final study guide Flashcards
post-partum blood loss
less than 500mL SVD is normal; less than 1000mL C/s is normal; weigh pads for quantification; saturating pad in 15 min- 1hour is abnormal
puerperal fever
any infection of genital canal within 28 days after abortion or birth; 100.4 fever or greater in 2/10 days following birth not including first 24 hours or 101 or greater within first 24 hours
post-partum women lab results
H&H, CBC, Rh status
eclampsia
occurrence of seizure or coma as result of HTN during pregnancy; treat with Magnesium Sulfate to prevent seizure and antihypertensive meds; fetus should recover when mom is stable
amniocentesis
procedure used to determine fetal lung maturity (measures lecithin and sphingomyelin ratio: greater than 2:1 = lung maturity);test for neural tube defects
psychosocial issues post birth
postpartum depression and postpartum psychosis
fertility awareness methods
temperature method: take temperature every day when get out of bed; cervical mucus: check vaginal discharge every day; calendar method: chart menstrual cycle on calendar; 77-98% effective
estrogen in contraception
suppresses ovulation
bacterial vaginosis
common bacterial infection d/t disruption in normal vaginal flora; signs/symptoms are fishy vaginal odor, gray/milky discharge; require antibiotic either orally or gel inserted into vagina
preeclampsia
blood pressure of 140/90 in pregnant women after 20 weeks gestation with or without presence of proteinuria; need 2 occasions in 4 hours or 1 occasion of 160+ systolic
gravida and para status
Gravida- number of times pregnant; Para- number of deliveries to viable babies
FHR
monitored via tracing; wanted moderate variability ~15 bpm; normal HR is 110-160
decelerations
last few seconds to 2 minutes
cord prolapse
obstetric emergency occurs when umbilical cord drops down alongside/in front of presenting part of fetus; circulation of fetus can be reduced causing serious physiological effects; place mom in tredelenberg or knee-chest position or elevate portion of fetus with sterile gloved hand
stages of labor
first stage: 0cm-10 full dilation and effacement; second stage: descent and expulsion of fetus (from full dilation to birth); third stage: expulsion of placenta (from birth to placental birth) usually about 5-10 minutes after; fourth stage: immediate postpartum following placental birth for 4 hours
fundus location
around umbilicus +/-1 cm and then descends 1cm per day until complete involution has taken place
postpartum lochia
rubra 1-3 days bright red bleeding (9 months shedding), serosa 3-10 days pale pink, alba 10-14 up to 6 weeks creamy yellow
back pain in labor
sign of impending labor; pain begins in back and spreads to abdomen
narcotic complications in delivery
can slow down labor, can cause respiratory depression in mom and fetus, can cause fetal distress
effect of epidurals
spinal is anesthesia that blocks sensation from area of admin down; epidural is partial anesthesia to lessen pain
naegels rule
last menstrual period - 3 months then add 7 days
1st trimester symptoms
decrease in BP in mom; fetus: ~3 inches, all organ systems present, audible HR, large head, ~1-2 oz,
APGAR scores
assessed at 1 and 5 minutes; indicative of transition to extrauterine life; 0-3 = severe distress, 4-6 = moderate difficulty with transition, 7-10 = stable status
transverse lie in labor
horizontal lying fetus that requires C-section
cervical changes in labor
effacement: thinning, dilation: expanding for birth of fetus
rubella issues
can infect all 3 germs layers during embryonic period; vaccine is live so do not get pregnant for 4 weeks following
Rh issues
Rh is present on surface of RBC; Rh- mother with Rh+ fetus can cause sensitization if RHOGAM not administered; next pregnancy with Rh+ infant can cause hemolysis
betamethasone
corticosteroids that promote fetal lung maturity usually following tocolytic to slow preterm birth
direct coombs test
used to determine hemolytic disease of newborn due to Rh or ABO incompatibility; positive test result means you have antibodies that are working to destroy own RBC
preeclampsia and the infant
HTN can cause uteroplacental spasm and result in IUGR, fetal hypoxia, fetal death
newborn signs of distress
grunting/flaring/tachypnea/gray skin/cyanosis/hypoxemia/subcostal retractions/hypoglycemia/hypothermia/hypotonia/tachycardia/apnea
physiologic jaundice
jaundice following first 24 hours (usually 2-5 days); increased bilirubin d/t polycythemia and short life spa of fetal RBC, decreased uptake by liver, decreased enzyme activity/ability to conjugate, decreased ability to excrete bilirubin, breast feeding
pathologic jaundice
jaundice within first 24 hours, total serum bili levels above 12mg/dL in term neonate or >15mg/dL in preterm, total serum bili level more than 5mg/dL per day, conjugated bili >2mg/dL, jaundice lasting greater than 1wk for term or 2 wk for premature
purulent amniotic fluid
can be sign of chorioamnionitis, prolonged rupture of membrane, or STI
