Exam 6- 1st Maternity Exam Flashcards
Maternity History 2-4 Birthing Choices/Expanded Roles/Trends 5-7 Vital Statistics 3-6 Standards of Care 2-3 A&P of Pregnancy 17-23 Sexuality in Pregnancy 2-4 Diagnosis of Pregnancy 5-8 Discomforts of Pregnancy 3-4 Psychosocial Adjustments 3-4 Heart Disease in Pregnancy 2-4 Nutrition during Pregnancy 4-7 Antepartal Nursing Management 10-14 Antepartal Nursing Care and Assessment “Jeopardy Game” 9-14 Pregestational Disea
1ST Drugs used to alleviate child birth pain
19th Century
WIC Established
1975
1981
Medicad reimburses for midwife deliveries
Shift to family centered nursing
1960’s
Presumptive Signs of Pregnancy
symptoms or changes felt by woman
Amenorrhea
N/V (Morning sickness)
Excessive Fatigue (1st/ 3rd Trimester)
Urinary Frequency (1st/ 3rd)
Breast Changes/ pain
Quickening
Earliest Presumptive Sign of Pregnancy
Amenorrhea
Probable Signs
Observed by healthcare provider;
Not definitive diagnosis
Ex: Positive Pregnancy Test
Goodell’s Sign
-Softening of the cervical tip
-Increased vascularity, hypertrophy, hyperplasia, edema, elasticity
Palpate fetal movements
20 weeks
Fetoscope FHR
FHR @ 17-20 wks
Doppler FHT
FHT @ 10-12 wks
Softening of isthmus (lower portion of uterus)
On exam it feels thin
Hegar’s Sign
Chadwick’s Sign
Change in color of the cervix, vagina, and vulva
Ballottement
palpate a floating fetus →gentle returning tap
strongest of probable sign; seen after 24 wks
strongest of probable sign
Ballottement
Seen after 24 wks
Morning Sickness Subsides
15-16 wks
1/2 - 3/4 pregnant women experience
Nausea/ Vomiting (“Morning Sickness”)
Ptyalism
increased saliva
May have bitter taste
often asc. with nausea
Tx: good oral hygiene, lozenges, candy, gum, Increased fluid intake
Class I - Heart Disease in Pregnancy:
Asymptomatic
No limits to physical activity
normal pregnancy with few complications
Common Problems of LGA
Birth Trauma
Hypoglycemia
Polycythemia
Hyperbilirubinemia
Postmature Characteristics
dry cracked skin (parchment paper)
long hard nails
decreased subcutaneous fat
“old person” appearance
No Vernix
meconium staining
wide eyed alert look
Amt of Fetal lung fluid in lungs @ birth
80-100ml
Vaginal Squeeze removes how much fetal lung fluid
1/3
Remainder=hypotonic–> removed via lymphatic system.
Primary Stimuli for respirations in NB
Chemical & Thermal
Mechanical (considered by some)
Secondary Stimuli for respirations in NB
Mechanica (recoil after vag. squeeze)
Physical
type II alveolar cells funx
synthesis and storage of surfactant
surfactant begins to equalize the pressure in the alveoli of various sizes and prevents flow of air from one alveolus to another
28- 32 weeks
Age of viability
24 wks
–>Severe problems
L/S Ratio @ 30-32 weeks
1.2 – 1
L/S Ratio @ >35 weeks
2-1
Maturity attained
Unless diabetic mother (gestational diabetes) d/t delayed production of surfactant
Lecithin
amt ⬆️ w/ ea. wk of gestation
Surfactant
→ alveolar stability;
secretions starts at 26wks
prevents alveolar collapse at end of expiration
Sphingomyelin
secreted @ 26 wks;
amt constant
phospholipid→ decreases surface tension→ prevents alveolar collapse at end of expiration;
PG
last matured surfactant
presence indicates good surfactant level
Severity of symptoms parallels the amount of meconium aspirated
MAS
ECMO
Extra corporeal membrane oxygenation
Most common anomaly of the nose
Choanal Atresia
Diaphragmatic hernia
defect in the formation of the diaphragm
mortality rate 50-80%
Diaphragmatic hernia mortality rate
50-80%
Very preterm
Neonates born <32wks
Premature
Neonates born 32-34wka
Late Premature
Neonates born 34-37WKS
Lanugo Premature Assessment
present btwn 20-28 wks gestation
@28wks begin to disappear from face and front of trunk
Creases on the front of foot start to form
28-30wks gestation
creases ⬆️ & spread towards heel w/ gestation
Eyelids open btwn
26-28wks gestation
Administer to women in preterm labor or when preterm labor is anticipated to reduce likelihood of RDS, NEC, IVH, need for respiratory support, systemic infections, and neonatal death
Corticosteroids, betamethasone, or dexamethasone
NEC s/s
Abdominal Distention, Discoloration
Bowel loops
Feeding intolerance (emesis/residuals)
