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Mark Klimek > Maternity > Flashcards

Maternity Flashcards

1
Q

Calculating due date (Nagele’s Rule)

A
  • Take first date of last menstrual period → add 7 days → subtract 3 months
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2
Q

Total weight gain during pregnancy

A
  • 28 lbs +/- 3 (25-31)
  • 1st-trimester weight gain
    • 1 lb per month (3 lbs total)
  • 2nd/3rd trimester weight gain
    • 1 lb per week
  • For expected weight gain, take the week of gestation and subtract 9.
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3
Q

Fundus (top of uterus)

A
  • Not palpable until week 12
  • Fundus typically reaches the umbilical at 20-22 weeks
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4
Q

Positive signs of pregnancy

A
  • Fetal skeleton on x-ray
  • Fetal presence on ultrasound
  • Auscultation of the fetal heart (doppler)
  • Examiner palpates fetal movement/outline
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5
Q

Probable/Presumptive signs of pregnancy

A
  • All urine and blood pregnancy tests
  • Chadwick’s sign (color changes of the cervix to cyanosis)
  • Goodell’s sign (cervical softening)
  • Hegar’s sign (uterine softening)
    • order of Chadwick/Goodell/Hegar alphabetical
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6
Q

Discomforts of Pregnancy

A
  • Morning sickness
    • 1st trimester
    • Treatment
      • Dry carbs before getting out of bed
      • Avoid empty stomach
  • Urinary incontinence
    • 1st/3rd trimester
    • Treatment
      • Void Q2H
  • Dyspnea
    • 2nd/3rd trimester
    • Treatment
      • Tripod position
  • Back pain
    • 2nd/3rd trimester
    • Treatment
      • Pelvic tilt exercises (put foot on stool)
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7
Q

Labor

A
  • Most valid sign of labor
    • Onset of regular contractions
  • Dilation
    • Opening of cervix (0-10cm)
  • Effacement
    • Thinning of cervix (thick-100%)
  • Station
    • Relationship of fetal presenting part to mom’s ischial spine (tightest squeeze for baby’s head)
    • Negative = above spine
    • Positive = below spine
    • Engagement = station 0 at ischial spines
    • If numbers don’t go positive, C-section
  • Lie
    • relationship between spine of baby and spine of mom
  • Presentation
    • part of baby that enters birth canal first
    • most commonly ROA or LOA
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8
Q

Patient education

A
  • Pattern of office visits
    • Once a month until week 28
    • Starting at week 28, once every 2 weeks until week 36
    • Starting at week 36, weekly until week 42 (induction or c-section)
  • Hemoglobin
    • normal to fall in pregnant women
    • Can fall to 11 in 1st trimester and be normal
    • Can fall to 10.5 in 2nd trimester and be normal
    • Can fall to 10 in 3rd trimester and be normal
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9
Q

Stages of Labor and Delivery

A
  • Stage 1: Labor
    • Purpose of uterine contractions: Dilate and efface the cervix
    • 3 phases
      • Latent → Active → Transitional
  • Stage 2: Delivery of baby
    • Purpose of uterine contractions: push the baby out
  • Stage 3: Delivery of the placenta
    • Purpose of uterine contractions: push the placenta out
  • Stage 4: Recovery
    • Purpose of uterine contractions: stop bleeding
    • Lasts 2 hours to stop bleeding
  • Postpartum begins 2 hours after delivery of the placenta
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10
Q

Stage 1: Labor

A
  • Latent
    • 0-4 cm dilated
    • 5-30 minute contraction frequency
    • 15-30 second contraction duration
    • Mild intensity
  • Active
    • 5-7 cm dilated
    • 3-5 minute contraction frequency
    • 30-60 second contraction duration
    • Moderate intensity
  • Transitional
    • 8-10 cm dilated
    • 2-3 minute contraction frequency
    • 60-90 second contraction duration
    • Strong intensity
  • Contractions should not be longer than 90 seconds or closer than every 2 minutes
    • Stop Pitocin if times exceed 90 seconds and 2 minutes
  • Intensity
    • Palpate with pads of fingers of one hand over the fundus
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11
Q

Stage 2: Delivery of baby

A
  • Nursing interventions
    1. Deliver the head (stop pushing)
    2. Suction mouth
    3. Suction nose
    4. Check for nuchal cord (cord around neck)
    5. Deliver shoulders and body
    6. Make sure baby has ID band
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12
Q

Stage 3: Delivery of the placenta

A
  • Check if intact
  • Check vessels
    • Should be 2 arteries and 1 vein (AVA)
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13
Q

Stage 4: Recovery

A
  • Assessments Q15 minutes for first 2 hours after delivery
    • Vital signs (assess for s/s of shock - pressures decrease, rates go up, pale, cold, clammy)
    • Check fundus (if boggy, massage; if displaced, void/cath)
    • Check perineal pads (excessive lochia = pad sat Q15 minutes)
    • Roll on to side (check for bleeding under patient)
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14
Q

