Maternity Flashcards
1
Q
Name of hormone that induces amenorrhea
A
progesterone
increased temp when ovulating
2
Q
Presumptive Signs of Pregnancy
A
amenorrhea
N/V
Urinary frequency (can be one of first signs)
breast tenderness (bc of excess hormones)
3
Q
Probable Signs of Pregnancy
A
positive pregnancy test (based on presence of hCG levels)
- hydatidiform (molar pregnancy) and meds can increase hCG
Goodell's sign
Chadwick's sign
Hedgar's sign
Uterine enlargment
Braxton Hicks contractions
pigmentation changes of skin
4
Q
Goodell’s sign
A
softening of cervix (2nd month)
5
Q
Hydatidiform
A
Molar Pregnancy
benign neoplasm of grape-like vesicles that CAN become malignant
if not malignant, DNC required w close follow-up
if malignant, treatment based on stage and grade of cancer
6
Q
Chadwick’s sign
A
bluish color of vaginal mucosa and cervix
4th week
7
Q
Hegar’s sign
A
softening of lower uterine segment
2nd / 3rd month
8
Q
Pigmentation changes of skin
A
linea nigra (dark line down abdomen) facial chloasma (mask of pregnancy) abdomen striae (stretch marks) darkening of areola
9
Q
Positive Signs of Pregnancy
A
fetal heartbeat
- doppler --> 10 to 12 weeks
- fetoscope --> 17 to 20 weeks
fetal movement
ultrasound
10
Q
Gravida
A
number of times someone has been pregnant
11
Q
parity
A
number of pregnancies in which fetus reachs 20 wks
12
Q
viability
A
24 wks gestation
infant has ability to live outside of uterus
20 wk is not viable
13
Q
TPAL
A
term
preterm
abortion
living children
14
Q
bleeding, cramping, backache, think
A
miscarriage
hCG levels drop with miscarriage
most before 20 wks
15
Q
Naegele’s Rule
A
add 9 months and 7 days
accurate plus or minus 2 weeks
16
Q
First trimester
A
Week 1 -13
17
Q
Second Trimester
A
week 14-26
18
Q
Third Trimester
A
Week 27-40
19
Q
Nutrition in First Trimester
A
increase protein to 60 grams/day
- normal protein is 40-45 g/day
culture (hot v. cold / kosher foods / fasting)
20
Q
First Trimester Wt Gain
A
1 to 4 pounds in first trimester
21
Q
Biggest complains with iron?
A
constipation and GI upset
always take iron with vitamin C
22
Q
Folic acid
A
prevents neural tube defects
daily dose = 400 mcg/day
23
Q
First Trimester Exercise
A
no high impact (walking / swimming are best)
no heavy exercise but can continue regular
DON’T LET HEART RATE GO OVER 140
- if it does, CO and uterine perfusion are decreased
don’t want them to get overheated so no hot tubs, heating blankets
- overheating can cause birth defects
24
Q
Danger Signs and Potential Complications of Maternity
A
- most commonly occurs in 3rd trimester but we teach it in 1st
sudden gush of vaginal fluid bleeding persistent vomiting severe headache abdominal pain increased temps edema no fetal movement
25
Common Discomforts in Pregnancy
```
constipation
ankle edema
N/V
breast tenderness
urinary frequency
tender gums
fatigue
heartburn
increased vaginal secretions
nasal congestion
varicose veins
hemorrhoids
backache
leg cramps
```
26
Smoking during pregnancy is associated with...
small for gestational age, low birth weight babies, cleft lip or palate, risk for placental abruption doubles w smoking
27
How often should a pregnant client visit the primary HCP?
first 28 weeks = once a month
28-36 weeks = every 2 weeks or twice a month
after 36 weeks = weekly until delivery
high-risk = more prenatal visits
28
What do you do before an ultrasound?
drink water to distend bladder to push uterus up for better imagining
29
Second Trimester Nutrition
increase by 300 calories a day
adolescent = increase by 500 calories a day
30
Second Trimester Weight Gain
1 lb per week
31
Does a pregnant lady still experience N/V in second trimester? Breast tenderness? Urinary frequency?
