Maternal Newborn 3 Flashcards
1
Q
Implantation of the blastocyst:
A
The embedding of the blastocyst( composed of an inner cell mass known as the embryoblast, which will develop into the embryo) into the endometrium of the uterus, begins around day 5 or 5.
2
Q
Where does implantation begin?
A
Implantation normally occurs in the upper part of the posterior wall of the uterus.
3
Q
Embryo:
A
The developing human is referred to as an embryo from the time of implantation through 8 weeks of gestation.
4
Q
What is Organogenesis:
A
The formation and development of body organs, which occurs during the first 8 weeks of gestation.
5
Q
When do the primary germ layers develop?
A
Around day 14
6
Q
Ectoderm:
A
This is the outer germ layer and the primary structures developed are the epidermis(hair, skin, nail, sweat glands), Nervous system, pituitary gland, adrenal medulla, lens and cornea, internal ear, mucosa of oral and nasal cavities, and salivary glands.
7
Q
Mesoderm:
A
The middle germ layer and the primary structured developed are the Dermis, bone and cartilage; skeletal muscles; cardiac muscle, most smooth muscles, kidney; adrenal cortex, bone marrow, and blood; lymphatic tissue; and the lining of blood vessels.
8
Q
Endoderm:
A
The inner germ layer and the primary structures developed are the Mucosa of esophagus, stomach and intestines; epithelium of respiratory tract, including lungs; and liver and mucosa of gallbladder; and thyroid gland, and pancreas.
9
Q
When does the heart form:
A
During the 3rd gestational week and begins to beat and circulate blood during the 4th.
10
Q
What gestational week does the human transform from primary germ layer to a clearly defined human that is 3 cm in length with all organ systems formed?
A
By the end of the 8th gestational week.
11
Q
When is the developing human referred to as a fetus:
A
From week 9 to birth. During this stage of development, organ systems are growing and maturing.
12
Q
How does oxygenated blood enter the fetal circulatory system?
A
High levels of oxygenated blood enter the fetal circulatory system from the placenta via the umbilical vein.
13
Q
How does the majority of the high oxygenated blood enter the right atrium?
A
By way of the ductus venous, which connects the umbilical vein to the inferior vena cava.
14
Q
What is the opening in the heart between the right and left atria:
A
The foramen ovale; Oxygenated blood is shunted to the left atrium via the foramen ovale. After birth it closes in response to increased blood returning to the left atrium. This can take up to 3 months to fully close.
15
Q
Ductus Arteriosus:
A
Connect the pulmonary artery with the descending aorta. The majority of the oxygenated blood is shunted to the aorta via the ductus arteriosus with smaller amounts going to the lungs. After delivery, the ductus arteriosus constricts in response to the higher blood oxygen levels and prostaglandins.
16
Q
Metabolic and gas exchange:
A
In the placenta, fetal waste products and CO2 are transferred from the fetal blood into the maternal blood sinuses by diffusion. Nutrients, such as glucose and amino acids, and O2 are transferred from the maternal blood sinuses to the fetal blood through the mechanisms of diffuse and active transport.
17
Q
Hormone Production of the placenta:
A
The major hormones the placenta produces are progesterone, estrogen, human chorionic gonadotropin(hCG), and human placental lactogen(hPL), also known as chorionic somatonmammotropin.
18
Q
What does progesterone do?
A
Progesterone facilitates implantation and decreases uterine contractility.
19
Q
What does estrogen do ?
A
Estrogen stimulates the enlargement of the breasts and uterus.
20
Q
What does hCG do:
A
hCG stimulates the corpus luteum so that it will continue to secrete estrogen and progesterone until the placenta is mature enough to secrete these hormones. This is the hormone assessed in pregnancy tests. hCG rises rapidly during the first trimester and then has a rapid decline.
21
Q
hPL:
A
Promotes fetal growth by regulating glucose available to the developing human. It also stimulates breast development in preparation for lactation.
22
Q
Week 12 Gestation:
A
8cm & 45 grams/ RBC produced in liver; fusion of palate complete; external genitalia developed to the point that sex of fetus can be noted with u/s; eyelids closed; fetal heart tone can be heard by Doppler.
