EXAM 2 Reproduction Flashcards
What is gametogenesis?
Creation of reproductive cells
Gametogenesis is the process that leads to the formation of gametes, which are the reproductive cells in organisms.
Define meiosis.
Reduction cell division in gametes that halves the number of chromosomes in each cell
Meiosis is crucial for sexual reproduction and ensures genetic diversity.
What is mitosis?
Cell division
Mitosis results in two identical daughter cells and is essential for growth and repair.
What is oogenesis?
Process of forming an ovum during female prenatal development
Oogenesis begins before birth and continues until menopause.
What is spermatogenesis?
Formation of male gametes in the testes
Spermatogenesis occurs continuously after puberty and produces sperm.
What is ovulation?
The release of an ovum into the fallopian tubes
Ovulation typically occurs about once a month in females.
What is ejaculation?
Expression of sperm and semen from penis
Ejaculation is a key part of male reproductive function.
Define zygote.
Cell formed by union of an ovum and a sperm
The zygote undergoes multiple divisions to develop into an embryo.
What is a morula?
An early stage of embryonic development around 4 days after fertilization, consisting of a solid ball of 12-16 cells
The morula resembles a mulberry and precedes the blastocyst stage.
What is the decidua?
The modified endometrium (uterine lining) that provides nutrients for the developing embryo/fetus during pregnancy
The decidua plays a vital role in supporting embryo development.
Define blastocyst.
An early stage of embryonic development around 5-6 days after fertilization, consisting of an outer trophoblast layer and an inner cell mass
The blastocyst is critical for implantation in the uterine wall.
What is the trophoblast?
The outer cell layer of the blastocyst that forms part of the placenta and surrounds the inner cell mass
The trophoblast is essential for establishing pregnancy.
What is the embryonic period?
The stage of pregnancy from day 15 through 8 weeks after fertilization when major organ systems develop
This period is critical and vulnerable to teratogens.
Define teratogens.
Substances, exposures, infections, or health problems that can cause abnormal fetal development and birth defects
Teratogens can have severe effects on the developing fetus.
What is the fetal period?
The stage after the embryonic period, from 9 weeks after fertilization until birth, when the developing baby is called a fetus
During this period, growth and maturation of organs continue.
What is the chorion?
The outer membrane surrounding the fetus that contributes to the placenta
The chorion plays a key role in nutrient and gas exchange.
Define amnion.
The inner membrane surrounding the fetus that contains amniotic fluid
Amniotic fluid protects the fetus and allows for movement.
What is monozygotic twinning?
When a single fertilized egg splits, resulting in identical twins with the same genetic makeup
Monozygotic twins share 100% of their genes.
Define dizygotic twinning.
When two separate eggs are fertilized by two different sperm, resulting in fraternal twins with different genetic makeups
Dizygotic twins share about 50% of their genes.
What are the three germ layers?
Ectoderm, Mesoderm, Endoderm
The germ layers are the primary layers of cells in the developing embryo.
What does the ectoderm develop into?
Nervous system, sensory organs, skin, nails, hair, tooth enamel
The ectoderm is the outermost layer of the germ layers.
What are the derivatives of the mesoderm?
Muscles, bones, connective tissues, blood, blood vessels, reproductive and excretory systems
The mesoderm is the middle layer of the germ layers.
What does the endoderm give rise to?
Digestive system, respiratory system, urinary bladder, thyroid, parathyroid glands
The endoderm is the innermost layer of the germ layers.
Which germ layer is responsible for developing the nervous system?
Ectoderm
The nervous system is a key derivative of the ectoderm.
Fill in the blank: The _____ develops into muscles and bones.
Mesoderm
The mesoderm plays a crucial role in forming the musculoskeletal system.
True or False: The endoderm contributes to the formation of the skin.
False
The skin is formed from the ectoderm, not the endoderm.
What systems are developed from the endoderm?
Digestive system, respiratory system, urinary bladder, thyroid, parathyroid glands
These systems are essential for various bodily functions.
What are the three shunts in fetal circulation?
- Ductus venosus
- Foramen ovale
- Ductus arteriosus
These shunts facilitate the unique blood flow requirements of the fetus.
What is the function of the ductus venosus?
Allows oxygenated blood from the placenta to bypass the fetal liver and enter the inferior vena cava.
It constricts after birth when umbilical cord blood flow stops.
What is the role of the foramen ovale in fetal circulation?
An opening between the atria that allows most oxygenated blood to flow from the right to left atrium, bypassing the lungs.
It closes after birth as lung circulation increases.
What does the ductus arteriosus do?
Allows most deoxygenated blood from the right ventricle to bypass the lungs and enter the aorta.
After birth, it constricts as oxygen levels rise, eventually becoming the ligamentum arteriosum.
Fill in the blank: The ductus venosus allows oxygenated blood to bypass the _______.
fetal liver
True or False: The foramen ovale remains open after birth.
False
Fill in the blank: The ductus arteriosus becomes the _______ after birth.
ligamentum arteriosum
What is a preterm (premature) infant?
An infant born before 37 completed weeks of gestation.
What defines a late preterm (premature) infant?
An infant born between 34 and 36 completed weeks of gestation.
What is the weight limit for a low birth weight infant?
Less than 2500 grams (5 lbs 8 oz) at birth.
What is classified as a very low birth weight infant?
An infant weighing less than 1500 grams (3 lbs 5 oz) at birth.
What defines an extremely low birth weight infant?
An infant weighing less than 1000 grams (2 lbs 3 oz) at birth.
What is kangaroo care?
Skin-to-skin contact between a preterm infant and parent, providing warmth, bonding, and developmental benefits.
What is periodic breathing in preterm infants?
Short periods of apnea alternating with breathing.
What is apnea?
A pause in breathing for 20 seconds or longer.
What does neutral thermal environment (NTE) mean?
Providing warmth to prevent heat loss and maintain normal body temperature in preterm infants.
What are enteral feedings?
Feedings delivered into the gastrointestinal tract, either orally or via feeding tube.
What is containment holding?
Positioning and swaddling preterm infants to decrease energy expenditure.
What is total parenteral nutrition (TPN)?
Intravenous nutrition solution providing calories, proteins, vitamins, and minerals.
What is corrected (gestational) age?
Adjusting for prematurity by adding the number of weeks premature to the chronological age.
What is intrauterine growth restriction (IUGR)?
Poor fetal growth resulting in low birth weight for gestational age.
What is macrosomia?
An infant with excessive birth weight, often over 4000-4500 grams.
What is the gestational age range for late preterm infants?
34 to 36 completed weeks of gestation
Late preterm infants may appear similar to full-term infants but often exhibit characteristics of prematurity.
What difficulties do late preterm infants often experience with breastfeeding?
Poor sucking, swallowing, and breathing coordination
These difficulties can lead to feeding issues and increased risk of jaundice.
What is the increased risk for late preterm infants regarding health outcomes?
Jaundice, feeding issues, and hospital readmission
Close monitoring and follow-ups are essential for these infants.
What recommendations are made for late preterm infants to ensure adequate feeding?
Close monitoring by a lactation consultant and frequent follow-ups with a healthcare provider
This is crucial until 40 weeks postconceptional age.
What is the gestational age range for moderately preterm infants?
32 to 33 weeks
This classification is part of the broader categorization of preterm infants.
What is the gestational age range for very preterm infants?
28 to 31 weeks
Very preterm infants face more complications than late preterm infants.
What is the gestational age for extremely preterm infants?
Less than 28 weeks
Extremely preterm infants are at the highest risk for health complications.
What are the main etiological factors for preterm birth?
Preterm labor, premature rupture of membranes, maternal or fetal conditions requiring early delivery
List three characteristics of preterm infants.
- Low birth weight
- Immature organ systems
- Thin skin
What respiratory problems are common in preterm infants?
- Respiratory distress syndrome
- Apnea
- Periodic breathing
Why do preterm infants have thermoregulation problems?
Increased heat loss due to large surface area to body mass ratio and lack of insulating fat
What fluid and electrolyte problems are associated with preterm infants?
- Increased insensible water loss
- Electrolyte imbalances
- Risk of dehydration
What skin problems are preterm infants prone to?
Fragile skin prone to injury and increased risk of infection
What increases the infection risk in preterm infants?
Immature immune system, invasive procedures, prolonged hospitalization
What causes pain in preterm infants?
Frequent painful procedures and stimuli due to necessary medical interventions
Define respiratory distress syndrome (RDS) in preterm infants.
Caused by lack of surfactant in immature lungs, leading to alveolar collapse and impaired gas exchange
What is bronchopulmonary dysplasia (BPD)?
Chronic lung disease resulting from lung injury and inflammation, often requiring prolonged oxygen therapy
What is intraventricular hemorrhage (IVH)?
Bleeding into the ventricular system of the brain, which can lead to neurological impairment
What is retinopathy of prematurity (ROP)?
Abnormal blood vessel growth in the retina that can cause vision impairment or blindness
Fill in the blank: Necrotizing enterocolitis (NEC) is an inflammatory disease causing _______.
intestinal injury and necrosis
What complications can arise from necrotizing enterocolitis (NEC)?
- Intestinal perforation
- Sepsis
What is defined as a pregnancy that extends beyond 42 weeks gestation?
Postterm pregnancy
Postterm pregnancy can lead to various complications for both the mother and the infant.
What are some risk factors for postterm pregnancy?
- Placental insufficiency
- Genetic factors
- Maternal conditions like obesity or diabetes
These risk factors can contribute to complications during labor and delivery.
What are common manifestations of postterm infants?
- Dry, peeling skin with little vernix
- Abundant hair
- Long nails
- Meconium staining
- Thin body with little fat
- Apprehensive appearance
These physical characteristics can indicate postmaturity in infants.
What complications can arise in postterm infants?
- Meconium aspiration
- Hypoglycemia
- Polycythemia
Complications may require immediate medical attention after birth.
What is the recommended therapeutic management for postterm pregnancy?
Induction of labor after 42 weeks
Inducing labor helps prevent complications associated with prolonged pregnancy.
What are important monitoring practices after delivery of a postterm infant?
- Fetal monitoring
- Neonatal resuscitation
- Glucose screening
These practices are crucial for ensuring the health of the newborn.
What nursing considerations should be taken for postterm infants?
- Assess for signs of postmaturity
- Monitor temperature
- Monitor respiratory status
- Monitor glucose levels closely
- Provide warmth
- Ensure early and frequent feedings
- Teach parents about cold stress prevention
- Watch for hyperbilirubinemia risk
These considerations are vital for the care and management of postterm infants.
What does SGA stand for?
Small-for-gestational-age
What is the primary etiology of SGA?
Intrauterine growth restriction (IUGR) due to placental insufficiency, maternal factors like hypertension or smoking, congenital anomalies, or chromosomal disorders
What are the manifestations of SGA?
Low birth weight below the 10th percentile for gestational age, may be symmetric or asymmetric, thin appearance, loose skin folds, prominent bones
What are the two types of SGA based on measurement symmetry?
- Symmetric (all measurements small)
- Asymmetric (head normal, body small)
What is a key aspect of therapeutic management for SGA?
Early identification of IUGR and treatment of underlying causes if possible
What should be monitored in therapeutic management of SGA?
Fetal growth and well-being
What may be indicated for severe IUGR in SGA cases?
Early delivery
What post-birth care is recommended for SGA infants?
Provide adequate nutrition and monitor for complications
What are nursing considerations for SGA?
- Assess for signs of IUGR
- Monitor temperature, respiratory status, glucose levels
- Promote adequate nutrition with early, frequent feedings
- Provide developmentally supportive care
- Educate parents on care needs
What does LGA stand for?
Large-for-gestational-age
What is the primary etiology of LGA?
Maternal diabetes, excessive maternal weight gain, prolonged gestation, genetic factors
What are the manifestations of LGA?
Birth weight above the 90th percentile for gestational age, large body size, abundant fat, plethora (reddened skin), difficult delivery
What is a key aspect of therapeutic management for LGA?
Monitoring for macrosomia during pregnancy
What may be recommended if macrosomia is detected in LGA?
Early labor induction
What should be monitored after the birth of an LGA infant?
Blood glucose levels
What feeding approach is recommended for LGA infants?
Early feedings
What are nursing considerations for LGA?
- Assess for signs of macrosomia
- Provide warmth and early, frequent feedings
- Monitor temperature, respiratory status, and glucose levels closely
- Assist with breastfeeding positioning
- Educate on risks like birth injuries
What is Lactogenesis?
The process of initiating milk production and secretion
Lactogenesis occurs in stages during pregnancy and after birth.
Define Colostrum.
The first milk produced after birth, rich in antibodies and nutrients for the newborn
Colostrum is produced in the first few days postpartum.
What is Transitional milk?
Milk produced 5-10 days postpartum as the milk transitions to mature milk
Transitional milk has a different composition than colostrum and mature milk.
When is Mature milk produced?
Fully developed breast milk produced around 2 weeks postpartum
Mature milk is the primary source of nutrition for the infant.
What is Foremilk?
The milk released first during a feeding, watery and lower in fat
Foremilk helps to quench the infant’s thirst.
Define Hindmilk.
The richer, fattier milk released towards the end of a feeding
Hindmilk is important for the infant’s growth and satiety.
What is Engorgement?
Painful overfilling of the breasts with milk, often in early breastfeeding
Engorgement can make breastfeeding difficult and uncomfortable.
What does ‘Latch on’ refer to?
The way an infant attaches to the breast and nipple for effective breastfeeding
A proper latch is crucial for successful breastfeeding.
What is nonnutritive sucking?
An infant sucking on a pacifier or finger for comfort, not nutrition
Nonnutritive sucking can help soothe infants.
Define Mastitis.
Inflammatory breast condition, often involving infection, that can occur during breastfeeding
Mastitis can cause pain, swelling, and flu-like symptoms.
What are the benefits of breastfeeding for the infant?
Optimal nutrition, antibodies for immunity, reduced risk of infections, lower risk of obesity and diabetes, potential cognitive benefits
Breastfeeding offers numerous health advantages for infants, including enhanced nutrition and immune support.
What benefits does breastfeeding provide for the mother?
Promotes uterine involution, burns calories for postpartum weight loss, reduces risks of breast and ovarian cancer, provides emotional bonding
Mothers experience both physical and emotional benefits from breastfeeding, contributing to their recovery and health.
List the forms in which formula feeding is available.
- Ready-to-use
- Liquid concentrate
- Powder
These various forms of formula allow for different levels of convenience and preparation.
True or False: Formula feeding provides antibodies that help with immunity.
False
Unlike breastmilk, formula does not contain antibodies, which are crucial for an infant’s immune system.