No N/V
Yes breast tenderness
No urinary frequency - uterus rises and relieves pressure on bladder
32
Quickening
fetal movement
15-20 weeks
33
FHR
110-160 in second trimester
less than 110 = panic
34
Kegel Exercise
strengthens pubococcygeal muscles (these stop urine flow and keep uterus from falling out)
35
Third Trimester Weight Gain
no more than 1lb a week
36
Third Trimester Assessment for Pre-E
```
monitor BP and report ANY increases from baseline
Pre-E develops after 20 weeks gestation
- increased BP
- proteinuria
- edema
```
watch for 2 or more lbs gain in a week
Magnesium Sulfate
Defined as BP of 160/110 or greater that lasts for 6 hrs or more
37
Magnesium Sulfate
acts like anticonvulsant
sedates
vasodilates (decreases BP)
pre-e means they haven't had a seizure yet
38
Normal FHR
110-160
39
How do you determine position / presentation of a fetus?
leopold maneuvers (palpating the uterus)
they should void first and they need to be done in between contractions
40
Signs of Labor
lightening
engagement
fetal stations
Other signs:
- braxton Hicks contractions become more frequent and stronger
- softening of cervix
- bloody show
- sudden burst of energy called nesting
- diarrhea
- rupture of membranes
41
Lightening
usually happens 2 weeks before term
lightening is when presenting part descends into pelvis
client will be able to breathe easier, but there is more pressure on bladder so urinary frequency is a problem.
42
Engagement
largest presenting part is in the pelvic inlet
poor engagement during rupture of membranes can lead to prolapsed cord
43
fetal stations
measured in cm
- means still in mom
+ means really low in pelvic inlet
44
When should the client go to the hospital?
when contractions are 5 minutes apart or when membranes rupture
when ROM occurs, we are worried about prolapsed cord
45
Non-Stress Test
NST
- when two or more accelerations of 15 bpm (or more) with or without fetal movement passes the NST
- each increase should last for 15 seconds and be recorded for 20 min
- you want the test to be reactive
46
Acceleration
increase from baseline by at least 15 bpm for at least 15 seconds and return to normal within 2 min
47
Biophysical Profile Test
BPP
commonly done in last trimester but can be done at 28 wks in high-risk pregnancy
high-risk may have BPP every week or twice a week in 3rd trimester
measurements are obtained by ultrasound and each parameter counts as 2 points. (10/10 is perfect score)
parameters: HR, muscle tone, movement, breathing, amount of amniotic fluid around baby
observation time is 30 min by sonogram
8-10 = good
6 = worriesome (repeat test in 24 hrs)
less than 4 = immediate delivery
48
Contraction Stress Test
CST / also called oxytocin challenge test
performed on high-risk pregnancies: pre-E, maternal diabetes, placental insufficiency
tests if baby can handle stress of contraction (they decrease blood flow to uterus and to placenta)
decelerations - mean hypoxia
late decels mean that placenta is wearing out / uteroplacental insufficiency
you want NEGATIVE CST = no late decels
rarely performed befroe 28 wks
results only good for 1 wk
49
Early Decelerations
not bad / benign
caused by physiological hypoxia from fetal head compression
50
Late decelerations
bad
caused by uteroplacental insufficiency (UPI)
51
variable decelerations
bad
caused by umbilical cord compression (CC)
52
True Labor
regular contractions
increase in frequency and duration
discomfort in back and radiates to abdomen
pain increases with activity
53
False Labor
irregular contractions
discomfort in abdomen
pain decreases / goes away with activity