23
Q
Week 16 Gestation:
A
14cm & 200 grams/ Lanugo is present on head; Meconium is formed in the intestines; teeth begin to form; sucking motions are made with mouth; skin is transparent.
24
Q
Week 20 Gestation:
A
19cm & 450 grams / Lanugo convers the entire body; vernix caseosa covers body; nails are formed; brown fat begins to develop.
25
Week 24 Gestation:
23cm & 820 grams / Eyes develop; Alveoli form in lungs & begin to produce surfactant; footprints and fingerprints are forming; respiratory movement can be detected.
26
Week 28 Gestation:
27 cm & 1300 grams/ Eyelid open; Adipose tissue develops rapidly; Respiratory system has developed to point that a gas exchange is possible, but lungs are not fully mature.
27
Week 32 Gestation:
30 cm & 2,100 grams/ Bones are fully developed; Lungs are maturing; Increased amount of adipose tissue are present.
28
week 36 Gestation:
34cm & 2,900 grams/ Lanugo begins to disappear; Labia majora and minora are equally prominent; testes in upper portion of scrotum.
29
Week 40 Gestation:
36 cm & 3,400 grams/ Fetus is consider full term at 38 weeks. All organs/systems are fully developed.
30
Polydramnios or hydramnios:
Refers to excess amount of amniotic fluid (1,500 to 2,000ml). Newborns of mothers who experienced polyhyramnios have an increased incidence of chromosomal disorder and gastrointestinal, cardiac, and/or neural tube disorders.
31
Oligohydramnios:
Refers to a decreased amount of aniotic fluid( <500ml at term or 50% reduction of normal amount), which is generally related to a decrease in placental function. Newborns of mothers who experienced oligohydamnios have an increased incidence of congenital renal problems.
32
Wharton's Jelly:
A collagenous substance which protects the vessels from compression (Arteries & veins).
33
Average length of umbilical cord:
Average length is 55 cm.
34
Infertility:
Inability to conceive and maintain a pregnancy after 12 months of unprotected sexual intercourse.
35
Risk factors for infertility in Women:
Autoimmune disorders, diabetes, eating disorders, excessive alcohol drinking, excessive exercising, obesity, older age, sexually transmitted infections.
36
Risk factors for infertility in Men:
Environmental pollutants, heavy use of alcohol, marijuana, cocaine, impotence, older age, sexually transmitted infections, smoking.
37
ANA (American Nurses Association)
Nurses moral and ethical responsibility to do the right thing. The code of ethics under ANA is a statement of the ethical obligations and duties of every nurse, the profession's non-negotiable ethical standard, and an Expression of nursing's own understanding of it's commitment to society.
38
Ethical dilemma:
A choice that has the potential to violate ethical principles. Action taken in response to our ethical responsibility to intervene on behalf of those in our care is patient advocacy.
39
Clinical examples of ethical dilemmas:
Court-ordered treatment , withdrawal of life support harvesting of fetal organs or tissue, fetal injury, maternal rights versus fetal rights, surrogacy, etc.,
40
Standards of Care which is the nursing profession's best judgment and optimal practice based on current research and clinical practice:
Assessment, diagnosis, Outcome identification, planning, implementation, coordination of care, health teaching and promotion, and evaluation.
41
Legal issues:
Maternity nursing is the most litigious of all areas of nursing especially the complexity of caring for two patients, the mother and fetus. its important to know the units, protocols, ANA guidelines to reduce risk.
42
EBP
Evidence-Based Practice: The integration of the best research evidence with clinical experts, and patient/family values for delivery of optimal health care.
43
Teratogens
Any drugs, viruses, infections or other exposures that can cause embryonic/fetal development abnormality.
44
When is the fetus most vulnerable to teratogens?
The first trimester( first 4 weeks).
45
Why are the fetus's most susceptive in the first trimester?
The woman is least likely to know she is pregnant so teratogenic drugs may lead to fetal malformation or miscarriage.