Fill in the blank: Formula feeding provides _______ nutrition for infant growth and development.
complete
Formula is designed to meet all nutritional needs of infants, similar to breastmilk.
What types of special formulas exist?
- For premature infants
- For allergies
- For metabolic disorders
These specialized formulas cater to the unique needs of certain infants.
What are the advantages of breastfeeding in terms of convenience and cost?
Convenient, economical, environmentally friendly
Breastfeeding is often more accessible and cost-effective than formula feeding.
What is the role of proper preparation and storage in formula feeding?
Important for safe formula use
Adequate preparation and storage techniques are crucial to ensure the safety and nutritional quality of formula.
What is uterine involution in the context of breastfeeding?
The process of the uterus returning to its pre-pregnancy size
Breastfeeding aids this natural recovery process post childbirth.
What hormone stimulates milk production in the alveoli?
Prolactin
Prolactin is crucial for initiating and maintaining milk production.
What is the role of oxytocin in breastfeeding?
Causes the milk ejection or let-down reflex
Oxytocin helps release milk into the ducts for the infant.
What are everted nipples?
Nipples that protrude outward
Everted nipples are considered normal for breastfeeding.
How do flat nipples differ from everted nipples?
Flat nipples appear flush with the areola
They may need stimulation to protrude.
What characterizes inverted nipples?
Nipples that are retracted inward
Inverted nipples can pose challenges for breastfeeding.
What happens to retracted nipples when the areola is compressed?
They draw inward
This can complicate the infant’s ability to latch properly.
What can help draw out flat, inverted, or retracted nipples?
Techniques like breast shells
These techniques assist in making latching easier for the infant.
What is the rooting reflex?
Turning head and opening mouth when cheek is stroked
A natural reflex in infants that helps them find food.
What are some signs of hunger in infants?
Sucking motions/noises, hand-to-mouth movements, fussiness/crying, awakening from sleep, lip smacking
These cues indicate that an infant is ready to eat.
Fill in the blank: Infants may show _______ when they are hungry.
fussiness/crying
True or False: Lip smacking can be a sign of hunger in infants.
True
What behavior may indicate that an infant is awakening from sleep due to hunger?
Fussiness/crying
Infants often wake up when they are ready to eat.
What does the ‘L’ in the LATCH scoring tool stand for?
Latch (Scoring 0-2 based on how well the infant grasps the breast)
LATCH is an acronym used to assess breastfeeding effectiveness.
What does the ‘A’ in the LATCH scoring tool represent?
Audible swallowing (Scoring 0-2 based on frequency of swallows)
This measures how often the baby swallows during feeding.
What does the ‘T’ in the LATCH scoring tool indicate?
Type of nipple (Scoring 0-2 based on nipple type - everted, flat, inverted)
Nipple type can affect breastfeeding success.
What does the ‘C’ in the LATCH scoring tool assess?
Comfort (Scoring 0-2 based on signs of mother’s comfort or discomfort)
Mother’s comfort is crucial for effective breastfeeding.
What does the ‘H’ in the LATCH scoring tool refer to?
Hold (Scoring 0-2 based on positioning, support from staff)
Proper hold is essential for successful breastfeeding.
What is the scoring range for the LATCH tool?
Scores range from 0-10
Higher scores indicate better breastfeeding practices.
Define ‘cradle hold’ in breastfeeding positions.
Baby is cradled across the mother’s lap, head supported by the elbow
This position promotes skin-to-skin contact.
What are the pros of the cradle hold?
- Allows skin-to-skin contact
- Easy to see baby’s latch
- Supports baby’s head and neck
This position is commonly used by breastfeeding mothers.
What are the cons of the cradle hold?
Can strain mother’s arm and back over time
It’s important to be aware of physical strain during prolonged use.
Describe the cross-cradle hold.
Similar to cradle, but uses opposite arm to support baby’s head
This position is useful for better control of the baby’s head.
What are the pros of the cross-cradle hold?
- Gives control over positioning baby’s head
- Helpful for premature babies
This hold can enhance feeding effectiveness.
What are the cons of the cross-cradle hold?
Arm across body can feel restrictive
Some mothers may find this position uncomfortable.
Define ‘football hold’ in breastfeeding.
Baby’s body extends along the mother’s side, cradled by that arm
This hold is beneficial for mothers recovering from a c-section.
What are the pros of the football hold?
- Good for small babies
- After c-section as less pressure on abdomen
This position can also assist in feeding twins.
What are the cons of the football hold?
Requires a pillow to support baby’s head
Proper support is necessary for effective feeding.
Describe the side-lying position for breastfeeding.
Mother and baby lie facing each other to feed
This position allows for a relaxed feeding experience.
What are the pros of the side-lying position?
- Allows resting while nursing
- Minimizes strain on arms/back
It’s a comfortable option for nighttime feedings.
What are the cons of the side-lying position?
- Requires pillow support
- Risk of rolling onto baby
Safety precautions should be taken to avoid accidents.
What should be monitored to ensure a breastfeeding infant is eating enough?
Weight gain, wet/dirty diapers, and audible swallowing during feeds
Sleepy infants may require arousal techniques such as undressing or gentle massage.
What is nipple confusion?
A condition where artificial nipples introduced too early make it harder for the baby to latch
Proper latch technique is crucial, aiming for a wide mouth gape that takes in much of the areola.
Name some infant complications that may interfere with breastfeeding.
- Tongue tie
- Lip tie
- Jaundice
- Illness
What is engorgement in the context of breastfeeding?
Temporary swelling and fullness of the breasts 2-4 days after birth due to increased milk production
Can lead to hard, painful breasts that make it difficult for the baby to latch.
What are some methods to relieve engorgement?
- Frequent nursing
- Cold compresses
- Gentle massage
What often causes nipple pain during breastfeeding?
Improper latch
Ensure the baby takes a large mouthful of areola, not just the nipple.
What can be done to soothe nipple pain?
- Use lanolin ointments
- Allow nipples to air dry
- Seek help for severe pain or cracking
How can flat or inverted nipples affect breastfeeding?
They can make it harder for the baby to latch deeply
Try nipple shells or breast pump before feeding to draw out the nipple.
What are plugged ducts?
Obstruction of milk ducts causing a tender lump
Can lead to mastitis if unresolved.
What are some remedies for plugged ducts?
- Apply warm compresses
- Massage the area
- Ensure full milk removal
Why is proper milk expression and storage important?
To maintain a healthy milk supply when directly breastfeeding is not possible.
Proper expression helps ensure the baby receives high-quality breast milk.
What should a mother do before pumping milk?
Wash her hands and pump parts.
Hygiene is crucial for preventing contamination.
What techniques can help initiate letdown during pumping?
Massage and warmth.
These techniques can promote milk flow.
What is the recommended approach to suction when pumping?
Start with low suction and gradually increase as needed, avoiding excessive vacuum.
This helps prevent discomfort and injury.
How can a mother increase her milk supply?
Pump more frequently rather than longer.
Frequent pumping signals the body to produce more milk.
How should pumped milk be stored?
In clean containers, labeled with the date, and refrigerated or frozen based on safe storage guidelines.
Proper storage prevents spoilage and ensures milk quality.
What is a common choice for many mothers in the United States?
Formula feeding.
It provides an alternative to breastfeeding.
What are the different forms of infant formula?
Ready-to-use, concentrated liquid, and powder.
Each form has specific preparation requirements.
What are some common brands of infant formula?
Enfamil, Similac, and Gerber.
These brands offer various formulations for different needs.
What types of specialized formulas exist?
Formulas for premature infants, those with allergies, or other conditions.
Specialized formulas cater to specific dietary needs.
What is a key difference between formula and breastmilk?
Formula does not provide the same immunological benefits as breastmilk.
Breastmilk contains antibodies that help protect infants.
What is recommended for infants regarding formula?
Iron-fortified formula.
Iron is essential for infant growth and development.
What should be followed when preparing formula?
Proper preparation, storage, and feeding techniques according to product instructions.
Adhering to guidelines ensures safety and nutrition.
What is plagiocephaly?
Flattening of one side of an infant’s skull, often from positioning and pressure on the same area.
Commonly seen in infants who spend a lot of time lying on their backs.
Define phimosis.
A condition where the foreskin cannot be pulled back over the glans of the penis.
This condition can lead to complications if not addressed.
What is ophthalmia neonatorum?
Conjunctivitis or eye inflammation occurring in a newborn, often caused by bacterial infection acquired during delivery.
Preventative antibiotic eye drops are routinely given at birth to mitigate this risk.
What is the purpose of administering phytonadione (vitamin K) to newborns?
To prevent vitamin K deficiency bleeding, a potentially life-threatening condition
Phytonadione is given as a single injection.
What is ophthalmia neonatorum?
A form of conjunctivitis that can occur from exposure to bacteria during delivery
It is prevented by applying erythromycin (0.5%) ophthalmic ointment to the eyes of newborns.
What medication is routinely applied to the eyes of newborns?
Erythromycin (0.5%) ophthalmic ointment
This medication helps prevent ophthalmia neonatorum.
What serious complications do phytonadione and erythromycin help protect against in newborns?
Vitamin K deficiency bleeding and ophthalmia neonatorum
Both conditions can lead to serious health issues in the first days of life.
True or False: Phytonadione is administered orally to prevent vitamin K deficiency in newborns.
False
Phytonadione is given as a single injection.
Fill in the blank: Erythromycin (0.5%) ophthalmic ointment is used to prevent _______.
ophthalmia neonatorum
What are the signs of respiratory distress in a newborn?
Signs include:
* Nasal flaring
* Grunting
* Retractions (intercostal, subcostal, suprasternal)
* Tachypnea (rapid breathing)
* Cyanosis
These signs indicate that the newborn is having difficulty breathing and may require immediate attention.
What interventions can be taken for a newborn in respiratory distress?
Interventions include:
* Using a bulb syringe to suction out mucus/secretions
* Positioning the infant with the head slightly extended
These measures can help clear the airway and improve breathing.
What is the importance of prompt medical evaluation in respiratory distress?
Prompt medical evaluation is crucial for any signs of significant respiratory distress.
Early assessment can lead to timely interventions that may prevent further complications.
What forms of respiratory support may be required for severe respiratory distress?
Forms of respiratory support may include:
* Supplemental oxygen
* Continuous positive airway pressure (CPAP)
* Intubation
The choice of intervention depends on the severity of the distress.
What is the first step in thermoregulation management for a newborn?
Immediately dry the newborn and place skin-to-skin on the mother’s chest or under a radiant warmer.
What is the target temperature range for maintaining a newborn’s body temperature?
36.5-37.5°C
What should be done to minimize heat loss during procedures for newborns?
Cap the head and minimize exposure.
What is a recommended practice for blood glucose management in newborns?
Check blood glucose levels at 1 hour after birth, before feedings, and with any signs of hypoglycemia.
What should be done if a newborn shows signs of hypoglycemia?
Provide early breastfeeding or formula supplementation.
What action should be taken if blood glucose levels remain low despite feeding?
Notify the provider promptly.
What is the first step in bilirubin management?
Visually assess for jaundice.
When should phototherapy be initiated for a newborn?
If bilirubin exceeds treatment thresholds.
How often should ongoing assessments be performed on a newborn?
Frequently.
What should be done to care for the cord stump of a newborn?
Keep it clean and dry.
How often should a newborn be bathed?
Every 3-4 days using a gentle technique.
What is a crucial practice to prevent abduction of a newborn?
Follow all security measures to prevent abduction.
What hygiene practice is emphasized in ongoing assessments?
Practice rigorous hand hygiene and sterile technique.
Fill in the blank: Blood glucose levels should be checked before _______.
feedings
True or False: Frequent breastfeeding is encouraged in bilirubin management.
True
What should be monitored in addition to bilirubin levels?
Hydration status.
What technique should be used for diapering and positioning of a newborn?
Proper techniques
What type of analgesia should be provided before circumcision?
Dorsal penile nerve block, ring block with local anesthetic, or topical anesthetic cream like EMLA
Acetaminophen should also be given before and after for post-procedural pain control.
What are non-pharmacologic methods for pain relief during circumcision?
Sucrose, pacifiers, low lighting, and soothing sounds
These methods can help comfort the infant during the procedure.
What is the most common technique used for circumcision?
Gomco clamp technique
In this technique, the foreskin is separated from the glans and a clamp is applied to crush the foreskin before excision.
What is an alternative device for circumcision?
Plastibell device
This device secures the foreskin with a plastic ring until it sloughs off.
What nursing considerations should be taken before circumcision?
Obtain informed consent, ensure vitamin K has been given, have supplies ready, position the infant securely, provide comfort measures during the procedure, monitor for bleeding/complications
These are critical steps to ensure the safety and comfort of the infant.
What are signs of complications following circumcision?
Excessive bleeding, infection (redness, swelling, purulent drainage), poor urinary stream, injury to the glans, adhesions or skin bridges forming
Monitoring for these signs is important for early intervention.
What vaccine is recommended for all newborns before hospital discharge?
Hepatitis B vaccine
It is given as the first dose in the hepatitis B vaccine series.
What should infants born to HBsAg positive mothers receive in addition to the first hepatitis B vaccine dose?
Hepatitis B immune globulin (HBIG)
This should be given within 12 hours of birth.
What are the remaining doses of the hepatitis B vaccine administered?
1-2 months and 6 months of age
Proper administration of the birth dose and series is crucial for prevention.
What screening should all newborns undergo before 1 month of age?
Hearing screening
This can be done using auditory brainstem response or otoacoustic emissions testing.
What should be done for infants who fail the hearing screening?
Further evaluation and possible early intervention services
Early detection is key for effective management.
What is involved in the newborn metabolic screen?
A blood sample is taken to screen for genetic/metabolic disorders
This includes disorders like phenylketonuria, hypothyroidism, and galactosemia.
What is the purpose of early detection in the newborn metabolic screen?
Prompt treatment to prevent complications
Early intervention can significantly improve outcomes.
What screening method is used for critical congenital heart defects (CCHD)?
Pulse oximetry screening
This is usually done with the metabolic screen.
What do abnormal results in the CCHD screening indicate?
Low oxygen levels that may indicate a CCHD
Examples include hypoplastic left heart syndrome.
What are the discharge criteria for a newborn?
- Term infant
- Appropriate for gestational age
- Normal physical exam
- Stable vital signs
- Successful feedings
- Passed urine/stool
- Bleeding from circumcision resolved
- Newborn screening tests completed
- No significant jaundice or follow-up plan in place
- Mother able to provide adequate care
These criteria ensure the newborn is ready for discharge.
When should the first pediatrician visit be scheduled after discharge?
