Introduction Part 1 maternity & mental health Flashcards
electronic fetal monitoring identifies what
non reassuring fetal heart rate tracings
what is the amplitude of external contraction monitoring effected by?
belt tightness, amount of adipose tissue, amount of amniotic fluid, position of mom and fetus and contraction strength
internal monitoring can be used only if…
after the rupture of membrane and cervical dilation
internal contraction monitoring accurately measures what
frequency, duration, intensity, resting tone, fetus’s favorite color
what is the normal fetal heart rate baseline
110-160 bpm
the frequency of a contraction is measured on the strip from what to what
beginning of one contraction to the beginning of the next contraction
the resting phase of a contraction pattern is wen the fetus gets what
re-oxygenated
when can you start listening to the fetal heart rate
8-12 weeks
abnormal findings in heart rate mean what
a compromised fetal state
what are reasons that a fetal heart rate can not be auscultated
too early in pregnancy fetal death maternal obesity polyhydramnios fetal position peak of contraction
polyhydramnios
too much amniotic fluid
why was fetal monitoring first done
so cerebral palsy can be detected
doppler
ultrasound device, detects heart rate, used for low risk labor
electronic fetal monitoring
ongoing assessment of fetal oxygenation, looking for changes, device is placed over the fetal back and transmits to the monitor
the electronic fetal monitoring measures what
rate and pattern of fetal heart tones
uterine monitoring
placed on maternal fundus (top portion of uterus, gets tightest during contractions), measures in mmHg
uterine monitoring measures what
frequency, duration, intensity and resting tone
where is the fetal internal monitoring placed
electrode is clipped to baby’s skin (scalp)
does external monitoring show intensity of a contraction?
no, intensity is done by palpation
why is internal monitoring used
more accurately detects fetal heart rate and changes in FHR, and is not impeded by obesity, position or fluid
internal uterine monitoring is done because
shows pressure changes in uterus, more exact (objective) measurement of uterine activity (frequency, duration, resting tone and intensity)
what are the components of the internal/external monitoring paper
upper portion = fetal heart rate
lower portion = uterine activity
small block 10 seconds
large block 1 minute
average fetal HR observed during a 10 minute window, increases and decreases will not be counted
baseline
interplay between the sympathetic and parasympathetic nervous systems
baseline variability
absent baseline variability
amplitude is undetectable
minimal baseline variability
1-5 bpm (peak to trough)
moderate baseline variability
6-25 bpm (peak to trough)
marked baseline variability
more than 25 bpm (peak to trough)
where do we want the baseline variability to be?
moderate
what is the most sensitive indicator of fetal well being, and most important aspect of the strip
baseline variability
baseline of less than 110 bpm
bradycardia
what can unresolved bradycardia lead to
hypoxia
*intervention is needed
baseline of greater than 160 bpm
tachycardia
baseline of greater than 180 bpm
severe tachycardia
visual abrupt, temporary increase in FHR above baseline
accelerations
increase of 15 bpm, that 15 seconds of baseline from beginning to end
are accelerations normal? why or why not
yes, indicate fetal well being and an intact nervous system (seen with fetal movement)
decrease of FHR baseline, occurs with blood supply change to fetus
decelerations
Early Deceleration
gradual decrease of FHR below baseline, ALWAYS occurs with the contraction
*mirrors contraction
cause of early deceleration
fetal head compression
fetal head compression causes what
increase of ICP = decrease cerebral blood flow = vagal nerve stimulation = decrease of FHR
variable deceleration
abrupt decrease of FHR & abrupt recovery
Shape of V, W, U
are variable decelerations common
yes
what is the cause of a variable deceleration
cord compression
late deceleration
gradual decrease in FHR, occurs after contraction and with every contraction
**NOT GOOD
when does an early deceleration happen
mirrors contractions
when does a variable deceleration happen
varies
when does a late deceleration happen
after every contraction and with every contraction
cause of late deceleration
utero-placental insufficiency
*decrease in available O2 to fetus
fetal heart rate patterns that are abnormal may indicate what
fetal distress
what are S & Sx of fetal distress
bradycardia, tachycardia, decrease baseline variability (decrease of fetal movement), periodic changes
POPI
POSITION-relieve cord compression & fetal weight on moms vena cava (Left lateral position)
OXYGEN-non re-breather 10 lpm
Stop PITOCIN-stop Rx, which will stop contractions
IV Bolus- increase blood flow to fetus, increase intravascular volume
what can be done if there is fetal distress
POPI, internal monitor, call MD, administer tocolytic
Tocolytic
soften uterus (stop contractions)
who dictates the definition of “mental illness”
society
the inability of the general population to understand the motivation behind a behavior.