Bloody Stools
Abnormal V/S
No sex during antepartum if
Uterine bleeding
History of abortion/ preterm birth
ROM
Must always avoid during the Antepartum Sex
Forceful penetration
Blowing into vagina (risk of air emboli)
Sex w/ someone w/ an STD
bimanual exam NOT done
at each prenatal visit or if patient presents with vaginal bleeding
Nagele’s Rule
determine due date
(LMP-3MO)+7DAYS
Most accurate -regular cycle
uterus just rises out of pelvic cavity
palpate fundus at level of synthesis pubis
12 weeks
20 weeks: umbilicus
Quad Screen
Screens
Screens for fetal aneuploidy
• AFP (Alpha Feto Protein)
• hCG- human chorion gonadotropin
• UE-unconjugated estriol
• Inhibin-A
Screening for preeclampsia
Urine Dipstick (protein) @ ea. Prenatal visit
GBS
cultures between 35-37 weeks (rectal/vaginal)
+ →prophylactic PCN
Fetal Movement Counts
non invasive, inexpensive reflection fetal oxygenation
Fetal Sleep Cycles
May last up to 20 mins
Non-stress Test Reactive
2 + 15x15 accels in a 20 min period
<32 wks 10x10 accels are considered reactive
Biophysical Profile 5 critical measurements
FHR Pattern
Fetal movements, tone, breathing
AFI or Volume
BPP/BPA score 8/10
reassuring
First to be lost with hypoxia
FHR reactivity–>breathing–> movement–>then tone
Adolescent Mom more likely to have
Fe Deficiency Anemia
Cephalopelvic disproportion
Preeclampsia and eclampsia
STD’s
Depression
Separation of the placenta from site of implantation before delivery
Abruptio placenta
Time period beginning with conception and ending with the onset of labor
Antepartum/ Antepartal
Augmentation
Stimulation of ineffective uterine contractions after the onset of spontaneous labor to manage labor dystocia
Bluish-purple coloration of the vagina and cervix evident in the first trimester of pregnancy
Chadwick’s sign
Occurrence of symptoms r/t to pregnancy, such as n/v & abd pain, in the mate of a pregnant woman
Couvade syndrome
Twins that result from the fertilization of two eggs;
may be different gender;
dichorionic
Dizygotic twins
Vomiting during pregnancy that is so severe it leads to dehydration, electrolyte and acid base imbalance, and starvation ketosis
Hyperemesis gravidarum
Decreased amniotic fluid (less than 500 mL at term or 50% reduction of normal amounts) during pregnancy
Oligohydramnios
Psychological work done by the mom to development of a + adaptation & establish maternal identity
Maternal tasks of pregnancy
(LMP- 3 mo + 7 days)= ~DOB
Naegele’s rule
Objective signs of pregnancy (noted by the examiner) that can only be attributed to the fetus
Positive signs
collagen substance that surrounds the vessels of the umbilical cord; protects the vessels from compression
Wharton’s Jelly
Chronic lung condition OF neonates asc w/ Mechanical ventilation and oxygen
Bronchopulmonary dysplasia (BPD)
Prevents alveolar collapse at end of expiration
Lecithin & Sphingomyelin
Hyperemesis Gravidarum
Excessive/ pernicious vomiting during pregnancy–> dehydration & starvation
Tx Hyperemesis Gravidarum (HG)
Hydration (3000mL/24h)
LR
NPO
Meds( Zofran)
Progress to Brat diet
Parental Nutrition PRN
Monitor urine for Ketones
Protein of fetal membranes
Fetal Fibronectin
Tocolytic Medications
Arrest Labor
Ritodrine Contraindications
Concurrent use w/ glucocorticoid steroids
Risk of Pulmonary Edema
CNS Depressant used for secondary action (relaxes smooth muscle)
Magnesium Sulfate
Antidote for Magnesium Sulfate
Calcium Gluconate
Administration Route Magnesium Sulfate
IV-loading dose, then drip
Monozygotic Twins
1 fertilized ovum divides–>2
Identical Twins
➡️production of colostrum as early as 16wks
Prolactin (produced by anterior pituitary)
Admin. of Corticosteroids pre-term or expected pre-term labor is anticipated reduce the occurrence of
RDS
NEC
IVH
4 defects of Tetralogy of Fallot
- VSD
- Severe Pulmonary Stenosis
- Mal-positioned Aorta
- RV Hypertrophy
classic sign of hypoxia
Irritability
Cyanotic
Clubbing (notes)
Inhibited growth
Cardiac Personality
Polycythemia
“Squatters”(Knee Chest Position)
TET spells
S/S Tetralogy of Fallot
Cyanotic Defects
Tetralogy of Fallot
Tricuspid artesia
Transposition of Great Vessels
Trunkus Arteriosis
TET spells
Hypercyanotic Spells
Increased RR & Cyanosis –> Decreased CO –>Seizure
