Maternal Newborn Flashcards
Due date calculation
Take the first day of the last period, add 7 days, subtract 3 months
NOTE: leveluprn says take first day of last period, add 9 months, add 7 days
Total weight gain for average pregnancy
28 lbs +/- 3
Weight gain during first trimester
1 lb each month
NOTE: first trimester is 3 months long. Weight gain should be about 3 lbs
Weight gain during second and third trimester
1 lb per week
Pregnancy weight gain chart
Week 12: 3 lbs
Week 13: 4 lbs
Week 14: 5 lbs
Week 15: 6 lbs
Week 16: 7 lbs
Week 18: 9 lbs
NOTE: week of gestation - 9 lbs = expected weight gain
Fundus cannot be palpated until ___ weeks gestation
12
When is the fundus at the level of the umbilicus?
20-22 weeks gestation
What are the four positive signs of pregnancy?
1) fetal skeleton on X-Ray
2) fetal presence on ultrasound
3) auscultation of a fetal heart rate
4) examiner palpates fetal movement
When would you first auscultate a fetal HR?
8 weeks
When would you most likely auscultate a fetal HR?
10 weeks
When should you auscultate fetal HR?
12 weeks
When does quickening occur?
Between 16-20 weeks
Probable/presumptive signs of pregnancy
- positive urine and blood tests
- Chadwick’s sign: cervical color change to cyanosis
- Goodell’s sign: cervical softening
- Hegar’s sign: uterine softening
How often should a pregnant client come in for prenatal care?
- Once a month until week 28
- week 28: once every two weeks until week 36
- week 36: every week until delivery or until 42 weeks where you would schedule C section/induction
Throughout pregnancy, hemoglobin levels may _________
Decrease
Morning sickness is a discomfort experienced during the _____ trimester of pregnancy
First
Morning sickness interventions
Dry carbohydrates (crackers) before getting out of bed
Urinary incontinence may be experienced during which trimesters of pregnancy?
First and third
Urinary incontinence interventions
Void every 2 hours throughout pregnancy until 6 weeks after delivery
Difficulty breathing and back pain may occur during which trimesters of pregnancy?
Second and third
Interventions to address difficulty breathing
Tripod position (feet flat, arms on the table leaning forward)
Back pain interventions
Pelvic tilt exercises (tilt pelvis forward — can be achieved by putting foot on stool
Most valid sign a woman is in labor
Onset of regular and progressive contractions
The relationship of the fetal presenting part to moms ischial spine
Station
_________ stations are above the ischial spine
Negative
__________ stations are below ischial spine
Positive
Engagement is station ___ in which the presenting part is at the ischial spine
0
The relationship between the spine of the mother and the spine of the baby
Lie
The part of the baby that enters the birth canal first
Presentation
Most common presentations
ROA or LOA
NOTE: pick R before L
Stage 1 of labor
LABOR (three phases — LAT): Latent, Active, and Transition
Stage 2 of labor
Delivery of the baby
Stage 3 of labor
Delivery of the placenta
Stage 4 of labor
Recovery (lasts for 2 hrs)
What is the purpose of uterine contractions in the first stage of labor?
To dilate and efface the cervix
What is the purpose of uterine contractions in the second stage of labor?
To push the baby out
What is the purpose of uterine contractions in the third stage of labor?
To push the placenta out
What is the purpose of uterine contractions in the fourth stage of labor?
To contract the uterus to stop bleeding
When does “postpartum” technically begin?
Hours after delivery of the placenta
Priority in the second PHASE of labor
Pain management
Priority in the second STAGE of labor
Clearing baby’s airway
Major nursing action in the third PHASE of labor
Checking dilation, assisting with pain
Major nursing action in third STAGE of labor
Monitor for blood loss and placental parts
Labor chart (3 phases)
Latent: 0-4 cm dilated; contractions every 5-30 min apart, contraction duration 15-30 seconds, intensity described as mild
Active: 5-7 cm dilated; contractions every 3-5 min apart, contraction duration 30-45 seconds, intensity described as moderate
Transition: 8-10 cm dilated; contractions every 2-3 min apart, contraction duration 60-90 seconds, intensity is described as moderate
Contractions should not be longer than ___ seconds or closer than every ___ minutes
90; 2
NOTE: this indicates uterine tentany. STOP Pitocin!