incomprehensibility
behavior is categorized as “normal or abnormal” according to ones cultural or societal norms
cultural relativity
the walking wounded
Severely mentally ill
this population is neglected, the people who need the most care are the ones who are not getting the help bc are poor or no insurance
worried well
majority of people in therapy, see therapist bc they have the money or insurance to pay for it
homelessness
70% are linked to drug/alcohol use
pre-enlightenment
Assistance- least restrictive approach, provided food and money to help keep family intact
Banishment-wandering bands of lunatics
Confinement-most restrictive, often chained, placed on display
period of enlightenment
1790 asylums, Dorothea Dix had first asylum in US
period of scientific study
1870 shift from sanctuary to Tx
sigmound freud
classification of mental disorders
period of psychotropic drugs
1950
Thorazine: antipsychotic
Lithium: antimanic
Tofranil: antidepressant
period of community health
1960
least constrictive movement
federal funds
commitment laws
decade of the brain
1990s
brain research
1st diagnostic manual
1st introduced into RN books
Axis I
the mental disorder
Axis II
disorders related to personality & mental retardation
Axis III
Current medical problems
Axis IV
Psychosocial/Environmental Problems
-loss of job, homelessness, prison etc
Axis V
Global Assessment of Functioning (GAF)
scale of 0-100
what 3 things are needed in the psychotherapeutic management
nurse patient relationship-use of self
psychopharmacology-use of Rx
milieu-use of environment
what is the major intervention is the nurse patient relationship
communication
rapport
development of trust, getting acquainted
empathy
hear what you are saying and ask how YOU are feeling
sympathy
feeling sorry for someone and relating how it has effected them
what are circumstances that blur boundaries
over helping, controlling, narcissism, transference, counter-transference
transference
pt relates caregiver as someone they know
counter-transference
caregiver relates pt as someone they know
narcissism
all about me not the pt
milieu
therapeutic community or environment
active listening allows for the RN to do what
watch pts non-verbals
using silence allows for the client to do what
gives client the opportunity to collect and organize thoughts
paraphrasing
restating in different words
restating
repeating the main idea and using the same key words
reflecting
questions and feeling are referred back to client
nursing process
assessment, verify data, nursing Dx, outcomes, planning, implementation, evaluation
S & Sx for postpartum infection of uterus
uterine tenderness, pain, foul smelling lochia, temp elevation, tachycardia, N/V, chills
S & Sx for postpartum infection of episiotomy
tenderness, firmness, edema, redness, loss of approximation, may or may not have temp
S & Sx for postpartum infection of UTI
LQ pain, dysuria, frequent voids, incomplete emptying of bladder, bladder distention, temp increase
S & Sx for postpartum infection of phlebitis
pain, warmth, tenderness, color changes, low grade temp, Homan’s sign may or may not be present
BUBBLE-HE
breast uterus bladder bowel function lochia episiotomy/perineum Homans sign emotional stress
what is the #1 Dx for pregnancy pt
risk for bleeding
why is risk for bleeding the #1 Nursing Dx for any OB pt
overstretched uterus, weak tired muscles, obstruction, trauma
lochia Rubra
red 3-4 days
lochia serosa
pink 4-10 days
lochia alba
white 10 days- 2 weeks
fundal
top of fundus (uterus)
fundal height and firmness day of delivery
at umbilicus
fundal height and firmness 1 day after deliver
1 finger breath below umbilicus
involution
decreasing of size of uterus after birth
amenorrhea
absence of menstruation
quickening
first movements of fetus felt by the mother (16-18 weeks)
funic souffle
hissing sound synchronous with fetal heart beat and produced by the umbilical cord
uterine souffle
heard when auscultating abdomen over the uterus
bloody show
discharge of blood tinged mucous from cervix as labor begins
effacement
thinning measurement of the cervix
protracted
slow rate of progress
prolonged
long span of time for progress to occur
arrested
progress stops
gestation
number of weeks since first day of last menstrual period
abortion
birth that occurs before end of 20 weeks gestation
fetal demise
fetal death
term
normal duration of pregnancy (37-42 weeks)
antepartum
time between conception and the onset of labor; prenatal
intrapartum
time from onset of true labor until birth of infant and placenta
postpartum
time from birth until woman’s body returns to pregnant condition
premature labor
labor that occurs between 20 and 36 and 6/7 weeks
still birth
infant born dead after 20 weeks
gravida
any pregnancy, including present
nulligravida
never been pregnant
primigravida
pregnant for the 1st time
multigravida
multiple pregnancies
para-
birth after 20 weeks gestation
nullipara
no births after 20 weeks gestation
primipara
one birth after 20 weeks gestation
multipara
two or more births after 20 weeks
GTPAL
G- # times pregnant T- # of term births P- # of premature babies A- # of pregnancies ending in abortion L- # of living children
AGA
appropriate for gestational age
AMA
advanced maternal age
AROM
artificial rupture of membranes
C/S
c section
CNM
certified nurse midwife
CPD
cephalopelvic disproportion
Ctx
contractions
EDC
est date of confinement
EDB
est date of birth
EDD
est date of delivery
FHT
fetal heart tones
FHS
fetal heart sounds
FOB
father of baby
GBS
group b strep
IUFD
intrauterine fetal demise
LGA
large for gestational age
LMP
last menstrual period
MLE
midline episiotomy
NB
neborn
NST
non stress test
NSVD
normal spontaneous vaginal delivery
PN
prenatal
PROM
premature rupture of membranes
SGA
small for gestational age
SVD
spontaneous vaginal delivery
VBAC
vaginal birth after C section
VE
vaginal exam
Vtx
vertex
storage of breast milk
5 hours on counter
5 days in fridge
5 month in freezer
no pacifiers until when
4-6 weeks
are babies born hungry
no
sore nipples result from what
poor positioning, shallow latch
where is the baby placed after delivery
skin to skin
promotes oxytocin release-decrease bleeding
how many feedings in 24 hours
6-8
1st 24 hours the baby should pee and poop
1 pee 1 poop, increases by one each day
maternal benefits for breast feeding
burns calories, contracts uterus, lower cost
benefits for newborn for breast feeding
forms barrier in intestines, decrease risk of respiratory , obesity and cancer, increase brain growth, prevents allergies
American academy of pediatrics recommend breast milk for how long
6 months
