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Maternal Newborn Flashcards

1
Q

How do you calculate a due date?

A
  1. Take the first day of the last period
  2. Add 7
  3. Subtract 3 mths

i.e June 10 + 7days - 3 mths = March 17th

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2
Q

What is the average weight gain for a pregnant women?

A

28 pds, plus or minus 3
1st trimester = 1 pd per mth.
2nd and 3rd trimester = 1 pd wk

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3
Q

How do you calculate weight gain?

A

Take the week of gestation and minus 9

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4
Q

Question:

A women in her 28th week has gained 22 pds. what is your inpression?

A

28-9=19pds
She gained 3pds more than she was suppose to therefore assess - if she’s within 1-2pds she’s ok. 3+ pds assess. 4 > trouble.

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5
Q

What is the formula for ideal weight gain?

A

Week of gestation minus 9

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6
Q

The fundus is the top part of the ______.

A

Uterus

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7
Q

Can you palpate the uterus in the first trimester?

A

NO! Cannot palpate till 12 weeks ( end of 1st trimester)

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8
Q

When is the fundus at the belly button (umbilicus)

A

Approx. 20-22 weeks gestation.

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9
Q

When is the date of viability

A

22-24 weeks ( end of the 2nd trimester)

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10
Q

Can you use uterine height to determine what trimester the women in?

A

YES!

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11
Q

1st trimester if you cannot palpate fundus who’s is the priority mom or baby?

A

Mother

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12
Q

2nd trimester where do you palpate the fundus?

Who is the priority mom or baby?

A

At or below the umbilicus.

Mother.

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13
Q

3rd trimester where do you palpate the fundus?

Who is the priority mom or baby?

A

Above the umbilicus

Baby

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14
Q

List the 4 positive signs of pregnancy.

A
  1. Fetal Skeleton on xray
  2. Fetal presence on ultrasound (8-12 weeks)
  3. Auscultation of fetal heart rate - 140
  4. Examinar palpates ( not mom)
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15
Q

Most OB questions give a range i.e. fetal heart rate 8-12 weeks, so read OB questions carefully. Pay particular attention to the wording.

  1. When would you FIRST auscultate a fetal heart rate?
  2. When would you MOST LIKELY auscultate a fetal heart rate?
  3. When SHOULD YOU BY?
A
  1. First = 8 weeks ( earliest part of range)
  2. Most likely = 10wks ( mid range)
  3. Should you by = 12 weeks ( end range)
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16
Q

For quickening:

  1. When would you FIRST feel quickening?
  2. When would you MOST LIKELY feel quickening
  3. When SHOULD YOU BY?
A
  1. FIRST-16 wks
  2. MOST LIKELY 18 wks
  3. SHOULD YOU BY 20 wks
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17
Q

List Maybe signs (probable and presumptive signs)

A
  1. All urine and blood tests

2. Chadwicks, Goodells Sign, Hegars

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18
Q

Is a positive pregnancy test a positive sign of pregnancy?

A

NO! it only means you have the hormones for pregnancy but not necessary fetus

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19
Q

Describe Chadwicks Sign, Goodells Sign and Hegars

A

Chadwicks - Cervical , color change to cyanosis ( All “C”)
Goodells - cervix softening
Hegars - Uterus softening

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20
Q

What is included in teaching the OB patient the pattern in office visits.

A

Good prenatal care decreases infant mortality.
Visits include:
1. Visit once a mth until 28 weeks.
2. From 28 wks - 36 wks visit every 2 weeks
3. 36 wks visit weekly until baby delivered or 42 wks.

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21
Q

What is the normal hemoglobin range?

A

12-16.

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22
Q

Is the hemoglobin level in a pregnant women expected to rise or fall? What are the expected levels in the 1st, 2nd, and 3rd trimester?

A

Fall.
1st - 11 normal
2nd - 10.5
3rd - 10

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23
Q

How should you tx. morning sickness?

A

1st trimester

Dry Carbs - before they get out of bed

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24
Q

How do you deal with urinary incontinence in the 1st and 3rd trimester?

A

Void every 2 hrs from day of pregnancy to 6 weeks after delivery.