46
Third Trimester and drug absorption:
Drugs may not be safely metabolized and secreted by the fetus.
47
After delivery and drug excretion:
Infants no longer have placenta to help with drug exertion and drugs.
48
The use of meds in pregnant women:
The lowest effective dose for the shortest period of time.
49
Drugs affecting lactation:
Many drugs are excreted through breast milk.
50
Risk factors for Infertility in women:
```
Autoimmune disorders
Diabetes
Eating disorders
Excessive alcohol drinking
Excessive exercising
Obesity
Older age
Sexually transmitted infections
```
51
Risk factor for infertility in Men:
```
Environmental pollutants heavy use of alcohol, marijuana, or cocaine
Impotence
older age
sexually transmitted infections
smoking
```
52
Medical HX. of the female partner regarding fertility:
Medical Hx: weight gain current medical problems and medications, and allergies.
Exposure to Chicken Pox?
Surgery Hx.
Menstrual Hx.
53
Medical HX. of the male partner regarding fertility :
Medical history: general health, erectile function, sexually transmitted infections, history of high temperatures such as hot tubs or recent fevers, vaccination history, allergies, surgical history , and family history.
54
Cause of men getting prostatis:
Drinking lots of coffee and soda.
55
A man with diabetes can give this to a women during sex:
Discharge in men can give women infections such as yeast.
56
Common fertility techniques:
Artificial insemination: sperm removed from semen deposited directly into cervix or uterus using a plastic catheter.
Testicular sperm aspiration: Aspirated or extracted directly from testicles and microinjected into the harvested eggs of the female partner.
IVF: Oocytes harvested and fertilization occurs outside female body in a lab.
ZIFT: Zygote place into fallopian tube via laparoscopy q day after oocyte received from woman and IVF is used.
GIFT: sperm and oocytes mixed outside of woman's body then placed into fallopian tube.
ET: Through IVF and embryo is place in uterine cavity via catheter.
57
When does the fetus's heart start to beat?
The 4th week of gestation.
58
The endometrial cycle pertains to the changes in the endometrium of the uterus in responses to hormonal changes that occur during ovarian cycle. There are 3 phases:
Poliferative phase: Occurs following menstruation and ends with ovulation
Secretory phase: begins after ovulation and ends with onset of menstruation. the endometrium thickens. The primary hormone during this phase is progesterone which is secreted from the corpus luteum.
Menstrual phase: Occurs in response to hormonal changes and results in sloughing offof the endometrial tissue.
59
CPD
Cephalopelvic disproportion: A condition in which the size, shape, or position of the fetal head prevents it from passing through the lateral aspect of the maternal pelvis or when the maternal pelvis is of a size or shape that prevents the decent of the fetus through the pelvis: term used when the maternal bony pelvis is not large enough or appropriately shagged to allow for fetal decent.
60
What is PPH
PPH is Postpartum hemorrhage: a blood loss greater than 500mL for vaginal deliveries and 1,000 mL for cesarean deliveries with a 10% drop in hemoglobin and or hematocrit.
61
Primary causes of PPH
Uterine atony, retained placental fragments, and lower genital track laceration. A major complications of PPH is hemorrhagic shock related to hypovolemia.
62
Indications of Primary PPH:
A 10% decrease in the hemoglobin and /or hematocrit post birth.
Saturation of the peripad within 15 minutes.
A fundus that remains boggy after fundal massage.
Tachycardia (late sign)
decrease in blood pressure (late sign)
63
What is uterine atony?
A decreased tone of the uterine muscle which is the major cause of primary PPPH. Uterine contractions constrict the open vessels at the placental site and assist in decreasing the amount of blood loss. When uterus relaxes, the vessels are less constricted and the woman experiences an increase of blood loss.
64
Assessment findings in PPH:
```
Soft (boggy) fundus versus firm fundus
Saturation of the peripad with 15 minutes
Bleeding is slow and steady or sudden and massive
Blood clots may be present
Pale color and clammy skin
anxiety and confusion
Tachycardia
Hypotension
```
65
Medication - Methergine:
Indication: PPH due to uterine atony or subinvolution.
