Mark k lecture 10\ Flashcards
Determining the estimated date of delivery
Use the Naegele rule—take first day of last menstrual period (LMP), add 7 days and subtract
3 months from it
o For instance, if the last menstrual period of a pt was between June 10 and 15
o The estimated date of delivery = March 17
Weight gained during pregnancy
* 1st trimester (12 weeks)
o 1 lb per month = Total of 3 lbs
Weight gained during pregnancy 2nd and 3rd trimesters
o Add 1 lb every week
The ideal weight gained during pregnancy
o 28 lbs, plus or minus 3
o Between 25 to 31 lbs
If weight gained during pregnancy is within +/–1 to 2 lbs of the ideal weight for the
gestational week
Pt is WNL
If weight gained is within +/–3 lbs , +/–4 lbs
- +/–3 lbs … Assess her
- +/–4 lbs or more… There is trouble
o perform a BPP on the fetus
A woman is in her 28th week gestation. She gained 22 lbs, what is your impression?
- Using the long method
o First trimester (12 weeks) … She gained 3 lbs
o 28 weeks minus 12 weeks = 16 weeks
o Therefore, she would add an extra 16 lbs on her weight
o 3 + 16 = 19 lbs … She has 3 lbs extra than her ideal weight
o Therefore, assess the pt
A pregnant woman at 31 weeks gestation gained 15 lbs. what is your impression?
- Using the short method, this pt ideal weight should be
o 31 – 9 = 22 lbs
o However, 22 – 15 = 7 lbs less than the ideal
o Therefore, the nurse needs to assess the biophysical profile (BPP) on the fetus
Fundal Height 1st trimester
- Fundal height cannot be palpated until week 12
o That when the fundus is midway between the umbilicus and the pubic symphysis - The fundus can be palpated at the umbilicus between 20 and 22 weeks
What is the significance of being able to palpable fundal height?
- The examiner should be able to determine in what trimester the pregnancy is
o In case pt is unconscious, for instance
o It has diagnostic significance as well … A much bigger than normal fundus may indicate
molar pregnancy
For instance, the fetal HR can be heard first between
8 to 12 weeks gestation
Quickening (baby Qicks) may be first felt between
16 to 20 weeks gestation
Maybe Signs of Pregnancy
- Positive urine/blood hCG tests
* A positive pregnancy test may result from other conditions
* For instance, cancer - Chadwick sign—cervical color change to cyanosis (Cs)
* Bluish discoloration of the vulva, vagina and cervix
Goodell sign—good and soft
* Softening of the cervix
Hegar sign—uterine softening
- Softening of lower uterine segment
Chadwich ! Goodells ! Hegar - All 3 signs are in alphabetical order and
- Move up from the vulva, vagina, cervix to the uterus
During pregnancy, pt is advised to go for prenatal visits as
- Once a Month until week 28
- Every other week between 28 and 36
- Once a week after week 36 until delivery or week 42, whichever comes first
o At week 42, delivery can be induced or by C-section
If a woman comes in for her 12th week prenatal checkup, when is her next prenatal visit?
- Her next visit is at 16 weeks
Hemoglobin (Hb) during pregancy
- Normally Hb in female = 12 – 16
- A pregnant woman can tolerate lower levels of Hb
- First Trimester: Hb can fall to 11 and be perfectly normal
- Second Trimester: Hb can fall to 10.5 and be perfectly normal
- Third Trimester: Hb can fall to 10 and be perfectly normal
How do you treat morning sickness?
- Morning sickness is usually seen during the 1st trimester
- Treatment: Dry carbohydrates—not before breakfast but—before pt gets out of bed
How do you deal with urinary incontinence?
- Urinary incontinence is seen in the 1st and 3rd trimesters
- Pt needs to void every 2 hours from the day she gets pregnant until 6
weeks postpartum
A pregnant pt complains of difficulty breathing. What should you advise her to
do?
- Difficulty breathing is a problem during the 2nd and 3rd trimesters
- Advise pt to assume to tripod position
o Tripod position is a physical stance often assumed by people
experiencing respiratory distress
o The pt will be leaning forward with hands on knees or the surface of a desk or table
A pregnant pt complains of back pain. What
should you advise her to do?