Complications of Labor

A
  • Intense back pain during labor (OP position “oh pain”)
    • Baby turned around backward
    • Low priority
    • Position, then push
      • Position knee/chest on hands and knees
      • Push fist into the sacrum
  • Prolapsed cord
    • High priority
    • Push, then position
      • Push head back in off cord
      • Position in knee/chest or trendelenburg
      • Prep for C-section
  • For all other complications of labor and birth
    • LION PIT
      • Left side/lateral
      • IV increase rate
      • Oxygen increase rate
      • Notify PCP
      • PIT (stop Pitocin)
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15
Q

Fetal Heart Tracing

A
  • Low FHR (<110)
    • bad
    • LION Pit
  • High FHR (>160)
    • not a problem
    • document
    • Take mother’s temp
  • Low baseline variability (FHR does not change)
    • bad
    • LION Pit
  • High baseline variability (FHR always changing)
    • good
    • document
  • Late decelerations (FHR slows at end of contraction)
    • bad
    • LION Pit
  • Early decelerations (FHR slows at beginning of contraction)
    • document
    • normal
  • Variable decelerations
    • very bad
    • prolapsed cord
    • Push, position
  • VEAL CHOP
    • Variable = Cord compression
    • Early = Head compression
    • Accelerations = OK
    • Late = Placental insufficiency
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16
Q

Postpartum Assessments

A
  • Q4-8 Hours
  • BUBBLE HEAD
    • Breasts
    • Uterine fundus
      • firm and midline (massage if boggy, cath if displaced)
      • height = day postpartum
        • by pubis by 24 hours
    • Bowel
    • Bladder
    • Lochia (vaginal drainag)
      • Color
        • Rubra - red (first few days)
        • Serosa - pink (1 week postpartum)
        • Alba - pale
      • Amount
        • 4-6 inches on pad in one hour is ok
        • excessive is pad saturation in 15 minutes
    • Episiotomy
    • Hgb/Hct
    • Extremity check
      • Assess for thrombophlebitis
        • bilateral calf circumference
    • Affect
    • Discomfort
17
Q

Abruptio Placenta vs. Placenta Previa

A
  • Abruptio Placenta
    • Premature separation of the placenta from the uterine wall
    • Primarily seen in multigravida over 35 y/o (w/ hx of HTN, trauma, cocaine)
    • Painful
    • Assessments
      • 5-15 minutes for bleeding, maternal VS
      • Continuous FHR monitoring, deliver baby at earliest sign of fetal distress
    • Babies usually delivered by C-section
    • Higher risk of fetal death
    • 3rd trimester
  • Placenta Previa
    • Not painful
    • more voluminous than abruptio
18
Q

Cardiac disease in Mothers

A
  • # 1 cause - rheumatic heart disease
  • S/s
    • JVD
    • Murmurs
    • Crackles/rales
    • SOB
    • Palpitations
  • Treatment
    • Rest
      • bedrest for one week after delivery
    • Diuretics, heparin, digoxin
    • can be given analgesics (morphine ok)
    • Dietary modifications (decreased Na, decreased water)
      • Increase iron and folic acid
  • Interventions
    • Assess lung sounds Q30-10 minutes during the stages of labor
    • Limit client’s effort to bear down
19
Q

1st Trimester findings

A
  • Increased leukorrhea (vaginal secretions
  • Nasal stuffiness
  • Urinary frequency increases
  • Fatigue
  • Epistaxis
  • N/V
  • Breast changes (tenderness, pain, tingling, fullness)
  • Pytalism (increased salivation)
  • Gingivitis
20
Q

2nd Trimester findings

A
  • Accepting fetus as being distinct from self
  • Heartburn
  • Striae gravidarum
  • Linea nigra
  • Urinary frequency lessens
  • Pruritis
  • Joint pain and mobility
  • Pelvic pressure
  • Chloasma “Mask of pregnancy”
    • begins after week 16 and lasts until delivery
  • Supine htn
  • Hemorrhoids
  • Backache
  • Varicose veins appear
  • Round ligament pain
  • Carpal tunnel syndrome
  • Oily skin and acne
  • Constipation
  • Palpitations
  • HA
  • Faintness
  • Food cravings (pica)
21
Q

Third Trimester

A
  • Preparing for birth and parenting
  • Fear defects in the baby
  • Pregnant women fears labor and delivery
  • SOB and dyspnea
  • Urinary frequency returns to normal
  • Insomnia
  • Braxton-Hicks contractions
    • irregular, false contractions
  • Ankle edema (non-pitting)
  • Leg cramps
  • Perineal pressure
22
Q

Discomforts and Dangers in pregnancy

A
  • Ambivalence
  • Spider nevi on neck, thorax, face, arms (2nd or 3rd)
  • Danger signs
    • Severe HA
    • UTI
    • Epigastric pain
    • severe abdominal pain
    • Seizures
    • Decreased fetal movements or absent fetal movements
      • movements first felt around 16 to 20 weeks
    • Blurry vision (pre-eclampsia)
    • Vaginal bleeding
    • Persistent, severe vomiting
    • Edema of face or fingers (possible HTN, pre-eclampsia)
23
Q

Endometriosis

A
  • Treatment
    • Androgens (Danazol)
    • No tampons
  • Diagnostics
    • Laparoscopy

Mark Klimek (21 decks)

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