Action: Stimulates contraction of the uterine smooth muscle
Common side effects: Nausea, vomiting, and cramps.
66
Medication - hemabate
Indication: PPH that has not responded to oxytocin or methylergonovine therapy.
Action: Uterine contractions
Common side effects: Diarrhea, nausea, vomiting, and fever
67
DIC:
Disseminated intravascular coagulation: is a syndrome in which the coagulation pathways are hyperstimulated. When this occurs, the woman's body breaks down blood clots faster than it can form them, thus quickly depleting the body of clotting factors and leading to hemorrhage and death.
68
Assessment finding in DIC
Prolonged, uncontrolled uterine bleeding
Bleeding from the IV site, incision site, gums, and bladder
Purpuric areas at pressure sites, such as blood pressure cuff site
Abnormal clotting study results, such as platelets platelets and activated partial thromboplastin time (PPT)
69
Nursing Actions of DIC:
Reduce risk of DIC:
Review prenatal and labor records for risks factors
Monitor women more frequently who are at risk for DIC.
Assess for PPH and intervene appropriately. Early intervention can decrease the risk of DIC.
Monitor vital signs and immediately report to the MD or CNM abnormal findings, such as an increase in heart rate, a decrease in blood pressure, and a change in quality of respirations.
Obtain IV site with large-bore intracatheter as per orders.
Administer Iv fluids as per orders
Administer oxygen as per orders
Obtain laboratory specimens as per orders.
Review laboratory results and notify the physician of results
Start a blood transfusion as per orders.
Provide emotional support and information to the woman and her family to decrease level of anxiety.
Facilitate transfer to intensive care unit.
70
Preeclampsia and eclampsia syndrome:
Preeclampsia is a systemic disease with hypertension accompanied by proteinuria after the 20th week of gestation. Ten percent of all first pregnancies are affected by preeclampsia-eclampsia.
71
Eclampsia:
The onset of convulsions or seizures that cannot be attributed to other causes in a woman with preeclampsia.
72
Preeclampsia:
Is a hypertensive, multisystem disorder of pregnancy whose etiology remains unknown. Preeclampsia is the best described as a pregnancy-specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation. Delivery is the only cure.
73
HELLP:
Hemolysis, Elevated Liver enzymes, and Low Platelets.
74
Preeclampsia assessment Findings:
Elevated blood pressure: hypertension with systolic pressure 140mmHg or greater and diastolic pressure 90 mm Hg or greater.
Proteinuria is 1+ or greater.
Lab values many indicate elevations in liver function tests, diminished kidney function, and altered coagulopathies.
75
Primary goal in preeclampsia and preeclampsia superimposed on chronic hypertension is to control the woman's blood pressure and to prevent seizure activity and cerebral hemorrhage. Medical management includes:
Magnesium sulfate: To reduce seizure activity without documentation of long-term adverse effects to woman and fetus.
Antihypertensive medications are used to control blood pressure.
Delivery of the fetus and placenta is the only "cure" for preeclampsia.
76
Nursing Actions for Preeclampsia:
Administer antihypertensive as per orders blood pressure >160/110mmHg.
Administer magnesium sulfate as per orders
Assess for CNS changes including headache, visual changes, deep tendon reflexes and clonus.
Auscultate lung sounds for clarity and monitor the respiratory rate.
Assess for signs and symptoms of pulmonary edema such as: SOB, chest tightness or discomfort, cough, oxygen saturation less than 95%, increased respiratory and heart rates.
Assess for epigastric pain or right upper quadrant pain indicating liver involvement.
Assess weight daily and assess for edema to assess for fluid retention.
check urine for proteinuria and specific gravity.
Evaluate laboratory values including:
Elevations in serum creatinine (72mg/dL)
Hematocrit levels(>35)
Low platelet count (100,000/mm3)
Elevated liver enzymes (AST?41units/L, ALT >30 units/L)
Perform antenatal fetal testing and fetal heart rate monitoring (NST & BPP)
Check intake of adequate calories and protein
Maintain I&O to evaluate kidney function.