Within 1-4 days
This helps to ensure the newborn’s health is monitored early.
What support should be ensured for the family upon discharge?
Adequate support system
This includes resources on infant care, breastfeeding, and signs of illness.
What should be confirmed regarding the infant car seat before discharge?
Proper infant car seat use
Ensuring safety during transport is crucial.
What is fetal lung fluid?
Liquid that fills the lungs of the fetus, removed during the first breaths after birth.
What is the function of surfactant?
Substance produced by type II alveolar cells that reduces surface tension in the lungs, preventing alveolar collapse.
What does the ductus venosus do?
Allows oxygenated blood from the umbilical vein to bypass the fetal liver and enter the inferior vena cava.
What is the foramen ovale?
Opening between the atria of the fetal heart that allows blood to bypass the lungs.
What is the ductus arteriosus?
Blood vessel connecting the pulmonary artery to the aorta in the fetus, bypassing the lungs.
What is asphyxia?
Impaired gas exchange leading to hypoxia and hypercapnia.
Define non-shivering thermogenesis.
Heat production by metabolism of brown fat without shivering.
What is brown fat?
Special fat that generates heat to maintain body temperature in newborns.
What is acrocyanosis?
Bluish discoloration of the extremities due to peripheral vasoconstriction.
What is bilirubin?
Yellow pigment produced by the breakdown of red blood cells.
What is hyperbilirubinemia?
Elevated levels of bilirubin in the blood.
What is kernicterus?
Neurological damage caused by bilirubin deposition in the brain.
What does jaundice refer to?
Yellowish discoloration of the skin and mucous membranes due to elevated bilirubin.
What is polycythemia?
Excess concentration of red blood cells.
What is meconium?
First intestinal discharge composed of debris from swallowed amniotic fluid.
What is the first period of reactivity?
Period of wakefulness after birth lasting 30-60 minutes.
What is the second period of reactivity?
Period of increased wakefulness 4-6 hours after birth.
What is vernix caseosa?
Protective white cheesy substance coating the fetal skin.
What is lanugo?
Fine downy hair covering the fetal body.
What are milia?
Small white bumps on the face caused by blocked pores.
What is erythema toxicum?
Rash with yellow or white papules surrounded by redness.
What does harlequin color refer to?
Asymmetric pinkish-red coloration of the body.
What is mottling?
Irregular patchy discoloration of the skin.
What is congenital dermal melanocytosis (CDM)?
Flat, grayish-brown birthmarks.
What is a nevus simplex?
Small, raised reddish birthmarks.
What is a nevus flammeus?
Flat, pink or reddish birthmarks.
What is a nevus vasculosis?
Raised, reddish-purple birthmarks.
What is a café au lait birthmark?
Light brown birthmarks.
What is the first step in the initiation of respirations?
Lung expansion and removal of fetal lung fluid
This process is crucial for establishing normal breathing patterns in newborns.
What is established as part of the initiation of respirations?
Functional residual capacity
This refers to the amount of air remaining in the lungs after a normal exhalation.
What physiological change occurs during the initiation of respirations that increases pulmonary blood flow?
Pulmonary vasodilation
This allows more blood to enter the lungs for oxygenation.
What fetal shunts close during the initiation of respirations?
Foramen ovale, ductus arteriosus, ductus venosus
These shunts are critical for fetal circulation and must close after birth to establish normal circulation.
List the methods of heat loss in newborns.
- Radiation
- Convection
- Conduction
- Evaporation
These methods are important to consider for maintaining a newborn’s body temperature.
What effect does cold stress have on newborns?
- Increased oxygen consumption and metabolic rate
- Peripheral vasoconstriction
- Acrocyanosis
Cold stress can lead to significant physiological responses in newborns that may require intervention.
What are the risk factors that increase bilirubin levels in newborns?
- Prematurity
- Hemolytic disease
- Bruising/cephalohematoma
- Cold stress/hypoglycemia
Elevated bilirubin can lead to jaundice in newborns, necessitating close monitoring.
What is physiologic jaundice?
Mild, harmless jaundice peaking around 3-5 days due to immaturity of liver enzymes. Levels usually <12 mg/dL.
It is a normal occurrence in newborns.
What causes nonphysiologic (pathologic) jaundice?
Caused by hemolytic disease, infections, metabolic disorders. Requires evaluation and possible treatment.
This type of jaundice is often more serious than physiologic jaundice.
What is breastfeeding jaundice?
Jaundice appearing in the first week, often due to caloric deprivation or dehydration. Resolves with increased feeding.
It highlights the importance of regular feeding in newborns.
What defines true breast milk jaundice?
Jaundice appearing after the first week, peaking around 3 weeks to 3 months, caused by substance(s) in breast milk. Usually resolves without treatment.
This condition is distinct from breastfeeding jaundice.
What is insensible water loss?
Fluid lost through the skin and respiratory tract that cannot be measured directly. Higher in newborns due to larger body surface area.
Newborns are particularly vulnerable to dehydration.
How do newborns’ urine concentration abilities affect their risk of dehydration?
Newborns have limited ability to concentrate urine, increasing risk of dehydration.
This limited ability is due to immature renal function.
What is the significance of electrolyte balance in newborns?
Newborns have limited ability to conserve sodium and water, increasing risk of electrolyte imbalances like hypernatremia.
Monitoring is crucial for maintaining proper electrolyte levels.
What is IgG?
The most abundant antibody, transferred from mother to fetus during pregnancy to provide passive immunity for the first 6 months. Predominant in secondary immune responses.
IgG plays a crucial role in long-term immunity.
What is the role of IgM?
The first antibody produced in a primary immune response. Large pentameric structure confined to intravascular spaces.
IgM is essential for initial immune defense.
What is IgA and its function?
Found in bodily secretions as secretory IgA, protecting mucosal surfaces from pathogens. Dimeric structure with secretory component.
IgA is vital for mucosal immunity.
What is the definition of deep sleep?
Eyes closed, regular breathing, no eye movements.
Deep sleep is characterized by a state of rest where the individual is unresponsive to external stimuli.
What are the characteristics of light sleep?
Some eye movements, irregular breathing and sucking movements.
Light sleep is a transitional phase between wakefulness and deeper stages of sleep.
Describe the drowsy state.
Eyes open briefly, then close again. Dull, glazed look.
This state indicates the individual is in a semi-conscious state, often transitioning to sleep.
What does quiet alert mean?
Eyes brighten and move about, appears awake and attentive.
Quiet alert is a state of readiness where the individual is engaged and responsive.
What behaviors are observed in the active alert state?
Moves arms and legs, shows excitement by crying or body activity.
This state is marked by high levels of activity and engagement with the environment.
What defines the crying state?
Vigorous body movement, crying loudly, difficult to console.
Crying is often a response to discomfort or need, indicating a heightened state of distress.
What is tachypnea?
Rapid, shallow breathing over 60 breaths/min, a sign of respiratory distress.
Define retractions in the context of breathing.
Inward movement of intercostal spaces, supraclavicular and subcostal regions with breathing efforts, indicating increased work of breathing.
What does flaring of nares indicate?
Widening of nostrils with inspiration, another sign of respiratory distress.
What is cyanosis?
Bluish discoloration of skin, mucous membranes and nail beds due to lack of oxygen.
What does grunting signify?
Grunting sound on expiration, a compensatory mechanism to keep alveoli open.
Describe seesaw respirations.
Paradoxical inward movement of abdomen with outward chest movement on inspiration, a sign of severe respiratory distress.
What does asymmetry in chest expansion indicate?
Unequal chest expansion, may indicate pneumothorax or diaphragmatic hernia.
What is choanal atresia?
Congenital blocked nasal passage, an obstructive airway anomaly.
What are normal temperature ranges for infants?
97.7-99.5°F (36.5-37.5°C), low temperatures may indicate cold stress.
What is the normal respiration rate for infants?
30-60 breaths/min, monitor rate, rhythm, effort.
What is the normal heart rate range for infants?
100-180 beats/min, bradycardia or tachycardia may signify distress.
What are normal blood pressure ranges for infants?
60-90/30-60 mmHg, lower limits may indicate hypovolemia.
What is the normal weight range for infants?
2700-4000 g (6-9 lbs), monitor for appropriate weight gain.
What is the normal length range for infants?
48-53 cm (19-21 inches), measure recumbent length.
What is the normal head circumference for infants?
33-35 cm (13-14 inches), larger may suggest hydrocephalus.
What is the expected posture of an infant?
Flexed position is normal.
What is a reassuring sign in an infant’s cry?
Lusty, vigorous cry.
What is the expected skin condition of an infant?
Smooth, pink, well-perfused skin.
What is molding in relation to an infant’s head?
Elongated shape from birth canal, resolves in 1-2 days.
What are sutures in the context of an infant’s skull?
Gaps between skull bones that allow molding.
What are fontanels?
Soft spots where skull bones meet, feel for pulsations.
What is caput succedaneum?
Diffuse swelling from pressure, resolves in 2-3 days.
What is a cephalohematoma?
Fluctuant swelling from bleeding under periosteum.
What does low-set ears indicate?
May indicate chromosomal abnormalities.
What should be assessed regarding an infant’s face?
Facial features should be symmetric without dysmorphic features.
What common eye condition can occur after vaginal delivery?
Edematous eyelids and subconjunctival hemorrhages, which should resolve.
What is a normal characteristic of an infant’s nostrils?
Nostrils should be patent and oval-shaped.
What is cleft lip/palate?
Inspect for incomplete fusion of the lip and/or palate, one of the most common congenital craniofacial defects.
What are Epstein’s pearls?
Small keratin-filled cysts on the gum ridges and palate, normal and resolve spontaneously.
What should be observed during an infant’s feeding?
The infant should demonstrate a coordinated sucking, swallowing, and breathing pattern.
What indicates a potential fracture in an infant’s neck/clavicles?
Palpate for crepitus or asymmetry.
What should be observed in the chest of an infant?
Expansion should be symmetric without retractions.
What is pseudomenstruation in female infants?
Thick, mucoid vaginal discharge is normal due to withdrawal of maternal estrogens.
What is hydrocele?
Fluid collection around the testicle causing swelling of the scrotum.
What is cryptorchidism?
Undescended testicle(s), may be inguinal, abdominal or ectopic.
What is hypospadias?
Urethral opening on underside of penis instead of the tip.
What does chordee refer to?
Ventral curvature of the penis due to short urethral plate.
What is syndactyly?
A congenital condition where two or more digits are fused together by soft tissue, bone, or both.
What is polysyndactyly?
A congenital condition where there are extra digits present, either fully formed or partially formed.
What does the Barlow maneuver test for?
Hip instability by applying gentle posterior force to the hip joint.
What is the Ortolani maneuver?
Relocates a dislocated hip by applying gentle anterior force.
What is spina bifida?
Incomplete closure of the vertebral column, ranging from mild to severe.
What is meningocele?
Protrusion of the meninges through a vertebral defect.
What is myelomeningocele?
Severe form where the meninges and part of the spinal cord protrude through a vertebral defect.
What are pilonidal dimples?
Small midline indentations or pits over the lower spine that may indicate an underlying spinal cord abnormality.
What is the Moro reflex?
When an infant is startled by a loud noise or movement, they extend their arms and legs outward and then bring them back in, as if embracing.
What triggers the rooting reflex in infants?
When the corner of the infant’s mouth is stroked, they turn their head and open their mouth to seek the breast or bottle.
What is the sucking reflex?
Infants have an innate ability to suck when their mouth area is stimulated.
What happens during the palmar grasp reflex?
When an object is placed in the palm of an infant’s hand, their fingers automatically close in a grasping motion.
What is the plantar grasp reflex?
Occurs when the sole of the foot is stroked, causing the toes to flex.
What occurs during the tonic neck reflex?
When the infant’s head turns to one side, the arm on that side extends while the opposite arm bends.
What is the asymmetric tonic neck reflex?
Similar to tonic neck, but the leg on the same side as the extended arm also extends.
What happens during the Babinski reflex?
When the sole of the foot is stroked, the toes fan out and the foot dorsiflexes.
What does the galant reflex indicate in infants?
When the infant is pulled to a sitting position, the head lags behind due to lack of neck muscle strength.
What does the square window test assess?
Ability to flex and extend the wrist, indicating maturity of flexor muscle tone.
A square window shape is formed when the wrist is flexed.
What does a smaller popliteal angle indicate?
More mature flexor tone.
The popliteal angle is formed behind the knee when the hip and knee are flexed.
What does the heel to ear test measure?
Hamstring flexibility and maturity.
This test involves bringing the heel close to the ear when the hip and knee are flexed.
What does arm recoil indicate in terms of maturity?
Flexor tone maturity.
The degree of recoil or return to flexion position is measured when the arm is extended and released.
What is assessed by the pectoral girdle test?
Adductor muscle tone by how easily the elbows can be moved across the chest midline.
This test evaluates muscle tone in the upper body.
What does the scarf sign test indicate?
Shoulder mobility and muscle tone.
It assesses the ability to pull the elbows across the neck/chin.
What skin characteristics are evaluated for physical maturity?
Opaqueness, stickiness, and presence of peeling/cracking.
These characteristics decrease with maturity.
What is lanugo and when is it thickest?
Fine body hair, thickest around 22 weeks gestation.
Lanugo sheds with increasing maturity.
What does the plantar surface assessment evaluate?
Creases on foot soles which deepen as maturity increases.
The depth of creases is an indicator of gestational age.
What does the breast assessment evaluate?
Size and maturity of breast node/bud development.
This is an indicator of physical maturity.
What does the eye/ear assessment score?
Fusion of pinna, formation of cartilage in the ear, and residual leakage from eyes.
These factors indicate maturity in the eye and ear structures.
What is assessed for male genital maturity?
Testicular descent and scrotal thickness.
This evaluation is specific to male infants.
What is assessed for female genital maturity?
Sizes of clitoris and labia.
This evaluation is specific to female infants.
What do buttock creases indicate in terms of maturity?
Deepening of gluteal folds as subcutaneous tissue increases with maturity.
The presence of deeper creases is a sign of physical maturity.
What is uterine atony?
Failure of the uterus to contract properly after delivery, which can lead to postpartum hemorrhage.
Uterine atony is a significant cause of postpartum hemorrhage.
Define hematomas in the context of childbirth.
Localized collections of blood outside the blood vessels, often caused by trauma during delivery.
Hematomas can complicate recovery after childbirth.
What are lacerations?
Tearing of the vaginal tissue, perineum, or cervix that can occur during childbirth.
Lacerations may require surgical repair.
What does subinvolution refer to?
Delayed return of the uterus to its pre-pregnancy size after delivery.
Subinvolution can lead to prolonged postpartum bleeding.