DVT in maternal setting
occurs most often in lower extremities (foot to iliofemoral region); can lead to pulmonary embolism; presents as hot red edematous region; treat with anticoagulants, then ambulation and anti-embolic socks once symptoms reside
thermoregulation of newborn
heat loss causes newborn to compensate; signs/symptoms are increased metabolic rate, decreased surfactant production and hypoxemia, hypoglycemia d/t increased glucose consumption, metabolic acidosis increases risk of jaundice
mastitis
infected nipple fissure (usually S. aureus) due to bacteria introduced through cracks/fissure via mom/caregiver; engorgement and stasis of milk precede; need to breast feed, analgesic, bedrest, fluids, antibiotics
1 hour glucose challenge
screening for gestational diabetes; at 24-28 weeks mother drink 50g glucose and test after 1 hour; >140mg/dL requires 3 hour glucose test; <140mg/dL is negative and mom can continue routine prenatal care
STD’s (STIs)
can be parasitic, bacterial, viral; can cause PID, infertility, cancer, chronic hepatitis
true labor
- presence of regular phasic uterine contractions increasing in frequency and intensity 2. progressive cervical effacement and dilation, discomfort begins in back then radiates to abdomen, sedation does not diminish contraction, show usually present
false labor
irregular contractions, no regular pattern, discomfort in lower abdomen and groin, show not present, no cervical change, contractions might stop when walking/rest, sedation stops or decreases contractions
contraceptives
natural family planning, barrier methods, hormonal methods, IUD’s, surgical
signs of ovulation
increased maternal estrogen levels (d/t LH surge), leukorrhea (increased discharge), pH of vagina becomes more alkaline (more favorable for sperm)
ABO blood compatibility
most common incompatibility is mother=O and infant type A or B
genital herpes
painful genital lesions that may be present internally or externally; up to 60% transmission rate from maternal-fetus with those who acquire herpes near time of delivery; less than 2% for those with recurrent herpes; treat with aycyclovir and antirviral therapy; c-section if active outbreak
fetal heart rate decelerations
indicative of fetal distress; decrease in HR; VEAL CHOP
neonatal abstinence syndrome
infants from substance abusing mothers; may be irritable (6-8 weeks), jittery, reduce withdrawals, promote adequate respiration/temp./nutrition, swaddle,
symptoms of hypoglycemic infant
jittery, tachypnea, diaphoresis, hypotonia, lethargy, apnea, temperature instability
syphilis in pregnancy
chancre or ulcer in mom and can lead to CNS and cause organ damage; can cause preterm birth, physical deformity, neurological complications, still birth, or neonatal death; transplacental transmission; treat with penicillin
emergency contraceptives
must be taken with 72-120 hours; for one time use by suppressing ovulation; ex levonorgestrel
nursing considerations prior to epidural
check lab values for bleeding or clotting abnormalities, check platelets; obtain consent; fluid bolus (NS or LR); ensure emergency equipment available; conduct time out; vitals (watch for hypotension)
PPH
> 500 mL in SVD; >1000 mL in C-section; any bleeding that puts mother in harm
positional changes during labor
walking,rocking, peanut ball/birthing ball; encourage change every 30 minutes
normal percent weight loss after birth (newborn)
lose up to 7% of birth weight
GBS treatment
if mom positive at 35-37 weeks, treat with penicillin or ampicillin to prevent transmission to fetus
phototherapy nursing considerations
assessments (VS, feeding, bowels), warmth (cold stress, acidosis), phototherapy (cover eyes, genitalia), tactile stim., readjust position q2hours, answer parent question/concerns
normal post partum bleeding
abnormal postpartum bleeding
saturating pad within 1 hour; saturating pad within 15 minutes is extreme; rubra after day 4; foul odor;from alba to bright red bleeding
contraceptives avoiding during breast-feeding
do not use estrogen; it can decrease milk supply
Vitamin K
intramuscular vaccination given to newborn to prevent hemorrhagic disease
natural family planning contraception
24% failure rate; need to have proper awareness of own body including temperature (increase in basal metabolic rate) and vaginal discharge (clear egg white like is fertile compared to white secretion)
transition phase of labor
8-10 cm; short but intense, contractions every 1.5-2 minutes for 60-90 sec; very irritable; may lose control; N/V common
epidurals
epidural: anesthetic injected into epidural space that allows for mother to walk and decreases pain; spinal: 100% block of sensation and motor function
HIV in pregnancy and transition to newborn
early antiretroviral and lessen chances of transmission to fetus (less than 2% with treatment); 15-25% chance of maternal-fetal transmission without treatment; treatment is anteviral and c-section; avoid breast-feeding
