Final Flashcards
Where is the uterus at 20 weeks gestation?
at the umbilicus
What are Braxton Hicks contractions? When do they occur?
irregular, painless, intermittent contractions that facilitate uterine blood flow through the placenta to promote oxygen delivery to the fetus
-can be felt after 4th month of pregnancy
What is the Goodell sign?
softening of the cervical tip, around the 6 week
What is the Chadwick sign?
violet-bluish color of the vaginal mucosa and cervix, due to increased vascularity, evident as early as the 6th week of pregnancy
What is Leukhorrhea?
a white or slightly gray mucoid discharge with a faint musty odor. Response to cervical stimulation by estogen and progesterone. Never bloody. Forms the operculum (or mucus plug)
What is the operculum?
mucus plug, acts as a barrier against bacterial invasion during pregnancy
When can quickening be felt?
14-16 weeks
What are some of the cardiovascular adaptations to pregnancy?
- Heart and lungs will be elevated and shift to the left from enlarged uterus
- Increased blood volume and cardiac output may lead to transient murmurs
- Pulse increases
- BP: systolic usually stays the same or slightly decreases, diastolic decreases then gradually increases by term
- Supine hypotensive syndrome can occur
- increase in clotting factors (lead to increased risk for clots/DVT/stroke)
Between ___ and ____ weeks of gestation, the pulse increases approximately ___ to ____ bpm
14 and 20 weeks
10-15 bpm
How does blood pressure change throughout pregnancy?
- Systolic usually remains the same, may decrease slightly as pregnancy advances
- Diastolic begins to decrease in the first trimester, continues to drop until 24-32 weeks, then gradually increases and returns to prepregnancy levels by term
What are some of the respiratory adaptations to pregnancy?
- Oxygen requirements increase (leads to increased basal metabolic rate)
- Estrogen causes increased chest expansion
- Diaphragm is displaced, thoracic breathing replaces abdominal breathing
- Upper respiratory tact becomes more vascular (due to estrogen) and creates congestion
- Lowered threshold for carbon dioxide (become more aware of the need to breathe), slight pH increase
Pregnant women are often in a state of what acid-base balance?
Compensatory Respiratory Alkalosis
What are some of the renal adaptations to pregnancy?
- Renal pelves and ureters dilate, which leads to larger volume of urine held and urine flow rate is slowed (urinary stasis)
- Bladder irritability, nocturia, urinary frequency and urgency
- GFR and renal plasma flow (RPF) increase
- Additional sodium is retained
Changes in the renal structure during pregnancy result from… (3 things)
- Hormonal activity (estrogen and progesterone)
- Pressure from an enlarging uterus
- Increase in blood volume
What causes urinary frequency in pregnancy?
initially from increased bladder sensitivity and later from compression of the bladder
Why does GFR and renal plasma flow (RPF) increase in pregnancy?
Mother must manage increased metabolic & circulatory demands and waste products of fetus
Why is additional sodium retained during pregnancy?
Because of the need for increased maternal fluid (intravascular and extracellular) sodium is needed to expand fluid volume and to maintain an isotonic state
How do we increase renal perfusion and function in a pregnant mother?
Put her on her side
-Never give diuretics for excess fluid in a pregnant woman, it will pull off to much fluid
What are some of the integumentary adaptations to pregnancy?
Darkening of the nipples, areolae, axillae, and vulva (~16 weeks) Chloasma Linea nigra Striae gravidarum (stretch marks) Palmar erythema (due to estrogen) Gum hypertrophy
What are some of the musculoskeletal adaptations during pregnancy?
Weight changes Abdominal distention Center of Gravity Changes Increase in lumbar and dorsal curves Waddling Diastasis rect abdominis (separation of the rectus abdominis)
What hormone, other than estrogen, aids in relaxation and softening of joints and tissues?
Relaxin, an ovarian hormone
What are some of the neurological adaptations to pregnancy?
Sensory changes in legs/hands
h/a, sciatica, hypocalcemia
Vasomotor instability
Postural hypotension
What are some of the GI adaptations to pregnancy?
Appetite: Pica cravings
Mouth: estrogen causes gums to bleed
Esophagus, stomach, and intestines: constipation and heartburn
Gallbladder and liver: thick bile, decreased emptying time
Abdominal discomfort
What causes constipation and heartburn during pregnancy?
increased progesterone = decreased GI motility/constipation and “heartburn
What causes an increase in cholesterol production, thickening of bile and decreased emptying time?
