Maternity Flashcards
true vs false labor
true:
- regular timing of contractions
- radiating contracting pain
- unable to relieve contraction pain with activity
- exam changes present
false:
- fails to have any changes to the cervix and baby posittion
- contraction goes away with activity
- contractions felt above belly button and dont radiate from back to abdomen
- irregular timing of contractions
tests to evaluate during first trimester
transvaginal probe placed inside vagina
- can help diagnose extopic pregnancy or abnormal vaginal bleeding
ultrasound
- used between 6 and 8 weeks
- determines the sex of the baby
- encourage NOT to void immediately before the test
because full bladder will enhance visualization
tests to evaluate during second trimester
urinalysis to monitor for presence of protein and glucose
AFP screening
- performed at 16-18 weeks
diabetes screening
- performed at 24-48 weeks
oral glucose tolerance testing
Hep B, HIV screening
TB test
amniocentesis
- performed at 15-18 weeks
Rh-factor incompatability screening
maternal changes in second trimester
heartburn
- avoid greasy, and fried foods
- eat smaller portions
bleeding gums
leg cramps
constipation
colostrum can be produced
fetal assessment in second trimester
ask about date of quickening (kickig)
- 18-20 weeks
dopplet ultrasound to measure fetal heart rate
- 12-14 weeks
heigh of fundus in cm
tests to evaluate during third trimester
encourage client to talk to partner about:
- pregnancy affecting sexually
- preparation for support
- preparation any other children about new siblings
should perform fetal movement count daily
maternal changes in third trimester
urinary incontinent
- perform kegel exercises
hemorrhoids
low back pain
insomnia
varicosities
- change positions frequently
- don’t cross legs
dyspnea or shortness of breth
leaking of colostrum
around wk 28, the nurse should:
- explain the purpose of and how to count kicks
call HCP if:
- vaginal bleeding
- abdominal pain, especially sudden and epigastric pain
- uterine contractions
- PROM
- decreased or absent fetal movements
- increased temp greater than 101 and is persistent
- persistent headache or visual disturbances
first stage of labor
latent stage:
irregular contractions become progressively coordinated
may be more than 10 minutes apart and last about 30 seconds
cervix effaces and dilates to 4 cm
lasts approx 8 hours
active phase:
lasts approx 4 hours for primipara, and 2 hours for multipara
cervix becomes fully dilated
contrctions will increase in frequency and duration
- they will become more regular
- about 3-5 min apart, lasting 45 seconds
second stage of labor
birth of the child
assist with positioning the mother for delivery
- supine with knees bent (dorsal lithotomy position)
- sims position
- partial sitting or squatting
- on her hands and knees
remind mother not to hold her breath while pushing
third stage of labor
placental separation
3 classic signs of pacental seapration:
- uterus contracts and rises
- umbilical cord suddenly lengthens
- gush of blood occurs
fourth stage of labor
take vital signs every 15 min
- rise in temp may be due to dehydration or epidural
- if the rise in temp lasts for 24 hours then it is infection
assess bladder for distention
encourage first void within one hour postpartum, then every 2 hours, 3 hours
fundus should be the size of a grapefruit
breasts should be soft with colostrum present
- warm compress or warm shower to stimulate milk flow
check calves for pain, tenderness or redness
newborn lab tests and screening
metabolic screening for metabolic diseases, genetic disorder , anemia
bilirubin levels should be less than 10
PKU screening after 24-48 hours
growth and gestational assessment
pain and hearing
newborn immunizations
Vitamin K
HEp B vaccine
newborn cord care and care of circumcision
umbilical cord clamp usually be removed in the first 24-48 hours
folding the diaper down to expose the cord to air may speed up the drying process
- cord will fall on its own with little to no bleeding
circumcision:
gently washing the penis with warm water after each diaper change
apply petroleum jelly on circumcised area
make sure diapers are fastened loosely
- with will have less pressure on penis while it heals
newborn feeding and burping
should eat every 3-4 hours if formula fed newborn
should every 2-3 hours if breastfed
naegeles rule
First day of last menstrual period + 9 months + 7 days
preeclampsia
hypertensive disorder that occurs after 20 weeks gestation
preeclampsia risk factors
history of preeclampsia or family hisotyr 1 st pregnancy diabetes, lupus, high BP kidney disease obese BMI >30 more than one baby age - young <18 or advanced >35
preeclampsia signs and symptoms
hypertension
proteinuria
- uric acid and creatnine levels icnrease
- urinary output decrease
edema upper abdominal pain increase in liver enzymes decreased platelets lead to: - DIV, hemolysis which can lead to HELLP syndrome
