Exam Number 1 Study Guide Flashcards
Nagele’s Rule
LMP - 3 months + 7 days
Presumptive signs of pregnancy
amenorrhea nausea/vomiting fatigue urinary frequency breast changes quickening
Probable signs of pregnancy
Changes in pelvic organs/vascular congestion Abdominal enlargement Braxton hicks contractions Skin pigmentation changes Uterine soufflé Fetal outline Pregnancy test Ballottement (sharp push against uterine wall)
Positive/diagnostic signs of pregnancy
FHT
Fetal movement
Visualization in ultrasound
purpose of hCG in pregnancy
maintains corpus luteum, maintains pregnancy until placenta is developed
hPL in pregnancy
antagonist to insulin, breaks down fats to feed baby
estrogen in pregancny
stimulates uterine development, develops ductal system in breast
progesterone in pregnancy
secreted until placental production is sufficient, maintains pregnancy, develops acini and lobes of breast
relaxin
inhibits uterine activity, relaxes pelvic ligaments
vaccines in pregnancy
no attenuted live viruses due to possible teratogenic effects.
pertussis vacc in third trimester
first trimester screenings
ultrasound for nuchal translucency
second trimester screenings (6)
gestational diabetes HGB and HCT Amnio if advanced maternal age US Rhogam Vaccinate for pertussis (third)
Third trimester
strep b
Chadwick’s sign
bluish coloring of cervix
Goodell’s sign
softening of cervix
respiratory changes in pregnancy
thoracic breathing
nasal stuffiness
CV changes in pregnancy
blood volume increases, pulse increases 10-15 BPM, BP decreases slightly
skin and hair changes in pregnancy
Linea nigra, hyperactive sweat and sebaceous glands, significant hair shedding
Metabolic changes in pregnancy
Gain of 25-35 points, water retention, need for carbs increases in 2nd and 3rd trimester
Additional calorie intake in pregnancy
300 kcal/day
Protein intake in pregnancy
add 60g/day
Micronutrient needs in pregnancy
increase calcium, iron, zinc, B12, D
Recommended weight gain in pregnancy for normal, overweight, obese, and underweight mothers
Normal: 25-35lbs
overweight: 15-25 lbs
Obese: 11-20 lbs
Underweight: 28-40lbs
Folic acid supplements in pregnancy
.4mg/day, >.4mg/day if previous child had neural tube defects
Frequency of contractions
determined from beginning of one contraction to the beginning of the next
FHR assessment frequency during second stage
q5-15 minutes
What types of fetal lie are there? Which is most favorable?
Longitudinal- most favorable and common
Transverse- oblique and horizontal
Fetal presentation types
Cephalic: head. Occiput (best), brow
Breech: buttocks first
Shoulder
engagement
largest part of the presenting part reaches/passes through the pelvic inlet
station
where the presenting part is in relation to the ischial spines. From -3 to +3, with 0 being at the ischial spine.
Fetal position designation
R/L
O/M/S/A
A/P/T
effacement
thinning of the cervix
secondary force of labor
the use of the abdominal muscles
acme
peak of contraction
decrement
relaxation of a contraction
contractions are stimulated by
oxytocin
Cause of cervical dilation
fetal head pushing against cervix
lightening
indicates engagement, fetus settling into pelvic inlet. decreased SOB and increased urinary frequency
False labor pains
relieved by ambulation, bath, rest, mainly in lower abdomen and groin
4 Stages of labor
- onset of labor -> full dilation
- complete dilation -> birth
- birth of newborn -> birth of placenta
- delivery of placent -> 1-4 hrs PP, uterus contractions for bleeding control
First stage of labor latent phase
Beginning of regular contractions -> 4cm dilation
~8 hours nulliparous
~5 hours multiparous
First stage of labor active phase
4-> 7cm dilation, fetal descent. Cervical dilation 1.2-1.5cm/hour
First stage of labor transition phase: how long?
Cervical dilation from 8cm-> complete. 1 hour for multip, 3 hours for nullip.
Second stage of labor—description and length
Pushing phase- 10cm-> birth. 15 minutes multips, 2 hours for nullips. 3 Hours wth epidural.
