FINAL EXAM Flashcards
PPH- Priority:
Fundal Massage is always first with pph.
· Measure pads to see how much blood loss, meds to stop bleed, see if there is leftover placenta, hematoma risk, pelvic exam
· If fundus is high up and deviated to the side- empty the bladder first
True vs. False labor
True Labor:
Contractions with cervical change.
Regular, becoming closer together, usually 4–6 minutes apart, lasting 30–60 seconds
Become stronger with time, vaginal pressure is usually felt
Starts in the back and radiates around toward the front of the abdomen
Contractions continue no matter what positional change is made.
Stay home until contractions are 5 minutes apart, last 45–60 seconds, and are strong enough so that a conversation during one is not possible—then go to the hospital or birthing center.
False Labor:
Irregular, not occurring close together
Frequently weak, not getting stronger with time or alternating (a strong one followed by weaker ones)
Usually felt in the front of the abdomen
Contractions may stop or slow down with walking or making a position change.
Drink fluids and walk around to see if there is any change in the intensity of the contractions; if the contractions diminish in intensity after either or both, stay home.
EFM interpretation/ VEAL CHOP: This is gonna be a strip, know what you see with the fetal heart rate and the veal chop, know what’s causing the issue (ex: cord compression), know what intervention to do.
Guidelines for assessing fetal heart rate
● Initial 10-20 minute continuous FHR assessment on entry into labor/birth area
● Intermittent auscultation every 30 minutes during active labor for low-risk women and every 15 minutes for high-risk women
● During second stage of labor intermittent auscultation every 15 minutes for low-risk women and every 5 minutes for high-risk women \
● Accelerations are GOOD and shows that baby is healthy
● Accelerations: abrupt increase in HR that come back down to baseline
● To be counted as a deceleration it has to go down by 10 and stay down for 10 seconds or longer
● Variability: Fluctuation in fetal heart rate from baseline, we do not want a straight line, we want the heart rate to vary.
○ Baseline (110-160) bpm
○ Absent: fluctuation range undetectable
○ Minimal: fluctuation range observed at <5 beats per minute
○ Moderate: (normal) fluctuation range from 6 to 25 beats per minute
○ Marked: fluctuation range >25 beats per minute
Interventions:
● Turn mom on side: Get pressure off vena cava, increase perfusion
● Fluid bolus (250-500 cc)
● Oxygen
● Stop Pitocin
● Call provider
● Prepare for emergency c/s
● Possible medication to stop contractions
V Variable Deceleration (Abrupt)
E Early Deceleration
A Acceleration
L Late Deceleration: Most concerning
C Cord compression
H Head compression
O Okay (good)
P Placental insufficiency
M Move-mom
I Identify labor progress
N No intervention
E Execute actions/delivery
ROM assessment:
Time of rupture- may need to start labor
· Infection is a risk- sterile gloves worn at all times, monitor temperature!
· Cord, color, odor
· SROM or PROM or broke by us to augment labor
Hep B:
· Mom’s immunity only lasts 6 months after birth, the series takes 6 months to be effective.
Circumcision Care/Assessment
· What is normal and abnormal after the procedure
Caput: What is it, how we assess for it, how we differentiate from a hematoma.
● “Cone head” caused by pressure being put on it in labor
● If it crosses suture line- localized edema on scalp that occurs from pressure of birth appears as poorly demarcated soft tissue swelling
○ This is edema that crosses suture lines.
● Localized edema on scalp that occurs from birth, soft tissue swelling that crosses suture line
Car Seat Safety:
● A bunch of pictures and say which one is correct and which is not, don’t use >5 yr old car seat check exp date, baby cant be released from hosp w/out carseat
○ Chest strap at armpit level, base off child size and wt
● Straps dip under baby’s shoulder
○ No blankets under straps
● Baby should not be in bulky clothing (coats)
○ No inserts that did not come with the car seat
● Rear Facing until 2 in back of car
● Don’t use a car seat that is over 5 years old-check expiration dates!
