Exam 6 OB Flashcards
what influenced early maternal practives?
affected by societal influences, generation Y (more interventions ex. epiderals, scheduled C/S)
early american colonists (17th century)
female family members/friends provided aid/support during child birth, viewd as natural, births occured at home, lay midwifes (no formal training)
what increased mortaility after birth in the 17th, 18th, and 19th centeries
postpartum fever
maternity History in the 19th century
florence nightingale, durgs were availble to allievate childbirth pain, specialized knowldge (anethesiologist) which led to lithotomy position and forecps being introduced bc moms couldnt push due to Rx
maternity history in the 20th century
eoidemics, to prevent spread of infection asepsis was emphasized and newborn nursing was introduced
what affected the 20th century
WWII, mother-infant couplet was effected bc of shortages
Mary Breckinridge
frontier nursing service provided health care to families isolated from health care
1960’s maternity history
family centered nursing, lamaze & Le Boyer, breastfeeding increased, midwife assited deliveries increased
what is the focus on todays birth experience
family and encouraging growth and development
what is the most common choice/trend for birth
hospital birth is the most common
LDRP
labor, delivery, recovery, postpartum
birthing center
alternative to hospital birth, free standing center, care by midwifes, low risk pts, no epiderals done here, OB provider availble for emergency
what is the priority with birthing centers
education and preparation
Doulas
person trained in labor support (pt advocate), do not provide nursing care
home births
increasing in popularity, prominent among amish, native americans, attended by lay midwives (no formal training), lack of emergency backup
birth plan
prefences in writing, Personnel obligated to follow as long as there is no interference with safe NB and mother
what preparation is done for childbirth
education is prioority due to leaving hospital quickly, education must be on-going,
what is the prime responsibility for nurse with preparation for childbirth
individualized education
home visits
conducted by OB nurse, provides ongoing assessment post discharge
nurse practitioner
masters degree, specialize in different areas, performs clinical assessments, completes procedures, have some Rx ability
clinical nurse specialist
masters degree, resource, staff education and policy making, prescriptive ability with additional certification
nurse midwife
educated in nursing (RN) & midwifery, low risk maternity and GYN care
Nurse Researcher
Doctoral degree, new research at universities
death that results from pregnancy, either pregnant or 42 days post partum
maternal mortality
major causes of maternal mortality
hemmorrhage, HTN disorders, puerpural infection (r/t childbirth), pulmonary emboli
what are the most preventable and early identificatoin and tx is critical
maternal mortality
sum of inutero & neonatal deaths
perinatal mortality
any inutero death at any gestation (ex still birth, miscarriage)
fetal death
any death that occurs from birth to 28 days of life
neonatal mortality
fetal death & neonatal death
perinatal death
death occurs after birth to 12 months of life
infant mortality
all fetal/newborn/and infant stats are expressed how
per 1,000 births
why do we have standards of care
developed to guide care
what is the purpose of standard of care
consistency care, know the standards of care, ANA & WHONN est. standards
what are the most common errors in standard of care
incomplete or inadequate documentation or examination, failure to act, failure to communicate changes
increased levels or estrogen and progesterone are produced first by what until around 12-14 weeks, and then they are produced by what
corpus luteum then by the placenta
when does the placenta develop
3rd week of embryonic development
when does the placenta take over production of progesterone
10-12 weeks
at what week does the placenta produce enough progestrone and estrogen to maintain pregnancy
11th week
what is the function of the placenta
produces hCG, 2 steriod hormones (est. & progest), waste removal, acts as lungs
physiologic changes in the first trimester
breast enlargement & tenderness (bc of estrogen), abd. cramps after orgasm, N/V, fatigue, low back pain, fear of hurting baby
physiologic changes in the second trimester
period of newnewed energy, increase pelvic congestion, increase libiod, improved sexual performance, orgasmic ability, decrease breast tenderness
physicologic changes in the third trimester
increase backache, physical size of abd, decrease coital frequency, increase cramping with orgasm, increase urinary frequency
in a normal pregnancy with no risk factors, is there a need for sexual abstinence
no
when would sex be contraindicated
uterine bleeding, Hx of abortion, Hx of preterm birth, rupture of membranes
when should sex always be avoided
forceful penetration, blowing into vagina, sexual intercourse with a partner with STD
sex during the 4th trimester (postpartum) when to avoid it
perineal pain, healing episiotomy, breast discomfort, concerns about pregnancy
difficulties with intercourse during the 4th trimester
decrease estrogen=increase vaginal dryness, prolonged with breast discomfort, lubricants are helpful, baby creates distraction
symptoms or changes felt by women
subjective or presumptive
changes noted by healthcare provider, but alone does not diagnose
objective/probable signs
positive diagnositc findings
Positive sign
name some subjective/presumptive signs of pregnancy
amenhorrea, N/V (morning sickness), excessive gatigue (1 & 3 trimester), urinary frequency (1 & 3 trimester), breast changes, quickening
name objective/probable signs of pregnancy
changes in pelvic organs, Goodell’s sign, chadwicks sign, Hegars sign, McDonalds sign, skin pigment changes, fetal outlite, Ballottement