What is hypovolemic shock?
Life-threatening condition caused by severe blood and fluid loss, leading to inadequate organ perfusion.
Hypovolemic shock is a medical emergency requiring immediate intervention.
What is a thrombus?
A stationary blood clot that forms within a blood vessel.
Thrombi can lead to serious complications if they obstruct blood flow.
Define thrombophlebitis.
Inflammation of a vein associated with a thrombus or blood clot.
Thrombophlebitis can cause pain and swelling in the affected area.
What is an embolus?
A detached thrombus or other matter (e.g. air, amniotic fluid) that travels through the bloodstream.
Emboli can lead to serious conditions like pulmonary embolism.
What is a pulmonary embolus?
A blockage in the pulmonary artery or its branches, often caused by a dislodged thrombus.
Pulmonary embolism is a critical condition that can lead to death.
What is superficial vein thrombosis?
A blood clot in a vein close to the surface of the skin.
Superficial vein thrombosis is generally less serious than deep vein thrombosis.
Define deep vein thrombosis.
A blood clot that forms within the deep veins, often in the legs or pelvic region.
Deep vein thrombosis can lead to pulmonary embolism if the clot dislodges.
What is puerperal infection?
Any bacterial infection of the genital tract after childbirth or miscarriage.
Puerperal infections can complicate the postpartum period.
What is endometritis?
Inflammation of the inner lining of the uterus, often caused by bacterial infection after delivery.
Endometritis can lead to severe symptoms and requires treatment.
Define mastitis.
Inflammatory condition of the breast, usually associated with infection during breastfeeding.
Mastitis can cause pain and may require antibiotics.
What is metritis?
Infection and inflammation of the uterine muscle wall after childbirth.
Metritis is a serious condition that can lead to systemic infection.
What is postpartum psychosis?
A rare but severe mental illness that can develop suddenly after childbirth, characterized by delusions, hallucinations, and mood disturbances.
Postpartum psychosis requires immediate psychiatric intervention.
What characterizes Bipolar II Disorder?
A type of bipolar disorder involving periods of severe depression alternating with periods of hypomania (less severe than mania).
Bipolar II Disorder can be challenging to diagnose and manage.
What are postpartum anxiety disorders?
Various anxiety disorders, such as panic disorder, obsessive-compulsive disorder, or generalized anxiety disorder, that can develop or worsen after childbirth.
Postpartum anxiety disorders can significantly impact a mother’s well-being and family dynamics.
What is uterine atony?
A condition where the uterus fails to contract properly after childbirth, leading to excessive bleeding.
Uterine atony is one of the most common causes of postpartum hemorrhage.
Name three predisposing factors for uterine atony.
- Over-distention of the uterus
- Multiparity
- Obesity
Other factors include prolonged or precipitous labor, induction or augmentation of labor with oxytocin, and retained placental fragments.
What is a common manifestation of uterine atony?
- Boggy, soft uterine fundus above umbilicus
- Excessive vaginal bleeding
- Clots or tissue expelled from vagina
- Hypotension
- Tachycardia
- Dizziness
These manifestations indicate signs of hypovolemia.
Fill in the blank: One therapeutic management technique for uterine atony is to _______.
massage fundus to stimulate contractions.
What types of medications are administered for uterine atony?
- Oxytocin
- Methylergonovine
- Misoprostol
These are uterotonic medications that help stimulate uterine contractions.
What is the purpose of providing IV fluids in the management of uterine atony?
For volume replacement
This is crucial for treating hypovolemia caused by excessive bleeding.
What surgical interventions might be considered for uterine atony?
- Exploratory curettage
- B-Lynch suture
- Hysterectomy
These interventions are options if conservative measures are ineffective.
True or False: Retained placental fragments can contribute to uterine atony.
True
What should be monitored in patients with uterine atony?
- Vital signs
- Fundal tone
- Lochia
Monitoring these parameters helps assess the patient’s condition and response to treatment.
What is a common predisposing factor for postpartum hemorrhage related to uterine function?
Uterine atony
Uterine atony refers to the lack of muscle tone in the uterus, which can lead to excessive bleeding after childbirth.
Fill in the blank: A retained _______ or placental fragments can predispose a woman to postpartum hemorrhage.
placenta
What type of trauma can be a predisposing factor for postpartum hemorrhage?
Lacerations and hematomas
Trauma during delivery can result in lacerations or hematomas that may lead to significant blood loss.
Name a coagulation issue that can predispose someone to postpartum hemorrhage.
Coagulation defects
What is uterine inversion in relation to postpartum hemorrhage?
Uterine inversion occurs when the uterus turns inside out during or after delivery, leading to hemorrhage.
What condition involving the placenta can lead to postpartum hemorrhage?
Placenta previa and placental abruption
Placenta previa occurs when the placenta covers the cervix, while placental abruption is the premature separation of the placenta from the uterus.
Fill in the blank: Overdistention of the uterus can occur due to _______ gestation, polyhydramnios, or macrosomia.
multiple
What labor-related factor can predispose a woman to postpartum hemorrhage?
Prolonged or augmented labor
What infection can be a risk factor for postpartum hemorrhage?
Chorioamnionitis
True or False: A history of previous postpartum hemorrhage is a risk factor for future occurrences.
True
Name two demographic factors that can predispose to postpartum hemorrhage.
Obesity and advanced maternal age
Both obesity and advanced maternal age can complicate pregnancy and delivery, increasing the risk of hemorrhage.
What is a common medication used to treat postpartum hemorrhage?
Oxytocin
Oxytocin is often administered to stimulate uterine contractions and reduce bleeding.
Fill in the blank: Methylergonovine is contraindicated in patients with _______.
hypertension
What type of drug is Carboprost tromethamine?
Synthetic prostaglandin F2α analog
How is Misoprostol administered for postpartum hemorrhage?
Orally or sublingually
What are the three components of Virchow’s triad?
Venous stasis, endothelial injury, hypercoagulability
These components predispose individuals to thrombosis.
Name three factors that increase the risk of venous stasis.
- Immobility * Heart failure * Bedrest
These factors can lead to poor blood flow and increased risk of thrombus formation.
What are some examples of endothelial injury?
- Trauma * Infection * IV infusions
Endothelial injury can disrupt the normal function of blood vessels and promote clotting.
List three causes of hypercoagulability.
- Inherited coagulation disorders * Cancer * Hormones
Certain conditions can increase the likelihood of clot formation.
What are additional risk factors for thrombosis?
- Advanced age * Obesity * Smoking * Surgery * COVID-19
These factors can further contribute to the risk of developing thrombus.
What are the common predisposing factors for deep vein thrombosis (DVT)?
- Immobility/bedrest * Recent surgery or trauma * Cancer * Pregnancy * Obesity * Oral contraceptives or hormone therapy * Prior history of DVT
These factors significantly increase the risk of DVT.
What are the manifestations of DVT?
- Unilateral leg pain * Tenderness * Swelling * Warmth and erythema of affected limb * Distended superficial veins
Symptoms may vary by individual but typically include these signs.
What is the primary therapeutic management for DVT?
- Anticoagulation therapy * Compression stockings * Ambulation * Leg elevation * Pain management
These strategies aim to prevent complications and alleviate symptoms.
What is the role of heparin in DVT treatment?
Anticoagulant that inhibits thrombin
Heparin is commonly used to prevent and treat thromboembolic events.
What is the antidote for heparin?
Protamine sulfate
This antidote is used to reverse the effects of heparin in cases of overdose.
What is warfarin and how does it work?
Oral anticoagulant that inhibits vitamin K
Warfarin is used for long-term management of thromboembolic disorders.
What is the antidote for warfarin?
Vitamin K
Administering vitamin K can reverse the anticoagulant effects of warfarin.
What is a pulmonary embolism (PE)?
A blockage in one or more pulmonary arteries by a thrombus, fat, air, or tumor tissue
This condition can severely impair oxygenation and lung function.
What are the pathophysiological effects of a PE?
- Obstructed blood flow * Ventilation-perfusion mismatch * Hypoxemia * Pulmonary hypertension * Right ventricular strain * Potential infarction
These effects can lead to serious complications and require urgent treatment.
What are the common manifestations of a PE?
- Sudden onset shortness of breath * Pleuritic chest pain * Cough (may be bloody) * Tachypnea * Tachycardia * Hypoxemia * Low blood pressure * Anxiety * Diaphoresis * Cyanosis
Symptoms of PE can be acute and severe, requiring immediate medical attention.
What therapeutic management options are available for PE?
- Anticoagulation (heparin, enoxaparin, warfarin) * Thrombolytics (alteplase, tenecteplase) * Embolectomy or thrombectomy * Vena cava filter placement * Oxygen therapy * Analgesia
These treatments aim to manage the embolism and restore normal blood flow.
What nursing considerations should be taken when managing a patient with DVT or PE?
- Monitor vital signs * Oxygenation * Cardiac rhythm * Administer oxygen and anticoagulants as prescribed * Provide emotional support * Breathing techniques * Encourage ambulation when stable * Patient education on anticoagulation and risk factor modification
Comprehensive nursing care is crucial for patient recovery and education.
What is the etiology of endometritis?
Bacterial infection of the endometrium, often following childbirth, abortion, or gynecological procedures. Risk factors include prolonged labor, prolonged rupture of membranes, frequent vaginal exams, cesarean delivery.
What are the key manifestations of endometritis?
Fever, uterine tenderness, foul-smelling lochia, tachycardia, malaise, anorexia.
What is the therapeutic management for endometritis?
Intravenous antibiotics (e.g. gentamicin and clindamycin), antipyretics, oxytocics to promote uterine drainage and involution.
What nursing considerations should be taken for endometritis?
Monitor vital signs, assess lochia, provide comfort measures (heat, hydration, nutrition). Teach signs of worsening condition, medication effects, treatment adherence. Support breastfeeding/pumping if separated from infant. Assess for impaired maternal-infant attachment.
What is the etiology of wound infection?
Invasion of wound tissues by microorganisms, often from contaminated instruments, healthcare personnel, air, or the patient’s own body flora. Risk factors include poor wound care, immunocompromise, diabetes, malnutrition.
What are the manifestations of a wound infection?
Erythema, increased drainage (purulent, foul-smelling), warmth, edema, pain at wound site. May have fever, elevated white blood cell count.
What is the therapeutic management for wound infections?
Wound cultures to identify causative organism. Antibiotics (oral or IV) based on culture results. Surgical debridement of necrotic tissue. Proper wound care and dressing changes.
What nursing considerations should be taken for wound infections?
Assess wound characteristics (drainage, odor, surrounding skin). Monitor vital signs. Obtain wound cultures as ordered. Administer antibiotics as prescribed. Provide wound care per protocol - cleansing, packing, dressing changes. Educate on signs of worsening infection. Promote nutrition, glycemic control if diabetic.
What is the etiology of urinary tract infections (UTIs)?
UTIs occur when bacteria, usually from the skin or rectum, enter the urinary tract and multiply. Risk factors include indwelling catheters, pregnancy, poor hygiene, and structural abnormalities.
What are the manifestations of urinary tract infections?
Dysuria, urgency, frequency, hematuria, suprapubic pain. May have fever, chills, flank pain if pyelonephritis.
What is the therapeutic management for urinary tract infections?
Antibiotic therapy based on culture and sensitivity (e.g. trimethoprim/sulfamethoxazole, nitrofurantoin, fluoroquinolones). Duration depends on complicated vs uncomplicated UTI. Increased fluids.
What nursing considerations should be taken for urinary tract infections?
Monitor intake/output, encourage fluids. Provide perineal care, avoid irritants. Administer antibiotics as prescribed. Teach signs of complications. For catheter-associated UTI, remove indwelling catheter if possible.
What is the etiology of mastitis?
Bacterial infection of the breast tissue, often caused by staphylococci entering through cracked nipples or milk ducts in lactating women. Can also occur in non-lactating women.
What are the manifestations of mastitis?
Localized breast pain, redness, swelling, warmth, fever, chills, malaise. Axillary lymph node enlargement and tenderness may occur.
What is the therapeutic management for mastitis?
Antibiotic therapy, pain medication, warm compresses. Surgical drainage if abscess forms. Continued breastfeeding or pumping to prevent milk stasis.
What nursing considerations should be taken for mastitis?
Provide breastfeeding support and education on proper latch/positioning. Encourage frequent feeding/pumping, avoid engorgement. Apply warm compresses before feeding. Ensure mother completes full antibiotic course. Monitor for complications like abscess formation.
What is the etiology of septic pelvic thrombophlebitis?
Infection of the pelvic veins, often following childbirth or pelvic surgery. Risk factors include prolonged labor, retained products of conception, and pelvic infection.
What are the manifestations of septic pelvic thrombophlebitis?
Fever, lower abdominal pain, uterine tenderness, tachycardia, malaise. May have pelvic or leg swelling/tenderness from thrombosis.
What is the therapeutic management for septic pelvic thrombophlebitis?
Intravenous antibiotics, anticoagulants if thrombosis present, possible surgical drainage of infected thrombophlebitic veins.
What nursing considerations should be taken for septic pelvic thrombophlebitis?
Monitor vital signs, assess abdomen/pelvis. Provide comfort measures like heat, hydration, positioning. Administer medications as prescribed. Educate on medication management, signs of complications. Encourage ambulation when stable.
What are the contributing factors to peripartum/postpartum depression?
Hormonal changes, psychological adjustment to parenthood, history of depression, lack of social support
These factors may interact in complex ways, influencing the likelihood and severity of depression.
List some manifestations of peripartum/postpartum depression.
- Depressed mood
- Loss of interest/pleasure
- Feelings of worthlessness/guilt
- Sleep disturbances
- Appetite disturbances
- Fatigue
- Difficulty bonding with infant
Symptoms must last at least 2 weeks for a diagnosis of depression.
What are some therapeutic management strategies for postpartum depression?
- Psychotherapy (cognitive behavioral, interpersonal)
- Antidepressant medications (SSRIs, SNRIs)
- Social support
- Self-care strategies
- Brexanolone
Brexanolone is a new medication specifically developed for postpartum depression.
What nursing considerations should be taken for postpartum depression?
- Screen for symptoms
- Provide emotional support
- Educate on self-care
- Facilitate mother-infant bonding
- Monitor medication effects/side effects
- Encourage involvement of partner/family
- Make mental health referrals as needed
These considerations aim to support the mother’s mental health and promote positive outcomes for both mother and infant.
Define puerperium.
The postpartum period, typically lasting 6-8 weeks after childbirth
During this time, the reproductive organs return to their pre-pregnancy state.
What is involution?