Third stage of labor
30 minutes
Placenta separates.
Placenta examined after delivery for vessels and fetal (Schultze) and maternal (Duncan) sides to ensure no retained parts.
Fourth stage of labor
1-4 hrs after birth
250-500ml blood loss is normal, blood is redistributed
Fundus should be massaged and midway between SP and umbilicus.
BP lowered, tachy
Nursing interventions fourth stage of labor
Check lochia
Check UT firmness q15 x 4 hours
check for hemmorhoids
vital signs q5-15
Early decelerations FHR
normal, positive sign. Indicates head compression
Contraction pattern: latent phase
q10-30min -> q5-7
Contraction pattern: active phase
q2-5 -> q40-60s
Contraction pattern: transition phase
q1.5-2min, -> 60s-90s strong
FHR assessment intervals
first stage of labor: q30 min low risk, q15 minute high risk
2nd stage: q15 minutes low risk, q5 minutes high risk
Before or following AROM, ambulation, med administration, abnormal UC pattern, VE
FHR accelerations
Transient increase in FHR, sign of fetal well-being and oxygenation
Normal FHR
110-160 bpm
Baseline FHR
average rounded to increments of 5 BPM during a 10 minute period
absent FHR variability
no detectable amplitude
minimal FHR variability
detectable but less than 5 BPM
moderate FHR variability
6-25 BPM, normal
marked FHR variability
> 25 bpm
best predictor for fetal compromise
reduced variability
late decelerations
uteroplacental insufficiency in bloodflow due to maternal hypo or hypertension, uterine tachysystole, diabetes, placental abruption- nonreassuring.
Interventions for late decelerations
continuous monitoring, immediate intervention
variable FHR decelerations
umbilical cord compression. Abrupt, V shaped decelerations.
Catergory I FHR
110-160 BPM Moderate variability No variable/late decels Early decels may be present or absent No action required
Category II FHR
Bradycardia or tachycardia BSL changes in variability No accels Episodic decels or variable decels Rx: evaluation, surveillance, reevaluation
Category III FHR
Absent variability Recurrent late decels or variable decels bradycardia Sinusoidal FHR patterns—may be due to fetal anemia, infx, drug response, cardiac issues Requires prompt eval, delivery ASAP
Fetal tachycardia
If accompanied by late decels, severe variable decels, decreased variability— ominous sign
If maternal fever, antipyretics/antibiotics.
interventions for late decels
L lateral position until FHR improves or stabilizes increase fluids O2 via mask 7-10LPM Alert provider Provide explanation and support D/C oxytocin Monitor BP and HR Assess cervix Prepare for possible C-section doc interventions
Variable decels nursing intervention
Position changes to relieve pressure on cord
O2 7-10L/min
Notify provider
Possible amnioinfusion if oligohydramnios present or decels persist
possible c-section
explanation to woman & partner
interventions for prolonged decels
Vaginal examination for prolapsed cord Change maternal position D/C oxytocin Notify provider Support Increase IV fluids Administer tocolytic if tachysystole is occurring Anticipate provider intervention
APGAR Scoring (5 variables)
HR >100
Respirations- good with crying
Tone- active extremity movement
reflex- cry, cough, sneeze, pulls away when touched
skin color- pink body and extremities (acrocyanosis=pink body with blue extremities)
≥7/10 indicates good condition
RR in newborn
30-60 RPM
Signs of imminent placental separation
Uterus rises upward in the abdomen
Umbilical cord lengthens
Sudden trickle or spurt of blood appears
Shape of uterus changes from disk to globe
What is administered after delivery of the placenta?
