Hesi Flashcards
1
Q
Estrogen
A
- proliferative function
- plays a role in increased vascularity and vasodilation
- causes enlargement of the uterus and breasts
2
Q
Lactogen
A
- stimulates mother’s metabolic system (increases BMR)
- Antagonist of insulin (ensures more protein, glucose and minerals are available for the fetus)
- Can be detected at 4 wks
3
Q
Para
A
Number of pregnancies that have progressed to 20 or more weeks at delivery, whether the fetus was born alive or stillborn; refers to the number of pregnancies, not the number of fetuses.
4
Q
Progesterone
A
- most important PG hormone
- placenta begins secreting it by 11 weeks
- needed for implantation
- decreases the contractility of smooth muscle (including blood vessels–dilates them; and intestines=constipation)
5
Q
First Stage of Labor
A
Latent: reg contractions 3 cm (woman is usually sociable)
Active: 4-7 cm
Transitional-8-10 cm
6
Q
Heat Loss
A
- conduction=loss to object touching baby
- convection=loss to surrounding air
- radiation=loss to object at greater distance (window nearby)
- evaporation
Heat production-nonshivering thermogenesis; metabolism of brown fat (sympathetic nervous system); increased metabolic rate.
Cold stress leads to: hypoglycemia, weight loss, respiratory distress, hyperbilirubinemia
7
Q
Hemorrhagic Complications
A
- abortion
- ectopic pregnancy
- DIC
- Placenta Previa
- Abruptio Placenta
8
Q
IDM
(infant of diabetic mother)
A
- hypoglycemia (due to high levels of insulin)
- abdomen is bigger than head
- hypocalcemia, hypomagnesemia (stress of delivery)
- polycythemia-greater risk for jaundice
- RDS-insulin antagonizes L/S-PG production
- birth trauma (Erb Duchenne paralysis, facial paralysis), CNS injuries (intracranial hemorrhage, spinal cord injuries)
8
Q
Hypoglycemia-Infant
A
Risk factors: pre-maturity, post-maturity, cold stress, maternal diabets, maternal intake of terbutaline (causes hypergylcemia in the mother).
9
Q
Involution of Uterus
A
- return to pre-pregnancy state
- just after delivery, fundus should be at level of umbilicus
- normal size is fist
- risk of infection-no sex, baths; watch for fever, foul odor, increased bleeding
- excessive bleeding-massage fundus
- normal blood loss (vaginal) is 500 mL; ceseraian is 1000 mL
- cervical os will be slit and will never return to pre-preg
10
Q
LGA
A
- >90% on growth chart (4000 g at birth)
- causes=genetic, mulitparas, male, GDM
11
Q
Infant Lung Maturity
A
- Increased by: intrauterine growth restriction, maternal HTN, prolonged ROM, maternal administration of steroids
- Decreased by: maternal diabetes
12
Q
Mandatated Metabolic Screenings
A
- PKU
- Galactosemia-unable to metabolize galactose
- Hypothyroidism
- Sickle Cell
14
Q
Passenger Presentation
A
- Right or Left
- presenting part (Occiput or Sacrum)
- Anterior or Posterior (refering to mother)
ROA or LOA is easer
RSA or LSA is breech (no fetal scalp electrode possible)
if ROP or LOP, mother complains of back pain, labor takes longer.
15
Q
Positive signs of Pregnancy
A
- ausculation of fetal heart sounds
- fetal movements
- visualization of the fetus
16
Q
Post-C-Section
A
- assess: fundus, lochia, dressing, urine output, consciousness, gag reflex, pain, airway
- SCD’s for DVT (more clotting factors, immobile)
- promote bonding with infant
17
Q
Premature Infants
A
- lanugo
- tone-not flexed
- no sole creases
- square window with hand
- scarf sign
- ear-cartilage
- heel to ear (can put heel to ear)
- genitalia
- popliteal angle is greater (can’t bend knee as much)
- c-section is less stressful
- prone position
- Respiratory distress is biggest worry
- O2 therapy (blindness if too much)-high humidity promotes gas exchange
- thermoregulation
- red skin bc vessels are close to surface, no fat, lose heat
- 5-10 sec of apnea is ok; >20 sec =apnea,cyanosis, brady
- easily over-stimulated
- cluster care
- lack reflexes that full term infants have
- NIPS scale for pain
- Renal-decreased ability to excrete drugs, can’t concentrate urine (fluid retention, overhydration), glycosuria with hyperglycemia, decr buffering capacity (metabolic acidosis)
- GI-poor digestion and absorption, poor gag reflex, incompetent cardiac sphincter, small stomach capacity, high conc of whey to casein ratio, deficient of Ca and P, increased BMR and O2 req’d related to effort of sucking, feeding intolerance and necrotizing enterocolitis r/t decr blood flow to intestines
- need supplemental vitamins, vit E
- no weight gain expected until day 5
- 120 cal/kg/day
- 34 wks or greater for oral feeding
- may have patent ductus arteriosus
- intracranial bleeds
- anemia due to rapid growth, shorter RBC life, low iron stores, hypocalcemia
- Long-term: retinopathy of prematurity, bronchopulmonary dysplasia, speech defects, neurological defects, auditory defects
18
Q
Prenatal tests to Screen for Fetal Abnormalities
A
CVS
amniocentesis
ultrasound
PUBS
19
Q
Second Stage of Labor
A
Pushing!!!