Progesterone
-The reason why gall stones are prevalent in pregnancy
Intrahepatic (liver) cholestasis of pregnancy may cause…
pruritus gravidarum – severe itching)
What is estrogen’s role/function during pregnancy
- Enlarges genitals, uterus, breasts and vasodilatation
- Pelvic ligaments and joints, retention of Na and H2O by kidney tubules.
- Decreases hydrochloric acid and pepsin (~nausea during preg)
What is prolactin’s role/function during pregnancy?
- Produced by anterior pituitary increase in 1st trimester and during preg; responsible for initial lactation
- Estrogen and Progesterone levels during pregnancy block the binding of prolactin to breast tissue – inhibiting lactation.
What is oxytocin’s role/fucntion pregnancy/PP?
stimulates contractions, stimulates let down and “milk-ejection reflex”
(high level of progesterone prevent contractions until near term)
What is hCg role/function?
- maintains the production b the corpus luteum of estrogen and progesterone until the placenta takes over production
- hCG or beta subunit of hCG, secreted by the placenta, detectable 7-10 days after conception
What is progesterone’s role/function?
- Maintaining pregnancy
- relaxes smooth muscles (decreased uterine contractility)
What is the role/function of estrogen and progesterone (together)?
cause fat to deposit in subcutaneous tissues over the maternal abdomen, back, and upper thighs
-Serves as energy reserve for both pregnancy and lactation
What is the role/function of hCS?
produces by the placenta, acts as a growth hormone and contributes to breast development
What do high levels of hCG indicate? Low levels?
- High levels: may indicate abnormal gestation (e.g. Downs syndrome)
- Low levels: slow increase or a decrease may indicate impending miscarriage
What does APGAR stand for?
A: activity/muscle tone (flaccid, some flexion, well flexed)
P: pulse rate (absent, 100)
G: grimace/reflex irritability (no response, grimace, cry)
A: appearance/skin color (blue/pale, extremities blue, completely pink)
R: respiratory effort (absent, weak cry, good cry)
What does the nurse do immediately after the baby is born?
suction mouth and nose, dries the infant, verifies respirations have been established, assess temp, ID bands, skin-to-skin, hat, no apparent life-threatening anomalies or risk factors requiring immediate attention
What are the 3 immediate interventions soon after birth?
- Eye prophylaxis: against opthalmia neonatorum from gonorrheal or chlamydial infection
- Vitamin K prophylaxis
- Umbilical cord care
What are some ways we use to prevent cold stress?
skin-to-skin, blankets, drying and swaddling, hat, radiant warmer, promote infant flexion
How do we assess gestational age once the baby is born? What do we look for?
Dubowitz and Ballard scales pg. 488
Assess physical and neuromuscular signs
-Posture, flexion, square window, arm recoil, popliteal angle, scarf sign, heel to ear, skin, lanugo, plantar creases, breast buds, eye lids fused?, ear cartilage?, genitals
If a newborn has physical injuries from birth, what do we worry about?
Jaundice, from the breakdown of RBCs (bruising)
-Infection if scalp electrode placed/other lacerations
What are 4 common newborn complications we look out for?
hyperbili, resp problems, hypoglycemia, hypothermia
Sickle cell anemia is most common in what ethnicity? Sickle cell anemic pts are at risk for…
African-American adults
At risk for preeclampsia, IUFD, preterm birth, LBW infants, postpartum endometritis, UTIs, miscarriage, IUGR, stilbirth
Pregnant women with pregestational diabetes are at risk for which complications?
miscarriage, fetal macrosomia,shoulder dystocia, c-sections,preeclampsia, preterm birth, maternal mortality, chronic HTN, polyhydramnios, PROM, PPH, infections, ketoacidosis, congenital malformations
Gestational diabetes is more likely to occur in which ethnicities?
Latina, Native American, Asian, and African American women
Risk factors for gestational diabetes:
maternal age over 35, previous macrosomic infant, multiple gestation, previous unexplained IUFD, previous pregnancy with GDM, strong immediate family history of type 2 diabetes or GDM, previous LGA, obesity, and fasting blood glucose above 140 or random blood glucose above 200
What are the risk factors associated preeclampsia?
Nulliparity, family history, obesity, multifetal gestation, preeclampsia in previous pregnancy, IUGR, placental abruption, fetal death, preexisting medical-genetic conditions (HTN, renal dx, type 1 DM, and thrombophilias)
Whar are the risk factors for preterm labor?