10-20units of IV pitocin, or 10 units IM
BP and pulse monitoring during 4th stage
monitored q5-10 minutes
Treating epidural hypotension
IV ephedrine, hydration (LR bolus prior to insertion and more for bradycardia). Maternal repositioning, 10L O2, leg elevation
Epidural nursing interventions
continuous fetal monitoring
IV infusion in place prior to epidural
Indwelling catheter if epidural in place for prolonged period
Assist mom in side lying or sitting for administration
Epidural documentation
“Black tip visualized”—ensure no part remains inside
Contraindications for an epidural
Coagulation deficiencies Hx of back injuries, back surgery Allergies Skin issues at epidural site Obesity- may complicate insertion
General anesthesia
rarely used, except for emergency c-section
Fetal depression and maternal intubation issues, blood loss, vomiting/aspiration, amnesia. Prophylactic antacid therapy for mom
conception occurs ___ after LMP
2 weeks
ovaries during pregnancy
cease ovum production
hCG matains corpus luteum
secrete progesterone until placental production is sufficient
maternal O2 requirements increase by _____% a minute
30-40%
breathing becomes ____ during pregnancy
thoracic
Blood volume increases by up to ____ % by ___ weeks
50% by 34 weeks
pulses increase ______ bpm
10-15
BP is lowest in the ____ trimester
2nd
What causes N/V in pregnancy?
elevated hCG and altered carbohydrate metabolism
What causes bloating and constipation in pregnancy?
delayed gastric emptying, decreased peristalsis due to progesterone
BMR increases by
20-25%
GPTPAL
gravida: # pregnancies
parity: # babies >20 weeks
T= term infants
P= infants from 20 weeks -> 36.6 weeks
A= number of pregnancies ending in spontaneous or induced abortions
L= number of current living children
Fundal height measurement: how is it done and when?
Tape measure measures from symphysis pubis to top of uterus. Used after 22 weeks to assess grown.
When does quickening occur?
between 16-22 weeks
When can fetal heart tones be detected?
between 8-12 weeks
When can US detect gestational sac?
4-5 weeks
Women with abnormal screening results are offered:
genetic counseling, CVS, and amniocentesis
Gestational diabetes screening is done when?
between 24 and 28 weeks
Second trimester nursing interventions
administer RhoGam
Educate on pertussus, administer vaccine each pregnancy.
Vegan diets during pregnancy require a supplement of ____
4mg of B12, along with calcium and vitamin D if no soy milk is consumed.
Danger signs of pregnancy (12)
Gush of fluid from vagina Vaginal bleeding Abdominal pain Fever about 38.3°C with chills dizziness, blurred vision, seeing spots persistent vomiting Edema Muscular irritability, convulsions Epigastric pain Oliguria Dysuria Absence of fetal movement
Frequency of PNC visits
Every 4 weeks for the first 28 weeks
Ever 2 weeks until 36 weeks
Weekly from 36-40 weeks
Biweekly with NST after 40 weeks
Frequency of fetal kicks
10x/hour is normal. Call provider if <10 movements within 3 hours
Amniotic fluid index. Normal amount?
Indicator of how much fluid is present. 5-20 cm is normal
quad screen
for AFP, hCG, UE and inhibin A (chromosomal disorders)—abnormal results lead to an amniocentesis. Occurs during second trimester
How often to check uterine firmness in the fourth stage of labor
q15 for the first 4 hours
Normal blood loss in 4th stage of childbirth
250-500mL
Mechanisms of birth
Descent Engagement Flexion Internal rotation Extension Restitution External rotation Expuulsion
Vital sign checks during the latent stage
Q1 vitals
Q4 temp
UC and FHR checks during latent stage
q30min
How often do you palpate UCs during the transition phase?
Q15 min
Labor support during childbirth reduces…
Use of pain meds Operative delivery Length of labor Low Apgar scores PP Depression Breastfeeding failure
BP and pulse monitoring frequency in the 4th stage
q5-15
When can an epidural be started?
As soon as active labor is established
ova are fertile for ___ hours
12-24
sperm are fertile for ___ hours
72
nidation
implantation—occurs 7-10 days after fertilzation
maternal portion of the placenta
decidua
fetal portion of the placenta
chorionic villi
when can fetal heart tones be heard?
12 weeks
when does spontaneous movement occur?
12 weeks
when is fetal movement felt by mother?
20 weeks (earlier if you are multiparous)
when is considered full term?
38 weeks
when do alveoli begin to form?
24 weeks
when does the heart first begin to beat?
4 weeks
Most significant time in the development of organs and main external features
embryonic period 15 days-8 weeks