Provide quiet environment to decrease CNS stimulation.
Maintain bed rest in the lateral recumbent position.
Provide information to the woman and her family.
Report deterioration in maternal or fetal status to provider.
77
Eclampsia:
The occurrence of seizure activity in the presence of preeclampsia.
78
HELLP syndrome:
(Hemolysis, Elevated Liver enzymes, and Low Platelets)
Is the acronym used to designate the variant changes in laboratory values that can occur as a complication of severe preeclampsia. hemolysis is a result of RBC destruction as the cells travel through constricted vessels.
Elevated liver enzymes result from decreased blood flow and damage to the liver.
Low platelets result from platelets aggregating at the site of damaged vascular endothelium causing platelet consumption and thrombocytopenia.
79
Placenta Previa:
Occurs when the placenta attaches to the lower uterine segment of the uterus, near or over the internal cervical os instead of in the body or fundus of the uterus.
80
Total placenta previa:
The placenta completely covers the internal cervical os.
81
Partial placenta previa:
The placenta partially covers the internal cervical os.
82
Marginal placenta previa:
The edge of the placenta is at the margin of the internal cervical os.
83
Low-lying placenta:
The placenta is implanted in the lower uterine segment in close proximity to the internal cervical os.
84
PPH can lead to what other diagnosis:
DIC
85
How much blood loss is to much in a post partum patient with a vaginal birth?
500ml of blood
86
How much blood loss is to much in a pt. with a cesarean delivery:
1000, ml of blood with a 10% drop in hemoglobin and/or hematocrit.
87
Lochia on the Pads:
```
2" = 10mL
4" = 10 to 25 mL
6' = 25 to 50 mL
Saturated = 50 to 80 mL
```
88
Causes of PPH: (Postpartum hemorrhage)
Placenta can cause tears
Infants can cause tears when coming through birth canal
Primary Hemorrhage happens within first 24 hour but can be up to 6 weeks postpartum.
89
Signs and symptoms of PPH
```
Decreased blood pressure(hypotension)
Weak
Pale, clammy skin
Tachycardia
anxiety and confusion
Decrease oxygen saturation
Bleeding is slow and steady or sudden and massive
Fundus is soft (boggy)
Saturation of peripad within 15 minutes.
Can lead to hypovalemia
```
90
Interventions for PPH:
Stop bleeding by massaging uterus or if doesn't work, admit oxytocin per order to bring on contractions and constriction of blood vessels. If was too excessive and there's a tear in the uterus and will need to go back to surgery.
Give fluid bolus to get oxygenation done.
check labs: H&H and type and cross match for blood type
If they are too low will administer PRBC (HGB below 8)
91
What too assess in PPH when administering blood:
Assess output: at least 30mL/hr.
vital signs & lung sounds( checking for fluid overload)
Listen for crackles( give Lasix during administration of blood)
If in Renal failure: Give blood through dialysis.
When pt., gets blood products, watch for too much potassium which is inside the cell, because can get cardiac arrest.
92
What is DIC:
Is a syndrome in which the coagulation pathways are hyperstimulated. When this occurs, the woman's body breaks down blood clots faster than it can form them, thus quickly depleting the body of clotting factors and leading to hemorrhage and death.
93
Assessment findings of DIC:
Prolonged, uncontrolled uterine bleeding
Bleeding from the IV site incision site, gums, and bladder
Purpuric areas at pressure sites, such as blood pressure cuff site
Abnormal clotting study results, such as platelets and activated partial thromboplastin time (PPT)
Increased anxiety
S/S of shock related to blood loss:
Pale & clammyskin
Tachycardia
Tachypnea
Hypotension
94
Risk factors for women:
Abruptio placenta ( primary cause of DIC)
HELLP syndrome
Amniotic fluid embolism
95
Nursing Actions of DIC:
Montior for signs of AFE
Notify the physician, immediately, of assessment data, so that early interventions can be initiated.
Administer oxygen
Establish 2 IV sites with large -bore intracatheters: one for IV fluid replacement and one for blood replacement.