The process of the uterus returning to its pre-pregnancy size and weight after childbirth
Involution is essential for the recovery of the mother’s body post-delivery.
What is decidua?
The mucosal lining of the uterus that is shed during childbirth
This process is part of the normal postpartum recovery.
What does exfoliation refer to in the context of childbirth?
The shedding or peeling off of the decidua from the uterine wall
This is a natural part of the postpartum process.
What is the fundus?
The top, rounded portion of the uterus felt through the abdomen after childbirth
The fundus can be assessed to monitor uterine involution.
Define subinvolution.
Delayed or incomplete involution of the uterus after childbirth
This condition can lead to complications such as postpartum hemorrhage.
What is dyspareunia?
Painful sexual intercourse
This can occur postpartum due to various physical and emotional factors.
What is uterine atony?
Lack of adequate uterine muscle tone and contractions after childbirth
Uterine atony can lead to postpartum hemorrhage, a serious condition.
Define diastasis recti.
Separation of the rectus abdominis (abdominal) muscles along the linea alba during pregnancy
This condition may affect abdominal strength and appearance postpartum.
What is prolactin?
A hormone produced by the pituitary gland that stimulates and maintains milk production
Prolactin levels are crucial for breastfeeding.
What is Rh0(D) Rhogam?
An injection of Rh immunoglobulin given to Rh-negative mothers after the birth of an Rh-positive baby
This prevents Rh sensitization in future pregnancies.
What does REEDA stand for?
Rubor, Edema, Ecchymosis, Discharge, Approximation of wound edges
REEDA is used to assess postpartum recovery.
Define bonding in the context of postpartum.
The formation of a close emotional attachment between a mother and her newborn
Bonding is critical for the emotional development of the infant.
What is attachment?
The deep, lasting emotional connection that develops between an infant and their primary caregiver(s)
This bond influences the child’s emotional and social development.
What are reciprocal attachment behaviors?
Behaviors exhibited by both the infant and caregiver that promote bonding and attachment
These behaviors can include eye contact, smiling, and cooing.
What does ‘en face’ refer to?
When an infant’s face is oriented directly towards the mother’s face during interaction
This position facilitates bonding and communication.
What is ‘fingertipping’?
An infant’s exploratory behavior of touching the mother’s face with their fingers
This behavior is part of the infant’s development and bonding process.
True or False: Postpartum blues are severe mood disturbances that require clinical intervention.
False
Postpartum blues are mild, temporary mood disturbances generally resolving without clinical intervention.
What is lochia rubra?
Reddish or red-brown lochia for the first 3 days after childbirth, consisting mostly of blood and decidual debris.
Lochia rubra is the initial discharge after childbirth, indicating the body’s process of healing and shedding uterine lining.
What characterizes lochia serosa?
Pinkish or brown-tinged lochia from around day 4, containing serous fluid, red blood cells, white blood cells, and tissue debris.
Lochia serosa signifies the transition in the postpartum healing process.
Describe lochia alba.
White, cream or light yellow lochia from around day 10, containing white blood cells, epithelial cells, and cervical mucus.
Lochia alba indicates the later stages of postpartum recovery.
What is a first-degree laceration?
Injury to the vaginal mucosa.
First-degree lacerations are the least severe type of perineal injury during childbirth.
Define a second-degree laceration.
Injury extending into the vaginal musculature.
Second-degree lacerations require more extensive healing compared to first-degree.
What constitutes a third-degree laceration?
Injury extending into the anal sphincter muscles.
Third-degree lacerations can impact bowel control and may require surgical intervention.
What is a fourth-degree laceration?
Injury extending through the anal sphincter into the anorectal mucosa.
Fourth-degree lacerations are the most severe and involve significant recovery.
How does cardiac output change postpartum?
Increases by 30-50% during pregnancy, begins decreasing after delivery but remains elevated for 1-2 weeks.
This increase supports the demands of pregnancy and recovery.
What happens to plasma volume after childbirth?
Increases by 40-50% during pregnancy, returns to pre-pregnancy levels by 2-3 weeks postpartum.
The return to normal plasma volume is crucial for maternal health.
What changes occur in blood values postpartum?
Hemoglobin and hematocrit levels decrease during pregnancy due to hemodilution, begin returning to normal postpartum.
Monitoring these values is essential for detecting anemia.
What is the purpose of Rho(D) immune globulin?
Given to Rh-negative mothers after delivery of Rh-positive infant to prevent isoimmunization.
This is critical in preventing hemolytic disease of the newborn.
How does coagulation change postpartum?
Increased clotting factors during pregnancy return to normal 3-6 weeks postpartum.
This change reduces the risk of thromboembolic events.
What are common gastrointestinal issues postpartum?
Constipation and hemorrhoids common due to decreased GI motility during pregnancy.
Addressing these issues can improve maternal comfort.
How does the urinary system adapt postpartum?
Bladder tone and control improve as uterus involutes.
This return to normal function is important for urinary health.
What musculoskeletal changes occur postpartum?
Abdominal muscle diastasis, pelvic floor weakness, joint laxity improve gradually.
These changes require time and often physical therapy for recovery.
What happens to integumentary system features after pregnancy?
Striae, chloasma, spider angiomas fade over time.
Skin changes are common and often resolve with time.
What neurological symptoms may resolve postpartum?
Carpal tunnel syndrome and lower extremity edema resolve.
These symptoms are often related to fluid retention and hormonal changes.
What is the role of prolactin postpartum?
Prolactin levels elevated to establish lactation, gradual return of menses over 6-12 weeks.
Prolactin is essential for milk production.
What is the recommendation for rubella vaccination during pregnancy?
The MMR vaccine is recommended for all pregnant women who are not immune to rubella.
This helps prevent congenital rubella syndrome in the baby.
When should pregnant women receive the Tdap vaccine?
During the third trimester of each pregnancy.
This allows transfer of pertussis antibodies to the newborn.
What is the recommendation for influenza vaccination in pregnant women?
The inactivated influenza vaccine is recommended during flu season.
This helps prevent influenza complications in the mother and potential adverse effects on the baby.
What vital signs should be monitored for signs of infection or complications?
Temperature, pulse, respirations, blood pressure
Monitoring these vital signs is crucial in assessing the patient’s health status postpartum.
What aspects of the fundus should be assessed postpartum?
Fundal height, firmness, position
This assessment helps monitor uterine involution and rule out hemorrhage.
What should be inspected in the perineum postpartum?
Lacerations, hematomas, edema, episiotomy healing
Inspecting these factors is vital for ensuring proper healing and identifying complications.
What is important to ensure regarding bladder elimination postpartum?
Adequate urinary output and ability to void
This prevents urinary retention and potential complications.
What should be assessed in the breasts postpartum?
Engorgement, cracked nipples, mastitis
Assessing these conditions is important for breastfeeding support and maternal comfort.
What lower extremities assessments should be performed postpartum?
Edema, tenderness, redness
These assessments help rule out thrombophlebitis or thromboembolism.
What comfort measures can be applied to the perineal area postpartum?
Ice packs, sitz baths, perineal care, topical medications, sitting measures, analgesics
These measures help reduce swelling and pain, promoting healing.
What is the purpose of sitz baths in postpartum care?
Cleanse and promote healing
Warm water soaks can provide comfort and aid recovery.
What should be done to manage bladder elimination postpartum?
Encourage voiding every 2-3 hours, provide privacy and running water, monitor urinary output
These actions help facilitate normal bladder function.
What measures can help prevent thrombophlebitis postpartum?
Early ambulation, leg exercises, anti-embolism stockings, anticoagulant therapy
These preventive measures are essential for reducing the risk of thromboembolic events.
What should be provided for pain relief after cesarean birth?
Analgesics as ordered, non-pharmacologic methods like positioning and relaxation techniques
Non-pharmacologic methods include techniques such as deep breathing, distraction, and relaxation exercises.
What should be monitored in terms of respirations after a cesarean birth?
Respiratory rate, encourage coughing/deep breathing exercises
This helps prevent atelectasis and pneumonia.
What abdomen characteristics should be assessed post-cesarean?
Firmness, tenderness, distension, characteristics of dressing, lochia, fundal height/position
These assessments help in evaluating the healing process and identifying potential complications.
How should intake and output be monitored after cesarean delivery?
Measure intake accurately, monitor urine output via catheter or voiding
This is essential to detect urinary retention or hemorrhage.
What is a key aspect of patient education regarding handwashing?
Teach proper handwashing technique to prevent infection
Proper handwashing involves washing with soap and water for at least 20 seconds.
What should patients be instructed about breast care?
Breastfeeding positions, pumping/storing milk if needed
Proper techniques can help ensure successful breastfeeding.
What methods can be advised to suppress lactation if not breastfeeding?
Medication, breast binding
Breast binding should be done carefully to avoid discomfort.
What should patients know about cesarean incision care?
Incision care, signs of infection, activity restrictions
Signs of infection include increased redness, swelling, or discharge.
What perineal care instructions should be provided?
Perineal hygiene, use of sitz baths, peri-pads for comfort
Sitz baths can help with pain relief and healing.
What are Kegel exercises intended to promote?
Pelvic floor exercises to promote healing
Kegel exercises strengthen pelvic muscles and can improve recovery.
How should rest and sleep be encouraged post-cesarean?
Encourage adequate rest and sleep when baby sleeps
This helps in recovery and managing fatigue.
What nutritional advice should be given to breastfeeding mothers?
Balanced diet with extra calories/fluids
Increased caloric intake supports milk production.
What should be discussed regarding bowel elimination?
Increasing fiber, fluids, stool softeners for constipation
Constipation is a common issue after cesarean delivery.
What body mechanics should be taught to avoid straining incisions?
Proper lifting, logrolling
This helps prevent injury and promotes healing.
When should sexual activity be resumed after cesarean delivery?
When ready, discuss birth control options
Patients should feel comfortable and healed before resuming sexual activity.
What follow-up appointments should be scheduled after cesarean birth?
Postpartum and newborn follow-ups
These appointments are crucial for monitoring recovery and infant health.
What signs should prompt a patient to contact their provider after cesarean birth?
Fever, heavy bleeding, severe pain, breathing issues
These symptoms may indicate complications that require medical attention.
What is the Taking-In Phase?
The mother is focused inward, recovering physically and emotionally from the birth experience and may seem passive.
What happens during the Taking-Hold Phase?
The mother becomes more independent, assumes responsibility for her care and the infant’s, and seeks information about newborn behaviors.
What is the Letting-Go Phase?
The mother and father relinquish previous roles and idealized expectations, potentially grieving the loss of their former lifestyle.
Criteria for discharge for the mother includes _______.
Vital signs stable, Lochia normal, Fundus firm, Able to void, Ambulating without dizziness, Healing episiotomy/lacerations, Understanding of self and infant care.
Criteria for discharge for the newborn includes _______.
Stable vital signs, Adequate feeding, Normal voiding/stooling patterns, No signs of illness, Screening tests completed, Proper car seat, Follow-up appointments scheduled.
What is dystocia?
Difficult labor or delivery.
Define hydramnios.
Excess amniotic fluid.
What does oligohydramnios refer to?
Deficient amniotic fluid.
What is hypotonic labor dysfunction?
Contractions are infrequent and lack intensity.
Define hypertonic labor dysfunction.
Excessive uterine muscle tone with little relaxation between contractions.
What is uterine resting tone?
Baseline muscle tone of the uterus between contractions.
What is abruptio placentae?
Premature separation of the placenta from the uterine wall.
What is a tocolytic?
Medication that inhibits uterine contractions.
Define macrosomia.
Excessive birthweight of a newborn.
What is shoulder dystocia?
Complication where the shoulders get stuck after head delivery.
What does cephalopelvic disproportion (CPD) mean?
Mismatch between fetal head size and maternal pelvis.
What is an external cephalic version?
Procedure to turn a breech baby to vertex presentation.
What is uterine rupture?
Tearing of the uterine muscle, potentially life-threatening.
Define prolonged labor.
Abnormally slow progress of labor.
What is precipitate delivery?
Extremely rapid labor and delivery.
What does PROM stand for?
Premature rupture of membranes.
What is pPROM?
PROM before 37 weeks gestation.
Define chorioamnionitis.
Infection of the amniotic fluid and placental tissues.
What is preterm labor?
Labor beginning before 37 completed weeks of pregnancy.
What does fetal fibronectin (fFN) indicate?
Risk of preterm birth.
Define prolonged pregnancy.
Pregnancy lasting beyond 42 weeks gestation.
What is placenta accreta?
Abnormal adherence of placenta to uterine wall.
What does placenta increta mean?
Placenta invades into the myometrium.
Define placenta percreta.
Placenta penetrates through the uterine wall.
What is a prolapsed umbilical cord?
Umbilical cord descends before the fetus.
What is anaphylactoid syndrome?
Severe reaction to medications used during labor.
What are possible causes of ineffective contractions?
- Maternal fatigue
- Dehydration
- Electrolyte imbalances
- Hypoglycemia
- Anemia
- Uterine overdistention
- Ineffective pain management
- Epidural analgesia
These factors can contribute to the failure of uterine contractions to effectively facilitate labor.
What causes ineffective maternal pushing?
- Inadequate pain relief
- Maternal exhaustion
- Improper pushing technique
- Fear of injury
- Lack of encouragement or coaching
- Anesthesia effects like epidural
Addressing these issues can help improve the effectiveness of maternal pushing during labor.
What fetal problems are associated with dysfunctional labor?
- Fetal hypoxia
- Fetal acidosis
- Meconium aspiration
- Birth injuries
These complications can arise due to prolonged or ineffective labor.
What are the signs of intrapartum infection?
- Maternal fever
- Fetal tachycardia
- Uterine tenderness
- Foul-smelling vaginal discharge
Recognizing these signs is critical for timely intervention during labor.
What is the etiology of premature rupture of membranes (PROM)?
The exact cause is often unknown, but risk factors include:
* Infection
* Smoking
* Previous PROM
* Cervical incompetence
* Polyhydramnios
These factors can contribute to the weakening of the membranes.
What are the manifestations of premature rupture of membranes?
Leakage of amniotic fluid from the vagina before labor begins.
This can indicate potential complications for both mother and fetus.
What therapeutic management is recommended for PROM if infection is present?
Antibiotics are administered.
This is to prevent further complications from the infection.
What is used to aid fetal lung maturity in cases of PROM at preterm?
Corticosteroids are used.
This helps in the development of the fetal lungs.
What are the nursing considerations for managing PROM?
Nursing considerations include:
* Monitor fetal heart rate
* Monitor temperature
* Monitor signs of chorioamnionitis
* Provide emotional support and education
* Encourage fluid intake
* Monitor intake/output
* Prepare for possible preterm birth
These actions help ensure the safety and health of both the mother and fetus.