Relieve TET spells
Remain Calm
Stop activity
Admin O2
Squat/ knee chest
Do NOT treat respiratory acidosis
Blalock-Tulsig Shunt
- Gortex graft btwn subclavian & pulmonary artery
- Increase blood to lungs
- Tx Severe Tetralogy of Fallot
Tetralogy of Fallot Prognosis w/ Tx
1-5% Mortality
w/o Tx:
- 30% by 2 yo
- 50% by 6 yo
- 95% by 20 yo
Failure of the Tricuspid valve to develop forces Foramen Ovale to remain open;
Blood completely bypasses lungs
Tricuspid Atresia
Tricuspid Atresia s/s
Cyanosis/ Chronic Hypoxia developing w/in 15h
Jatene
Arterial Switch Sx
10-14d
Takes 20h
Tx: Transposition of Great Vessels
Aorta and Pulmonary artery do NOT divide
often accompanied by VSD
Trunkus Arteriosis
d/t Underdeveloped LV, mitral valve, & aorta;
PDA maintains systemic circulation
Hypoplastic Left Heart
Norwood Procedure
Bypasses LV–> Deoxygenated blood directly to lungs, RV pumps blood for systemic circulation
3 Sx @ 1wk, 6mo, 12 mo
Tx Hypoplastic Left Heart
Tx Hypoplastic Left Heart
Norwood Procedure
Transplant
Lanoxin > 1mL
CHECK YOUR MATH
Normal Dose Lanoxin
10-20 mcg/kg/24h
RN Double Check
Lanoxin –>
increase contractility & CO
decrease HR
ALWAYS ask MD for parameters!!
Hold Lanoxin
4hrs on a missed dose
Includes Mestural, Obstetric, Gynecological, Contraceptive, and Sexual History
Reproductive Assessment
Folic acid supplementation (Prenatal)
decrease risk of neural tube defects
greatest impact 1 mo prior and through first trimester
0.4mg/d for childbearing-aged women
Chloasma
aka mask of pregnancy/ Melasma
brownish pigmentation over the forehead, temples, cheek, and/ or upper lip
Dark line that runs from the umbilicus to the pubis
Linea Nigra
Softening of lower uterine segment
Palpated at 6wks
Probable Sign
Hegar’s sign
First trimester
1st day LMP-14 completed wks
2nd Trimester
15wks-28 completed wks
Oxytocin
Uterine Contractions
Milk let-down
Leukorrhea
vaginal discharge
increases during pregnancy d/t influence of estrogen
Acidic pH of Vag during Preg->
inhibits bacteria
May–>overgrowth of Candida albicans– Risk for yeast infections
Braxton-Hicks Contractions
Intermittent, painless
Begin in 2nd tri, most won’t feel until 3rd
Wt of Uterus at Term
1100-1200 g
Prolactin
Produced by ant. pituitary
Production of colostrum (16wks)
Maternal CO
increases (30-50%) peaks 25-30wks
Maternal HR
increases 15-20bpm
Maternal Plasma Volume
increases 40-50%
peaks 32-34 wks
Maternal Plasma Volume
increases 40-50%
peaks 32-34 wks
Iron-deficiency anemia
hgb <33%
Hypervolemia of preg
Blood volume increases to 1500mL (40-45%)
Peaks during 2nd tri
Hypotensive condition d/t compression of IVC when lying on back (mid to late preg)
s/s–>dizzy & faint
Supine Hypotensive Syndrome
Hypotensive condition d/t compression of IVC when lying on back (mid to late preg)
s/s–>dizzy & faint
Supine Hypotensive Sydrome
Avoid excess (>10,000 IU), increases the risk of birth defects
Vit A
secretes estrogen & progesterone until around 12-14 wks; then the placenta takes over that role
Corpus luteum
After implantation produce hCG which maintains the corpus luteum
the fertilized ovum and the chorionic villi
Cotyledons
segments of the placenta
By the 7th week the placenta is
producing the majority of estrogen
By the 10th-12th wk the placenta is
producing the majority of progesterone
By the 11th wk the placenta is
producing enough estrogen & progesterone to maintain the pregnancy;
hCG levels will drop
corpus luteum begins to shrink
During preg. growth increases in capacity (500-1000 x bigger than normal)
Uterus (smooth muscle organ)
80% of uterine blood flow is to the
placenta
decrease in CO=
decrease in uterine blood flow
As uterine contraction duration & intensity increases
blood flow to the placenta decreases
thick, rich, gold in color, contains a lot of antibodies, forms in last trimester
Colostrum’s
Supine Hypotensive Syndrome
(Vena Cava Syndrome): pts should not lie flat!
Hemoglobin <11
requires iron supplementation
posterior pituitary
secretes oxytocin→stimulates uterine contraction and the let-down reflex (milk is released from the milk ducts after birth)
anterior pituitary
produces prolactin–> stimulates breast development and the production of milk