● No newborn can be released from the hospital until they have a car seat
● Select a car seat that is appropriate for child’s size and weight
● Use the cars seat correctly every time the child is in the car
● Use REAR FACING safety seats for most infants up to 2 years of age or until they reach a certain weight allowed by the manufacturer
● Car seats should be in the back of the car
● Make sure the harness is in the slots at or below the shoulders and is SNUG
● Retainer clip placed at the center of the child’s chest in line with the armpits
● Make sure the car seat is secured with a seatbelt and at a good angle so that the child’s head is not flopping around
● Keep away from airbags; if they inflate and hit baby’s head, this could cause major injury
● If your car seat was in a crash, you should not reuse it even if it looks fine because something may still be wrong
● It is not safe to use a used car seat
● Nurses are not certified to check car seat
PostPartum Safety (Symptoms/Ambulation)
● Make sure they are safe to ambulate, not bleeding to much to get up
PP Pain Management:
● Promoting comfort ● Cold and heat applications ● Topical preparations ● Analgesics ● Breast care-cold cabbage leaves, breast pads ● Tucks pads help with perineal pain and hemorrhoids ● Sitz bath ● Tucks ● Witch hazel ● Ice packs ● Numbing spray ● Peri bottle-take home with you
PP Danger Signs:
Fever more than 100.4°F (38°C)
● Foul-smelling lochia or an unexpected change in color or amount
● Large blood clots, or bleeding that saturates a peripad in an hour
● Severe headaches or blurred vision
● Visual changes, such as blurred vision or spots, or headaches
● Calf pain with dorsiflexion of the foot
● Swelling, redness, or discharge at the episiotomy, epidural, or abdominal sites
● Dysuria, burning, or incomplete emptying of the bladder
● Shortness of breath or difficulty breathing without exertion
● Depression or extreme mood swings
Cardiovascular changes in pregnancy: r/t position
● Laying down on your back is harder to breathe due to vena cava pressure
● Supine position- BP lowers d/t weight and pressure of the gravid uterus on vena cava, which decreases venous blood flow to heart
● Maternal hypotension/ fetal hypoxia- dizziness, pallor, clammy skin, lightheaded
● Encourage client to lay on left side, semi-fowler’s position or if supine, place a wedge under one hip
RhoGAM: Who gets it?
● Mom gets this, if mom has a negative blood type rhogam is given at 28 weeks and again 24 hours after birth if baby is positive
Pregnancy Danger signs:
● 1st Trimester
○ Spotting or Bleeding (miscarriage)
■ Painful Urination (infection)
○ Persistent Vomiting (hyperemesis gravidarum)
■ Fever greater than 100F (infection)
○ Lower Abdominal Pain (ectopic pregnancy), Dizziness, Shoulder Pain
● 2nd Trimester
○ Regular Contractions
■ Pain in Calf (blood clot)
○ Gush of Fluid (water break b4 37 weeks)
■ No fetal movement > than 12 hours
● 3rd Trimester
○ Sudden Weight Gain (preeclampsia)
■ Periorbital or Facial Edema (preeclampsia)
○ Severe Upper Abdominal Pain/liver pain (preeclampsia)
■ Headache with visual changes (preeclampsia)
○ Decrease in Fetal Movement
■ Any previous warning signs
Expected findings: For each Trimester
● 1st trimester- SATA on test so know the normal discomforts
○ Urinary Frequency/Incontinence - report pain or burning, reduce caffeine intake do kegals
■ Fatigue - schedule rest times, left side with pillow with support
○ N/V - avoid empty stomach and strong odored food
■ Breast Tenderness - larger bra with good support
○ Constipation - increase fiber and activity daily eat at regular intervals avoid straining
■ Nasal Stuffiness -blow nose gently good oral hygiene
○ Bleeding gums
■ Epistaxis (nose bleed)
○ Cravings -PICA abnormal craving of non food items (soil, clay, laundry detergent)
■ Leukorrhea - white discharge-keep perineal area clean/dry, wear cotton underwear/nightgown
● 2nd Trimester
○ Backache
■ Varicosities of Vulva and Legs
○ Hemorrhoids
■ Flatulence with Bloating
● 3rd Trimester
○ Return of 1st trimester discomforts
■ Shortness of breath with dyspnea
○ Heartburn and Indigestion
■ Dependent edema
○ Braxton Hicks Contractions- can talk thru them come and go, go away with walking
■ After eating, you want them to be up
○ No reclining
■ No laying down
○ r/t to delayed gastric emptying that can lead to GERD
■ Decrease fried/fatty foods
○ Eat smaller meals
After 24 weeks, the fundal height often matches the number of weeks you are pregnant
■ Distance (cm) measured from the top of pubic bone to the top of uterus (fundus) w/ client on back w/ knees slightly flexed
○ At 12-14 weeks the fundus can be palpated above the symphysis pubis
■ The fundus reaches the level of the umbilicus at 20 weeks and measures 20cm
○ Fundal measurement changes at 36 weeks due to lightning and it may no longer correspond w/ weeks of gestation, reaches xiphoid process at 36 wks
Hyperemesis S/S
● Excessive or intractable N/V ● Patho: dehydration, F/E imbalance, increased pulse, poor skin turgor and dry mucous membranes, hyperkalemia- leads to metabolic acidosis ○ Excessive N/V of pregnancy ○ Criteria: ■ Dehydration ■ Ketourina- KETONE IN URINE- on exam ■ Weight loss of 5% ■ Intractable vomiting
Preeclampsia Assessment
Preeclampsia w/o Severe Features ● Systolic > 140 ● Diastolic >90 ● > or equal to 1+ on dipstick, proteins in urine ● Oliguria: decreased urine output <500/ 24 hr ● Elevated liver enzymes ● Increased HCT ● Elevated serum creatinine ● Cerebral and visual disturbances ● HA ● Epigastric pain ● Blurred vision ● Pulmonary edema ● Low platelets (<100,000/ mm3)
Preeclampsia With Severe Features ● Systolic > 160 ● Diastolic >110 ● 3+ or 4+ on dipstick ● Elevated serum creatinine (greater than 2mg) ● Creatinine: ↑ > 1.1 mg/dl ● Oliguria ≤500 ml/24 ● ↑Hct ● Elevated liver enzymes ● Low platelets <100,000/mm3 ● Headache, pain, blurred vision, pulmonary edema ● If seizures=eclampsia
HELLP (Hemolysis Elevated Liver enzymes Low Platelets)
- Hemolysis
- Elevated Liver Enzymes
- Low Platelets
- Symptoms: multiple organ failure, delivery as quickly as possible
Gestational Diabetes Risk
● Obesity, prior hx or fam history of gestational diabetes
● Uncontrolled Glucose, pre pregnancy or during 1st 8 weeks organogenesis
● Prior delivery of large babies and stillbirth
● Lack of exercise
● PCOS, HTN, glycosuria
● Hormones released during pregnancy, hpl, cortisol, growth, progesterone
● History
○ Previous Pregnancies
○ In family
○ Large Baby History
Placenta Previa Management
● Pelvic Rest
○ Bedrest
○ Nothing in vagina
● If caught early, modified bed rest from home
● Management
○ Usually a C-section
○ Varies by type and gestational age
○ Close monitoring
○ Monitor blood loss (keeping risk low for bleeding)
○ Don’t do a vaginal exam if you have unknown bleeding!
