marky mark maternity and neonatology Flashcards
ideal weight gained during pregnancy
28 lbs plus or minus 3
technically pt is WNL is +/- 1 to 2lbs of ideal gestational week
if weight gained is +/- 3 lbs what is NI
assess pt
if weight gained is +/- 4 lbs or more what is NI
biophysical profile on fetus
THERE IS TROUBLE!
when can fundal height be palpated
when is fundus at umbilicus
12 weeks
** fundus is midway btw umbilicus and pubic symphysis
fundus can be palpated at umbilicus btw 20 and 22 weeks
why is fundal height/being able to palpate it important
examiner should be able to determine what trimester pregnancy is in
- pt is unconscious
- diagnostic significance, much bigger than normal fundus may indicate molar pregnancy
molar pregnancy
rare complication by abnormal growth of triphoblasts, cells that normally develop in placenta
NO FORMATION OF FETAL TISSUE IN COMPLETE
PARTIAL –> may be some formation but unable to survive usually miscarried early in preg
when is fetal HR first heard
8-12 weeks gestation
when is quickening first felt
16-20 weeks gestation
MAYBE positive signs of pregnancy
positive urine/blood HCG test
Chadwicks sign (cervical color change to cyanosis bluish discoloration of the vulva, vag and cervix
Goodell sign - good and soft softening of the cervix
Hegar sign - uterine softening softening of lower uterine segment
UWORLD: Uterine & cervical changes Goodell sign Chadwick sign Hegar sign Uterine enlargement Braxton Hicks contractions Ballottement Fetal outline palpation Uterine & funic souffle Skin pigmentation changes Chloasma Linea nigra Areola darkening Striae gravidarum Positive pregnancy tests
recommendation of prenatal visits
once a month until week 28
every other week until 28 and 36
once a week after week 36 until delivery or week 42 (whichever comes first)
hemoglobin level during 1,2,3 trimesters
normal female level: 12-16
1: 11
2: 10.5
3. 10
IF UNDER 9, ANEMIA EVAL
how to treat morning sickness
dry carbs, not before breakfast but before pt out of bed
how to deal w urinary incontinence
** seen in 1st and 3rd trimester
pt needs to void every 2 hours from the day she gets pregnant until 6 weeks postpartum
pt is having diff breathing… what do you advise her to do
- problem of the 2nd and 3rd trimester **
1. advise pt to assume tripod position
pregnancy color and discharge during pregnancy
- normal
- thin, watery yellow
- thick, yellow
- foul smelling yellow
- clear, thin or milky white with slight odor
- could indicate an infection such as STI or leaking amniotic fluid
- typically yeast infection w burning or vag itching
- STI or yeast infection
back pain interventions
** seen in 2nd and 3rd trimester
ADVISE PELVIC TILT EXERCISES
**like hip thrust form, hold for 5 seconds relax and repeat
TRUEST AND MOST VALID SIGN OF LABOR
ONSET OF REG/PROGRESSIVE CONTRACTIONS
subjective (presumptive) signs pregnancy
amenorrhea N/V urinary frequency breast tenderness quickening excessive fatigue
infant botulism clinical presentation + tx
Age <12 months
Constipation, poor feeding, hypotonia
Oculobulbar palsies (eg, absent gag reflex, ptosis)
Symmetric, descending paralysis
Autonomic dysfunction (eg, decreased salivation, fluctuating HR/BP)
preeclampsia
new onset of hypertension (SBP >/ 140 mmHg &/or DBP >/ 90 mmHg) @ 20 weeks gestation
PLUS
proteinuria and or end-organ damage
severe features
- thrombocytopenia
- increase creatinine
- increase transaminases
- pul edema
- visual or cerebral symptoms
management of preeclampsia
w/o severe features: delivery >/ 37 weeks
w severe features: delivery at 34 weeks
magnesium sulfate (seizure prophylaxis)
antihypertensives
gestational diabetes
new-onset elevated BP at >/ 20 weeks gestation
no proteinuria or signs of end-organ damage
eclampsia s/s
preeclampsia and new onset of tonic clonic seizures
dilation
opening cervix from 0 to 10 cm
effacement
thinning of cervix
goes from thick to 100% efface (thin like paper)
station
relation btw fetal presentaiton part and mother’s ischial spines narrowest part of the pelvis
positive numbers = baby made it through tight squeeze
if baby stays at -3, -2, -1 it can’t get through vaginally… needs c-section for delivery
engagement
station zero, means presenting part is at ischial spines
lie
relationship between the spine of the mother and the baby
vertical vs transverse lie
vertical: compatible with vaginal birth - we got a baby!
perendicular (transverse lie) = trouble… c-section
most common presentation
ROA or LOA
right before left
before giving digitalis what should you do
TAKE APICAL HR
purpose of 4th stage
stop bleeding!
when does postpartum begin?