What are the risk factors for preterm labor?
Risk factors include:
* Maternal age <18 or >40 years
* Low socioeconomic status
* Previous preterm delivery
* Intrauterine infections
* Polyhydramnios
* Multiple gestation
* Uterine anomalies
* Antepartum hemorrhage
* Smoking
* Drug use
* Urinary tract infections
* Incompetent cervix
These factors can increase the likelihood of labor starting prematurely.
What are the manifestations of preterm labor?
Manifestations include:
* Uterine contractions
* Cervical changes (effacement, dilation)
These signs indicate that the body is preparing for labor.
What therapeutic management is used to inhibit contractions in preterm labor?
Tocolytics are used to inhibit contractions.
This helps delay delivery and allows for further fetal development.
What is the purpose of administering corticosteroids in preterm labor?
Corticosteroids are administered to aid fetal lung maturity.
This is critical for reducing respiratory complications in preterm infants.
What nursing considerations are important for managing preterm labor?
Nursing considerations include:
* Assess for signs/symptoms of PTL
* Monitor fetal heart rate
* Provide emotional support
* Educate on PTL symptoms
* Encourage fluid intake
* Prepare for potential preterm birth
These considerations are essential for the health and safety of the mother and fetus.
What is the primary use of magnesium sulfate in obstetrics?
Relaxes uterine smooth muscle, used for tocolysis and preeclampsia prevention
Given IV with loading then maintenance doses.
What is the mechanism of action of calcium antagonists like nifedipine?
Inhibits calcium entry into smooth muscle cells
Used off-label for tocolysis with oral administration.
What is the role of prostaglandin synthesis inhibitors like indomethacin?
Inhibits prostaglandin production, decreasing uterine contractions
Used for short-term tocolysis and contraindicated in some conditions.
Which beta adrenergic medication is used for acute tocolysis?
Terbutaline
Stimulates beta-2 receptors to relax uterine smooth muscle; not recommended for prolonged use due to maternal risks.
What is the purpose of corticosteroids like betamethasone and dexamethasone in preterm delivery?
Aid fetal lung maturity
Given as injections 24 hours apart when preterm delivery is anticipated.
What are common etiologies for uterine rupture?
- Previous uterine surgery (cesarean birth, myomectomy)
- Obstructed labor
- Excessive uterine activity
- Trauma
What are the manifestations of uterine rupture?
- Severe abdominal pain
- Abnormal fetal heart rate
- Vaginal bleeding
- Loss of contractions
- Maternal shock
What is the therapeutic management for uterine rupture?
- Emergency cesarean delivery
- Treatment for hemorrhagic shock
- Possible hysterectomy
What nursing considerations are important for uterine rupture?
- Promptly recognize signs/symptoms
- Monitor vital signs
- Prepare for emergency delivery
- Provide emotional support
- Anticipate need for blood products
What is a common cause of uterine inversion?
- Excessive traction on the umbilical cord
- Fundal pressure before placental separation
- Abnormal adherence of the placenta
What are the manifestations of uterine inversion?
- Severe pain
- Hemorrhage
- Shock
- Protrusion of the uterus through the cervix
What is the therapeutic management for uterine inversion?
- Prompt manual replacement of the inverted uterus
- Oxytocin to contract the uterus
- Treatment for hemorrhagic shock if present
What nursing considerations should be taken for uterine inversion?
- Recognize signs promptly
- Call for assistance
- Provide emotional support
- Monitor vital signs
- Prepare for potential surgery if manual replacement fails
What is Amniotomy?
Artificial rupture of the amniotic membranes to induce or augment labor.
Define Chorioamnionitis.
Inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection.
What is Hydramnios?
Excessive accumulation of amniotic fluid, defined as an amniotic fluid index greater than 25cm or a single deepest pocket over 8cm.
What does Cephalopelvic disproportion (CPD) refer to?
Failure of the fetal head to pass through the maternal pelvis due to inadequate pelvic dimensions.
What is a Chignon?
A circular mass of edematous vaginal tissue that forms behind the fetal head during labor.
What is an Episiotomy?
A surgical incision made in the perineum to enlarge the vaginal opening during childbirth.
What does VBAC stand for?
Vaginal Birth after Cesarean.
List the indications for Amniotomy.
- Induce or augment labor
- Aid in internal fetal monitoring
What are the risks associated with Amniotomy?
- Infection
- Cord prolapse
- Fetal injury
Describe the technique of Amniotomy.
A plastic hook is used to rupture the amniotic sac during a vaginal exam, and the hole is enlarged with a finger to allow fluid drainage.
What nursing considerations should be taken before performing an Amniotomy?
- Ensure fetal presentation is cephalic and engaged
- Monitor fetal heart rate
- Watch for cord prolapse
- Provide emotional support and explain procedures
What are the indications for Induction and Augmentation of labor?
- Post-term pregnancy
- Premature rupture of membranes
- Maternal conditions (hypertension, diabetes)
- Fetal compromise
What are the risks of Induction and Augmentation of labor?
- Uterine hyperstimulation
- Non-reassuring fetal heart rate
- Increased risk of cesarean delivery
What is the role of Prostaglandin E2 (dinoprostone) in cervical ripening?
It is used as an intravaginal or intracervical gel/insert to soften and dilate the cervix.
What is Misoprostol used for in the context of labor?
It is a synthetic prostaglandin tablet used off-label for cervical ripening.
How is Oxytocin administered for labor induction?
As an IV infusion to stimulate uterine contractions, requiring continuous fetal monitoring.
What nursing considerations are important during Induction and Augmentation of labor?
- Assess cervical status
- Obtain informed consent
- Monitor fetal heart rate and uterine activity
- Watch for complications
- Provide emotional support
What are the indications for performing a version?
Breech presentation at or near term.
What risks are associated with performing a version?
- Placental abruption
- Umbilical cord complications
- Fetal distress
- Need for emergency cesarean delivery
Describe the technique used for performing a version.
The provider applies pressure to the abdomen to rotate the fetus to a vertex (head-down) position.
What nursing considerations should be taken during a version procedure?
- Ensure procedure is performed in a setting with capability for emergency cesarean
- Monitor fetal heart rate continuously
- Provide analgesia as needed
- Prepare for potential complications
What are the indications for using a vacuum extractor during operative vaginal birth?
Shortening second stage of labor, fetal distress
Indications highlight when the vacuum extractor is deemed necessary for safe delivery.
What are the risks associated with the use of a vacuum extractor?
Scalp injuries, cephalohematoma, subgaleal hemorrhage
Understanding risks is crucial for informed consent and monitoring.
Describe the technique used for a vacuum extractor.
A vacuum cup is applied to the fetal scalp and traction is applied during contractions
Proper technique is essential to minimize risks and ensure efficacy.
List the nursing considerations when using a vacuum extractor.
Ensure proper cup placement, monitor fetal heart rate, watch for trauma
Nursing considerations are vital for patient safety and effective care.
What are the indications for using forceps during delivery?
Prolonged second stage, fetal distress
These indications help determine the necessity of forceps.
What risks are associated with the use of forceps?
Facial injuries, cephalohematoma, eye trauma
Awareness of risks can aid in monitoring and postoperative care.
Explain the technique for using forceps in delivery.
Forceps blades are inserted around the fetal head and traction is applied during contractions
This technique requires skill to prevent injury to both mother and baby.
What nursing considerations should be taken into account when using forceps?
Ensure proper placement, monitor fetal heart rate, watch for trauma, provide postpartum perineal care
Comprehensive nursing care is essential for recovery.
What are the indications for performing a cesarean section?
Fetal distress, abnormal fetal presentation, cephalopelvic disproportion, placental problems, failed labor progress, maternal conditions
These indications guide the decision-making process for cesarean delivery.
List the risks associated with cesarean sections.
Hemorrhage, infection, injury to surrounding organs, increased risks in future pregnancies
Understanding these risks is crucial for informed decision-making.
Describe the technique of performing a cesarean section.
Abdominal and uterine incisions are made to deliver the fetus. The placenta is then removed
The surgical technique requires precision and skill.
What nursing considerations are important following a cesarean section?
Provide preoperative teaching, emotional support, monitor vital signs, fundal height, lochia, pain levels postpartum, encourage early ambulation, breastfeeding, coughing/deep breathing, assess for complications
Postoperative care is critical for recovery and complication prevention.
What is analgesia?
Relief of pain without loss of consciousness.
What is anesthesia?
Loss of sensation or consciousness, induced for medical purposes.
Define pain perception.
The subjective experience of pain as interpreted by the brain.
What is pain tolerance?
The maximum level of pain that is bearable.
What is effleurage?
A massage technique using long, gliding strokes to promote relaxation.
List the sources of pain in childbirth.
- Uterine contractions
- Cervical dilation
- Descent and rotation of the fetal head
- Stretching of the birth canal and perineum
What is self-massage in the context of nonpharmacological interventions?
The woman uses effleurage or circular motions on her lower back, abdomen, or thighs.
How does massage serve as a nonpharmacological intervention?
The support person provides massage to the woman’s back, shoulders, or legs.
What is thermal stimulation?
Applying heat (e.g. warm packs) or cold (e.g. ice packs) to the back or abdomen.
What is acupressure?
Applying pressure to specific points on the body to relieve pain.
Define hydrotherapy.
Immersion in a warm shower or bath to promote relaxation.
What is guided imagery?
Visualizing a peaceful scene or memory to shift focus away from pain.
What is a focal point in pain management?
Concentrating on an object or picture to distract from contractions.
Fill in the blank: _______ is a breathing technique involving inhaling and exhaling slowly to remain calm.
Slow-paced breathing
What is modified-paced breathing?
Inhaling through the nose and exhaling through pursed lips.
Define pattern-paced breathing.
Inhaling for a specific number of counts and exhaling for a different number.
What is regional anesthesia?
Blocks pain in a specific region of the body
Regional anesthesia is used to target specific areas for pain relief.
What is a pudendal block?
Anesthetic injected near the pudendal nerve to numb the vagina and perineum
Commonly used in obstetric procedures.
What is local infiltration?
Local anesthetic injected into the perineum
Used for minor surgical procedures in the area.
What is an epidural block?
Anesthetic injected into the epidural space in the spine to numb the body from the abdomen down
Often used during labor and delivery.
What are some complications associated with epidural blocks?
Hypotension, headache, difficulty urinating
These complications can arise due to the effects of the anesthetic.
What is a subarachnoid (spinal) block?
Anesthetic injected into the cerebrospinal fluid to numb the body from the abdomen down
Provides rapid onset of anesthesia.
What are inhalants used for in anesthesia?
Nitrous oxide gas inhaled to provide analgesia
Commonly used for pain relief in various procedures.
What are opioids?
Narcotics like meperidine or fentanyl given IV to provide analgesia
Used for severe pain management.
What are sedatives (barbiturates)?
Medications that depress the central nervous system, providing sedation
Often used to calm patients before surgical procedures.
What is general anesthesia?
Complete unconsciousness induced by intravenous or inhaled anesthetics
Used for major surgical procedures requiring full sedation.
What is hypoxia?
Deficient oxygenation of tissues and organs
Hypoxia can lead to tissue damage and organ dysfunction.
Define hypercapnia.
Excess carbon dioxide in the bloodstream
Hypercapnia can cause respiratory acidosis and affect brain function.
What does hypoxemia refer to?
Deficient oxygen in the blood
Hypoxemia can result from various conditions including respiratory diseases.
What is acidosis?
Excessive acidity in the blood and body tissues
Acidosis can occur due to metabolic or respiratory issues.
What does tachysystole mean?
Abnormally frequent uterine contractions
Tachysystole can complicate labor and affect fetal well-being.
Define transducer.
A device that converts one form of energy into another for measurement
Transducers are commonly used in medical monitoring equipment.
What is a tocotranducer?
A transducer that measures uterine contractions
Tocotransducers help monitor labor progress.
What is uterine resting tone?
The muscle tone of the uterus between contractions
Uterine resting tone is important for fetal oxygenation.
What is amnioinfusion?
Instillation of fluid into the amniotic cavity
Amnioinfusion can help relieve umbilical cord compression.
Define variability in the context of fetal heart rate.
Fluctuations in the fetal heart rate pattern
Normal variability indicates a healthy fetal condition.
What are accelerations in fetal heart rate?
Temporary increases in fetal heart rate
Accelerations are generally a sign of fetal well-being.
What are decelerations in fetal heart rate?
Temporary decreases in fetal heart rate
Decelerations can indicate potential fetal distress.
What is fetal scalp stimulation?
Stimulating the fetal scalp to prompt fetal heart rate accelerations
This technique can provide information about fetal status.
What is a tocolytic?
A medication that inhibits uterine contractions
Tocolytics are used to manage preterm labor.
List the five factors that interact to regulate fetal heart rate.
- Autonomic nervous system
- Chemoreceptors
- Baroreceptors
- Hormones
- Blood gases
These factors work together to maintain fetal homeostasis.
What are the maternal risk factors for fetal compromise?
- Hypertension
- Diabetes
- Substance abuse
Maternal health directly impacts fetal development.
What are the placental risk factors for fetal compromise?
- Placental insufficiency
- Abruption
Issues with the placenta can lead to inadequate oxygen and nutrient supply.
List umbilical cord factors that can compromise fetal health.
- Cord compression
- Knots
- Prolapse
Umbilical cord issues can significantly affect fetal heart rate and well-being.
What fetal factors can lead to compromise?
- Congenital anomalies
- Growth restriction
- Postdates
These factors can affect the fetus’s ability to cope during labor.
What are intrapartum factors that may contribute to fetal compromise?
- Abnormal labor
- Fetal intolerance to labor
Monitoring during labor is crucial to detect these issues.
What is external fetal monitoring?
External fetal monitoring involves using two transducer devices placed on the mother’s abdomen.
The two devices are the ultrasound transducer and the tocotransducer.
What does the ultrasound transducer do in external fetal monitoring?
It detects the fetal heart rate by using the Doppler principle to identify fetal cardiac motion.
The ultrasound transducer is one of the two devices used in external monitoring.
What is the function of the tocotransducer?
The tocotransducer measures the frequency, duration, and intensity of uterine contractions by detecting changes in the shape of the mother’s abdomen.
It is a pressure sensor used in external fetal monitoring.
What information does external fetal monitoring provide?
It provides a continuous record of fetal heart rate patterns and uterine activity during labor.
This helps assess fetal oxygenation and response to contractions.
What is internal fetal monitoring?
Internal fetal monitoring involves the use of an electrode attached directly to the fetal presenting part to obtain an accurate measure of fetal heart rate.