54
Premature Labor
contractions occur w dilation between 20 to 37 weeks
goal is to stop labor
treat vaginal or urinary infections and hydrate mom
place on bedrest
Meds
55
Medications to stop Preterm Labor
magnesium sulfate (relaxes uterus)
betamethason (IM / steroid that helps fetal lungs mature)
terbutaline (SQ)
Indomethacin (PO)
Nifedipine (PO)
56
Epidural Anethesia
lie on left side, legs flexed, prop on bedside table
given in stage 1 at 3 to 4 cm dilation
usually no headache
major complication is hypotension
Bolus with 1L of NS or LR to fight hypotension
put in semi-fowlers tilted on their side to prevent vena cava compression (which decreases venous return, CO, and BP)
hypotension leads to decreased perfusion of placenta
alternate position from side to side hourly
check UOP and assess bladder
57
Oxytocin Patient
need one-on-one care
Complications: hypertonic labor, fetal distress, uterine ruptrue
want contraction every 2 to 3 minutes with each lasting 60 seconds
Oxy is piggybacked into main IV fluid
place in any position except flat on back
- if there's any unreassuring fetal heart tones, put on left side to enhance uterine perfusion
if late decels occur, turn off infusion
58
Discontinue oxytocin when
contractions are too often
contractions last too long
any sign of fetal distress
59
Emergency Delivery / Precipitous Delivery
pant / blow to decrease urge to push
* don't push between contractions
wash hands / elevate HOB
something clean under booty
decrease touching vaginal area
as head crowns, tear amniotic sac
place hand on fetal head and apply gentle pressure
when head is out, feel for cord around neck (nuchal cord)
ease each shoulder out / rest will deliver fast
keep baby's head down
dry baby / place on mom's abdomen
covery baby (skin to skin)
wait for placenta to separate / deliver
can push to deliver placenta (want out in 30 min)
inspect placenta for intactness
tie cord off with something clean like shoestring or strip of cloth
- no ccloser than 4 in to baby's navel and second about 8 inches from baby's navel
check firmness of uterus
60
Post-Partum Assessment: VS
temp - 100.4 is normal for first 4 hours
BP - stable
HR - 50-70 common for 6 to 10 days after
* tachycardia + postpartum = think hemorrhage
61
Post-Partum Assessment: Breasts
soft for 2 to 3 days then engorgement comes
62
Post-Partum Assessment: Abdomen
soft / loose
63
Post-Partum Assessment: GI
hungry af
64
Post-Partum Assessment: Uterus
fundus midline 2 to 3 fingers below umbilicus
few hours after birth, rises to level of umbilicus or to one finger above
FUNDUS SHOULD BE FIRM
Fundus is boggy? Massage until firm and then check for bladder distention.
fundal height will descend one finger /day
65
Involution
fundus descends and uterus returns to its pre-pregnancy size
66
Afterpains
common for first 2 to 3 days and will continue if breast feeding due to oxytocin
67
Post-Partum Assessment: Lochia
Rubra (3 to 4 days) - dark red
Serosa (4 to 10 days) - pinkish brown
Alba (10 to 28 days) - whitish yellow
can have alba for up to six weeks
clots are okay as long as they are no larger than a nickel
68
Post-Partum Assessment: Urine Output
diuresis the excess fluid around 24 hours after delivery
dehydration is possible
inspect for DVT
69
Perineal Care Post-Partum
intermittent ice packs for first 24 hours to decrease edema
warm water rinses
sitz baths 2 to 4 times per day
anesthetic sprays
change pads frequently
don't want more than 1 saturated peripad/hour
teach to report foul smell and any lochia changes
70
Bonding - How does baby benefit from skin-to-skin?