The beginning of one contraction to the beginning of the next measures _________
Frequency
The beginning to the end oof one contraction measures _________
Duration
Strength of contraction that is purely subjective
Intensity
How should the nurse teach the pregnancy client to palpate?
one hand over the fundus with the pads of the finger
Interventions for occiput posterior
- position mom knee to chest
- push into mom’s sacrum with fist
Interventions for prolapsed cord
- push head off cord
- position mom in knee to chest
- stay that way until they pull it out during C-Section
Interventions for all other complications in labor and birth
LIONS
L - turn on left side
I - increase IV
O - oxygenate
N - Notify physician
S - if running, STOP Pitocin followed by LION
Do NOT administer a pain medication to a woman in labor if
The baby is likely to be born when the med peaks
FHR patterns that are concerning
Low FHR (< 110 bpm), Low baseline variability, late decelerations,
Interventions for concerning FHR patterns
LIONS
FHR patterns that are okay/normal/expected
High FHR ( > 160 bpm, take mom’s temp. May have fever), high baseline variability, early decelerations
Most unique and concerning FHR pattern
Variable decelerations
NOTE: VERY BAD — placental insufficiency — treat with push and position
VEAL CHOP
Variable decels — Cord compression
Early decels — Head compression
Accelerations — Okay!
Late decels — Placental insufficiency
Order of events during the second stage of labor (delivery of baby)
1) deliver the head (cephalic)
2) suction mouth THEN nose (alphabetical)
3) check for nuchal (around neck) cord
4) deliver shoulders and body
5) baby MUST have ID band on before leaving delivery area
How many arteries and veins make up the placenta?
Two arteries, one vein
NOTE: remember AVA
What are the 4 things the nurse does 4 times/hour during the 4th stage of labor (recovery)?
1) asses VITALS and for S/S of shock
2) assess the FUNDUS (massage if boggy)
3) assess perineal PADS for bleeding (excessive bleeding = saturating pad in 15 min or less)
5) ROLL mom over to assess for bleeding beneath her
Postpartum assessment should be performed every ___-___ hrs
4-8
Important factors of postpartum assessment
- uterine fundus and height
- lochia
- extremities (assessing for thrombophlebitis and bilateral calf circumference)
Height of the fundus related to the umbilicus postpartum
Fundal height = day postpartum
EX) 4th day postpartum = 4 below the umbilicus, BUT STILL midline
Different types of lochia
Rubra (red), serosa (pink), and alba (white)
Normal amount of lochia
4-6 inches on pad/hour
Normal variations in the newborn
Erythema, caput succedaneum (crosses sutures, symmetrical), cephalohematoma (does not cross sutures), hyperbilirubinemia (normal physiologic jaundice appears after 24 hrs)
Action of tocolytics
Stop labor
Examples of tocolytics
Terbutaline, Magnesium Sulfate
Key side effect of terbutaline
Maternal tachycardia
Side effects of magnesium sulfate
Hypermagnesemia — decreases HR, BP, RR, DTRs, and LOC
NOTE: if respirations are below 12 and reflexes are 1+ — slow DOWN mag infusion; if reflexes are above 3 — speed infusion UP
Action of Oxytoxics
Stimulate and strengthen labor
Examples of Oxytoxics
Pitocin, Methergine
Key side effect of Pitocin
Uterine hyperstimulation (contractions longer than 90 sec and closer than every 2 min)
Key side effect of Methergine
Maternal hypertension
Fetal lung maturing medications
Betamethasone (steroid), surfactant
Betamethasone characteristics
- given to mom IM
- given before baby is born
- may repeat as long as baby is in-utero
Surfactant characteristics
- given to neonate
- administered transtracheal (blown into trachea)
- given after baby is born