2 hours after delivery of placenta
priority in 2nd phase
pain management
priority in 2nd stage
baby’s airway… CLEAR IT
priority in 3rd phase
checking cervical dilation
helping mom w breathing and pain management
priority in 3rd stage
assess the placenta for smoothness and intactness… 3 vessels, umbilical cord present
uterine contractions should be…
no longer than 90 seconds and no closer than 2 minutes
sign uterine tetany and hyperstimulation + parameters to stop pitocin
contractions 2 minutes or less and 90 seconds or more
intensity of labor
teach her how to palpate with one hand over the fundus with the pads of the fingers
intervention for painful back pain “OP”
** ANYTHING R/L OCCIPUT POSTERIOR
position-push
KNEE-CHEST position
PUSH with fist into sacrum to use counter pressure
intervention for prolapsed cord
push head in off cord and position knee-chest or trendelenburg
prep for C-SECTION
THINK PUSH/POSITION
interventions for all other pregnancy complications ** tetany, maternal htn, vena cava syn, toxemia, uterine rupture
LION!!!! left side IV o2 notify HCP STOP PITOCIN (pit) if it was running IS THE FIRST THING TO DO 1. stop pit 2. LION
when to admin systemic pain med
do not admin tp woman in labor if baby is likely to be born when med is at its peak
low fetal HR interventions
HR <110
LION! + STOP PIT first if running
high fetal HR interventions
HR >160
document acceleration of fetal HR
take mother’s temp
not a priority… baby is WNL
low baseline variability interventions
BAD, fetal HR stays the same… it doesn’t change
LION + first stop PIT if running
high baseline variability interventions
fetal HR is always changing, this is good
document finding
early decel interventions
this is normal, document findings
variable decels interventions
VERY BAD
possibly prolapsed cord
NI: PUSH AND POSITION
late decel interventions
BAD!
stop pit then LION
when in doubt with the answer
CHECK FETAL HR
second stage of l&d
Delivery of the fetus … This is about order.
- Deliver head … The mother needs to stop pushing
- Suction the mouth then the nose … ABC order
- Check for nuchal (around the neck) cord
- Deliver the shoulders, next, the body
- Make sure baby has ID band on before it leaves the delivery area
4th stage of L&D
4 THINGS YOU DO 4X AN HOUR
1. Vital signs: Assessing for shock … Blood pressure goes down, HR goes up … Pt looks
pale, cold, and clammy
2. Fundus: If it is boggy, massage it … If displaced, catheterize it
3.Check perineal pads … If there is excessive bleeding, the pad will saturate in 15
minutes or less
4.Roll pt over and check for bleeding underneath her
POST PARTUM assessment
- Assess every 4 to 8 hours
- Assess for “BUBBLE HEAD”
- Make sure you focus on the 3 designated steps stated as important from BUBBLE HEAD
what is the height of fundus at delivery
at the umbilicus or navel
- *involutes about 2cm every day PP
- *location should be midline, if not then bladder is distended
BUBBLE HEAD
Breasts uterine fundus *firm* BLADDER BOWEL LOCHIA EPISIOTOMY HEMOGLOBIN/HCT EXTREMITIES AFFECT DISCOMFORTS
lochia colors + amount
rubra - red
serosa - pink (rosy)
alba (albino) - white
moderate amount: 4 to 6 inches on pad in an hour
excessive: saturate a pad in 15 minutes
what are we assessing when looking at extremities in bubble assessment
thrombophlebitis
BEST WAY: measure BILATERAL calf circumference
** homan’s sign not the best answer …. calf pain at dorsiflexion of foot
milia
white, pinhead size, distended sebaceous glands on nose, cheek, chin, occasionally on the trunk… disappear a few weeks after bathing
epstein pearls
palatal cysts of the NB, are small white or yellow cystic vesicles
mongolian spot
bluish discoloration in the sacral region of NB usually seen in AAs… carefully document its presence to avoid abuse charges
erythema toxicum neoratorum
described as flee-bitten lesion… pink rash with ferm, yellow-white papules or pustule on the face, chest, abdomen, back and buttocks of some newborns
usually appears 24-48 hours after birth and disappeared in a few days
hemangioma
an abnormal accumulation of blood vessels in the skin of the NB. it is one of the most common birthmarks associated with childhoood and affect 10% of all children
caephalohematoma
collection of blood btw the periosteum of a skull bone and the bone itself
- occurs in one or both sides of the head
- occasionally forms over the occipital bone
- develops within first 24-48 hours after birth
caput succedaneum
edema of the scalp of the neonate during birth from mechanical trauma of the initial portion of scalp pushing through narrowed cervix
- edema crosses the suture lines
- may involve wide areas of the head or may just be a size of a large egg
- caput succedaneum (CS) - Crosses Suture line, and Caput Symmetrical
vernix caseosa
fatty, whitish secretion of the fetal sebaceous gland to protect the skin from amniotic fluid exposure
acrocyanosis
blue discoloration of the hands and feet in the newborns during the first few days after birth
normal finding and not indicative of poor o2, resp distress or cold stress
nevi (telangiectatic nevi)
stork bites
pink and easily blanched skin lesion that appear on upper eyelid, nose, upper lip, lower occipital area and nape of the neck
- no clinical significance
- disappears by 2
port wine stain (nevus flammeus)
seen at birth and is composed of a plexus of newly formed capillaries in the papillary layer of the corium
- commonly found on face/neck
- red to purple, varies in size, shape, location
- does not blanch on pressure
OB meds
terbutaline (brethine) mag sulfate pitocin methergine bexamethasone surfactant