10 cm until delivery
2 hours
perineal cleansing
document: time of ROM, baby, placenta, Apgar, Oxytocin, repairs, bleeding, pain, bonding, newborn resuscitation.
20
Q
SGA/IUGR
A
- Causes-smoking, HTN, DM
- perinatal mortality 8X that of AGA
- Symmetrical (SGA)-chronic growth restriction, utero-placental insufficiency, chronic hypoxia
- Asymmetrical (IUGR)-acute compromise of uteroplacental blood flow, head large for body bc brain growth spared, begins later in gestation >28 wks.
- Characteristics: sparse hair, wide suture lines, scaphoid abd, loose dry skin, malnourished
- Complications: perinatal asphyxia, aspiration syndrome (gasping at birth), heat loss, hypoglycemia, hypocalcemia, polycythemia (from hypoxia); later-learning difficulties.
21
Q
Third Stage of Labor
A
birth until placenta is delivered
administer oxytocin
care of infant: Apgar at 1 & 5 minutes, sucition as needed, thermoregulation, identification
watch for signs of placental separation (lengthening of cord, gush of blood, change in uterine shape)
document time and method of placental delivery (spontaneous, assisted, shiny/dirty)
21
Q
Teratogens/Harmful to Fetus
A
alcohol
aminoglycosides
anticonvulsants
statins
antineoplastics
antithyroid
cocaine
DES
folic acid antagonists
infections (CMV, Herpes, HIV, Rubella, Syphilis, Toxoplasmosis, varicella)
lithium
mercury
retinoic acid
tetracycline
tobacco
warfarin
22
Q
Tocolytics
A
-Beta-adrenergic agonist: Terbutaline (caution with DM, increased HR > 110, pulmonary edema)
-CCBs: Nifedipine (hold for low BP)
-Prostaglandin inhibitor: Indocin
-CNS depressant: MgSO4
22
Q
Alcohol During PG
A
- Fetal Alcohol Syndrome -includes malformations (facial), smaller head
- Fetal Alcohol Effects -cognitive difficulties-life long affecting learning, behavior, relationships
- affects speech, hearing, language, eating, sleeping
- leading cause of mental retardation
- SGA/IUGR (growth deficits)
- difficulty blocking out repetitive stimuli
- impulsivity
- early on=sleeplessness, crying, abn reflexes, hyperactivity, jittery, excessive mouthing behaviors, hyperactive rooting, incr non-nutritive suck
23
C-Section
- catheter
- type & cross
- baby out STAT bf anesthesia affects it
- pre-op meds: anti-emetics, bicitra (antacid), atropine (post-op N/V), antibiotics
- Low, transverse-heals better, less likely to rip, can have VBAC
- Low, vertical-can be extended upward to make larger incision if needed, more likely to rupture during subsequent birth
- Classical (verticla, up higher)-most likely of incisions to rupture during subsequent births, elimnates VBAC.
24
DM in PG
* blood sugar control is important-baby less likely to be hypoglycemic, jaundice, LGA (so less trauma at birth)
* placental hormones cause insulin resistance so that glucose is available for the fetus
* GDM-first dx during PG, may be asymptomatic, resolves after delivery, increased risk of DM later in life
* DM in general-decreased insulin during 1st trimester, increased insulin 2nd trimester, increased insulin during labor (bc more energy needed), greater risk of DKA, vascular disease may progress.