Smoking, dehydration, infection, nutritional status, drugs, age (adolescents), low socioeconomic status
What are the signs of respiratory distress in a newborn?
nasal flaring, intercostal or subcostal retractions, or grunting with respirations, rate of less than 30 or more than 60/minute
LGA babies, what would you be worried about?
hypoglycemia, birth injuries, asphyxia, congenital anomalies (like heart defects)
SGA/IUGR babies, what are you worried about?
similar to preterm infants with similar problems
poor gas exchange, hypoglycemia, hypothermia, perinatal asphyxia, meconium aspiration, immunodeficiency, and polycythemia
What are the risk factors for SGA and IUGR?
cigarette smoking, gestational HTN, low socioeconomic status, multifetal gestation, gestational infections, diabetes, placenta problems, and cardiac problems
What 4 ways do babies lose heat?
Convection, Radiation, Evaporation, and Conduction
Which type of heat loss is this?
Occurs when liquid is converted to vapor, vaporization of moisture from the newborn’s skin. Occurs from failure to dry the infant after birth, or dry too slowly after a bath
Evaporation
Which type of heat loss is this?
Loss of heat form the body surface to a cooler solid surface not in direct contact but in relative proximity
Radiation
Which type of heat loss is this?
Loss of heat from the body surface to cooler surfaces in direct contact.
Conduction
Which type of heat loss is this?
Flow of heat from the body surface to cooler ambient air.
Convection
What are the probable signs of pregnancy?
changes observed by the examiner
- Hegar sign (softening/compressibility of lower uterine segment), ballottement, pregnancy tests, Goodell sign, Chadwick sign, Braxton Hicks contractions, uterine soufflé
- can be other possible causes which is why it’s labeled probable
What are the presumptive signs of pregnancy?
specific changes felt by the woman
- amenorrhea, fatigue, nausea/vomiting/breast changes, urinary frequency, fatigue, quickening
- Can be caused by reasons other than pregnancy, which is why it’s labeled as presumptive
What are the positive signs of pregnancy?
signs that are attributable only to the presence of the fetus
-hearing fetal heart tones, visualization of the fetus, palpating fetal movements
What in mom is the actual thing that affects ability to carry oxygen?
RBCs
BPP, what kind of info does that tell us about baby’s growth and development?
includes fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate, and amniotic fluid volume
Aka a physical examination of the fetus
What is Nagele’s rule?
LMP minus 3 calendar months plus 7 days
What are the side effects of regional anesthesia?
hypotension (leading to decreased placental perfusion, fetal bradycardia, absent/minimal FHR variability), local anesthetic toxicity (light-headedness, tinnitus, metallic taste, slurred speech, loss of consciousness), fever, urinary retention, pruritus, longer 2nd stage labor, increased use of oxytocin, and respiratory problems if too high
What do we do if there’s a prolapsed cord?
Call for help, put pressure on the presenting part, knee chest position/extreme Trendelenburg, or modified Sim’s position, notify dr, wrap cord loosely in sterile towel saturate with warm sterile saline, O2, IV fluids, monitor FHR continuously
What are the signs and symptoms of abruptio placentae?
Painful bleeding, abdominal pain, uterine tenderness, contractions, coagulopathy, mild to severe uterine hypertonicity, board-like abdomen
-Can lead to hypovolemic shock, DIC, IUGR, preterm birth, risks for fetal neurologic effects and death from SIDS
What are the signs and symptoms of an amniotic fluid emboli?
Similar to PE
Abrupt onset of respiratory distress and chest pain, hypotension, tachycardic, loss of consciousness, restless, cyanosis, fetal bradycardia and distress if delivery has not occurred at the time of the embolism
(Interventions: O2, intubation/mechanical ventilation, pt on her side, IV fluids, blood, meds, monitor fetal status)
Succenturiate placental lobes: whats the biggest problem?
Hemorrhage, placental retention
Placenta divided into two or more separate lobes
What is placenta previa?
What are the symptoms?
Placenta partially or completely covers the cervix, which will cause bleeding when the cervix dilates or the lower uterine segment effaces
-painless, bright-red vaginal bleeding during the 2nd or 3rd trimester, presenting part of the fetus is high because placenta occupies lower uterine segment –> increased fundal height
What is placenta accreta, placenta increta, and placenta percreta?
Accreta: slight penetration of myometrium by placental trophoblast
Increta: deep penetration of myometrium by placenta
Percreta: Perforation of uterus by placenta
What are the risk factors for placenta previa?
previous c-section, advanced maternal age, multiparity, previous suction curettage, and smoking
Mastitis: what would you look for? When?
Unilateral breast pain, shiny, red, hot, flu-like symptoms, hardness underneath clogged spot.