It provides more precise measurements compared to external methods.
What is a fetal scalp electrode?
A spiral electrode inserted through the dilated cervix and attached to the fetal scalp to detect electrical signals from the fetal heart.
This is one type of internal monitoring.
What is fetal scalp sampling?
A small plastic cone is guided through the cervix to obtain a sample of fetal scalp blood for measuring fetal acid-base balance.
It is another type of internal monitoring.
What is the normal fetal heart rate (FHR) range?
110-160 beats per minute.
This range is essential for assessing fetal well-being.
What causes early decelerations in fetal heart rate?
Fetal head compression during contractions.
Early decelerations are not associated with fetal compromise.
What are variable decelerations caused by?
Umbilical cord compression.
Recurrent variable decelerations may indicate fetal compromise.
What interventions may be necessary for recurrent variable decelerations?
Amnioinfusion, changing maternal position, oxygen.
These interventions aim to alleviate cord compression.
What causes late decelerations in fetal heart rate?
Uteroplacental insufficiency/fetal hypoxia.
Late decelerations signal serious fetal compromise.
What interventions may be required for late decelerations?
Oxygen, hydration, positioning, preparing for operative delivery.
These interventions are critical in cases of fetal distress.
What is a contraction?
Rhythmic tightening and relaxation of the uterine muscles during labor to dilate the cervix and push the fetus through the birth canal.
Contractions are essential for labor progression.
What is cervical effacement?
Thinning and shortening of the cervix during labor as it prepares for dilation.
It is a key process in labor preparation.
What is cervical dilation?
Opening and stretching of the cervix during labor to allow passage of the fetus.
This is critical for childbirth.
What are sutures?
Fibrous joints between the bones of the fetal skull that allow molding during birth
Sutures facilitate the flexibility of the fetal skull during delivery.
What are fontanels?
Soft spots on the fetal skull where the skull bones meet but have not yet fused
Fontanels allow for further molding of the skull during birth.
What is molding in the context of childbirth?
Overlapping and shifting of the fetal skull bones to allow passage through the birth canal
Molding helps the fetal head fit through the narrower parts of the birth canal.
Define fetal lie.
Relationship of the long axis of the fetus to the long axis of the mother
Fetal lie can be longitudinal, transverse, or oblique.
What is fetal attitude?
Relationship of the fetal body parts to itself, such as flexed or extended
Fetal attitude affects the delivery process.
What is cephalic presentation?
Head-first position of the fetus in the birth canal
This is the most common and favorable presentation for birth.
What is breech presentation?
Buttocks or feet-first position of the fetus in the birth canal
Breech presentation can complicate delivery and may require cesarean section.
Define Braxton Hicks contractions.
Irregular, painless uterine contractions that occur before true labor
Often referred to as ‘practice contractions’.
What does lightening refer to in pregnancy?
Dropping of the fetal head into the pelvis before labor begins
This often occurs a few weeks before labor starts.
What is a bloody show?
Small amount of bloody vaginal discharge from dilation of the cervix
This can indicate that labor is approaching.
Define true labor.
Regular, progressively stronger uterine contractions signaling the start of active labor
True labor leads to cervical dilation and effacement.
What is false labor?
Irregular contractions that are not true labor and do not cause cervical change
False labor can be confusing for expectant mothers.
What is fetal station?
Measurement of descent of the fetal presenting part in relation to the ischial spines
Fetal station is measured in centimeters above or below the ischial spines.
What does crowning mean?
Appearance of the fetal presenting part at the vaginal opening
Crowning indicates that delivery is imminent.
What is an amniotomy?
Artificial rupture of the amniotic membranes
This procedure is often performed to induce or accelerate labor.
What does APGAR stand for?
Scoring system to evaluate the newborn’s condition at 1 and 5 minutes after birth
APGAR assesses Appearance, Pulse, Grimace response, Activity, and Respiration.
List the four components of the Birth Process.
- Powers
- Passage
- Passenger
- Psyche
Each component plays a crucial role in the labor and delivery process.
What are the ‘Powers’ in the Birth Process?
The forces that help expel the fetus, including uterine contractions, maternal bearing-down efforts, and intra-abdominal pressure
Effective powers are essential for successful labor.
What does ‘Passage’ refer to in the Birth Process?
The path the fetus must travel, including the bony pelvis and soft birth canal (cervix, vagina)
The passageway must be adequate for the fetus to be delivered.
What is the ‘Passenger’ in the context of childbirth?
The fetus itself, including size, presentation, position, and attitude
The characteristics of the passenger can influence the labor process.
What does ‘Psyche’ refer to in the Birth Process?
The psychological and emotional state of the mother, which can influence labor progress and pain perception
A positive mental state can facilitate smoother labor.
What occurs during the latent phase of the first stage of labor?
Early, irregular contractions and cervical effacement occurs
The latent phase is characterized by slow cervical changes and variable contractions.
What defines the active phase of the first stage of labor?
Regular, stronger contractions and rapid cervical dilation
This phase typically occurs when dilation is between 4-7 cm.
What is the transition phase in the first stage of labor?
Contractions intense and frequent, fetal descent begins
This phase occurs when cervical dilation reaches 8-10 cm.
What is the second stage of labor also known as?
Laboring down
This stage involves complete cervical dilation and the mother actively pushing to deliver the baby.
What happens during the third stage of labor?
Separation and delivery of the placenta after the baby is born
This stage is crucial for maternal recovery and preventing hemorrhage.
What is monitored during the fourth stage of labor?
Bleeding and uterine tone in the first 4 hours after placenta delivery
This stage is critical for maternal safety and recovery.
List three nurse responsibilities during birth.
- Provide emotional support and coaching to the laboring woman
- Monitor fetal heart rate and uterine contractions
- Administer medications and IV fluids as ordered
Nurses play a crucial role in supporting both the mother and the healthcare team during labor.
What should a nurse assess after the birth of the mother?
Mother’s fundus, lochia, and for bladder distension
This assessment helps ensure the mother’s recovery and identify any complications.
What vital signs are monitored postpartum?
Vital signs and uterine tone
Monitoring these is essential for detecting any immediate postpartum complications.
What are some postpartum teaching topics for new mothers?
- Self-care
- Contraception
- Newborn care
- Breastfeeding
These topics are important for the health and well-being of both mother and child.
What should the nurse do with the placenta after delivery?
Inspect placenta for completeness and membranes
This is important to prevent complications such as retained placenta.
True or False: The nurse assists with pushing efforts during the second stage of labor.
True
Nurses provide crucial support and coaching to help the mother during this stage.
What is one of the key responsibilities of a nurse when preparing for delivery?
Cut the umbilical cord
This is part of the immediate care provided to the newborn after birth.
Fill in the blank: The first stage of labor consists of three phases: latent, active, and _______.
transition
Each phase has distinct characteristics and progression.
What is the focus during the fourth stage of labor?
Monitoring for bleeding and uterine tone
This is to ensure the mother’s safety and recovery after childbirth.
What is one way a nurse facilitates parent-infant bonding after delivery?
Facilitate parent-infant bonding
This can include skin-to-skin contact and encouraging breastfeeding.
What is abortion?
Purposeful termination of pregnancy.
What is Dilation & Evacuation (Curettage)?
Procedure where the cervix is dilated and products of conception are removed from the uterus, typically used for later abortions.
Define abruptio placentae.
Premature separation of the implanted placenta before birth, an obstetric emergency.
What is cerclage?
Procedure where the cervix is stitched closed to prevent premature birth.
What is an ectopic pregnancy?
Pregnancy where the fertilized egg implants outside the uterus, usually in the fallopian tube.
What is a salpingectomy?
Surgical removal of a fallopian tube, often due to ectopic pregnancy.
Define gestational trophoblastic disease.
Group of rare tumors that involve abnormal growth of cells inside the uterus.
What is vacuum aspiration?
Procedure using suction to remove contents of the uterus, common for early abortions.
What is placenta previa?
Placenta implants low in the uterus, partially or completely covering the cervix.
Define hyperemesis gravidarum.
Severe, excessive nausea and vomiting during pregnancy.
What is preeclampsia?
Pregnancy complication of high blood pressure, protein in urine, and other symptoms.
What is eclampsia?
Life-threatening condition where preeclampsia leads to seizures.
Define HELLP syndrome.
Syndrome of hemolysis, elevated liver enzymes, and low platelets occurring with preeclampsia.
What is ABO incompatibility?
Condition when the mother’s and baby’s blood types are incompatible, causing anemia in the newborn.
What is a spontaneous abortion?
Unintended termination of pregnancy before 20 weeks gestation.
What characterizes a threatened abortion?
Vaginal bleeding with closed cervix, pregnancy may continue or abort.
What is an inevitable abortion?
Cervix dilated with cramping/bleeding, unable to stop the abortion process.
What is an incomplete abortion?
Some products of conception remain in the uterus after passage of fetal/placental tissue.
What is a complete abortion?
All products of conception expelled from the uterus.
Define missed abortion.
Fetal demise without expulsion of products of conception.
What is habitual/recurrent abortion?
Three or more consecutive spontaneous abortions, may be caused by uterine abnormalities, genetic factors, or other conditions.
List manifestations of ectopic pregnancy.
- Abdominal/pelvic pain (may be sharp, unilateral)
- Vaginal bleeding (can range from spotting to heavy)
- Missed period, nausea, breast tenderness (early pregnancy symptoms)
- In severe cases: hemorrhage, dizziness, signs of shock
What diagnostics are used for ectopic pregnancy?
- Quantitative hCG levels
- Transvaginal ultrasound
- Culdocentesis (aspiration of peritoneal fluid)
What are therapeutic management options for ectopic pregnancy?
- Methotrexate (medication)
- Salpingectomy (surgical removal of fallopian tube)
- Salpingostomy (making an incision in tube to remove pregnancy)
What is the function of methotrexate in ectopic pregnancy?
Stops rapidly dividing cells by inhibiting DNA synthesis.
What are nursing considerations for ectopic pregnancy?
- Monitor vital signs, symptoms like pain/bleeding
- Provide emotional support
- Teach about ectopic pregnancy and treatment options
- Prepare for procedures or surgery
- Assess for treatment side effects like abdominal cramping
What are the manifestations of Hydatiform Mole?
- Excessive nausea/vomiting
- Vaginal bleeding (dark, old blood)
- Uterus larger than gestational age
- Ovarian cysts
- High hCG levels
Hydatiform mole is characterized by abnormal growth of trophoblastic tissue.
What diagnostic methods are used for Hydatiform Mole?
- Pelvic exam
- Ultrasound (shows grapelike placental vesicles)
- Quantitative hCG levels
Ultrasound is crucial for visualizing the characteristic vesicles.
What are the therapeutic management options for Hydatiform Mole?
- Suction dilation and curettage (D&C)
- Hysterectomy if severe bleeding or malignancy
D&C is often the first-line treatment to remove the abnormal tissue.
What nursing considerations are important for a patient with Hydatiform Mole?
- Monitor vital signs, vaginal bleeding
- Provide emotional support for pregnancy loss
- Teach about hydatidiform mole and treatment
- Prepare for D&C or surgery
- Monitor for complications like infection, hemorrhage
- Contraception counseling after treatment
Emotional support is vital due to the nature of pregnancy loss.
What are the types of Placenta Previa?
- Marginal - placenta extends to the edge of the internal cervical os
- Partial - placenta partially covers the internal cervical os
- Total - placenta completely covers the internal cervical os
The classification of placenta previa is based on how much the placenta covers the cervical opening.
What are the main manifestations of Placenta Previa?
- Painless vaginal bleeding in third trimester
- Soft, non-tender uterus on palpation
Painless bleeding is a hallmark of placenta previa.
What diagnostic methods are used for Placenta Previa?
- Ultrasound examination
- Speculum exam to visualize placenta
Ultrasound is important for assessing the location of the placenta.
What are the therapeutic management strategies for Placenta Previa?
- Expectant management if bleeding is light and fetus premature
- Corticosteroids to mature fetal lungs
- Cesarean delivery, often before labor
Timing of delivery is critical based on the severity of the condition.
What nursing considerations are important for a patient with Placenta Previa?
- Monitor bleeding, vital signs, fetal status
- Prepare for possible urgent C-section
- Provide emotional support
- Administer medications as ordered
- Avoid vaginal exams which can cause bleeding
Avoiding vaginal exams is crucial to prevent exacerbating bleeding.
What are the classic signs and symptoms of Abruptio Placentae?
- Vaginal bleeding
- Abdominal pain
- Uterine tenderness
- Abnormal fetal heart rate
- Uterine contractions
Abruptio placentae involves premature separation of the placenta from the uterus.
What additional signs may accompany Abruptio Placentae?
- Back pain
- Signs of hypovolemic shock
- Fetal death
These signs indicate potential severity and complications of the condition.
What diagnostic methods are utilized for Abruptio Placentae?
- Physical exam findings like uterine tenderness and abnormal fetal heart tones
- Ultrasound to visualize placental separation
- Laboratory tests like fibrinogen levels and coagulation studies
Diagnosis often requires a combination of clinical assessment and imaging.
What are the therapeutic management options for Abruptio Placentae?
- Expectant management with bed rest and monitoring for mild cases before 34 weeks
- Prompt delivery via C-section for severe cases or fetal compromise
- Blood products for hemorrhage
- Tocolytics and corticosteroids as needed
Management is determined by the severity of the condition and gestational age.
What nursing considerations are critical for a patient with Abruptio Placentae?
- Monitor maternal vital signs, bleeding, pain levels, and fetal status
- Prepare for potential urgent delivery
- Provide emotional support
- Administer ordered medications and blood products
- Assist with postpartum hemorrhage precautions
Close monitoring is essential for maternal and fetal well-being.
What are the manifestations of hyperemesis gravidarum?
Severe, persistent nausea and vomiting, dehydration, electrolyte imbalances (low sodium, potassium, chloride), weight loss, ketonuria
What diagnostics are used for hyperemesis gravidarum?
Physical exam, hemoglobin/hematocrit levels, electrolyte studies, elevated creatinine indicating renal dysfunction
What are the therapeutic management strategies for hyperemesis gravidarum?
Hydration with IV fluids and electrolyte replacement, total parenteral nutrition (TPN) if unable to tolerate oral intake, antiemetics like promethazine, ondansetron, metoclopramide, pyridoxine (vitamin B6), ginger, corticosteroids like methylprednisolone
What nursing considerations are important for hyperemesis gravidarum?
Monitor intake/output, weight, electrolytes, administer antiemetics and other medications as ordered, provide small, frequent meals and hydration, suggest non-pharmacological nausea relief techniques, provide emotional support and education
What is the blood pressure threshold for gestational hypertension?