Obtain laboratory specimens as per orders.
96
Menstrual Cycle has 4 phases:
```
Menstrual phase (1 -5) degeneration & discharge of most endometrium if conception doesn't occur.
Porliferative phase(6-14)graafian follicle is approaching maximum development in ovary( follicular fluid contains estrogen, which is responsible for thickening of endometrium)
Secretory/luteal phase(14-28) Corpus luteum secretes progesterone, which changes the character of uterine lining to prepare for implantation of fertilized ovum.
Ischemic phase (occurs if fertilization does not occur
```
97
First stage of labor has 3 phases:
```
Laten phase (0-3cm)
Active phase (4-7 cm)
Transition phase (8-10cm)
```
98
Second stage of labor:
from complete dilation of cervix to delivery of the baby
99
Third stage of labor:
birth and delivery of placenta within 30 minutes
100
Normal fetal heart rate :
110-160 bpm
101
Fetal heart rate: Tachycardia
> 160bpm - is associated with prematurity, maternal fever, fetal activity, or fetal hypoxia/infection, drugs; if continued for >10minutes, or accompanied by late decelerations, indicates fetal distress.
102
Fetal heart rate: Bradycardia
<110 bpm -associated with fetal hypoxia, maternal drugs/hypotension, prolonged cord compression, congenital heart lesion; persistent bradycardia or persistent drop of 20 bpm below baseline may indicate cord compression or separation of the placenta.
103
EFM: Late decelerations:
Onset after peak with slow return to baseline; indicative of fetal hypoxia because of deficient placental perfusion
104
APGAR scoring:
Based on five signs: heartbeat, respiratory effort, muscle tone, reflex irritability, color:
0-3 is extremely poor condition / resuscitation & intensive care are required
4-6 is fair condition and may require close observation
7-10 Good condition and should do well in normal neonatal nursery.
105
Position of fundus in the first 12 hours postpartum:
1 Cm above umbilicus for the first 12 hours, then descends by one finger breadth each succeeding day.
106
Lochia: Endometrial sloughing: day 1-3
Rubra (bloody with flesh odor; may be clots)
107
Lochia day 4-9
Serosa: pink/brown with fleshy odor
108
Lochia day 10
Alba: yellow-white; at no time should there be a foul odor (indicates infection)
109
Taking In Phase of PP
Preoccupied with self and own needs (food and sleep)
110
Taking hold Phase of PP
performing self-care; expresses concern for self and baby; open to instructions
111
Letting go Phase of PP
Assuming new role responsibilities; may be grief for relinquished roles; adjustment to accommodate for infant in family
112
Resuming of sexual activities:
Abstain from intercourse until episiotomy is healed and lochia has ceased ( usually 3-4 weeks).
113
Ultrasonography:
Visualizes the fetus, placenta, amniotic fluid
114
Amniocentesis:
Amniotic fluid aspirated as early as 14-17 weeks to detect inborn errors of metabolism, chromosomal abnormalities, NTD's and sex-linked disorders after 28 weeks; determine lung maturity after 30 weeks.
115
Chorionic Villus sampling (CVS)
aspiration of chorionic villi that allows for first trimester (8-12 weeks) dx. of genetic disorders such as Downs syndrome, sickle cell anemia, PKU.
116
Nonstress test: NST
Evaluates FHR by EFM in response to fetal movement as early as 27 weeks.
117
Reactive FHR
FHR accelerations of 15 or more BPM lasting 15 or more seconds with at least 2 FM in a 20 minute period; monitor NST 1-2 times/wk
118
Alpha-fetoprotein(AFP)
Assessing for levels of AFP in maternal blood which is a screening tool for certain developmental defects in the fetus such as fetal NTD and ventral abdominal wall defects.
119
Amniotic Fluid Index: AFI
Amount of fluid. Normal AFI is 8-24 cm
and abonorma aFI is below 5 cm.
AFI< 5 cm is indicative of oligohydrammios which is associated with prenatal mortality and need for close maternal and fetal monitoring.