-Mastitis can occur at any time, although the majority of cases occur day 5 to 6 weeks post partum
What is the normal progression of normal lochia?
How long will she expect lochia: rubra, serosa, alba?
Rubra: red, blood-tinged, birth to 2-4 days
Serosa: serous, pinkish brown, watery vaginal discharge, after rubra until approx. 10 days after birth
Alba: thin, yellowish to white, vaginal discharge, after serosa to 2-6 weeks after birth
Can you have gestational diabetes on top of a type II diabetes?
Yes
What is the newborn of a diabetic mother at risk for?
hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, hypocalcemia, and congenital anomalies
Blood glucose levels should be within…
65 and 130 mg/dL
What are the insulin needs of a diabetic mother by trimester?
1st trimester: insulin needs decrease, at risk for hypoglycemia
2nd and 3rd trimester: decreased glucose tolerance, increased insulin resistance, maternal insulin requirements gradually increase from ~18-24 weeks to ~36 weeks gestation. Can double or quadruple b the end of the pregnancy
PP: if mom is breastfeeding does insulin needs change?
Yes, will still have residual insulin needs; if not breastfeeding insulin needs will return to pre-pregnancy needs 7-10 days PP
What are the medications for preterm labor? what route are they each given?
Magnesium Sulfate: IV, CNS depressant
Terbutaline: Subcut., beta agonist
Nifedipine: Oral, Calcium channel blocker
Indocin: Oral, NSAID prostaglandin inhibitor
Do not use ______ if you have renal/hepatic disease, active peptic ulcer disease, poorly controlled HTN, asthma, or coagulation disorders
Indocin
What GA do we give Terbutaline?
over 20 weeks and less than 35 weeks
What is the max rate for giving mag? Why do we give it?
max 125 ml/hr
-prevent convulsions, treat HTN, and stop preterm labor
Which tocolytic should not be used in women with history of cardiac disease, diabetes (DM or GDM), preeclampsia or eclampsia, hyperthyroidism, or hemorrhage?
Terbutaline, watch mom’s sugars, increased risk of hyperglycemia
HELLP syndrome puts the mother at high risk for…
high risk for hepatic rupture, placental abruption,pulmonary edema, DIC, acute renal failure, ARDS, sepsis, stroke, hemorrhage, and death
What does HELLP stand for?
Hemolysis, Elevated Liver enzymes, Low Platelets
HELLP syndrome is a laboratory diagnosis for…?
variant of severe preeclampsia that involves hepatic dysfunction
What lab values are changed with HELLP syndrome?
Low platelets, but PT and PTT remain normal
decreased H&H, increased BUN, increased AST and ALT, increased uric acid, and increased bilirubin
What is PIH?
- Onset of hypertension without proteinuria after week 20 of pregnancy
- Systolic BP >140, or diastolic >90
- Goes to normal 6th week postpartum
- The earlier it starts, more severe it can be a preeclampsia
What is the difference between chronic HTN and PIH and preeclampsia?
Chronic HTN: prior to pregnancy or diagnosed before 20 weeks
PIH: mild HTN diagnosed after 20 weeks
Preeclampsia: HTn and proteinuria (3+) in normotensive women after 20 weeks gestation
What are the signs and symptoms of preeclampsia?
pitting edema, headache, epigastric pain, blurred vision
What are the nursing considerations for eclamptic seizures?
Stay with the pt! call for help, turn on the side, give oxygen
What are the main goals for newborns?
Euthermic, euglycemic, maintain skin integrity, oxygenation, and resp. function
What should you have nearby if mom is on narcotics within 1 hours of delivery?
Narcan (for mom and/or baby)
Does the fetus/newborn have any antibodies? Which 2 kinds??
IGG and IGM
Fetus produces IGM by first trimester
IGG is the only IG that crosses the placenta
What is included in the intrapartum assessment during labor?
General assessment, vitals, leopold maneuvers, FHR, assess uterine contractions, vag exam, general hygiene, void every 2 hours, IV fluids, ambulation/positioning, labor support
What are some emergency interventions for a nonreassuring FHR during labor?
Notify Dr, change position, stop pitocin, increase IV fluid rate, O2, check temperature, assist with amnioinfusion if ordered, perform fetal scalp stimulation as ordered
What are some emergency interventions for inadequate uterine relaxation during labor?
Notify Dr, stop pitocin, put her in side-lying position, increase IV fluid rate, O2, evaluate contractions, give tocolytic
What are some emergency interventions for vaginal bleeding during labor?