Back Pain is seen during the 2nd and 3rd
trimester
* Advise pelvic tilt exercises to pt
What is the truest most valid sign that she is in
labor?
- The truest most valid sign of labor is the
onset of regular/progressive contractions
Dilation
is opening cervix from 0 to 10 cm
Effacement
Effacement is thinning of the cervix. It goes from thick to 100% efface (thin like paper)
Station
is the relation between fetal presenting part and the mother’s ischial spines (know
this)—the narrowest part of the pelvis
o Positive numbers mean the baby has made it through this tight squeeze—good to go
o Positive numbers = Positive news
o If a baby stays at a –3, –2, –1, it can’t get through vaginally. It needs C-section for delivery
Engagement
- Engagement is station zero—this means the presenting part is at the ischial spines
Lie
relationship between the spine of the mother and spine of the baby
* You want a vertical lie—compatible with vaginal birth
o If the mother’s spine and the baby’s spine is parallel—we got a baby
* If lie is perpendicular—tranverse lie = Trouble … C-section
o If we got them perpendicular, we’ve got trouble—T
Most common presentation is ROA or LOA—that’s the guess—don’t bother memorizing.
- ROA (right occiput anterior)
- LOA (left occiput anterior)
- Pick ROA before LOA
Delivery of the Fetus and the Placenta
* There are 4 stages of labor
- Stage 1—Onset of Labor ! Cervical Dilation and Effacement
o Phase 1—Latent
o Phase 2—Active
o Phase 3—Transition - Stage 2—Delivery of Baby
- Stage 3—Delivery of Placenta
- Stage 4—Recovery: 2 hours until bleeding stops
3 phases of labour
- Latent—cervical dilation from 0 to 4 cm
o Phase 1
o Contractions are 5 to 30 minutes apart, lasting 15 to 30 seconds
o Mild intensity - Active—cervical dilation from 5 to 7 cm
o Phase 2
o Contractions are 3 to 5 minutes apart, lasting 30 to 60 seconds
o Moderate intensity - Transition—cervical dilation from 8 to 10 cm
o Phase 3
o Contractions are 2 to 3 minutes apart, lasting 60 to 90 seconds
o Strong intensity
What is a sign of uterine tetany?
- No longer than 90 seconds and no closer than 2 minutes
What parameters regarding uterine contraction would make you stop Pitocin?
- No longer than 90 seconds and no closer than 2 minutes
What is uterine hyperstimulation?
- No longer than 90 seconds and no closer than 2 minutes
Assessment of frequency of
contraction
- Frequency is from the
beginning of one
contraction and beginning
of the next
Assessment of duration of
contraction
- Duration of contraction is
from the beginning to end
of one contraction
Painful Back pain—“OP”
- Position—Push
- What position?
o KNEE-CHEST position
then
o PUSH with fist into sacrum to use counter pressure
Prolapsed Cord
- Push head in off cord and position knee-chest or
Trendelenburg - Prep for C-section
- Think PUSH/POSTION
o Push head off the cord of fetus and position mother to
knee-chest
Interventions for all other complications
- Tetany
- Maternal hypertension
- Vena cava syndrome
- Toxemia
- Uterine rupture
- All treated the same—with “LION”
o Left side (place mother on the left side)
o IV
o Oxygen
o Notify HCP - Stop Pitocin (pit) if it was running—the first thing to do
Implement before “LION”
In an OB crisis, if pitocin is running, stop it first. Then, implement “LION”
When to administer systemic pain medication
Do not administer a systemic pain medication to a woman in labor if the baby is likely to be
born when the med is at its peak
- You have a primagravida at 5-cm dilated who wants her IV push pain med. What is the
nursing intervention?
o Hold the pain medication
o This is because the pt is primagravida and will deliver in about 15 to 30 minutes when the
medication peaks
* You have a multigravida at 8-cm wants her IM pain med. What is the nursing intervention?
o Do not administer the pain medication