AFI above 34 cm is polyhydramnios which may indicate fetal malformation such as NTDs
120
What is a nonreactive NST:
One without sufficient FHR accelerations in 40 minutes and should be followed up with further testing such as a BPP
121
BPP(biophysical profile)
8 = Good Total and the lower the score the more critical the delivery.
Looks at HR, movement, amount of fluid, and breathing.
122
Daily Fetal movement count:
Kick Count: 4 kicks every hour or 10 kicks every 2 hours
123
Vibroacoustic stimulation
A screening tool that uses auditory stimulation to assess fetal well-being with EFM when NST is nonreactive. This test may be effective in eliciting a change in fetal behavior, fetal startle movements and increased FHR variability.
124
Hypertonic uterine dysfunction:
Uncoordinated uterine activity. Contractions are frequent and painful but ineffective in promoting dilation and effacement. Early in labor called "Prodomal labor".
125
Assessment findings ofhypertonic uterine dysfunction:
Painful, frequent UCs with inadequate uterine relaxation. May be Category II or III FHR related to prolonged labor and inadequate uterine relaxation.
126
Nursing actions for hypertonic dysfunction:
Promote rest, administer pain med such as Demoral or morphine to decrease labor contractions and allow uterus to rest. Hydrate women with IV or PO fluids as dehydration can result in dysfunctional labor. Assess UC and FHR.
127
Hypotonic dysfunction:
Pressure of UC insufficient to promote cervical dilation and effacement. IUPC less than 25 mmHg. Abnormal during active labor.
128
Assessment findings of hypotonic uterin dysfunction:
Decreased frequency, strength, and duration of UCs, little or no cervical change, increase fear and anxiety levels.
129
Nursing action of hypotonic dysfunction:
Assess uterine activity, assess fetal status, stimulate to achieve normal labor by ambulatory, changing woman's position, hydrate, and augment labor with oxytocin per protocol. Evaluate labor with SVE, provide support, maintain good technique to minimize risk of infection if ROM by minuting vaginal exams.
130
Precipitous labor:
Labor that last fewer than 3 hourS from onset of labor to birth.
131
Assessment findings of precious labor:
Hypertonic UC Q 2 mins. Saying more than 60 seconds, potential for category II or III FHR, rapid cervical dilation.
132
Nursing actions of precipitous labor:
Remain in room with patient, monitor FHR and UC Q 15 min., assess labor progress and cervical change with SVE, anticipate potential maternal postpartum complications such as hemorrhage,and potential neonatal complications such as hypoxia, CNS depression related to rapid birth.
133
5 Ps:
```
Powers: contractions
Passage: pelvis & birth canal
Passenger: fetus
Psyche: response of mom
Position: maternal posture & physical position
```
134
Three phases of contractions:
Increment phase: ascending or buildup if contraction.
Acme: Peak
Decrement: descending/ relaxing of uterine muscle.
135
Ballotment:
A light tap of examining finger on cervix causes fetus to rise up and rebound.
136
Zero (0) station:
Ischial spine
137
Fetal factors :
As placenta ages it begins to deteriorate, triggering contractions. There's a release of prostaglandin which did to increase, causes contractions as well as oxytocin.
138
Impending sign of labor: lightening
Descent of fetus into true pelvis that occurs approximately 2 weeks before term.
139
Position of baby:
```
Roa: right side of shoulder
Lop: left occiputposterior
Loa: left occiput posterior
Rot: right occiput transverse
Lot: left occiput transverse
Op. occiput posterior
Oa: occiput anterior
```
140
First stage of labor has 3 stages:
Latent: average length is 9 hrs. Primigravida and 5 hr. for multi.
0-3cm dilation, 0-40% effacement, contractions 5-10 min. Lasting 35-45 seconds
Active: placenta and cervix thins dilation 1.2 cm / hr., dilation 4-7 cm, UC 2-5 min., lasting 45-60 seconds.
Transition phase: 8-10 cm dilation, 109% effacement, UC 1-2 mins. Apart lasting 70-90 seconds.