Placenta Previa: Know management
● Placenta may get low enough that it fully or partially covers the os and blocks baby’s exit; if cervix dilates during this, placenta can become detached from the uterus and require c/s
● S/S
○ Sudden, painless bleeding (maybe be enough to be considered hemorrhage)
○ Anemia
○ Pallor
○ Hypoxia
○ Low BP
○ Tachycardia
○ Soft, nontender uterus
○ Rapid, weak pulse
○ Can be asymptomatic because of intrauterine bleeding with no outside signs
Magnesium Sulfate
● Used to prevent and treat eclamptic seizures
○ Calcium gluconate antidote for toxicity
● Relaxes smooth muscles slows everything down in the body
● Lowers reflex response
○ Respiratory depression
○ Lower O2 saturations
● Monitor serum magnesium levels closely
● Assessment:
○ Assess deep tendon reflexes → check for ankle clonus, BP, Fetal Heart Rate, Watch urine, decreased urine → inadequate renal perfusion → increase risk of magnesium sulfate toxicity, Respirations, O2 sats, fluid overload, Monitor for signs and symptoms of toxicity:
■ Flushing, sweating, hypotension, and cardiac and CNS depression.
● Hypertensive problems=reflexes will be hyperactive
● TOO MUCH=absent reflexes
VBAC
● Baby should be head down
● Increased risk for uterine rupture if they had a previous C-section
● Contraindications
○ Classic C-section incision
○ Myomectomy (remove thyroid from uterus)
○ Uterine scars other than C/S scar
○ Pelvic shape
○ Anything that can cause uterine rupture
○ Short maternal status
○ Obesity
○ Macrosomia
○ Maternal age > 40
○ Gestational diabetes
○ Contracted pelvis
○ Cervical ripening (increased risk for uterine rupture)
Abruption: Know management
● Painful!! Abdominal pain, rigid abdomen. It doesn’t come and go, it is constant.
● No Vag Exams: Pelvic Rest
● When the placenta becomes detached from the myometrium
● Risk factors
○ Preeclampsia
○ Gestational diabetes
○ Seizure activity
○ Uterine rupture
○ Smoking/cocaine use (anything that causes issues with blood vessels)
○ PROM
○ Trauma/uterine trauma
● S/S
○ uterine/abdomen pain, especially on palpation
○ New, frank, bright red bleeding from vagina (don’t do vaginal exam if cause of bleeding is unknown)
○ s/s hypovolemic shock r/t bleeding
○ Fetal distress (late decelerations)
○ Lose variability/baby gets stressed out
○ Firm uterus
○ Uterine contractions that do not relax
● Emergency! If minimal enough, may not deliver right away but most of time, immediate delivery needed
Thrombophlebitis
● very similar to dvt, more of a peripheral issue not deep, same s/s: redness, warmth, swelling, inflammation at the site of pain
Fundal Massage
● Used for hemorrhage- helps contract and decrease bleeding in PPH
Mastitis
● Infection/inflammation of breast tissue
● Teach mom proper way to breastfeed: latch, position
● Use good hand hygiene before and after each client care activity.
● Reinforce measures for maintaining good perineal hygiene.
● Screen all visitors for any signs of active infections to reduce the client’s risk of exposure.
● Review the client’s history for preexisting infections or chronic conditions.
● Monitor vital signs and laboratory results for any abnormal values.
● Monitor the frequency of vaginal examinations and length of labor.
● Treatment: apply warm compress, hot shower, use both breasts, no tight bras, increase fluids