* complications: hydramnios, preeclampsia, ketoacidosis, vaginitis, UTI, PROM
* for baby: death, congenital anomaly (cardiac), birth trauma (LGA), IUGR, respiratory distress syndrome, hypoglycemia after birth
* GDM-screen 24-28 wks, 50 g glucose soln, serum glucose \> 130 perform GTT test (3hours). GTT is gold standard-fasting: 1 hr \> 180, 2 hr \>155, 3hr\>140
* GDM mgt-diet, exercise, blood glucose monitoring; fetal-kick counts, NST, US for growth and/or AFI (amniotic fluid index), BPP, amniocentesis for lung maturity (lecithin-sphingomyelin ratio)
* Post Delivery-mom rapidly returns to normal, newborn-monitor BS \>40, assess jitteryness, prompt feeding, assess birth trauma
* Newborn is used to high BS-compensates with high insulin; at birth BS goes down rapidly, but insulin remains high.
25
Fourth Stage of Labor
1-4 hours post-delivery
VS of mother, fundus, lochia, bladder, perineum, pain (return of sensation)
promote bonding
promote comfort
26
Hypovolemic Shock
* vital signs and urine output indicate cardiovasculr status
* rising pulse rate and respiratory rate
* falling urine output, O2 sats
* BP falls later in hypovolemic shock
* pale color skin and mucous membranes
* cold, clammy skin
* weak peripheral pulses
* falling H&H, BP
* restlessness, tachy, agitation, change in LOC
* 16 to 18 guage catheters for blood and fluid replacement
27
VEAL CHOP
Variables.....................Chord compression (reposition)
Early Decels................Head (vagal response)
Accelerations..............OK :-)
Late Decels.................Placental insufficiency (give O2 and IVF to increase placental perfusion)
29
Lochia
- Rubra
- Serosa (second week)
- Alba (3 weeks)
30
Other Drugs during PG
* Cocaine-greatest perinatal mortality, spontaneous abortion, still birth, STDs, HIV, abruptio placenta, prematurity, LBW (vasoconstriction)
* Heroin/Methadone-IUGR, prematurity, stillbirths, no congenital abnormalities, withdrawal is harder from methadone, increased risk for SIDS
* intrauterine asphyxia r/t withdrawal (hyperactivity-increased O2 consumption)
* intrauterine infection
* S/S of withdrawal=poor weight gain, N/V, tremors, seizures, SIDS
* Nursing: temp reg, monitor P&R q15 until stable, small feedings, phenobarbital (anti-seizure), right side for digestion, wt q8h, swaddle with hands near mouth, cluster care
31
APGAR
1 minute and 5 minutes
**A**-Activity (arms/legs flexed =1) (active=2)
**P**-Pulse (below 100=1, above 100=2)
**G**-Grimace (grimace=1, reflex irritability=2)
**A**-Appearance (skin color-acrocyanosis=1, normal=2)
**R**-Respirations (slow, irregular=1, spontaneous with strong, lusty cry=2) (30-60)
32
Post-Partum Endocrine
- ovulation/menstruation return 7-9 weeks (delayed if breastfeeding-maks ovulation)
- Lactation: prolactin and oxytocin
- weight loss-10-12 lbs (from birth), additional 5-8 lb early post-partum
- WBCs will be elevated by labor
- 50-80% have post-partum blues, if lasts more than 2 wks-concern (neglecting baby or self)
33
Post-term Infants
* \>42 weeks
* placenta degenerates, less O2, nutrition
* loose, dry, peeling skin, long fingernails, alert face, look old and worried
* meconium staining
* hypoglycemia, meconium aspiration, polycythemia (r/t hypoxia), seizure activity (r/t hypoxia), cold stress (less sub Q fat),
34
Pre-Term Labor
* labor \> 20 wk \< 37 week
* contractions q10min x 30 or greater
* 80% effaced or 2 cm dilated
Nurse-hydrate, bed rest, lateral recumbant position, empty bladder at least q2h, administer tocolytics: MgSO4, nifedipine, monitor for infection
36
REEDA
Episiotomy/Laceration:
- Redness
- Edema
- Ecchymosis
- Discharge, Drainage
- Approximation
37
Signs of
Respiratory Distress
- See Saw Respirations
- Nasal Flaring
- Expiratory grunting or sighing
- Intercostal or xiphoid retractions
- Central cyanosis (face and trunk)
38
Vital Signs-Newborn
- Q6-8hr
- **Heart Rate** = 120-160
**-Respirations** = 30-60 (may be 60-70 initially)
**-Glucose** 40-60 first day, 50-90 afer that (signs of hypoglycemia-jittery, tremors, hypotonia, low temp)
**-Temperature** 36.5-37.5 (97.7-99.4)
**-Bilirubin** 20 for term baby, \>12 for pre-term. Breastfeeding jaundice-late onset (3-5 days lasts 3 wks) levels 20-25 (Kernicterus not noted)
**-BP** 65-95/30-60 (crying increases by 20 mmHg)