Blood pressure ≥140/90 mmHg after 20 weeks gestation
What are the manifestations of preeclampsia?
Hypertension plus proteinuria, edema, headaches, visual disturbances
What diagnostics are used for preeclampsia?
24-hour urine protein, bloodwork, ophthalmoscopy
What are the manifestations of eclampsia?
Preeclampsia plus seizures
What diagnostics are used for eclampsia?
Physical assessment, bloodwork
What are the manifestations of HELLP syndrome?
Hemolysis, elevated liver enzymes, low platelets
What diagnostics are used for HELLP syndrome?
Bloodwork (LFTs, platelets, peripheral smear)
What is the therapeutic management for eclampsia and severe preeclampsia/HELLP?
Delivery for eclampsia, severe preeclampsia/HELLP, antihypertensives like hydralazine, labetalol, nifedipine, magnesium sulfate for seizure prophylaxis
What is hydralazine used for?
Vasodilator for acute hypertension
What is nifedipine used for?
Calcium channel blocker antihypertensive
What is labetalol used for?
Alpha/beta blocker antihypertensive
What is magnesium sulfate used for?
Anti-seizure, smooth muscle relaxant
What nursing considerations should be taken for patients with gestational hypertension or preeclampsia?
Frequent monitoring of BP, symptoms, fetal status, strict I&O, bedrest, side positioning, prepare for potential urgent delivery, administer medications per protocol, provide education and emotional support
What are the manifestations of Rh incompatibility?
Jaundice, anemia, edema in newborn with hemolytic disease of the newborn (HDFN), fetal hydrops, heart failure in severe cases
What diagnostics are used for Rh incompatibility?
Maternal/newborn blood typing and antibody screening, amniocentesis to check bilirubin levels, Doppler ultrasound to assess fetal anemia
What is the therapeutic management for Rh incompatibility?
Rho(D) immune globulin for unsensitized Rh-negative mothers after potential sensitizing events, intrauterine fetal blood transfusions, exchange transfusions after birth, phototherapy for newborn jaundice
What is Rho(D) immune globulin used for?
Prevents Rh isoimmunization in Rh-negative mothers
What nursing considerations are important for Rh incompatibility?
Provide emotional support to families, monitor maternal/fetal status closely, prepare for procedures like amniocentesis, transfusions, administer Rho(D) immune globulin properly, educate on Rh incompatibility and future pregnancies
What is ultrasound?
Imaging technique using high-frequency sound waves to visualize the fetus, placenta, and maternal structures during pregnancy.
What does alpha-fetoprotein (AFP) measure?
A protein produced by the fetus that can be measured in maternal serum to screen for neural tube defects and other abnormalities.
What is Multiple Marker Screening?
Blood test in the second trimester that measures AFP along with other analytes like hCG, estriol and inhibin-A to screen for chromosomal abnormalities and neural tube defects.
What is Chorionic Villus Sampling (CVS)?
Prenatal diagnostic test where a sample of chorionic villi is taken from the placenta, usually between 10-13 weeks, to test for chromosomal disorders and genetic conditions.
What is amniocentesis?
Procedure where a needle is used to remove a sample of amniotic fluid, usually after 15 weeks, to test for chromosomal abnormalities, neural tube defects, and genetic disorders.
What does the Lecithin/sphingomyelin (L/S) ratio assess?
A test done on amniotic fluid to assess fetal lung maturity by measuring these two compounds that are involved in surfactant production.
What is surfactant?
A substance produced by fetal lungs that reduces surface tension and prevents alveolar collapse, allowing for proper breathing after birth.
What is percutaneous umbilical blood sampling (PUBS)?
Procedure to obtain a fetal blood sample from the umbilical cord, used to evaluate fetal anemia, Rh incompatibility, and other blood disorders.
What is a non-stress test (NST)?
Assesses fetal heart rate accelerations in response to fetal movement, indicating fetal oxygenation and well-being.
What does a contraction stress test assess?
Assesses the fetal heart’s ability to tolerate contractions induced by oxytocin or nipple stimulation.
What is a biophysical profile (BPP)?
Combines the NST with ultrasound evaluation of fetal breathing, movement, tone, and amniotic fluid volume to assess fetal well-being.
What is vibroacoustic stimulation?
Using a small device to provide sound/vibration stimuli to the fetus to prompt fetal movement during NSTs or BPPs.
What does the amniotic fluid index (AFI) measure?
Ultrasound measurement of the deepest vertical amniotic fluid pockets to estimate amniotic fluid volume.
What are fetal movement/kick counts?
Method of tracking the frequency of fetal movements as an assessment of fetal well-being.
Progressive fetal hypoxia and acidosis results in what signs?
- Tachycardia
- Late decelerations
- Decreased variability
- Bradycardia
- Absence of accelerations
What is the recommended dietary allowance (RDA)?
The average daily nutrient intake level that meets the requirements of 97-98% of healthy individuals in a particular life stage and gender group.
What is adequate intake (AI)?
A recommended nutrient intake value based on approximations of observed intakes in apparently healthy population groups, used when there is insufficient evidence to set an RDA.
What does tolerable upper intake level (UL) refer to?
The highest daily nutrient intake level that is likely to pose no risk of adverse health effects for most individuals in the general population.
What is the estimated average requirement (EAR)?
The daily nutrient intake level estimated to meet the requirements of 50% of healthy individuals in a particular life stage and gender group.
What are kilocalories?
A unit of measurement of food energy, with one kilocalorie representing the amount of energy needed to raise the temperature of one kilogram of water by one degree Celsius.
What is pica?
An eating disorder characterized by persistent cravings and compulsive consumption of non-food substances that have no nutritional value, such as clay, chalk, or ice.
What is the recommended weight gain for normal pre-pregnancy BMI?
25-35 lbs (11-15 kg)
This range supports healthy fetal growth and maternal health.
How much should carbohydrate intake be increased during pregnancy?
Increase intake for energy needs
Carbohydrates are crucial for providing the energy necessary for both the mother and the developing fetus.
What is the recommended increase in daily caloric intake during pregnancy?
300 kcal/day
This increase helps meet the energy demands of pregnancy.
What is the daily protein requirement during pregnancy?
60g/day
Protein is essential for fetal growth and development.
What is the recommended daily intake of folic acid during pregnancy?
600-800 mcg/day
Folic acid is important for preventing neural tube defects in the developing fetus.
What is the recommended daily intake of iron during pregnancy?
27 mg/day
Iron is necessary to support increased blood volume and fetal development.
What is the recommended daily intake of calcium during pregnancy?
1000-1300 mg/day
Calcium is vital for building the baby’s bones and teeth.
What is the recommended daily limit for sodium intake during pregnancy?
Limit to 2300 mg/day
Excess sodium can lead to increased blood pressure.
What types of foods are recommended for a healthy pregnancy diet?
- Whole grains
- Vegetables and fruits
- Dairy
- Protein sources (lean meats, eggs, legumes)
These foods provide essential nutrients for both mother and baby.
What are some socioeconomic nutritional risk factors during pregnancy?
WIC program assistance
The Women, Infants, and Children (WIC) program helps provide nutritional support to low-income pregnant women.
What dietary concerns are common among adolescents during pregnancy?
Poor dietary habits, body image concerns
Adolescents may struggle to meet nutritional needs due to these factors.
What potential nutrient deficiencies might vegetarian pregnant women face?
Iron and vitamin B12 deficiencies
These nutrients are often found in animal products.
What is the recommended daily intake of vitamins for lactating women compared to pregnancy?
Higher than during pregnancy
Increased needs include vitamins A, B6, B12, C, E, riboflavin, zinc, iodine, potassium, copper, and selenium.
How many additional calories are recommended during the first 6 months of lactation?
330 calories per day
This includes 170 calories from maternal fat stores.
What is the total caloric increase recommended during the second 6 months of lactation?
400 additional calories per day
This helps support continued breastfeeding and maternal health.
True or False: Routine supplements are necessary for all lactating women.
False
Supplements are only necessary if the diet lacks essential vitamins and minerals.
What are Braxton Hicks?
Practice contractions of the uterus that do not cause cervical changes.
What is Chadwick’s sign?
Bluish discoloration of the vaginal mucosa and cervix due to increased vascularity.
What is Goodell’s sign?
Softening of the cervix during pregnancy.
What are striae gravidarum?
Stretch marks that appear on the abdomen, breasts, and thighs during pregnancy.
Define physiologic anemia in pregnancy.
Normal dilutional anemia that occurs in pregnancy due to increased plasma volume.
What is supine hypotension?
Drop in blood pressure when lying supine, caused by the weight of the uterus compressing blood vessels.
What is melasma/cholasma?
Darkening of the skin on the face during pregnancy due to hormonal changes.
What is linea nigra?
Dark line that appears on the abdomen during pregnancy due to hyperpigmentation.
What is diastasis recti?
Separation of the abdominal muscles during pregnancy.
What does amenorrhea indicate?
Absence of menstrual periods, a sign of pregnancy.
What is Hegar’s sign?
Compressible softening of the lower uterine segment in pregnancy.
What does ballottement refer to?
Rebounding of the fetus against the uterine wall when pushed gently.
What is meant by gravida?
The number of pregnancies a woman has had.
Define primigravida.
A woman who is pregnant for the first time.
What is a multigravida?
A woman who has been pregnant more than once.
What does para refer to in obstetrics?
The number of pregnancies reaching viable gestational age.
What is a nullipara?
A woman who has never given birth.
Define primipara.
A woman who has given birth once.
What is multipara?
A woman who has given birth more than once.
What is fundal height?
Measurement from pubic bone to top of uterus to estimate fetal size.
What are Leopold’s maneuvers?
Technique to determine fetal lie, presentation, position, and descent.
What does ambivalence mean in the context of pregnancy?
Mixed feelings or uncertainty about being pregnant.
What is bonding in terms of parent-infant relationship?
The emotional attachment between parents and infant.
Define narcissism.
Excessive interest in or admiration of oneself.
What is introversion?
The tendency to be inward-looking and reserved.
What does mimicry refer to in psychology?
Imitating the behavior or emotions of another.
What is couvade?
Sympathetic pregnancy where the partner experiences pregnancy-like symptoms.
What is a doula?
A trained professional who provides support to the mother during pregnancy and childbirth.
List the five major changes in blood flow during pregnancy.
- Increased blood volume (up to 50% above non-pregnant levels)
- Increased cardiac output (30-50% above non-pregnant levels)
- Decreased blood pressure
- Decreased peripheral vascular resistance
- Increased blood flow to the uterus, kidneys, and skin
What are presumptive signs of pregnancy?
- Amenorrhea (missed periods)
- Nausea and vomiting
- Breast changes (tenderness, tingling)
- Fatigue
- Frequent urination
- Food cravings or aversions
What are probable signs of pregnancy observed by a nurse?
- Softening of the cervix (Goodell’s sign)
- Bluish discoloration of cervix/vagina (Chadwick’s sign)
- Uterine enlargement
- Fetal heart tones
What are positive signs of pregnancy?
- Fetal movement felt by examiner
- Outlining of fetal parts on ultrasound
- Positive pregnancy test (detects hCG hormone)
What does GTPAL stand for?
G - Gravidity
T - Term births
P - Preterm births
A - Abortions
L - Living children
What is Naegele’s rule?
A method to estimate the expected date of delivery (EDD) based on the first day of the last menstrual period.
What are common interventions for nausea and vomiting during pregnancy?
Eat small, frequent meals, avoid spicy/fatty foods, stay hydrated, try ginger or vitamin B6 supplements.
What lifestyle changes can help relieve heartburn in pregnancy?
Eat smaller portions, avoid trigger foods, don’t lie down after eating, use antacids as needed.
What are some recommended practices for managing backache during pregnancy?
Practice good posture, wear supportive shoes, apply heat/cold packs, get prenatal massages.
What should be done to alleviate round ligament pain?
Change positions slowly, avoid sudden movements, use a maternity support belt.
How can urinary frequency be managed during pregnancy?
Perform Kegel exercises, avoid caffeine, don’t resist the urge to urinate.
What are common interventions for constipation in pregnancy?
Increase fiber and fluid intake, exercise regularly, use stool softeners if needed.
What measures can help with varicosities during pregnancy?
Elevate legs, wear compression stockings, avoid prolonged standing/sitting.
What are the recommended treatments for hemorrhoids in pregnancy?
Increase fiber, use over-the-counter creams/suppositories, sitz baths.
What strategies can help prevent leg cramps during pregnancy?
Stretch calves regularly, ensure adequate calcium/magnesium intake, apply heat.
What benefits do warm baths provide during pregnancy?
Relieve muscle aches and promote relaxation.
Why should hot tubs be avoided during pregnancy?
Due to risk of overheating and dehydration.
Is douching recommended during pregnancy?
Not recommended as it can disrupt vaginal flora.
What recommendations are there for breast care during pregnancy?
Wear supportive bras, use lanolin cream for sore nipples.
What type of clothing is suggested for pregnant women?
Choose loose, breathable fabrics and low-heeled shoes.
What types of exercise are beneficial during pregnancy?
Low-impact activities like walking, swimming, prenatal yoga.
What sleep position is recommended after 20 weeks of pregnancy?
Sleep on the left side.
What dietary components are crucial during pregnancy?
Adequate protein, iron, calcium, and folate.
What should be discussed with employers regarding pregnancy?
Any workplace hazards or needed accommodations.
What travel precautions should pregnant women take?
Avoid long periods of immobility, stay hydrated, follow airline guidelines.
Which immunizations are recommended during pregnancy?
Flu and Tdap vaccines.
What should be done regarding medications during pregnancy?
Discuss all prescriptions/OTCs with your provider for safety.
What substances should be avoided completely during pregnancy?
Tobacco, alcohol, and illegal drugs.
What could vaginal bleeding during pregnancy indicate?
Placenta previa, abruptio placentae, or threatened miscarriage.
What does severe abdominal pain in pregnancy potentially signify?
Ectopic pregnancy or preterm labor.
What are potential signs of preeclampsia?
Severe headaches/visual disturbances.
What does decreased fetal movement require?
Evaluation for fetal well-being.
What could leaking fluid during pregnancy indicate?
Premature rupture of membranes.
What is the function of antacids during pregnancy?
Relieve heartburn/acid reflux by neutralizing stomach acid.
What is docusate sodium used for during pregnancy?
A stool softener that helps relieve constipation.
What do prenatal vitamins provide during pregnancy?
Essential nutrients like folic acid, iron, calcium.
Why is folic acid important during pregnancy?
Prevents neural tube defects.
True or False: All pregnant women should take a folic acid supplement.
True.