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25
What do you do in the 2nd and 3rd trimester when you pt. is having difficulty breathing?
Teach the tripod postion
26
How do tx. back pain in the 2nd and 3rd trimester?
Tx. pelvic tilt exercises tilt pelvis forward.
27
How do you know if a women in labour?
Onset of regular progressive contractions
28
Define Dilation
Opening of the cervix 0-10cm 0 = closed 10 = fully dilated
29
Define Effacement
Thinning of the cervix - goes from thick ( not effaced) to 100% ( fully effaced).
30
Define Station
The relationship of fetal presenting part to moms ischial spine. Its the smallest diameter and narrowest part of the pelvis station will tell you if the baby will fit through.
31
Define Negative Station
Means the presenting part (head) is above this tight squeeze. "Negative News"
32
Define Postive Station
Means presenting part has already made it through the tight squeeze. " Positive News"
33
Define Engagement
Station 0 means presenting part is at the presenting spot.
34
Define Lie of the baby
Relationship of spine of mom and spine of baby i.e vertical lie = good and Transverse lie = BAD ( t = trouble)
35
Define Presentation
Part of the baby that enters the birth canal first! | Alphabet soups ROA, LOA etc pick ROA when in doubt.
36
Define: 4 stages of Labour and the 3 phases of labour
1. LABOUR - 3 Phases = 1. Latent 2. Active 3. Transition 2. DELIVERING OF THE BABY 3. DELIVERING OF THE PLACENTA 4. RECOVERY - lasts only 2 hrs after placenta delivered.
37
What is the purpose of uterine contractions in the various stages?
First Stage: Dilate and Efface Cervix Second Stage: push baby out Third Stage: push placenta out Forth Stage: Stop bleeding - contract uterus
38
When does POST PARTUM begin?
2 hrs after the placentas delivered.
39
Whats the #1 priority in 2nd PHASE of Labour?
Pain mangement
40
Whats the #1 priority in 2nd STAGE of Labour?
Clearing babys airway
41
What nursing actions take place in the 3rd phase
Dilation Breathing Pain
42
Describe the 3 Phases of Labour L.A.T.
``` Latent: Dilate: 0-4 cm Contractions: 5-30 min apart Duration: 15-30 seconds Intensity: Mild ``` ``` Active: Dilate 5-7cm Contractions: 3-5 min apart Duration: 30-60 seconds Intensity: Moderate ``` ``` Transition: Dilate: 8-10 cm Contractions: 2-3 min apart Duration: 60-90 seconds Intensity: Strong ```
43
A women arrives at the L and D she is dilated 5cm, her contractions are every 5 mins apart lasting 45 seconds. What phase is she in?
Active phase
44
Memorize Active Labour
Dilation 5-7cm Contration Freq: 3-5 min Duration: 30-60 sec Intensity: Moderate
45
Alert: Contractions should not be longer than ______ seconds or closer than ______ minutes.
90 Seconds 2 minutes This is very Bad they will test this!
46
What are the signs of uterine Tetany?
Contrations longer than 90 seconds and closer than 2 minutes.
47
When do you stop Pitosin?
Contractions longer than 90 seconds and closer than 2 minutes.
48
How do you time contractions?
Time the frequency starting from the beginning of one contraction to the beginning of another contraction.
49
how do you palpate intensity of strength of contraction?
Palpate with one hand over fundus with pads of finger tips.
50
List the possible complications of Labour
1. Painful Back Labour: low priority TX by position then push. Position knee chest on hands & knees, then push push into sacrum. ROA 2. Prolapsed Cord: High Priority - the cord is the presenting part -- kills baby. Tx. PUSH-POSITION, push head back up off cord, position knee chest. 3. Interventions for all other complications with labour and birth TX. with L.I.O.N. Left side I.V. O2 Notify * in a OB CRISIS STOP PIT first then L.I.O.N.
51
When wouldn't you deliver pain medication to a women in labour?
If the baby is likely to be born when the med peaks!! | I.V.meds peak 15-30 min
52
Primagravidia at 5 cm who wants I.V. push pain med, would you give it to her?
Yes, because its unlikely that she will deliver in the next 15-30 mins.