postpartum depression
occurs in 10-20% of all postpartum patients; pervasive sadness, mood swings, fear, anger, anxiety, unable to care for self or infant, irritability that may lead to violence, rejection of infant, obsessive thoughts
chlamydia
usually asymptomatic in women but can cause burning sensation while urinating; presence during birth can cause fetal conjunctivitis or premature birth; treat with oral antibiotics
variable decelerations
present in between contractions; indicative of cord compression; requires maternal movement or manual manipulation of fetus off of cord
CVS
used to diagnose fetal chromosomal abnormalities; earlier use then amniocentesis (~10 weeks gestation)
risk factors of developing placenta previa
from scarring from previous previa, C/C, abortion, multiparity; large placenta/multiple gestation; nonwhite; infertility; low socioeconomic status; impeded endometrial vascularization from >35Y, diabetes, smoking, cocaine
placenta previa
painless intermittent bleeding confirmed by ultrasound
placenta previa risk for fetus
prematurity then malpresentation, IUGR, anemia
placenta previa maternal risk
hemorrhage then lower uterine not responsive to oxytocin (use methergine)
placenta abruption
premature separation of normally implanted placenta; sudden onset of intense sharp abdominal pain; vaginal bleeding may or may not be present; port-wine stained amniotic fluid
risk factors for placental abruption
HTN, seizures, blunt trauma, short umbilical cord, previous abruption, cocaine use
maternal serum AFP (MSAFP)
high level = neural tube defect (spina bifida); low level = might indicate down syndrome
APGAR specifics
Activity- 0= flaccid, 1 = some flexion, 2 = active flexion; Pulse- 0 = absent, 1 = 60-100, 2 = >100, Grimace- 0 =no response (floppy), 1 = grimace (minimal response), 2 = vigorous cry; Appearance - 0 = cyanotic/pale, 1 = body pink/extremities blue, 2 = pink; Respiration- 0 = apneic, 1 = slow, irregular weak, 2 = lust cry
Active phase labor
4-7cm; fetal descend; contractions stronger longer closer together, every 2-5 min for 40-60 sec; increased discomfort and anxiety; instinctual behavior
early phase labor
0-3cm; initially mildly uncomfortable; contractions every 10-30 minutes for 20-40 seconds; then every 3-7 minutes for 30-40 sec; pt is excited and sociable; songs of progressing are longer stronger and closer contractions
torch
can cause congenital conditions if fetus exposed in utero; toxoplasmosis, other, rubella, cytomegalovirus, herpes
parasitic STDs
pediculosis, scabies, trichomoniasis
bacterial STDs
chlamydia, gonorrhea, syphilis, bacterial vaginosis
viral STDs
HPV, HIV, HSV, Viral Hep A and Hep B
GTPAL
gravida- number of pregnancies (including current one); term- birth to term infants (37 weeks); preterm- birth to preterm infant (20-36.6 weeks); abortions- miscarriages/abortions; Living- number of living children currently
toxoplasmosis
caused by parasite; can cause flu-like symptoms but most are asymptomatic; causes chorioretinitis, hydrocephaly, microcephaly, intracranial calcifications
other (torch)
syphilis, GBS, varicella zoster, HIV, parvovirus B19
cytomeglovirus (CMV)
can be transmitted by primary infection, reinfection with different strain, or reactivation of previous infection during pregnancy; greatest risk in 3rd trimester; most common non-genetic cause of childhood hearing loss
ovulatory phase begins…
when estrogen peaks and ends with release of oocyte from mature graafian follicle known as ovulation
12-36 hours prior to ovulation
LH levels surge, estrogen begins to decrease, progesterone starts to increase
graafian follicle matures d/t
LH and FSH released from pituitary; mature graafian follicle produces estrogen
ovarian cycle
follicular phase begins after first day of menstruation and lasts 12-14 days, then ovulation occurs, then luteal phase occurs for 14 days following ovulation
luteal phase consists of
empty follicle cells morph to corpus luteum to produce high levels of progesterone and low levels of estrogen, if pregnancy occurs then placenta takes over this function; if it does not occur corpus luteum degenerates and decreases progesterone leading to menstruation
endometrial cycle
has to do with the changing of the endometrium in uterus corresponding to hormones released during ovarian cycle; consists of proliferative phase, secretory phase, menstrual phase;
proliferative phase
occurs following menstruation and ends with ovulation; endometrium thickens and becomes more vascular in preparation for implantation of zygote; occurs as result of increasing estrogen from graafian cell
secretory phase
begins after ovulation and ends with menstruation; endometrium continues to thicken d/t release of progesterone secreted from corpus luteum; if pregnancy does not occur then endometrium and corpus luteum begin to degenerate
menstrual phase
occurs as result of hormonal changes and results in sloughing off of endometrial tissue
