks
normal reflexes of newborns
- sucking/rooting
- swallowing
- palmar/plantar grasp
- moro
- startle
- babinski
alterations in newborn skin
- vernix: skin protectant, looks like cheese
- lanugo: peach fuzz body hair for extra warmth
- mongolian spot: blue/black pigmentation on low back or booty, common in darker skinned ethnicities
s/s of hypoglycemia in newborn
- tremors
- lethargy
- hypotonia
- hypothermia
- weak suck
- diaphoresis
- poor feeding
biggest contributor to hypoglycemia in the newborn is ______
cold stress
newborn calorie requirement
120 calories/kg/day
types of heat loss in newborns
- convection- loss from cooler air (cold room)
- radiation- loss from cooler surface not in direct contact (unwrapped baby nect to window)
- evaporation- loss from wet body (wet diaper, after bath)
- conduction- loss from cooler surface in direct contact (cold scale)
nursing interventions for jaundice
- maintain normal skin temp (97.7-98.6)
- monitor stool (best way to eliminate bilirubin is to poo it out)
- encourage feedings
- phototherapy
- monitor for worsening, eating patterns, and number of wet diapers
indication for vitamin K injection
activates clotting factors and is found in normal gut flora.
since babies don’t have a developed gut flora, they’re at a higher risk for bleeding
the newborn is likely to demonstrate ___ in response to infection
hypothermia
indication for erythromycin at birth
-prevents against eye infections and potential blindness caused by gonorrhea that the baby could’ve been exposed to during delivery
- state-mandated med, give within an hour of delivery
respiratory distress syndrome
respiratory complication in the newborn, especially in premature infants d/t insufficient surfactant in the lungs
s/s of RDS
- tachypnea
- nasal flaring
- grunting
- retractions
- apnea
- pallor
- cyanosis
- diminished lung sounds
RDS interventions
- monitor ABGs, O2
- reposition
- administer surfactant via ET tube
prevention of SIDS
- back to sleep, tummy to play
- no smoking
- immunizations
- firm bedding, no blankets or stuffed animals
- no co-sleeping
- pacifier with sleep
cold stress
a period of inadequate temperature regulation
what does cold temperature increase
- metabolism
- O2 consumption
characteristics leading to heat loss
- little subcutaneous fat
- blood vessels close to the surface
- greater surface area
s/s of cold stress
- lethargy
- pallor
- poor feeding
- hypoglycemia
- respiratory distress
nonshivering thermogenesis (NST)
- initiated by skin receptors
- stimulation of sympathetic nervous system
- utilization of brown fat
evaporation
occurs during birth, bathing, wet linens or clothes, or insensible water loss from moisture on skin
conduction
occurs when the infant comes in contact with cold objects or surfaces (ex: scale, cold hands, stethoscope)
convection
occurs when drafts come from open doors, air conditioning, or air currents
radiation
occurs when the infant is near cold surfaces (ex: window, air conditioner)
types of jaundice
- physiologic
- breastfeeding
- pathologic
- breast milk
physiologic jaundice
occurs after the first 24 hours of life
breastfeeding jaundice
- lack of sufficient intake
- develops in the first few days of life
pathologic jaundice
- begins in the first 24 hours
- associated with blood incompatabilities
breast milk jaundice
- delayed onset
- related to composition of mother’s milk
SIDS etiology
- brainstem abnormality
- stressors (sleep position, sleep environment)
- critical development period
- NOT associated with apnea or immunization
SIDS risk factors
- sleep position
- bed space (soft surface, fluff)
- sleep environment (temperature, co-bedding)
- exposure to smoke (prenatal, secondhand smoke)
- family hx SIDS
- age (2-4 mo., 90% of SIDS deaths before 6 mo.)
- race (#1: native american, #2: african american, #3: caucasian)
- prematurity/low birth weight