```
stabilizes HR
improves O2 sats
regulates temp
conserves calories
breasts regulate temp
```
71
kangaroo care
skin to skin
held for 1 hour at least 4 times a week
72
Breastfeeding moms --> breast care
cleanse with warm water after each feeding (soaps = drying)
let air dry
supportive bra
ointment for soreness
express some colostrum and let it dry
breast pads - absorb moisture (change frequently)
mother needs to initiate breastfeeding ASAP after birth and alternate breasts
mom can pump if needed
increase caloric intake by 500 calories per day
fluid / milk intake - 8 to 10 glasses of fluid / day
73
Non-Breastfeeding moms --> breast care
ice packs
breast binders (ACE wraps / tight bras)
chilled cabbage leaves (decreases inflammation and engorgement)
no stimulation of breast
74
Post Partum Infection
infection within 10 days after birth (E. Coli / Beta hemolytic strep)
teach proper hygiene (front and back cleansing)
cultures and antibiotics
75
Postpartum Hemorrhage
early --> more than 500 mLs of blood lost in first 24 hours accompanied by 10% drop from admission hematocrit
late --> after 24 hrs and up to 6 wks postpartum
76
Causes of Postpartum Hemorrhage
uterine atony
lacerations
retained fragments and forceps delivery
77
Meds to Stop Postpartum Hemorrhage
oxytocin
methylergonovine maleate
carboprost tromethamine
misoprostol
78
Mastitis
poor hygiene / improper breastfeeding
staphylococcus
usually occurs around 2 to 4 wks
79
Mastitis S/sx
rapid onset of fever and chills
the breast will be swollen and hard and tender to touch
malaise
80
Mastitis Treatment
bed rest
support bra for engorgement
binding and chilled cabbage leaves
- only use if breastfeeding is being discontinued
breastfeed / pump frequently
- affected breast first
penicillin / erythromycin
pain meds
heat
81
Newborn Care Immediately post delivery
maintain body temp / dry / skin to skin
APGAR - assessed at 1 and 5 min
erythromycin (eye ointment) to kill Neisseria gonococcus and Chlamydia
Phytonadione (Vit. K) promotes formation of clotting factors (IM - give in vastis lateralis)
82
Newborn Care - Cord Care
dries and falls off in 10 to 14 days
cleanse with each diaper change using alcohol or NS
fold diaper below cord
no immersion until cord falls off
watch for infection
83
APGAR
assessed at 1 and 5 min
looks at HR, Respiration, muscle tone, reflex irritability, color
want score of at least 8 to 10
84
Newborn Complications
Hypoglycemia
Pathologic Jaundice
Physiological Jaundice
Rh Sensitization or Rh Factor
85
Hypoglycemia in Newborns
no longer getting glucose from mom
babies at greatest risk are large for gestational age, small for gestational age, babies of diabetic moms
86
Pathologic Jaundice in Newborns
occurs first 24 hrs
usually means Rh/ABO incompatibility
87
acrocyanosis
purple hands and feet
88
Physiological Jaundice Newborns
after 24 hours
due to normal hemolysis of excess RBCs releasing bilirubin and immaturity of liver
89
Rh Sensitization
occurs when you have Rh- mom and Rh+ baby
baby from first pregnancy is not affected, but second pregnancy the mom's antibodies will breakdown babies RBC (hemolysis)
90
when does babies and mom blood mix?
placenta separates at birth, during miscarriage, amniocentesis, trauma to mom's abdomen
if mom is Rh - and baby is Rh + then give Rhogam
91
When Rh - mom's antibodies attack Rh + baby, what happens?
Hemolysis
baby compensates by releasing immature RBCs
this is called erythroblastosis fetalis
92
Diagnosis of Rh Sensitization
Indirect Coombs - done on mom; measures antibodies in blood
Direct Coombs - done on baby; tells if there are any antibodies stuck to RBCs
- done on cord
93
Treatment of Rh Sensitization
frequent ultrasounds
94
Prevention of Rh Sensitization
RhoGAM
95
RhoGAM
prevents Rh Sensitization
given to mom within 72 hours after birth
most HCP give RhoGAM twice
- once at 28 wks
- again 72 hrs after birth
it's also given with any bleeding episode
*RhoGAM destroys Rh+ fetal blood cells that are in mom's Rh- blood before antibodies are formed