141
Fetal Heart Circulation:
Oxygenated blood enters fetal circulatory system from placenta via umbilical vein. Ductus venosus connects umbilical vein to inferior vena cava. This allows the majority of high levels of oxygenated blood to enter the right atrium. Foramen ovale is an opening between right and left atria. Oxygenated blood is shunted to the left atrium via foramen ovale.
142
Risk Factors for Preterm Labor Less than 35 weeks:
IVF, working long hours & long periods of standing, age older than 35 or younger than 17, unmarried, Hx. of second trimester loss, Hx. of incompetent cervix, uternine/cervical abnormalities, hydramnios or oligohydramnios, infection, PROM, short pregnancy interval, PIH, GDM, clotting disorders, inadequate nutrition low BMI, late or no prenatal care, High BMI, and family history.
143
Patient diagnosed with Preeclampsia/Eclampsia, and on Mag. Sulfate - what are the interventions:
Assess VS before begin infusion and every 5 - 15 min., assess DTRs Q 2 hrs. (could be sign of resp. depression - mag. toxicity), Monitor I&Os, lab mag. serum level 5-7mg/dL., Respiration <14 breath per min. sign of resp. depression, or SOB, chest pain, EKG changes. If toxicity suspected, D/C infusion and notify MD. Keep calcium gluconate available (1 g IV).
144
PrePROM:
Premature rupture of membranes before 37 weeks.
144
PROM:
Premature rupture of membranes before 37 weeks.
145
AROM:
Artificial rupture of membranes
146
SROM:
Spontaneous rupture of membranes
147
NST / Non-stress test
Screening tool that uses EFM to assess fetal condition: Need to monitor for fetal activity for 20-30 minutes while running a FHR contraction strip for interpretation. Testing is in a nonstressful situation and moms contractions are monitored. IF contractions, doesn't necessarily mean labor/ not labor. It depends on size mom as she may or may not feel.
148
FHR:
Accel. (always good)
D - cel.( deplete everything causing and compressing umbilical.
Variable cel. ( ok if not continuous - re assessing strip to make sure baby be oxygenated).
Minimum variability: give juice, water, or reposition mom.
149
NONREACTIVE NST :
Is one without sufficient FHR accelerations in 40 minutes and should be followed with further testing.
150
FHR:
Accel. (always good)
D - cel.( deplete everything causing and compressing umbilical.
Variable cel. ( ok if not continuous - re assessing strip to make sure baby be oxygenated).
151
Internal Electronic Fetal and uterine monitoring:
Uses a fetal scalp electrode that is applied to the presenting part of fetus to directly detect FHR. The decision to insert FSE is based on need for continuous FHR tracing to get a better trace. Contraindications: choriamnionitis, active maternal genital herpes and HIV are condition that preclude vaginal exam.
152
IUPC:
is placed in the uterine cavity to directly measure uterine contractions. It provides a measure of pressure of contractions expressed as mmHG and monitor frequency, duration and strength of UC. Resting Tone: is the uterine pressure between contractions and should be about 5-25mgHg. Used when external monitoring is inadequate, or category II tracing(eg. recureent variable decelerations with nadir greater than 60mmhg from baseline via ammioinfusion.
153
IUPC:
is placed in the uterine cavity to directly measure uterine contractions. It provides a measure of pressure of contractions expressed as mmHG and monitor frequency, duration and strength of UC. Resting Tone: is the uterine pressure between contractions and should be about 5-25mgHg. Used when external monitoring is inadequate, or category II tracing(eg. recureent variable decelerations with nadir greater than 60mmhg from baseline via ammioinfusion.
154
Ectopic pregnancy:
Anything outside of uterus: fallopian tubes most common and abdominal wall. S/S: lots of bleeding, severe pain in abdomen, + HCG. Diagnostic Test: u/s detects ectopic pregnancy and fetus cant live outside of uterus because no nutrients.
155
Ectopic pregnancy:
Anything outside of uterus: fallopian tubes most common and abdominal wall. S/S: lots of bleeding, severe pain in abdomen, + HCG. Diagnostic Test: u/s detects ectopic pregnancy and fetus cant live outside of uterus because no nutrients.