53
Multi gravdia at 8 cm who wants a I.V. pain med. Would you give it to her?
no because she could deliver in the next hour.
54
Describe the fetal heart tracings that are important to know.
1. Low fetal heart rate < 110: - TX. by stopping PIT & LION 2. High fetal heart rate > 160: - no big deal, document and take mom's temp, she likely has a fever - low priority. 3. Low base line variability: fetal heart rate stays the same it does not change = VERY BAD. TX. LION. 4. High base line variabliity = baby's heart rate is always changing = good and document. 5. Late Decelerations - heart rate slows down near the end or after contraction = BAD TX. LION 6. Early Decelerations - heart slow down before contraction or at beginning of contraction = NORMAL DOCUMENT. 7. Variable Deceleration = VERY BAD PROLAPSED CORD. TX. PUSH then POSITION. SUMMARY: IF the heart rate tracing starts with "L" then TX. with LION. If it doesn't start with "L" then it means its ok, unless its variable then its VERY BAD - PUSH POSITION!
55
What does VEAL CHOP stand for?
Variable Early Deceleration Acceleration Late Deceleration Cord Prolapse Head compression Ok Placenta insufficiency
56
What is the Ace of Spades answer in OB?
Check Fetal Heart Rate
57
2nd stage of labour in what order should you deliver the baby?
1. Head 2. Suction mouth than nose 3. Check Nuchel Cord 4. Deliver shoulders & body 5. I.D. band on b/f leaving the delivery room
58
3rd stage of labour delivery of placenta what is important to check ?
1. Ensure that the placenta is all there. | 2. Ensure cord has 3 blood vessels "AVA"
59
4th stage LandD recovery what are you checking for?
1. First 2hrs - every 15 min vital signs, checking for signs of shock ( decreased pressure, increased rate, pale, cold and clammy). 2. Check Fundus - boggy = massage, Displaced + catheterized 3. Check Pads: Perennial pads excessive = saturated pad in 15 min = trouble. Should be checking pad every 15 min. 4. Role her over: check for bleeding underneath. Summary 4th stage: 1. Vitals 2. Fundas 3. Pads 4. Roll
60
How often do you do a postpartum assessment?
Every 4-8 hours, depends on if she is stable or not.
61
Describe BUbbLe hEad
``` BREASTS UTERINE FUNDUS-firm, midline, if boggy massage Bladder Bowel LOCHIA -Rubra = red, Surosa=pink, Alba=white Episiotomy Hemoglobin Extremity check -thrombophlebitis Affect Discomfort ```
62
What is the difference b/w Cuput Succedaneum and Cephalohaematoma?
Cuput Succedaneum - crosses sutures "cs" & caput cemtrical Cephalohaematoma - blood of head
63
When does physiologic Jaundice Appear?
24hrs
64
List and describe OB meds
Tacomedix - stops labour Terbutaline - stops labour and speeds up heart Mag Sulfate - stops labour, but will cause a decrease in heart rate, BP, reflexes, rest, LOC. Mg makes everything go down.
65
Nclex will ask what does Mag Sulfate do to the respirations and breathing?
Lowers both
66
Mag Sulfate acts as a sedative so, what do you monitor and what are your perimeters?
Monitor Reflexes and Respirations Perimetres for titrating Mag Sulfate include: Respirations > 12 Mg ok Respirations < 12 Slow Mg down Reflexes +1 slow down, +3 speed up * DO NOT WANT TO SEE < 11 respirations or +1 Refexes
67
What do oxytoxics do? (opposite of tocolytics)
Stimulate and strengthen labour -pitosin causes uterine hyper stimulation which = contractions longer than 90 sec and contractions closer than 2 min. Hold PIT!
68
What does Methergine do?
Used after childbirth to help stop bleeding from the uterus | Causes High BP and causes vasoconstriction.
69
List the fetal lung maturing meds and who they are given to ( mom or baby) and how they are administered.
1. Betamethazone - steroid. - given to mom - I.M. - Given b/f baby is born and can repeat, while baby is in utero 2. Servonta aka: surfactant - - given to neonate - Transtrachealy - blown in thru trachea - After baby is born * they are both given to make the baby lungs mature faster.

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