severe preeclampsia condition can lead to
HELLP
- hemolysis
- elevated liver enzymes
- low platelets
eclampsia: seizures
placental abruption
restrict fetal growth or death
preeclampsia management
check urine
- > 1+ dipstick test
- 24 hours urine: >300 mg
- > 0.3 mg creatinine to protei ration
hyperactive deep tendon reflexes
monitor BP and edema
- weight gain of 2 pounds in a week
left side lying position
assess for seiure activity
mag sulfate - monitor for txocitiy
calcium gulconate - antidotes
protein rich diet
- watch salt intake
watch for HELLP, eclampsia, placental abruption and restricted fetal grwoth and death
administer antihypertensives
- labetalol
- hydralazine
gravidity and parity
gravidity: # of times a woman has been pregnant whether abortion or not
parity: # of times a woman has BIRTHED or COMPLETED pregnancy at 20 weeks gestation
GTPAL
g: gravidiity
T: term
-number born (alive or stillbonr) at 37 weeks onward
- if they are twins or triplets its still 1, because you are counting the number of pregnancies
Preterm: number born 20-37 weeks
- whether alive or stillborn
a: aboriton
l: living
APGAR
appearance:
0: pale/bleu all over
1: acrocyaosis
2: pink
pulse:
0: absent
1: <100 bpm
2: >100 bpm
grimace:
0: no response
1: grimace (no cry)
2: cry, active movement
activity:
0: none, flaccid
1: some
2: arms, leg flexed
respiration:
0: absent
1: weak/irregular cry
2: strong, vigorous cry
performed at 1 min and 5 min after birth
may be reassessed at 10 min after birth so, 5 min later, if score is 6 or less
Rh incompatability
occurs when Rh positive father and Rh negative mother have an Rh positive baby
Rh negative and Rh negative can get blood, but because the baby is Rh positive, the mom’s blood will start attacking the baby’s RBCs
Prevention is key
- done by getting a Rhogam shot if Rh negative at 28 weeks and then within 72 hours AFTER delivery of baby is baby is Rh positive
rhoGAM stops the immune system from creating antibodies against the baby’s Rh positive blood
if mom already has antibodies created, then RhoGAM won’t be effective
hyperemesis gravidarum
excessive nausea, and vomiting leading to weight loss, electrolyte imbalances, nutritional deficiencies and ketonuria
hyperemesis gravidarum interventions
antiemetics
IV hydrations
correction of electrolyte imbalances
ectopic pregnancy
ovum implants outside of the uterus
not a viable pregnancy and will rupture if not caught in time
ectopc pregnancy symptoms
abdominal pain
delayed menses
abdnormal vaginal bleeding
ectopic pregnancy interventions
teaching for clients receiving medical therapy like methotrexate
perioperative care for clients receiving surgical treatment
gestational hypertension
elevated BP >140/90 after the 20th week of pregnancy on more than one occasion and absence of proteinuria
gestational hypertension interventions
accurate and regular BP monitoring urinanalysis 24 hour urine collection lab tests: - creatinine - platelet count - liver enzymes
fetal movement counts
non-stress testing
low sodium diet
moderate to low actvity
client teaching
bedrest is no longer recommended for those with gestational hypertension
proplapsed cord
most common after the membranes rupture and cord is “washed” by escaping fluid
when fetus presses on the cord, blood flow to and from the fetus is reduced or completely blocked leading fetal hypoxia
prolapsed cord care
remain with the client and request emergency help
insert 2 gloved fingers into the vagina and hold the presenting part of the cord
sims position, knee to chest or trendelenburg
cover protruding cord with sterile, saline soaked gauze or twoel
administer high flow oxygen
C-section
placenta previa
painless bright red vaginal bleeding
goal: prevent hemorrhage during delivery
will require C-section
abruption placentae risk factors
gestational hypertension
cocaine use
smoking
blunt external abdominal trauma
abruption placentae manifestation
vaginal bleeding
abdominal pain
contractions
abruption placentae interventions
immediate birth is treatment of choice
should be suspected in pregnant clients who experience a sudden onset of severe, localized uterine pain with or without vaginal bleeding
preterm labor and birth interventions
primary goal is prevention
give prophylactic progesterone
activity restrictions, including bedrest
restriction of sexual activity to provide “pelvis rest”
hospitalization administration of tocolytics - indomethacin - terbutraline - mag sulfate - CCB
mag sulfate
- closely monitor resp status, deep tendon reflexes and LOC
dystocia
lack of progress in labor for any resons
dystocia causes
ineffective uterine contractions
abnormalities in fetal presentation
maternal pelvic structure
dystocia interventions
version
- turning of the fetus
cervical ripening with miso
administration of oxytocin
amniotomy-artificial rupturing of membranes