Notify Dr, ultrasound, FHR and contraction monitoring, anticipate emergency C-section, and do NOT perform a vag exam
What are some emergency interventions for infection during labor?
notify Dr, cooling measures, get urine sample and amniotic fluid sample, give antibiotics
Where is the fundal height at 22 weeks?
Slightly above umbilicus
True or False:
Prematurity of a newborn is determined by birth weight
False
What are the pros and cons to natural contraception?
Pros: low to no cost, absence of chemicals and hormones, and lack of alteration in the menstrual flow pattern
Cons: time consuming/may be difficult to learn, decrease the spontaneity of coitus, illness can alter woman’s core temperature, decreased effectiveness in women with irregular cycles, does not protect against STIs or HIV, failure rate is 25% during the first year
What are the pros and cons to to combined oral contraception pills?
Pros: decreased menstrual blood loss, decreased iron-deficiency anemia, regulation of menorrhagia and irregular cycles, reduce PMS, protection against endometrial cancer and ovarian cancer, reduce incidence of benign breast disease, improve acne, protect against development of ovarian cysts, salipingitis and decrease risk of ectopic pregnancy, almost 100% effectiveness rate if taken correctly
Cons: no protection against STIs, risk of stroke, MI, thromoembolism, HTN, gall bladder disease, and liver tumors, nausea, fluid retention, spotting, increased appetite
Contraindicated: thromboembolic disorders, CVA or CAD, vascular heart disease, breast cancer, impaired liver function, liver tumor, >35 years old and smoke, severe HRN, diabetes, or prolonged immobilization
Review types of contraceptive methods – IUDs, what are complications/risk factors associated with these; failure rates
Pros: long-term protection from pregnancy and immediate return to fertility when removed
Con: increase risk of pelvic inflammatory disease, unintentional expulsion of the device, infection, and possible uterine perforation, no HIV or STI prevention
Failure rate for copper: 0.8%
Failure rate for hormonal: 0.2%
If a pt has HTN or cardiovascular disease, which PPH drugs are contraindicated?
Methergine and Hemabate
Hemabate is a _______ and is contraindicated in…
Prostaglandin F2
-asthma, HTN
Misoprostil is a __________
Synthetic Prostaglandin E-1
What route(s) can you give Methergine for PPH?
IM, intrauterine, or orally
What route(s) can you give Hemabate for PPH?
IM or intrauterine
What route(s) can you give Dinoprostone for PPH?
vaginal or rectal suppository
What route(s) can you give Misoprostol for PPH?
rectally
What route(s) can you give Pitocin for PPH?
IV or IM
Latent phase: ____cm dilated
How long is the latent phase?
1-3 cm
Approx 6-8 hours
Active Phase: ____cm dilated
How long is the active phase?
4-7 cm
Approx 3-6 hours
Transitional Phase: ___cm dilated
How long is the transitional phase
8-10
Aprox 20-40 minutes
When is “hind milk” obtained? What is the benefit of hind milk?
Feed on one breast until it softens to assure “hind milk” is obtained
- higher fat content to make them full
- foremilk is higher in lactose (sugar)
How long is the 2nd stage of labor?
What are the s/s?
Primip – 50 mins -2 hrs; multip – 20 mins to 1.5 hrs
- perineal bulging/ stretching/ pain , pass flatus/ stool, crowning, diaphoresis
- psychosocial – less irritable, cooperative, focused on pushing, modesty unimportant, exhaustion building
How long is the first stage of labor?
1-20 hours
How long is the third stage of labor?
3-30 minutes
How long is the 4th stage of labor?
2 hours after delivery of placenta
What are the maternal and fetal risks for lupus in pregnancy?
Maternal: Miscarriage, Nephritis, PIH, PTL, Renal disease
Fetal:Preterm Birth, IUGR, Stillbirth, Neonatal Lupus
Postpatum depression with psychosis is most often characterized by ______, _____, and __________.
depression, delusions, and thought by the mother of harming either the infant or herself
What are some early signs of post partum depression with psychosis?
fatigue, insomnia, restlessness, episodes of tearfulness and emotion lability. Complaints regarding the inability to move, stand, or work
What are the treatment options for PPD?
There is usually gradual improvement over the 6 months after birth. Supportive treatment alone is not effective for major PPD and pharm. is needed.
- Antidepressants, anxiolytic agents, and electroconvulsive therapy
- Psychotherapy focuses fears and concerns of new responsibilities and roles, and monitoring for suicidal or homicidal thoughts
What are the treatment options for postpartum psychosis?
Psychiatric emergency; may require psychiatric hospitalization
Antipsychotics and mood stabilizers such as lithium are the treatments of choice
